The Bonati Institute Glossary: Spondylosis

The mission of The Bonati Institute is to provide hope to people suffering with chronic pain from a back or neck condition. We believe that a well-informed patient is vital to restoring hope and finding answers to pain. We developed this web site primarily to help educate pain sufferers and their families. We’ve found that the more individuals in pain learn about their anatomy, their condition and the options available to them the more likely they will be to choose the advanced arthroscopic procedures offered by The Bonati Institute.

Spondylosis

The gradual deterioration of the disc between the vertebrae is also referred to as Degenerative Disc Disease (DDD). As people age, the composition of the cartilage of the body changes, resulting in thinner and more fragile cartilage. These changes cause the intervertebral discs and the joints that stack the vertebrae (also known as facet joints) to wear over time. This degeneration of the disc is also referred to as spondylosis. Spondylosis can be seen on MRI scans of the spine as a narrowing of the normal disc space between adjacent vertebrae

Any level of the spine can be affected. Degeneration of the disc can cause local pain in the affected area. When Degenerative Disc Disease specifically affects the spine of the neck, it is more specifically referred to as cervical spondylosis. When the mid-back is affected, the condition is known as thoracic spondylosis. Degenerative Disc Disease affecting the lumbar spine is referred to as lumbar spondylosis.

Spondylosis is a chronic degenerative condition of the spine that affects the vertebral bodies and intervertebral discs as well as the contents of the spinal canal. Spondylosis progresses with age and often develops at multiple interspaces. Chronic degeneration is the most common cause of progressive spinal cord and nerve root compression.

Spondylotic changes can result in spinal canal, lateral recess, and foraminal stenoses. Intervertebral discs lose hydration and elasticity with age, and these losses lead to cracks and fissures. The surrounding ligaments also lose their elastic properties and develop traction spurs. The disc subsequently collapses, causing the annulus to bulge outward. As the disc space narrows, the annulus bulges, and the facets override one another.

Spondylosis is a common condition that is estimated to account for 2% of all hospital admissions. It is the most common cause of spinal cord dysfunction in patients older than 55 years. Approximately 90% of men older than 50 years and 90% of women older than 60 years have evidence of degenerative changes in the spine. Symptoms of cervical spondylosis may appear in those as young as 30 years, and spondylosis usually starts earlier in men than in women.

Probable Treatment

The Bonati Arthroscopic Laser Cervical Decompression

The Bonati Arthroscopic Laser Cervical Decompression-Posterior Approach is done from the back of the patient's neck to remove bone spurs and enlarged ligaments that are compressing the spinal cord and nerves leading to the arms. This procedure is usually employed to treat Degenerative Disc Disease and/or facet joint arthritis. However, patients who have had previous cervical fusions with residual pain can also benefit from an Arthroscopic Laser Cervical Decompression-Posterior Approach.

The Bonati Arthroscopic Laser Foramenoplasty of the Lumbar Spine

A foramen is the window through which a nerve root exits the spine. Bone spurs that form as a result of Degenerative Disc Disease or spinal arthritis may narrow the foramen causing spinal stenosis or foraminal stenosis, conditions that typically cause leg pain. Also, a foramen may be narrowed by a herniated disc or scar tissue from previous surgery. These problems are treated by foramenoplasty.

Foramenoplasty is performed through a small incision in the back, while the patient is conscious under a low-level IV sedation. The narrowed foramen is located with fluoroscopic x-rays, and a guide wire is placed down to the area of disease. Then, a hollow tube is inserted over the wire to the foramen.

The endoscope and surgical instruments are inserted through the tube. The miniaturized television camera on the endoscope provides direct visualization of scar tissue, bone spurs, and diseased disc material. After surgery the patient is prescribed a short course of physical rehabilitation.

The patient is positioned on his / her stomach with the back of the neck facing up. Intravenous sedation and local anesthesia are applied. A guide pin is placed through the skin and down to the area of pathology around the nerves using x-ray guidance.

A hollow metal tube is then placed over the guide wire to the bone. The endoscope and specially- designed instruments are directed down the tube and a decompression of the abnormal ligaments and bone spurs is done until the spinal cord and nerves are visualized as completely cleaned. The operation is complete when the patient's pain in the neck and arms is gone. Because the patient is awake during surgery, anesthesia risk is minimal, postoperative recovery is shortened, and post-operative recovery is shortened.