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Spondyloarthritis

Spondyloarthritis: what is it and how can it be treated?


Spondylarthrosis is a degenerative disease of the small vertebral joints, also known as facet joints. These joints connect the individual vertebral bodies to each other and allow the spine to move. Spondyloarthritis leads to wear and tear of the cartilage that protects the joint surfaces and to the formation of bone growths (osteophytes) at the edges of the joint. This can lead to pain, stiffness and restricted movement in the back.


Causes and risk factors for spondyloarthritis


The most common cause of spondyloarthritis is the natural ageing process, which leads to wear and tear of the cartilage. With increasing age, the cartilage loses its elasticity and ability to bind water, making it thinner and more prone to cracking. The joint surfaces rub against each other more and an inflammatory reaction occurs, which promotes the formation of osteophytes. These in turn can press on the nerve roots or the spinal cord and cause further discomfort.

In addition to age, there are other factors that can increase the risk of spondylarthrosis, such as

- Overloading through sport, heavy physical work or being overweight

- Poor posture or misalignment of the spine

- Injuries or inflammation of the vertebral joints

- Genetic predisposition

- Diseases such as rheumatism or osteoporosis


Symptoms of spondyloarthritis


The symptoms of spondyloarthritis can vary depending on the section of the spine affected. The most common forms are cervical spondylarthrosis (cervical spondylarthrosis) and lumbar spondylarthrosis (lumbar spondylarthrosis). Thoracic spondylarthrosis is less common, as this area is less mobile.

The typical symptoms of spondylarthrosis are

- Back pain that cannot be localized precisely, often worse during the day and with exertion

- Morning stiffness of the spine, which improves after a while

- Pain radiating to the arms, legs or neck, depending on the nerve affected

- Numbness, tingling or weakness in the extremities

- Restriction of mobility of the spine

- Cracking noises during movements


Diagnosis of spondyloarthritis


Spondyloarthritis is usually diagnosed on the basis of a medical history, a physical examination and imaging procedures. The doctor asks about the symptoms, the course of the disease and possible risk factors. He palpates the spine and checks mobility, reflexes and sensitivity. X-rays, magnetic resonance imaging (MRI) or computer tomography (CT) can be performed to visualize changes in the vertebral joints. These can also rule out other causes of back pain, such as a herniated disc or a tumor.


Treatment of spondyloarthritis


The treatment of spondyloarthritis aims to relieve pain, reduce inflammation, improve mobility and slow down further wear and tear. Treatment is usually conservative, i.e. it does not involve surgery. The most important treatment methods are

- Medication: painkillers such as paracetamol or ibuprofen can reduce pain and inhibit inflammation. Opioids or cortisone can also be administered for more severe pain. Muscle relaxants such as tetrazepam can relieve muscle tension.

- Physiotherapy: Physiotherapy, massage, heat or cold applications, electrotherapy or ultrasound can promote blood circulation, strengthen the muscles and improve joint function. The physiotherapist can also show you exercises to do at home, which should be carried out regularly.

- Occupational therapy: The occupational therapist can give tips on how to make everyday life easier on the back, for example by adopting an ergonomic sitting posture, a suitable mattress or aids such as pillows or support belts.

- Manual therapy: Manual therapy comprises various techniques that are carried out by a specially trained doctor or therapist. These include, for example, mobilization, in which the joints are gently moved, or manipulation, in which the joints are straightened with a short impulse. These methods can release joint blockages and relieve pain.

- Injection therapy: Injection therapy involves injecting medication directly into the affected joint. This can be cortisone, for example, which inhibits inflammation, or a local anesthetic, which numbs the pain. Another option is to obliterate the nerve fibers that supply the joint (denervation). This can be done with radiofrequency therapy or laser therapy.



Surgery for spondyloarthritis


Surgery for spondyloarthritis is only considered in rare cases if all other treatment methods have failed or if there are serious complications, such as paraplegia. The type of surgery depends on the individual situation. Possible interventions are

- Decompression: decompression involves releasing the spinal cord or nerve root from the pressure caused by the osteophytes or other structures. This can be done by a laminectomy (removal of part of the vertebral arch) or a foraminotomy (widening of the vertebral foramen).

- Fusion: In fusion, two or more vertebrae are joined together to reduce the mobility and thus the wear and tear of the affected joint. This can be achieved by spondylodesis (stiffening with bone material) or implantation of artificial joints (facet prostheses).

Translated with DeepL.com (free version)


Prognosis of spondyloarthritis


The prognosis of spondyloarthritis depends on various factors, such as age, the severity of the disease and the response to treatment. In many cases, the symptoms can be well controlled with conservative treatment and the quality of life can be improved. However, a cure is not possible, as cartilage wear and tear cannot be reversed. It is therefore important to do regular exercises to strengthen the back muscles and to maintain a healthy lifestyle.


Prevention of spondyloarthritis


Spondyloarthritis cannot be completely avoided, as it is usually age-related. However, there are some measures that can reduce the risk

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