The natural history of spinal osteoarthritis is difficult to define. Most patients will present with back or neck pain, the etiology of which can be hard to determine. Some investigators feel that facet joints are a significant pain generator. Facet joints are innervated by branches of the dorsal rami of the same level and, the level above. After the capsule of the facet joint is innervated with nociceptive fibers. However, studies using facet blocks to examine facet joint contribution to spinal pain report varying prevalence from 7% to 75%.5 In addition, a large study of the prevalence of spinal osteoarthritis in women demonstrated a peak in incidence of osteoarthritis in the mid thoracic spine region. However, this radiographic peak did not correlate with any clinical symptoms. The same study did demonstrate a peak at the L4-L5 segment, which correlated with increased symptom scores.3 This study underlines the variability of clinical symptoms with significant radiographic findings.
In general, osteoarthritis is a progressive disease. Whereas disease modifying agents are currently employed in the treatment of gout, rheumatoid arthritis, and psoriatic arthritis, the treatment of osteoarthritis is primarily symptomatic. This treatment may be beneficial to most, but some patients still develop enough spinal degeneration to result in significant morbidity and disability. Decreased mobility coupled with deconditioning portends significant physical decline. Thus, while most patients will stabilize with current therapy, some patients will progress to developing significant pain, neurological deficit, and disability. These patients are the most likely to present to a spine surgeon for evaluation and treatment.
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