“It is confusing, unless you are fluent in ancient Greek,” says Jonathan D. Krystal, MD, an orthopedic surgeon at the Montefiore Health System in New York City. “The conditions sound similar, but they mean different things.”
Each condition begins with the prefix “spondyl,” which means “backbone or vertebrae.” And in each one, the rest of the name gives a clue as to what is.
Spondylitis (“itis” means inflammation) is the only one that is an inflammatory condition. Spondylosis (“losis” means problem) results in wear and tear on your spine and occurs as you get older. Then there is the tongue-twisting condition called spondylolisthesis. The name combines “spondyl” with “listhesis,” which means “slipping, sliding, or movement” in Greek.In this one, bones in your back (called vertebrae) slip out of position, moving either forward or backward.
A chief symptom of spondylitis is back pain that comes on with stiffness in the morning and lasts for at least half an hour. Over time, this condition can proceed to ankylosis, or new bone formation on the spine. If this happens, sections of the spine can fuse. It is then known as ankylosing spondylitis (AS). Ankylosing spondylitis is an inflammatory condition that causes pain, stiffness, and inflammation in other parts of the body like the hips, ribs, shoulders, heels, and other joints.
Ankylosing spondylitis is the most common form of spondylitis, says Li Sun, DO, of RWJBarnabas Health in New Jersey.
“It doesn’t just affect your spine,” he says. “It affects your large joints as well as your eyes.” The condition is diagnosed with imaging like X-rays or magnetic resonance imaging (MRI), along with blood tests.
Spondylitis tends to affect people in their 30s and 40s. “It’s different from general wear and tear arthritis,” says Dr. Krystal. “There is more likely to be an underlying inflammatory arthritis with spondylitis.”
“In spondylitis, the immune system actually attacks the spine and causes inflammation,” explains Vinicius Domingues, MD, a rheumatologist with the Allergy, Asthma and Arthritis Center in Daytona Beach, Florida and a medical advisor to CreakyJoints (creakyjoints.org) “Age is not a factor with this one. It definitely tends to affect the young.”
This condition rarely requires surgery, but you may be referred to a rheumatologist. This doctor, who specializes in joints, can help take care of your symptoms, says Dr. Krystal. Treatment includes not just medication, exercise, and physical therapy, but also good posture practices. People with spondylitis may also be told to apply heat or cold to relax their muscles and reduce their joint pain. It is the only one of the three spine conditions for which you may be prescribed an immune-suppressing medication.
“A rheumatologist can help with specific medications that can slow down the disease process as well as help with pain,” Dr. Sun says.
When osteoarthritis affects the joints in the spine, it’s called spondylosis. However you refer to it, spondylosis is very common in older people. “More than 80 percent of people over 40 will have some degeneration, or wear and tear, of the spine,” Dr. Domingues says. And although it is common, spondylosis doesn’t always cause pain. In fact, says Dr. Krystal, many people have spondylosis on their x-rays and MRIs without having any pain at all.
“Many of the findings on X-rays are normal age-related changes,” says Dr. Krystal.
While spondylosis can be painful, the pain does not radiate to the arms or legs. It tends to be more common when you have been active or sitting for a long time, and you may have stiffness when you get out of bed in the morning or when you sit for a long time. Once you’re up and moving about, the pain gets better.
If your doctor suspects spondylosis, you will most likely have an imaging test like an X-ray, CT scan, or MRI. You may be given nonsteroidal anti-inflammatory drugs (NSAIDs) or pain relievers. Narcotic pain relievers should be used sparingly for these age-related degenerative conditions. Physical therapy and exercise, such as swimming, also can help.
The risk factors for getting spondylosis are age and occupation, says Dr. Sun. “Labor workers, truck drivers and some professional athletes are more likely to get it,” he says.
Spondylolisthesis develops when a vertebra has actually slipped forward or backward onto the vertebra below it. This puts pressure on that lower vertebra. Often, people have no symptoms but it can cause nerve compression or a “pinching” of the nerve roots, which can lead to pain radiating down an arm or leg.
There are various kinds of spondylolisthesis, but the most common one is degenerative spondylolisthesis. This means that it develops as people get older. With age, the discs that cushion the vertebrae lose water and get thinner. This is a risk factor for those bones to slip out of position. The second most common form of spondylolisthesis is when there is a crack in the spine that causes it, says Dr. Sun.
“I see younger people in their 20s and 30s, coming in with isthmic spondylolisthesis, and older people, in their 50s, 60s and above, with the degenerative form,” says Dr. Sun. “Typically, people have pain with activities and when they sit and relax, the pain resolves.”
The treatment is typically physical therapy, and medication management like nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin. Epidural steroid injections also can be helpful.
If you are having back pain, talk to your doctor to see if you could have one of these conditions or if you should be referred to an orthopedist or a rheumatologist. “Definitely call your doctor if the pain has been going on for more than four weeks, if you have pain down your legs, or if you see no improvement at all,” Dr. Sun says.
It also is important to care for yourself, says Sherry McAllister, MS (Ed.), DC, CCSP, a chiropractor and president of the Foundation for Chiropractic Progress in San Jose, California. “If your mind is always driven with stress and anxiety, that can set the body off,” she says. “Think of your mind as the key to starting the ignition, which is your body. If your mind is stressed, the body doesn’t heal very well. Lower your anxiety level and create a healthy self-care environment. This should include a good night’s sleep, gentle stretching, and meditation. Remember, your body responds to your brain, setting the stage for a healthy, pain-free lifestyle.”