Spondylosis is osteoarthritis of the spine. The symptoms may vary from mild and episodic to aggressive and painfully chronic. Spondylosis affects the spine's joints; the facet joints in the cervical (neck), thoracic (mid back), and/or lumbar (low back) spine. Fortunately, most people with spinal osteoarthritis do not need surgery. Many of the common nonoperative treatments are featured below.

• Acupuncture is a popular treatment used to help alleviate back and neck pain. Tiny needles, about the size of a human hair, are inserted into specific points on the body. Each needle may be twirled, electrically stimulated, or warmed to enhance the effect of the treatment. It is believed that acupuncture works (in part) by prompting the body to produce chemicals that help to reduce pain.

• Bed Rest: Severe cases of spondylosis may require bed rest for no more than 1-3 days. Long-term bed rest is avoided as it puts patient at risk for deep vein thrombosis (DVT, blood clots in the legs).

• Brace Use: Temporary bracing (1 week) may help relieve symptoms, but long-term use is discouraged. Braces worn long-term weaken the spinal muscles and can increase pain if not constantly worn. Physical therapy is more beneficial as it strengthens the muscles.

• Chiropractic: Chiropractors believe that a healthy nervous system is synonymous with a healthy body. A subluxation, or the misalignment of a vertebra, may distress the nervous system and lead to a disorder causing back and neck pain. Chiropractors do not prescribe drugs or use surgery. Their practice includes ice/heat, ultrasound, massage, lifestyle modification, and spinal adjustments -- also called spinal manipulation.

• Lifestyle Modification: Losing weight and maintaining a healthy weight, eating nutritious foods, regular exercise, and not smoking are important 'healthy habits' to help spine function at any age.

• Muscle Relaxants: Muscle relaxant medication helps to alleviate muscle spasm and pain.

• Narcotics: Narcotics (opioids) may be prescribed for short periods of time to reduce acute pain.

• NSAIDs: Non-steroidal anti-inflammatory drugs (NSAIDs) relieve inflammation that often contributes to pain. Many NSAIDs are available over-the-counter (OTC) and others by prescription only. Do not combine OTC medications with prescription drugs without the physician's permission. Doing so may cause a serious and adverse affect.

• Physical therapy combines passive treatments with therapeutic exercise. Passive treatment modalities include heat/ice, ultrasound and electrical stimulation to alleviate muscle spasm and pain. Therapeutic exercises teach the patient how to increase flexibility and range of motion while building strength. Patients need not be fearful of physical therapy. Even patients experiencing pain and great difficulty moving have found that isometric exercises are beneficial.

• Spinal Injections: There are many types of spinal injections including epidural steroid injections and facet joint injections. These injections combine a local anesthetic and steroid medication to reduce inflamed nerve tissues and thereby often help to reduce pain.

Seldom is Surgery Needed
Very few patients with spondylosis require surgery. When surgery is necessary, seldom is it an emergency. Non-operative therapy is tried first. The physician may determine that combining two or more therapies may benefit the patient to quickly resolve their symptoms. In most cases, non-surgical treatments work.

However, some patients suffer neurologic deficit; such as weakness, incontinence, or develop spinal instability. The cause of severe symptoms often determines the type of surgery needed. For example, it may be necessary to surgically remove bone spurs or disc tissue compressing spinal nerves or causing spinal cord compression. Depending on the extent of the surgery, spinal fusion to stabilize the spine may be necessary. Fortunately, newer minimally invasive spine surgical techniques greatly benefit patients. Minimally invasive spine surgery enables patients to return to normal activities sooner.

Conclusion
Patients with chronic back pain are urged to seek the advice of a spine specialist. The all-important first step to relieve back and neck pain is to obtain a proper diagnosis. Back pain can be caused by many problems including spinal stenosis, fibromyalgia, spondylolisthesis, osteoporosis, compression fractures, and bone tumors. The in-depth and specialized training spine physicians receive equips them to treat a variety of disorders causing back and neck pain.