Spondylarthrosis is classified according to location, severity, and accompanying changes:

1. By location:
   • Cervical spondylarthrosis: Affects the cervical spine, often associated with neck and headaches.
   • Thoracic spondylarthrosis: Affects the thoracic spine, rather rare and often asymptomatic.
   • Lumbar spondylarthrosis: Most common in the lumbar spine, with back pain and radiating symptoms into the legs.
2. By severity:
   • Mild: Minor wear with mild symptoms.
   • Moderate: Significant cartilage damage and symptoms under stress.
   • Severe: Pronounced cartilage loss, bony growths (osteophytes), and chronic pain.
3. By accompanying symptoms:
   • With nerve involvement: Irritation of nerve roots due to bony constrictions.
   • Without nerve involvement: Local pain without neurological deficits.

The causes are predominantly mechanical and degenerative, but can be exacerbated by other factors:

• Degenerative changes:
  • Age-related wear and tear of the cartilage in the facet joints.
• Mechanical stress:
  • Overload from heavy physical work, frequent lifting, or prolonged sitting.
  • Misalignments of the spine, such as scoliosis or hyperlordosis.
• Injuries:
  • Consequences of spinal trauma, e.g., from falls or traffic accidents.
• Risk factors:
  • Overweight, which increases the load on the spine.
  • Lack of exercise, which impairs the stability of the back muscles.

The symptoms depend on the location and progression of the disease, but often include:

- Back pain:

- Localized or radiating, often stronger in the morning and with exertion.

- Movement restrictions:

- Stiffness of the spine, especially after prolonged rest.

- Crepitus:

- Crunching or grinding noises during movement.

- Radiating pain:

- In lumbar spondylarthrosis, pain radiating into the legs.

- In cervical spondylarthrosis, neck pain radiating into the arms.

- Neurological deficits:

- Rare, but possible with nerve root compression, e.g., tingling or numbness.

The diagnosis is made through a thorough medical history, clinical examination, and imaging techniques:

- Medical history:

- Recording of symptoms, possible stressors, and disease progression.

- Physical examination:

- Checking mobility and pain provocation through specific tests.

- Imaging:

- X-ray: Visualization of joint space narrowing, osteophytes, and other degenerative changes.

- MRI: Assessment of soft tissues and nerve structures.

- CT: Detailed analysis of bony changes.

Conservative Therapy

The treatment aims to relieve pain, improve mobility, and slow the progression of the disease:

• Medication Therapy:
  • NSAIDs: To relieve pain and inflammation.
  • Muscle relaxants for tension.
  • Injections of corticosteroids or hyaluronic acid directly into the facet joints.
• Physiotherapy:
  • Exercises to strengthen the back muscles and improve mobility.
  • Manual therapy to relieve the facet joints.
• Alternative Methods:
  • Acupuncture, heat therapy, or electrotherapy for pain relief.

Surgical Therapy

In severe cases or persistent complaints, surgery may be necessary:

• Denervation: Ablation of pain fibers in the facet joints for pain relief.
• Decompression: Removal of bony growths to relieve nerve structures.
• Spinal Fusion (Spondylodesis): Stabilization of unstable segments with implants.

The following measures are suitable for preventing and alleviating symptoms:

1. Regular exercise: Promoting stability and flexibility through targeted exercises.
2. Weight control: Reducing strain through a healthy body weight.
3. Ergonomic posture: Avoiding poor posture at work and during leisure time.
4. Strengthening the back muscles: Strengthening stabilizing muscles through back training.
5. Stress management: Avoiding tension through relaxation exercises.