Arthritis affects approximately 80% of people over the age of 55 in the United States.^1,¹² It is often triggered by injury, a weakened immune system, and/or hereditary factors. Symptoms include inflammation, joint pain, and progressive deterioration of joint surfaces over time which may result in anatomical changes of the joint surface, and edema inside the joint accompanied by tissue debris. This condition demonstrates mechanical instability in the joint related to the wearing away of the cartilage that is responsible for friction-free motion of the joint. The debris causes an inflammatory response that can induce bone overgrowth and osteophyte formation that eventually interferes with joint mobility. Rheumatoid arthritis is a progressive form of arthritis that can be painfully destructive and may cause the interior joint tissues to swell and thicken, resulting in joint disintegration and eventual significant deformity.

Osteophytes or bone spurs are visible indications of a changing mechanical environment and are often found in areas affected by arthritis such as the disc or joint spaces where cartilage has deteriorated. The formation of osteophytes is the body’s attempt to halt the motion of the arthritic joint and deal with the degenerative process, but often causes impingement on the surrounding nerve roots.

Ankylosing spondylitis is a chronic hereitable disease characterized by progressive inflammation of the spine with early sacroiliac joint involvement, followed by hardening of the anulus fibrosus and surrounding connective tissue and arthritic changes in the facet joints.⁵; ⁶ The disease eventually results in a loss of segmental mobility and “stiffening” of the spinal tissues.

Spinal Stenosis

Spinal stenosis is a disorder causing narrowing of the spinal canal or the neuroforamen through which nerves exit the spinal column, thereby placing pressure on the spinal cord. It occurs in all areas of the spine, however, most often in the lumbar and cervical areas. Lumbar spinal stenosis-related symptoms include pain, weakness, or numbness in the legs, calves, or buttocks, and are exacerbated when walking short distances and reduced when sitting, bending forward, or lying down. Cervical spinal stenosis demonstrates similar symptoms in the shoulders, arms, and legs, in addition to fine motor skill and balance disturbances. Treatment for spinal stenosis includes drug therapy such as nonsteroidal antiinflammatory drugs to reduce swelling and pain, and analgesics to relieve pain. Further conservative approaches to pain involve corticosteroid injections (epidural steroids) to reduce swelling and treat acute pain. Certain medical conditions may confound the diagnosis and affect treatment choices. Diabetes-related peripheral vascular disease and diabetic neuropathy or polyradiculopathy may superficially mimic the neurogenic claudication of spinal stenosis, causing pain and neurological deficits to the patient.

Osteoporosis

Osteoporosis is defined as the loss of bone mass and density due to a loss of calcium exchange, which significantly compromises the strength of the vertebral body.¹ It is often detected during the later stages of bone loss and will weaken the mechanical integrity of the spinal column. Deformities may develop as the vertebral segments lose a great deal of the cancellous structure, and eventually lead to compression and crush fracture resulting in a kyphotic posture. Loss of bone strength may cause spontaneous fractures to occur, in which the patient’s own body weight alone may cause vertebrae to collapse leading to compressed nerves.