Spondylopathy as a Spinal Disorder in Spondylitis, Spondylosis, and Spondyloarthropathy

The World Health Organization (WHO) classifies spondylopathies under ICD-10 codes M45 through M49. Code M48 specifically covers all spondylopathies not otherwise specified.

Essentially, there are four different forms of spondylopathies:

• Undifferentiated spondylopathies: In this group, the underlying cause is unknown. Furthermore, there are no clear, disease-specific symptoms.
• Inflammatory spondylopathies: Changes to the vertebral bodies are often caused by inflammatory processes. Triggers include acute inflammation, infections, immune reactions, and autoimmune diseases. Long-term consequences typically include changes to the skeletal system, such as ossification and restricted mobility in ankylosing spondylitis.
• Neuropathic spondylopathies usually develop as a result of infections, following severe traumatic injuries, and in cases of cancer. They are associated with sensory disturbances.
• Axial spondylopathies: These degenerative diseases primarily affect the lower back, such as the lumbar spine, and result from chronic inflammatory processes. Axial spondyloarthritis is classified as an axial spondylopathy. It leads to bone changes in the vertebrae due to chronic inflammation. Younger patients between the ages of 20 and 30 are particularly affected.

Axial spondylopathies primarily affect younger people. However, most other spondylopathies are considered “classic” age-related conditions. Between the ages of 50 and 70, the risk of degenerative changes in

• joints,
• spine, and
• their intervertebral discs.

As we age, the natural elasticity of the intervertebral discs continues to decline. As a result, they become flatter and wear out more quickly. Eventually, the vertebral bodies rub against each other, causing pain. Herniated discs also occur more frequently. 

Osteoarthritis, spinal stiffness, and the resulting significant limitations in movement also become more common. The spine changes and attempts to adapt to the altered stresses through remodeling. In the process, the spinal cord and the nerve fibers branching off from it can be compromised. This leads to

• sensory disturbances,
• symptoms of paralysis, and
• chronic pain. 

In principle, spondylopathies can occur in any section of the spine. However, they tend to develop in areas subject to particularly high stress, such as

• the cervical spine,
• the thoracic spine, or
• lumbar spine.

Back pain has become a widespread condition in today’s office-based society. As a result, it is not immediately apparent that a serious degenerative spinal disorder might be the underlying cause. Spondylopathies are often detected relatively late and even then only as an incidental finding on an X-ray.

A targeted diagnostic approach begins with a medical history (anamnesis). During this process, the doctor often identifies several risk factors for spondylopathies, such as:

• obesity,
• infections,
• chronic inflammatory diseases,
• or previous spinal injuries (trauma).

During the subsequent physical examination, the doctor assesses the back and the alignment of the spine. If the patient reports sensory disturbances or paralysis, neurological tests are also performed.

Specialists diagnose “spondylopathy” using imaging. X-rays play a particularly important role in spinal diagnostics. However, not all changes to the vertebral bodies can be clearly assessed on an X-ray. For this reason, magnetic resonance imaging (MRI) is also used when further clarification is needed.

Laboratory tests can also detect rheumatoid factors and inflammatory markers in the blood. These are particularly important in cases of

• infections,
• chronic inflammation, and
• autoimmune diseases

.

Spondylopathies have a wide variety of causes, and treatment should be tailored accordingly. The underlying condition must be identified in order to address it with the appropriate treatment methods.

In cases caused by chronic inflammation or infection, treatment involves pain relief and anti-inflammatory therapy. To support this, doctors also prescribe physical therapy and back exercises to improve posture and strengthen the muscles.

Surgery is always a last resort for spondylopathies. It becomes an option only after all conventional treatment options have been exhausted. Orthopedic surgeons and neurosurgeons work together using minimally invasive techniques and an endoscope. The goal is to correct the vertebral bodies and to ablate nerve endings.

Physical therapists also play a role in helping to strengthen the back muscles again. Follow-up care—for example, after necessary surgery—is provided by certified rehabilitation centers.