Generality
Interapophyseal arthrosis (or posterior vertebral arthrosis) is a degenerative pathology involving the joints of the spine.
This process occurs when in an articulation an imbalance occurs between the functional stresses and the resistance of the cartilage, favored or aggravated by local or general factors, such as concomitant diseases, age, genetic predisposition and lifestyle.
In interapophyseal arthrosis, wear and erosions typically involve the articular cartilage located between the vertebral apophyses . These structures undergo slow deterioration, which causes pain and other problems, including back stiffness and limited mobility.
The interapofisaria arthrosis is unfortunately irreversible, since the cartilage does not spontaneously regenerate. However, a series of pharmacological and surgical treatments can relieve pain and improve the functions of the affected joints.
What's this
Preliminary notions: arthrosis
- ARTHROSIS is a joint disease sustained by a degenerative process. The latter always starts with the articular cartilage and then gradually extends to the whole joint.
- JOINTS are structures that connect or "articulate" the bones together. In this context, articular cartilage is a thin smooth and elastic tissue that covers the terminal parts of the bones and allows sliding without friction between the articular heads, when they perform reciprocal movements. If the articular cartilage is progressively reduced in thickness, in addition to causing chronic pain, it can limit the movements of the affected joints.
- Osteoarthritis does not manifest itself suddenly, but over the years. It is, in fact, a wear-related disease, in the sense that the joints suffer damage which, in some way, is related to their excessive use or overloading. Not surprisingly, osteoarthritis is often a consequence of traumatic events and processes related to aging .
- The degenerative process underlying arthrosis is slow and progressive. Little by little, the cartilage thins, so also the synovial membrane and the bones involved in the joint movement can suffer damage. The bony heads are no longer protected, in fact, from the cartilage and can make friction on each other.
- Any articulation can be affected by arthrosis, but some are more frequently "targeted" than others. The joints most affected by weight and activity are mainly affected, therefore: spine, knees, hips, shoulders and hands.
Did you know that…
In the vertebral column, osteoarthritis can be anterior ( intersomatic ) or posterior ( interapophysial ).
Interapophyseal arthrosis: what is it?
INTERAPOFISARIA ARTHROSIS (also called posterior vertebral arthrosis) is a pathology characterized by a degenerative process that affects the spine.
More in detail, the arthritic disease involves the zygapophysial joints (or facet joints).
Interapophyseal arthrosis generally affects women over 60 years and can worsen in case of overweight: this situation tends to accentuate natural lordosis, worsening the disorder.
What are zygapophyseal joints?
- The interapofisaria arthrosis is characterized by a destruction or erosion of the articular cartilage, located between the vertebral apophyses .
- The zygapophyseal joints represent the main joints of the back. These are covered with cartilage and are wrapped by the joint capsule .
- When the cartilage is consumed, the bony surfaces come into contact and rub against each other, causing pain and hindering movement. Over time, bony growths ( osteophytes ) can form, which increase friction between the bony heads and accentuate acute crises of interapophyseal arthrosis.
Did you know that…
In anatomy, apophyses are bony protrusions that often become part of the joints. There are also some in the vertebral column and can be subject to arthrosis (the so-called interapofisaria arthrosis). The apophyses of the spine contain the facet joints, through which the vertebrae articulate with each other. The facet joints are, in fact, vertebral bone structures that have the function of connecting the vertebrae between them allowing the movements of bending and torsion of the column, controlling, at the same time, the movements beyond a certain limit.
Causes
The interapofisaria arthrosis is a chronic disease that occurs when in one or more zygapophyseal joints there is an imbalance between cartilage resistance and functional stress, due to the intervention of various general or local factors.
Initially, interapophyseal osteoarthritis is characterized by degenerative lesions affecting the cartilage, which covers and protects the bone ends involved in the joints of the spine. Over time, the arthrosis process is not limited to the cartilage alone, but tends to gradually involve the whole joint. It follows a localized pain and a limitation of the movements that, with the passing of the years, get worse and worse.
Interapophyseal arthrosis: what is it caused by?
As with all diseases, the susceptibility to interapophyseal arthrosis is individual, in the sense that there are local and general factors, that is the whole organism, which can predispose to the disease.
The main causes include:
- Age and gender . The interapofisaria arthrosis is one of the consequences of the natural aging process which the body faces. Over the years, in fact, all the structures of the body, including the joints, degenerate. Hormonal implications, on the other hand, can then explain why interapophyseal osteoarthritis occurs in women, usually after menopause.
- Genetics . Genetic predisposition plays an important role in the onset of the degenerative process. This is demonstrated by the fact that interapophyseal osteoarthritis is more common in people who are familiar with the same disease.
- Environment and lifestyle. The interapofisaria arthrosis can be favored by various factors, which include the overweight of a certain entity, the postural vices and the sedentary lifestyle . In fact, these conditions cause abnormal compressions on the joints of the spine; people who remain many hours standing or sitting in front of a desk are at risk. We must not forget, then, that the excessive use of the vertebral column favors its degeneration. Inter-pituitary osteoarthritis is more common in workers who subject their backs to excessive and repeated loads, forced positions or the continuous use of some joints, such as nurses, masons or drivers. Other times metabolic alterations are involved, related, for example, to feeding or to the presence of concomitant pathologies, such as osteoporosis.
