Multilevel Degenerative Spondylosis is a chronic, age-related condition involving the progressive wear and tear of the spine’s structural components across multiple segments. This common aging process affects the vertebrae, the intervertebral discs, and the small facet joints. It is a slow deterioration that can lead to pain and restricted movement over time. Characterized by arthritic changes, it is often used synonymously with spinal osteoarthritis. When degeneration affects two or more distinct levels of the spine, it is termed “multilevel.”
Defining the Condition’s Components
The medical term “Multilevel Degenerative Spondylosis” can be broken down into three parts. “Spondylosis” is a broad term referring to degenerative changes in the spine, particularly the wear and tear affecting the discs and vertebrae. It is essentially the medical name for arthritis of the spine, where the joint cartilage begins to break down.
The term “Degenerative” identifies the underlying cause as natural aging and mechanical wear. Over a lifetime, the spine endures constant stress, leading to a gradual breakdown of its tissues. This process is considered a normal, though sometimes painful, part of aging.
“Multilevel” specifies the extent of the condition, meaning degenerative changes are present at more than one spinal segment. A spinal “level” consists of two adjacent vertebrae and the intervertebral disc between them. Multilevel spondylosis may involve multiple segments within a single region, like the lower back (lumbar spine), or affect different regions entirely, such as the neck (cervical) and the lower back.
The Mechanism of Spinal Degeneration
Spinal degeneration typically begins within the intervertebral discs, which function as the spine’s primary shock absorbers. These discs have a soft, gel-like center (the nucleus pulposus) that provides pliability and cushioning. As a person ages, the nucleus pulposus gradually loses its water content, a process known as disc desiccation.
This dehydration causes the discs to become less elastic and lose height, reducing their ability to absorb mechanical stress. The loss of disc height places increased pressure on the small facet joints located at the back of the vertebrae. This altered biomechanics initiates changes in the joints, similar to osteoarthritis elsewhere in the body.
To stabilize the segment and compensate for instability, the body often grows small, bony projections called osteophytes (bone spurs) along the edges of the vertebrae. While this is a natural stabilization effort, these osteophytes can narrow the space available for the spinal cord and nerve roots. This narrowing of the spinal canal or the nerve root openings (foramina) is known as spinal stenosis and is a common consequence of advanced spondylosis.
Recognizing the Symptoms
The symptoms of multilevel degenerative spondylosis vary widely depending on the specific spinal segments affected. Many people show signs of degeneration on imaging without experiencing discomfort. When symptoms manifest, they generally fall into two categories: localized pain and radicular symptoms.
Localized or axial pain is felt directly at the site of degeneration, commonly presenting as a dull ache or stiffness in the neck or lower back. This pain is often worse with movement or after prolonged periods in one position, such as sitting or standing. Stiffness is frequently most noticeable in the morning or after long periods of inactivity.
Radicular symptoms occur when degenerative changes, such as bone spurs or disc material, compress or irritate a spinal nerve root. This nerve compression can cause pain, numbness, tingling, or weakness that radiates into the extremities. For example, cervical spine degeneration can cause pain traveling down the arm, while lumbar involvement often results in leg pain (sciatica). Severe nerve compression can also lead to difficulty with balance, coordination, or loss of bladder or bowel control.
Treatment Strategies
Management of multilevel degenerative spondylosis generally begins with conservative, non-surgical approaches aimed at reducing pain and improving function. Medications such as non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage inflammation and pain. Muscle relaxants may also be prescribed for acute muscle spasms.
Physical therapy is a cornerstone of conservative treatment, focusing on exercises to strengthen core muscles, improve flexibility, and improve posture. Lifestyle modifications, including maintaining a healthy weight and avoiding aggravating activities, are also recommended to reduce stress on the spinal structures.
If initial conservative measures do not provide adequate relief, interventional pain management techniques may be considered. These include spinal injections, such as epidural steroid injections, which deliver anti-inflammatory medication directly near the affected nerve roots to reduce swelling and pain.
Surgical intervention is typically reserved for cases where conservative treatments have failed or when there is evidence of severe neurological deficits, such as progressive weakness or myelopathy (spinal cord compression). The goals of surgery are usually to decompress the nerves or spinal cord by removing the impinging tissue and to stabilize the affected spinal segments, often through spinal fusion.