CINN Medical Group Physician Blog

Is it just arthritis?

Everyone gets arthritis, at least on pictures.  Arthritis basically means wear and tear (also known as degeneration) in the joints.  Just like everyone will get at least a little grey, get a few skin wrinkles, and maybe even lose some hair (luckily the picture of me posted is a bit old J, but you can look at Dr. Cerullo’s picture),  everyone, usually by the age of 40, will start to show some arthritis on x-rays, MRI scans, or other studies.  Luckily, most of the time the changes on the pictures don’t cause pain or any other problems, and there is nothing that needs to be done.  On the pictures, the arthritis in the spine shows up in a number of ways:  the discs can bulge out of place, other joints, called facet joints, can get bigger, the ligaments (kind of like rubber bands that hold the bones together) get bigger as well, and sometimes get a little weak, which can cause the bones to slip a little(since everything needs a long medical name, we call slippage of the bones spondylolisthesis).   Even with these changes, a lot of time patients don’t have any problems, and no treatment is necessary.  Sometimes arthritis causes the joints to become painful, and so there may be localized back pain(I will discuss this in another post-  hopefully).  But sometimes the combination of all these changes causes narrowing of the space for the nerves, and patients start to have problems because of pressure on the nerves, a condition called lumbar stenosis.  As mentioned in the previous post, the nerves from the spinal cord run in a canal in the bones of the spine.  This canal gets narrowed if the discs bulge into the canal, the facet joints or ligaments enlarge and take up some space in the canal, or if the bones slip.  The canal is made up of bony rings stacked up one on top of the other.  If they are stacked up perfectly, the canal has the maximum possible amount of space.  If one ring slips forward or backward, the amount of space in the canal goes down pretty quickly (to visualize this, make a ring with the thumb and first finger of each hand, and overlap them perfectly, one on top of the other.  Observe the amount of space inside the rings.  Now slowly move your hands apart, so that the rings no longer overlap perfectly.  As they move apart, the space where the rings overlap decreases).  So, even though the films may only show ‘arthritis’, sometimes all the changes from the arthritis causes narrowing of the space for the nerves, or lumbar stenosis.  The symptoms of lumbar stenosis are pain in the buttocks, going down to the back of the thighs.  My next post will discuss diagnosis and then go on to treatment.

Previous posts by Dr. Stadlan:
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