Osteophytes (Bone Spurs)

What are Osteophytes?

Osteophytes are bony outgrowths which develop on the edge of normal bone and are more often than not, attributed to the ageing process.  They are more colloquially referred to as bone spurs, although the bone enlargements are not sharp as one would imagine a spur to be, but typically smooth. Osteophytes do not always cause symptoms, in fact many individuals over the age of 60 may have spinal osteophytes but be unaware of them. Painful symptoms are presented when the enlarged bone comes into contact with other bony or soft structures, irritate nearby soft tissues or compress nerves.

Where Do Osteophytes Occur?

Osteophytes most commonly occur in the spinal vertebrae but may also develop in the shoulders, knees, feet and fingers.

What Causes Osteophytes?

The formation of osteophytes is usually due to degenerative conditions such as osteoarthritis, spinal stenosis, ankylosing spondylitis and the effects of general wear and tear.

Osteoarthritis

The ageing process causes cartilage at the end of the bone to break down – once this protective cartilage has worn down, bones may come into contact with one another and rub causing swelling and inflammation. In response the body tries to repair the damage by producing more bone, which forms irregularly at the edges of the bone.

Disc Degeneration

The function of the cervical discs is to serve as shock absorbers as well as preventing the vertebrae from coming into contact with one another. Disc degeneration causes the discs to wear away shrink, lose height and elasticity, when the space of the vertebrae is reduced considerably the bones may come into contact and grind against one another – inducing the formation of osteophytes.

Repetitive Strain

Poor posture over long periods, tight ligaments and repetitive movement can encourage the formation of osteophytes. The shoulder is a common location for osteophytes, they can form in response to wear and tear, pinching the rotator cuff tendons and causing pain and inflammation. This disorder is frequently seen in athletes such as tennis or baseball players.

Traumatic Injury

Additional bone can develop in response to trauma such as fracture.

DISH

Diffuse idiopathic skeletal hyperostosis – a disease process which may result in the hardening or calcification of the ligaments attached to the spine.

Symptoms

Osteophytes may provoke a range of different symptoms depending on the area affected. A clear diagnosis is important as the symptoms of pain, stiffness and restricted movement are easily confused with other joint disorders.

In some cases, there may be no symptoms at all, however when osteophytes encroach upon individual spinal nerves, cervical discs, or the spinal cord itself painful and problematic neurological symptoms can occur.  This typically occurs when osteophytes form on the edge of vertebra and encroach on nearby nerve roots exiting the spinal column, this compression may result in a range of different symptoms depending on the location – symptoms may include:

  • mild to severe pain
  • numbness
  • tingling sensations or loss of sensation
  • weakness
  • headaches (if nerve compression occurs in the neck)

Diagnosis

A detailed medical history and analysis of symptoms with other investigative measures is necessary for an accurate diagnosis. An X-Ray will highlight any bone changes as well as any signs of arthritis in the joints, and an MRI scan may be useful for illustrating torn ligaments and tendons.

Treatment

These may be directed at the symptoms caused by the osteophytes or at the excess bone itself. Most physicians will recommend a course of traditional conservative treatment methods, this may include a combination of pain medication, physiotherapy and gentle exercise. Surgery may be considered in chronic cases where conservative treatment methods have failed.

Pain Medication

Medications such as over the counter analgesics and anti-inflammatories may be prescribed initially, however in more severe cases, stronger prescription painkillers may be issued for short term use.

Steroid Injections

In cases where osteophytes cause significant pain to surrounding tissue, an injection composed of steroid and local anaesthetic may be administered to reduce local pain, swelling and inflammation. Steroid injections can provide pain relief for longer periods of time.

Surgery

In cases of severe nerve compression surgery may be required, typically a minimally invasive laminectomy – this involves trimming the lamina, an arched piece of bone at the back of the vertebra to allow decompression of the spinal nerve root.

The Pain Management Clinic

The pain management clinic adopts a multidisciplinary approach toward the management of chronic pain related conditions. The understanding and subsequent treatment of pain related conditions is based on the bio-psycho-social model which takes into consideration the physical, socio-economic and psychological state of the patient in order to devise an individualised treatment plan which may involve pain management consultants, psychologists, physiotherapists, surgeons and other health specialists.

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