Multilevel spondylosis describes age-related wear and tear in the spine, also known as spinal osteoarthritis. The condition involves degenerative changes to the vertebrae, intervertebral discs, and facet joints, which are natural parts of the aging process. The seriousness of multilevel spondylosis varies significantly depending on the individual’s symptoms and the extent of nerve involvement. Many people over the age of 60 have some degree of spondylosis visible on imaging without experiencing significant pain or functional limitations. The severity is primarily determined by whether the structural changes are compressing nearby neural structures, rather than the mere presence of degeneration.
Understanding Spondylosis and Multilevel Involvement
Spondylosis is a general term for the deterioration of the spinal column, which includes the bones (vertebrae), the cushioning discs between them, and the small facet joints that allow movement. This degenerative process begins when the intervertebral discs lose water content and height, becoming less elastic and providing less shock absorption. This disc desiccation places stress on the surrounding structures, leading to the formation of bone spurs, known as osteophytes, and the thickening of ligaments.
The term “multilevel” indicates that these degenerative changes are occurring across two or more vertebral segments, which may be adjacent or non-adjacent. For instance, a person might have degeneration in both the cervical spine (neck) and the lumbar spine (lower back), or at multiple consecutive levels within just one of those regions. Multilevel involvement increases the potential for more widespread or complex symptoms compared to single-level degeneration. However, the presence of multilevel changes alone does not automatically designate the condition as severe.
Neurological Impact and Functional Limitations
The seriousness of multilevel spondylosis is directly proportional to the degree of compromise it causes to the nervous system. When the degenerative changes—such as bone spurs and disc bulges—narrow the spaces where nerves exit the spine, two primary types of neurological impact can occur: radiculopathy and myelopathy.
Radiculopathy
Radiculopathy results from the compression of a specific nerve root, often causing symptoms that radiate along the path of that nerve. This can manifest as pain, tingling, numbness, or muscle weakness in a limb. Examples include pain shooting down the arm from the neck or down the leg from the lower back.
Myelopathy
Myelopathy is a more serious consequence that occurs when the spinal cord itself is compressed, typically in the cervical (neck) region. Signs of myelopathy include widespread issues like gait instability, difficulty with balance, and a loss of fine motor skills, such as struggling to button a shirt or handle small objects. This condition is considered urgent because untreated spinal cord compression can lead to permanent neurological deficits and global weakness. The functional limitations resulting from these impacts are what truly determine the severity of multilevel spondylosis for the individual.
Medical Assessment and Confirmation of Diagnosis
Physicians use a combination of physical examination and diagnostic imaging to accurately determine the extent of spondylosis and confirm the link between structural changes and patient symptoms. A thorough physical exam involves testing reflexes, muscle strength, and sensation to pinpoint which nerve roots or areas of the spinal cord may be affected.
X-rays are commonly used as an initial step to visualize the bony structures of the spine, revealing the presence of bone spurs (osteophytes) and the degree of disc space narrowing, which suggests degeneration. Magnetic Resonance Imaging (MRI) is often the preferred next step, as it provides clear images of soft tissues, including the intervertebral discs, ligaments, the spinal cord, and nerve roots. MRI is essential for visualizing the soft tissue compression that leads to radiculopathy or myelopathy. Computed Tomography (CT) scans may be used when a clearer view of the bone structure is needed, such as in cases where surgical planning is being considered.
Conservative and Interventional Management Pathways
For most patients, the initial treatment for multilevel spondylosis begins with conservative management, particularly when neurological compromise is absent or mild. This first-line approach typically includes physical therapy aimed at strengthening core muscles, improving flexibility, and correcting posture to better support the spine. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used to manage pain and reduce inflammation, sometimes supplemented by muscle relaxants.
If symptoms of radiculopathy persist or are moderate, interventional strategies may be employed, such as epidural steroid injections. These injections deliver anti-inflammatory medication directly to the area of nerve compression, providing temporary relief of pain and inflammation. Surgical intervention is generally reserved for cases where neurological function is rapidly declining, symptoms are severe and unresponsive to months of conservative care, or when there is definitive evidence of spinal cord compression (myelopathy). Surgery aims to relieve pressure on the neural structures and prevent further deterioration.