Arthritic Changes on Spinal X-Rays Generally Have Little Functional Significance

Health care professionals should not overreact to the presence of arthritic changes on spine x-rays in older individuals. As a matter of fact, they probably shouldn't react to them at all. When older patients present with back pain, their doctors often thoughtfully examine their imaging scans and then pronounce gravely: "You have spinal arthritis." This casual disease labeling often makes patients think that their spines are falling apart.

According to a new community based study, spinal osteoarthritis has little functional significance. It rarely limits everyday activities in either men or women. In older men it doesn't seem to produce obvious functional limitations at all.

D.L. Schneider, MD, and colleagues at the University of California at San Diego used dual x-ray absorptiometry to examine the spines of 628 men and 908 women living in Rancho Bemardo, California. The subjects ranged in age from 60 to 98 years and are all taking part in a cross-sectional, community based study of osteoporosis. An independent musculoskeletal radiologist read the scans and assessed the level of osteoarthritic changes.

Significant spinal osteoarthritis was evident on the scans of 35% of men and 40% of women. Prevalence of osteoarthritis increased steadily with age, occurring in 21% of both men and women aged 60 to 69 and 45% of men and 59% of women aged 80 and over.

Older men with osteoarthritis almost never reported significant limitations in everyday activities. Among older women with evidence of osteoarthritis, about 15% had problems in bending activities and about 11 % had trouble getting in and out of cars. The women with osteoarthritis reported, however, that they experienced few limitations in walking, housework, shopping, and other everyday activities.

These findings are consistent with other studies showing that asymptomatic abnormalities are common in older individuals. An MRI study of 67 aysmptomatic individuals by Scott Boden, MD, et al. in 1990 found that 93% of subjects aged 60 to 80 showed degenerative changes at one or more lumbar levels. (See Journal of Bone and Joint Surgery, 1994; 72-A(3): 403-408.)

The vast majority of degenerative changes seen on the scans of older individuals do not cause pain and do not interfere with function. They are as normal as gray hair and wrinkled skin, and are generally not a cause for concern.