Disease Description (Causes and Symptoms)
- Definition summary: A condition in which degenerative changes in the spine cause deformity and enlargement of the vertebral bodies, intervertebral discs, facet joints, ligaments, and other structures, narrowing the spinal canal or intervertebral foramina and compressing nerves (the spinal cord and nerve roots) (e.g., spinal canal stenosis, lumbar spondylolisthesis, ossification of the posterior longitudinal ligament).
- Main pathophysiology: Degenerative disc dehydration and loss of height → narrowing of the intervertebral foramina, enlargement of the facet joints, thickening and ossification of the ligaments (the ligamentum flavum or posterior longitudinal ligament), and formation of osteophytes, resulting in mechanical compression of the spinal canal or nerve roots. Compression in the cervical region causes myelopathy (paralysis, gait disturbance, and reduced hand function), while compression in the lumbar region causes low back pain, radiculopathy, and neurogenic intermittent claudication (neurogenic intermittent claudication: a symptom in which the legs become numb when walking and improve with rest).
- Main symptoms:
- Localized low back pain or neck pain
- Radiating pain (lower back → legs, neck → shoulders, arms, and hands)
- Numbness, decreased sensation, and muscle weakness
- Joint stiffness and restricted movement
- In severe cases, urinary or bowel dysfunction (severe compression at the lumbar level) or gait disturbance (myelopathy of the cervical spine)
- Risk factors: Older age, repetitive use of the lower back or lifting heavy objects, smoking, obesity, osteoarthritic changes and osteoporosis, and congenital narrowing of the spinal canal. The exact cause of ossification of the posterior longitudinal ligament is unknown, but age-related, genetic, and metabolic factors may be involved.
Treatment Methods
- Conservative treatment (preferred initially and when symptoms are mild):
- Lifestyle management: Weight control, posture correction, limiting repetitive lifting of heavy objects and bending at the waist, and smoking cessation
- Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, medications for neuropathic pain (gabapentin, pregabalin), and short-term oral corticosteroids (selectively)
- Physical therapy and exercise therapy: Core muscle strengthening, flexibility exercises, and aerobic exercise. Physical therapy for symptom relief (such as heat therapy and electrical therapy)
- Injection treatment: Epidural steroid injections (for symptom relief)
- Use of braces (such as a lumbar brace) and walking aids
- Examples of recommended exercises (helpful for self-management): Partial sit-ups (repeatedly raising the upper body to 15°), pulling the knees toward the chest, raising the legs while lying face down (one side at a time), and raising the upper body halfway while lying face down and holding for 10 seconds (perform according to individual condition and stop if pain occurs)
- Surgical treatment (considered in the following cases):
- No improvement despite conservative treatment, with severe pain or neurological deficits (progressive muscle weakness or loss of sensation)
- Inability to perform daily activities due to severe neurogenic intermittent claudication in the lumbar spine
- Acute and severe urinary or bowel dysfunction (emergency surgery required)
- Surgical methods: Decompression surgery (posterior decompression or partial resection), decompression plus fusion (when instability or spondylolisthesis is present), anterior approach for cervical cases (anterior decompression and fusion) or posterior decompression and fusion; in cases of ossification of the posterior longitudinal ligament, the anterior or posterior approach is determined according to the location and extent of the lesion
- Precautions and self-management during treatment:
- Weight management and smoking cessation (to reduce the risk of surgical complications and inhibit accelerated degeneration)
- Regular exercises to strengthen the lower back and abdominal muscles (according to the instructions of a doctor or physical therapist)
- Avoid strenuous exercise, standing for long periods, and lifting heavy objects during acute exacerbations
- Monitor for side effects when taking medication (such as gastrointestinal symptoms and dizziness)
Outpatient Visit Checklist (Including Example Questions)
- Items to prepare (recommended to bring):
- List of currently used medications and supplements (including doses and times of administration)
- Allergies and history of previous surgeries and illnesses
- Existing test results (recent MRI, CT, or X-ray films or reports), medical certificates, and medical records from other departments
- Symptom records: Onset, factors that worsen or improve symptoms, pain intensity (VAS), pattern of radiating pain, changes in sensation or muscle strength, and urinary or bowel abnormalities
- Photos (such as walking or abnormal posture) or videos of situations in which symptoms worsen during activities (optional)
- ‘Red flags’ to check at the outpatient visit (things to report immediately):
- Acute or progressive muscle weakness or symptoms of paralysis
- Urinary or bowel dysfunction occurring along with sciatic nerve symptoms, or loss of sensation in the face or groin area (suspected sacral paralysis)
- Systemic symptoms such as fever or weight loss (suspected infection or tumor)
- Recent history of severe trauma
- Information that is useful to show the doctor directly during the outpatient visit:
- Notes organized chronologically describing when symptoms began and how they have progressed
- Movements limited during daily activities and factors that worsen symptoms
General Example Questions to Ask the Doctor
- What are the side effects of this medication? (Including interactions with other medications I am taking)
- What is the prognosis of my condition? If I undergo surgery, how much recovery can I expect?
- Which movements should I particularly avoid, and which exercises are recommended among lifestyle habits?
- If surgery is recommended, what are the risks of the surgery and how long is the recovery period?
- Are there any additional nonsurgical treatments I could try for pain control?
Examples of Condition-Specific Questions
- What is the degree of spinal canal stenosis on my MRI (or CT), and how likely is it to improve with conservative treatment?
- If ossification of the posterior longitudinal ligament (OPLL) or lumbar spondylolisthesis is confirmed, which surgical approach (anterior vs. posterior, and whether fusion is necessary) is recommended, and what are the prognosis and risks of complications?
Note: The information above is general information, and the diagnosis and treatment plan may vary depending on an individual’s test results, symptoms, and overall health. If symptoms worsen acutely or a ‘red flag’ is suspected, visit a medical institution immediately.