130 - Degenerative Conditions of the Cervical and Thoracolumbar Spine

Abstract

Degenerative conditions of the cervical and thoracolumbar spine are highly prevalent with advancing age. Commonly encountered conditions in the primary care and sports medicine settings that affect the cervical spine include axial neck pain, cervical spondylosis, discogenic pain, cervical disc herniation, foraminal stenosis, cervical radiculopathy, central stenosis, and cervical myelopathy. Rheumatoid cervical spondylitis and ossification of the posterior longitudinal ligament are additional cervical degenerative conditions that are frequently treated in these settings. Although similar forms of each of these disease entities also occur in the thoracic spine, they are relatively rare. Therefore the principal degenerative condition of clinical significance in this region is herniation of a thoracic disc. Low back pain is prevalent in the aging population and is encountered at all levels of referral. Other commonly encountered degenerative conditions affecting the lumbar spine include discogenic low back pain, lumbar disc herniation and radiculopathy, synovial facet cysts, degenerative lumbar spinal stenosis, and degenerative spondylolisthesis. With an understanding of degenerative spinal conditions, the clinician may accurately determine whether conservative management is indicated or whether a condition will be more amenable to referral to a spine specialist. Diagnosis hinges on a thorough history and physical examination as well as x-ray imaging. Advanced imaging such as computed tomography (CT) or magnetic resonance imaging (MRI) is typically mandatory to aid in diagnosis and, if indicated, operative planning. Although there are clinical nuances to the treatment of each of the discussed degenerative conditions, a basic treatment algorithm includes a trial of nonoperative therapy followed by operative management if symptoms fail to improve.