By Femi Ogunyemi

I have seen a few patients in Lagos these last few weeks whose MRI scans show something called osteophytes. Someone, usually a fellow physician, has requested this investigation. A few times the report has already been discussed in detail with the patient. But the patient is not satisfied. He/she is concerned ……a tumour? A growth? cancer in the bone? The patient wants more explanation and answers. Osteophytes, otherwise known as “bone spurs” are none of these.

The term “bone spurs” is not really accurate. The word “spurs” implies that these bony growths are spurring or poking some part of the spinal anatomy and causing pain. They are actually smooth structures that form over time. Above 60 years of age they are quite common, and normal, findings on radiological studies.

The two commonest causes of bone spurs are osteoarthritis and spinal stenosis. Osteoarthritis can cause stiffness and lower back pain that is usually worse in the morning, gets better after moving around, and then gets worse again toward the end of the day.

The most common root cause of cervical and lumbar osteoarthritis is a genetic predisposition. Patients may typically develop symptoms of osteoarthritis in their mid 40s to early 50s. Men are more likely to develop arthritic related symptoms earlier in life, however, postmenopausal women with stiffening spines (accelerated bone spur formation) rapidly approach men in incidence and severity of osteoarthritis.

Patients complain of dull pain in the neck or lower back when standing or walking. Radiating pain into the shoulders (often including headaches) for cervical spurs

Radiating pain into the bottom and thigh for lumbar spurs. The symptoms of bone spurs are made worse with activity and often improve with rest.

Lumbar bone spurs often improve when an individual is bending forward and flexing at the waist, such as leaning over a shopping cart or over a cane.

As the nerves become compressed, patients with bone spurs complain of several neurological symptoms including: Pain, tingling and progressive weakness in one or both arms or legs. In very rare cases, bowel and bladder incontinence may occur.

Diagnosis is usually made through radiographs like Xrays, CT and MRI scans. Electromyographic (EMG) and nerve conduction studies (NCV) also aid diagnosis when nerve involvement is suspected.

Treatment can be divided into three broad groups -Non surgical Conservative Treatment, Injection therapy and Surgical treatment.

Nearly all bone spur related pain will respond well to conservative therapy with medications (anti inflammatories and muscle relaxants) bed rest, and rehabilitation. Bed rest reduces joint irritation.

Rehabilitation over 1-2 weeks will involve physical therapy, exercise, and chiropractic adjustment. These modalities attempt to restore flexibility and strength to the neck and back, improving posture and possibly decreasing any nerve compression.

Injections

Cortisone epidural steroid injections have potential therapeutic value for some patients with facet joint inflammation by reducing the joint swelling and improving spinal pain and radiating extremity pain syndromes. The results are usually only temporary, but repeat injections maybe indicated. Pain relief from an injection may allow the patient to progress with rehabilitation.

In my experience with these patients over the past two decades, results for epidural steroids to bone spurs in the neck may not be as good as for the lower back.

Scientific evidence does however support the use of special heating (radiofrequency) techniques to the facet joints in situations of facet joint arthritis.

A surgical consultation (though rare) is appropriate if these nonsurgical measures to treat bone spurs fail. A referral is appropriate if patients suffer from severe pain or there is clinical evidence of nerve compression and damage. I would recommend surgery only in situations of impending nerve damage, paralysis, incontinence or extreme disability.

A procedure such as a laminectomy, is designed to relieve the pain and neurological symptoms by removing the bone spurs and thickened ligaments causing painful nerve compression.

In my experience, the risks of developing a distinct pain condition called “post laminectomy syndrome” remains high. Patients often return to the pain clinic with more pain and debilitation months after any initial good results. Bone spurs? Don’t panic.