HE TITLE given to this discussion covers a very common and varied T symptomatology. Neck and back aches are as irequent as headaches, especially when degeneration of the lumbosacral joints and sequential instability of this articulation is included. Although the manifestations of osteoarthritis of the spine are many, the cases tend to group themselves into syndromes. Because of editorial restrictions of time and space, only the most frequent of these will be mentioned. We will discuss the subject from the point of view of medical management.
Four principles must be borne in mind. The first is that the etiology is incompletely understood but is undoubtedly multiple. Some factors, such as heredity, age, and sex, are of course beyond control, but others, such as the traumas of occupation, poor body mechanics, and osteoporosis, are at times subject to remedial management. The second principle is that the symptoms come in attacks and are usually caused by a superimposed trauma on a preexisting degeneration of one or many components of the spine, resulting in inflammation. It is this latter which is susceptible to therapy, usually leaving the basic osteoarthritic changes uninfluenced. The third principle is that symptomless osteoarthritis, as demonstrated by x-ray, is very common, in fact almost universal after middle life, but requires no treatment. Lastly, even symptomless osteoarthritis should more often be viewed from the point of view of retarding the progression of the disorder. Prophylaxis of osteoarthritis is a subject too little discussed, but it has broad, practical implications.
The areas of the spine most often the site of symptoms are those where mechanical stress is most focal, and includes in probable order of frequency, the lumbosacral, lower cervical, dorsal, and first lumbar articulations. These four areas are so frequently involved that they warrant the name of syndromes, such as "cervical syndrome." However, any part of the spine may produce symptoms in an osteoarthritic spine, depending on the areas where stress is unduly concentrated, as by the demands of unique oocupations and special orthopedic situations.