Spondylosis¶
Definition¶
Spondylosis is a broad term describing degenerative changes of the vertebral column, encompassing disc degeneration, osteophyte formation, facet arthropathy, ligamentous hypertrophy, and endplate sclerosis. It is essentially the radiologic and pathologic manifestation of spinal "wear and tear" and is nearly universal with advancing age.
Anatomy and Pathophysiology¶
Spondylosis affects the three-joint complex at each spinal level:
- Anterior: intervertebral disc degeneration → loss of height, bulging, osteophytes
- Posterior: paired facet joint degeneration → cartilage loss, hypertrophy, osteophytes
- Ligaments: ligamentum flavum hypertrophy, ALL/PLL thickening or calcification
These changes are interrelated — disc height loss increases facet loading, accelerating facet arthropathy, which in turn alters segmental mechanics and promotes further disc degeneration.
Imaging Findings¶
Radiography¶
- Disc space narrowing
- Marginal osteophytes (anterior, posterior, lateral)
- Endplate sclerosis
- Facet joint narrowing and sclerosis
- Loss of normal curvature (straightening of lordosis)
- Vacuum phenomenon
CT¶
- Superior to radiography for evaluating osteophyte size, location, and relationship to the spinal canal and foramina
- Facet hypertrophy and joint space narrowing
- Calcification of ligaments
- Uncovertebral joint hypertrophy (cervical spine — a major cause of foraminal stenosis)
MRI¶
| Finding | Appearance |
|---|---|
| Disc degeneration | Loss of T2 signal, height loss, bulging |
| Osteophytes | Low-signal bony projections at vertebral margins |
| Facet arthropathy | Joint effusion, cartilage loss, periarticular edema |
| Ligamentum flavum hypertrophy | Thickened low-signal band compressing thecal sac posteriorly |
| Stenosis | CSF effacement on T2, cord compression, foraminal narrowing |
Clinical Pearl
Spondylosis is a radiologic diagnosis, not a clinical diagnosis. Virtually everyone over age 60 has spondylotic changes on imaging. The clinical significance depends entirely on whether the changes are causing neural compression (stenosis, radiculopathy, myelopathy) or mechanical pain. The term "spondylosis" on a report should prompt correlation with symptoms, not alarm.
Key Points¶
- Spondylosis describes the collective degenerative changes of the spine — disc, facet, and ligament
- It is nearly universal with aging and does not necessarily indicate disease
- The three-joint complex (disc + paired facets) degenerates as an interdependent unit
- Clinical significance depends on the presence of neural compression or symptomatic instability
- CT is best for evaluating bony changes; MRI is best for evaluate spinal cord compression
References¶
- Kushchayev SV, Glushko T, Jarraya M, et al. ABCs of the Degenerative Spine. Insights Imaging. 2018;9(2):253-274. doi:10.1007/s13244-017-0584-z. PMID: 29569215.
- Teresi LM, Lufkin RB, Reicher MA, et al. Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging. Radiology. 1987;164(1):83-88. PMID: 3588931.
- Middleton K, Fish DE. Lumbar spondylosis: clinical presentation and treatment approaches. Curr Rev Musculoskelet Med. 2009;2(2):94-104. doi:10.1007/s12178-009-9051-x. PMC2697338.
- Margetis K, Tadi P. Cervical Spondylosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. NBK551557.
- Margetis K, Dowling TJ. Cervical Degenerative Disc Disease. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. NBK560772.
- Ofiram E, Garvey TA, Schwender JD, et al. Cervical degenerative index: a new quantitative radiographic scoring system for cervical spondylosis with interobserver and intraobserver reliability testing. J Orthop Traumatol. 2009;10(1):21-26. PMC2657349.
- Spondylosis. Radiopaedia.org. https://radiopaedia.org/articles/spondylosis (accessed 2026).