Thoái hóa cột sống

Spinal spondylosis is age‑related “wear and tear” of the spine—joints, discs, and ligaments gradually break down, sometimes causing neck or back pain and stiffness. Many people have these changes on scans without symptoms; others develop nerve or spinal cord pressure that needs closer attention.​

1) What is this condition?

  • It is degenerative arthritis of the spine, often called spinal osteoarthritis, involving thinning discs, bone spurs, and worn facet joints.​

  • It can affect the neck (cervical), mid‑back (thoracic), or low back (lumbar), sometimes narrowing the spaces for nerves (radiculopathy) or spinal cord (myelopathy).​

2) How serious is it?

  • Many cases cause mild or episodic stiffness and pain and are not dangerous.​

  • When bone spurs and thickened ligaments compress nerves or the spinal cord, people can develop arm or leg pain, numbness, weakness, trouble walking, or (rarely) bowel/bladder issues requiring prompt care.​

3) Non‑surgical treatments

  • Activity changes and posture work to avoid prolonged neck flexion, heavy lifting, or repetitive strain.​

  • Physical therapy: exercises to improve flexibility, posture, and core/neck/hip strength; sometimes gentle traction for the neck.​

  • Medicines: anti‑inflammatory drugs, short‑term muscle relaxants, and other pain relievers as needed.​

  • Injections: epidural steroid injections or facet joint/nerve blocks can reduce inflammation and pain in selected patients.​

  • Heat/ice, manual therapy, acupuncture, and short‑term bracing (soft collar for neck, lumbar brace) may help during flares.​

4) Types of surgery that may be necessary

  • Decompression surgery: removing bone spurs, thickened ligaments, or disc material to free up pinched nerves or spinal cord (e.g., laminectomy, foraminotomy, discectomy).​

  • Fusion: sometimes added to decompression if there is significant instability or deformity, joining vertebrae with bone graft and hardware.​

  • In the neck, options include anterior cervical discectomy and fusion (ACDF), posterior laminectomy with or without fusion, or disc replacement in select cases.​

5) Goals of surgery vs non‑surgical care

  • Non‑surgical goals:

    • Reduce pain and stiffness, maintain or improve mobility, and protect nerve function without major surgery.​

    • Manage flares and keep people active and independent as long as possible.​

  • Surgery goals:

    • Relieve pressure on nerves or spinal cord and stabilize the spine when needed.​

    • Improve or prevent worsening of symptoms like arm/leg pain, weakness, balance problems, and loss of hand coordination or walking ability.​

6) How surgery can “fix” the problem

  • Decompression removes bone spurs, overgrown joints, or ligament tissue narrowing the nerve channels, giving nerves and/or spinal cord more room.​

  • Fusion (when used) holds the affected vertebrae still with screws and rods while bone grafts heal, preventing painful or unstable motion at that level.​

7) Risks of surgery (general and specific)

  • General risks: infection, bleeding, blood clots, anesthesia complications, and medical issues (heart, lung).​

  • Spine‑specific:

    • Nerve or spinal cord injury causing new numbness, weakness, or bowel/bladder problems (uncommon but serious).​

    • Dural tear (spinal fluid leak), sometimes needing repair and longer stay.​

    • With fusion: hardware failure or nonunion (bones not fully fusing), and increased stress on nearby levels over time.​

8) Chances this surgery will work

  • For nerve‑root compression (radiculopathy) from spondylosis, decompression typically relieves arm or leg pain in a large majority of appropriately selected patients.​

  • For lumbar spondylotic stenosis with slippage, evidence suggests decompression alone often works as well as decompression plus fusion, with fewer risks, in many patients.​

  • Outcomes are best when symptoms clearly match imaging and non‑surgical care has been tried without sufficient relief.​

9) Possible complications from the surgery

  • Short‑term: wound infection, hematoma, spinal fluid leak, or transient nerve irritation causing increased pain or numbness.​

  • Long‑term: recurrent stenosis, adjacent‑segment wear (especially after fusion), persistent pain, or need for re‑operation in a minority of patients.​

10) Typical recovery from the condition

  • Many people manage spondylosis long‑term with cycles of flares and quiet periods, using exercise, posture changes, and periodic therapy or injections.​

  • Mild to moderate cases often remain stable for years; a smaller group gradually develops more nerve or cord symptoms and may eventually need surgery.​

11) Typical recovery after surgery

  • Most decompressions/fusions require a short hospital stay, then several weeks of activity limits (no heavy lifting, limited bending/twisting).​

  • Walking is usually encouraged early; formal physical therapy typically begins within days to weeks to restore motion, strength, and posture.​

  • Full recovery and, for fusion, solid bone healing can take 3–12 months, with gradual improvement in pain and function.​

12) How long in the hospital

  • Many single‑level neck or low‑back decompressions are 1–3 day stays; some minimally invasive cases are same‑day.​

  • Multi‑level fusions or patients with other medical problems may need longer hospitalization.​

13) Long‑term outlook

  • Spondylosis is a chronic, age‑related process, but many individuals maintain good quality of life with conservative care and lifestyle adjustments.​

  • After well‑indicated surgery, many have lasting relief of limb pain and improved walking, though some neck/back stiffness or residual discomfort is common.​

  • Ongoing attention to posture, strength, weight, and general health helps reduce future flare‑ups and stress on other spinal levels.​

14) Need for outpatient follow‑up

  • Non‑surgical cases: periodic follow‑up with primary care, physiatry, or spine specialists to adjust medicines, therapy, and exercise plans, especially if symptoms change.​

  • Post‑surgery: scheduled visits and imaging to monitor healing, hardware, and nerve function, plus guided progression in activity and physical therapy.​

  • Long‑term: reassessment if new numbness, weakness, balance problems, or bladder/bowel symptoms appear, as these may signal new or worsening nerve/cord compression.