Have you ever been told you have spondylosis, spondylolisthesis or spondylitis and
wondered what on earth the difference is?
These are three terms that sound very similar and are very easy to get mixed up. I know a
lot of people use the terms incorrectly after hearing them from different medical
practitioners, so I wanted to give you a quick and simple explanation of the differences.
Although they all relate to the spine, they describe very different things.
What is spondylosis?
Spondylosis is a term used to describe age-related or degenerative changes in the spine.
As we get older, the discs and joints in our spine naturally change. The discs can lose some of their height and flexibility, while the joints can develop changes associated with osteoarthritis. Bony changes such as osteophytes (bone spurs) can also develop.
These changes are often described as “wear and tear”, although I prefer to think of them as normal changes that can happen to the spine as we age.
Importantly, having spondylosis on an X-ray or scan does not automatically mean that it is the cause of your pain.
Some people can have quite noticeable degenerative changes on a scan and have very little or no pain, while someone with relatively minor changes may experience significant symptoms.
Spondylosis can affect different areas of the spine, including the neck, upper back and lower back.
What symptoms can spondylosis cause?
Spondylosis may cause:
- Back or neck pain
- Stiffness
- Reduced movement
- Aching around the affected area
- Sometimes pain, numbness or tingling if changes in the spine affect nearby nerves
However, you can also have spondylosis without having any symptoms at all.
What is spondylolysis?
This is one that is particularly easy to get confused with spondylosis!
Spondylolysis is a small stress fracture or defect in a part of the vertebra called the pars interarticularis.
This most commonly occurs in the lower back and can be associated with repeated loading or extension of the spine. It is more common in some athletes, particularly those involved in activities that repeatedly put the spine into extension.
Spondylolysis can sometimes cause lower back pain, but it does not always cause symptoms.
So, to make it nice and simple:
Spondylosis = degenerative changes in the spine
Spondylolysis = a defect/stress fracture in part of a vertebra
They sound almost identical but are completely different things!
What is spondylolisthesis?
So, to make it nice and simple:
Spondylolisthesis is where one vertebra slips forward in relation to the vertebra below it.
It most commonly occurs in the lower back, although it can occur elsewhere in the spine.
There are several different reasons why this can happen, including:
- A stress fracture or defect in the pars interarticularis
- Degenerative changes in the spine
- A vertebral fracture
- Developmental or congenital differences
- Less commonly, other conditions affecting the spine
Interestingly, spondylolysis and spondylolisthesis can be linked. A defect in the pars interarticularis can sometimes allow one vertebra to move forward in relation to the one below it.
What symptoms can spondylolisthesis cause?
Just like spondylosis, spondylolisthesis doesn’t always cause symptoms.
When symptoms are present, they can include:
- Lower back pain
- Pain into the buttocks or thighs
- Tightness in the hamstrings
- Numbness or tingling
- Sciatic-type pain if nerves become irritated or compressed
Symptoms can vary depending on the severity and the structures affected.
What is spondylitis?
Now we get to the one that is quite different from the other two.
Spondylitis means inflammation of the spine.
It is associated with inflammatory conditions rather than the typical age-related degenerative changes we see with spondylosis.
One condition you may have heard of is ankylosing spondylitis (AS), which is a type of axial spondyloarthritis. It is a long-term inflammatory condition that can affect the spine and the joints between the spine and pelvis.
Unlike typical age-related changes, inflammatory spinal conditions involve the body’s immune system and can cause ongoing inflammation.
What does inflammatory back pain feel like?
Inflammatory back pain can be different from the more typical mechanical back pain that many people experience.
For example, with ankylosing spondylitis, symptoms can include:
- Back pain and stiffness
- Stiffness that is worse in the morning
- Pain that can be worse at night
- Symptoms that improve with movement or exercise rather than rest
- Pain around the buttocks
- Fatigue
- Inflammation in other joints or where tendons and ligaments attach to bone
These symptoms can develop gradually over months or years.
If inflammatory back pain is suspected, it is important to speak to your GP, as conditions such as axial spondyloarthritis require appropriate medical assessment and management.
So, what is the difference between spondylolysis, spondylolisthesis and spondylitis?
I know… that’s a lot of very similar words!
Here’s the easiest way I remember them:
Spondylosis
Degenerative/age-related changes in the spine.
Spondylolysis
A defect or stress fracture in part of a vertebra.
Spondylolisthesis
One vertebra slips forward in relation to another.
Spondylitis
Inflammation affecting the spine.
They may sound similar, but they describe different changes within the spine.
Do these conditions always cause back pain?
No!
This is really important.
Finding a change on an X-ray or MRI does not necessarily mean that the change is the reason you are experiencing pain.
Spinal changes are very common, particularly as we get older, and many people have these changes without experiencing any symptoms.
This is why it is important to look at the person as a whole rather than just the scan.
Your symptoms, medical history, lifestyle, physical examination and how your body is moving all provide important information.
How are these conditions diagnosed?
The way these conditions are diagnosed depends on which condition is suspected.
Your healthcare professional will usually start by taking a detailed history and carrying out a physical examination.
Depending on your symptoms and the suspected condition, imaging such as an X-ray or MRI may be appropriate.
For example, an X-ray can be used to identify a vertebra that has slipped forward in spondylolisthesis. An MRI may be used when there are neurological symptoms such as pain, numbness or weakness, or when more detailed information about the nerves and surrounding tissues is needed.
If an inflammatory condition such as ankylosing spondylitis is suspected, further investigations may include blood tests and imaging, and you may be referred to a rheumatologist.
You don’t automatically need an X-ray or MRI just because you have back pain. The appropriate investigation depends on your symptoms and whether the results would change your treatment or management.
Can an Osteopath help with these conditions?
If you’re experiencing back pain or have been told you have one of these conditions, an Osteopath can take a detailed history and assess your spine and the surrounding muscles and joints.
We can look at how your back, hips and surrounding tissues are moving and how this may be contributing to your symptoms.
Treatment can then be tailored to you and may include hands-on treatment, movement advice, exercises and self-care strategies.
However, it’s important to remember that not every type of back pain is suitable for hands-on treatment, particularly when an underlying inflammatory or more serious condition is suspected.
If your symptoms suggest that you need further investigation or assessment from another healthcare professional, we can also advise you on when it would be appropriate to speak to your GP or another specialist.
When should you see your GP?
If your back pain is persistent, getting worse or is affecting your everyday life, it is worth getting it assessed.
You should also speak to your GP if you have symptoms that could suggest an inflammatory condition, such as persistent back pain and stiffness that is worse at night or in the morning and improves with exercise.
Similarly, symptoms such as unexplained weight loss, fever, significant weakness or numbness, or other unusual symptoms alongside your back pain should be medically assessed.
Don’t let the terminology confuse you!
There are a LOT of “spondy-” words out there, and it is completely understandable if you aren’t sure what your diagnosis actually means.
The important thing to remember is that having a spinal change on a scan doesn’t necessarily mean that it is the cause of your pain.
If you have been given one of these diagnoses and you’re not sure what it means, or you’re experiencing back pain and don’t know what is causing it, an assessment can help you understand what may be going on.
If you’re experiencing pain or have any questions about your symptoms, why not book an appointment with us? We can assess your back and the surrounding areas and provide treatment and self-care advice tailored to you.
If your symptoms suggest that further investigation is needed, we can also advise you on whether it would be appropriate to speak to your GP or another healthcare professional.
Book a treatment today! We are here to help!
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