- Other pathologies . An increased risk of suffering from interapophyseal arthrosis is represented by local factors, such as the concentration and the maldistribution of mechanical stresses on the articular surface of the back. The degenerative process can also be favored by articular alterations produced by inflammation (rheumatoid arthritis), post-traumatic lesions (bone fractures, as can occur in some contact sports or as a consequence of car accidents), vertebral column deviations ( such as scoliosis or kyphosis) and vascular changes .
Symptoms and Complications
Inter-pituitary osteoarthritis is a chronic and progressive disease, so it tends to worsen over time. If it is not addressed and treated properly, the degenerative process is not limited to the cartilage alone, but tends to gradually involve the whole joint. It follows a localized pain and a limitation of the movements, that over the years is getting worse and worse.
In the presence of interapophyseal arthrosis, the involvement of the nervous and vascular structures protected by the same cervical spine can determine the onset of annoying pains and tingling that extend from the lumbar area to the legs; in the worst case, serious difficulties arise in performing certain movements.
Did you know that…
The back pain from interapofisaria arthrosis is easily confused with that typical of the herniated disc . Osteoarthritis, in fact, can compress the points from which the nerves exit from the spinal canal, exactly as it happens in the herniated disc.
Interapophyseal osteoarthritis: how does it manifest itself?
The main symptoms of interapophyseal osteoarthritis include:
- Stiffness of the back : it appears above all in the morning, upon awakening, and in the evening, when the tiredness of the day accumulates;
- Pain (back pain);
- Hindrance or difficulty in performing even trivial movements .
Sometimes, interapophyseal osteoarthritis involves numbness and loss of muscle strength, especially in the morning or after a period of inactivity. The pain also manifests itself when one tends to hyper-extend the back (accentuating the natural lordosis of the lumbosacral area) and after one has been standing for a long time. This manifestation is attenuated, however, by sitting down and bending the back forward on the knees (a position that also allows the muscles to relax). There may also be noises known as articular "thunder", tingling or small shocks and loss of sensitivity.
In the initial stages of interapophyseal arthrosis, moments of crisis alternate with periods in which pain is practically absent. This does not mean that the damage caused by the disease disappears: the lesions remain and do not regress, in fact they tend to worsen over the years and, if the pain was intensified by the efforts and relieved by rest, in the most advanced stages it may also be present in rest and even hinder sleep.
Diagnosis
The diagnosis of interapophyseal arthrosis is made through an orthopedic examination and is confirmed by radiological investigations .
First, the doctor collects information related to the patient's age, body weight, past traumas and associated diseases. Subsequently, during the visit, the location, the type of pain and the possible limitation to the movement are evaluated.
The alterations of the affected joints due to interapophyseal osteoarthritis are then clearly shown with imaging techniques, such as standard radiographs, CT scans and magnetic resonance imaging.
The characteristic finds of the interapophysial degenerative process are three and include:
- The reduction of joint space due to the disappearance of cartilage tissue;
- Osteosclerosis, or alterations of the bone below the worn or suffering cartilage;
- Osteophytosis along the edges of the joint (the ultimate consequence of which is foraminal stenosis).
In the more advanced stages of interapophyseal arthrosis, subchondral or geoid cysts, articular deformity and spondylolisthesis may occur.
In addition, a visit that evaluates neurological problems or electromyography may be useful.
Note. Electromyography is an investigation considered for those patients who continue to complain of persistent back pain, although significant alterations do not emerge from radiographic images.
Treatment
Unfortunately, at present, interapophyseal osteoarthritis cannot be cured, but it can be kept under control. Indeed, cartilage and joint degeneration is progressive and the treatment consists in alleviating pain and avoiding further deterioration, as well as slowing down the evolution of the pathological process.
The therapy of acute crises of interapofisaria arthrosis is of a pharmacological type and involves the administration of analgesics and anti-inflammatories to limit pain and allow joint movement. In particular cases, it is possible to resort to infiltration with hyaluronic acid, while the use of corticosteroids is limited to cases of concomitant inflammation.
Drugs such as painkillers, anti-inflammatories and, sometimes, muscle relaxants, which are useful in the acute phase, to relieve symptoms. Care should be taken, however, not to abuse these medicines, as they produce considerable side effects in the long run.
During painful crises, the back must be kept at rest and movements that are too abrupt must be avoided to avoid worsening the pain.
In the periods between one crisis and another, massages and rehabilitative physical therapies can be very useful.
In the most serious and invalidating cases, it may be necessary to resort to surgery, especially in the presence of a severe compression of the nerve or spinal cord.
Sometimes, the affected joint can be replaced with an artificial prosthesis . The positioning of this device allows you to correct or restore the compromised joint, with good results.
Some advice
One of the main causes of interapophyseal arthrosis is excessive wear of the joints due to their overload. During the chronic phase of the disease, therefore, the first step of the treatment consists in the reduction of body weight, where in excess. However, repeated traumas and incorrect postures that predispose to the degenerative process should be avoided.
The last therapeutic-preventive pivot is physical exercise . Many people with interapophyseal arthrosis, in fact, follow a saving instinct of the suffering joint, leaving the movement in the background. In reality, targeted exercise can strengthen the muscles and maintain joint function, positively stimulating all parts of the back, relieving it of any tension. Useful sporting activities are, for example, fast walking, swimming and the so-called "sweet" gymnastics, such as yoga.
