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Spondylitis and spondylosis are both conditions that affect the spine, but they do so in different ways. If you’re wondering which is more severe, it’s important to know that severity isn’t just about pain levels. It also depends on how the condition progresses, what treatment is needed, and how much it affects daily life. All of these factors can vary from person to person.
In this article, we’ll take a closer look at the progression and symptoms of spondylitis and spondylosis. We’ll discuss how these factors differ between the two diseases, and how each condition may affect someone’s quality of life.
Spondylitis and spondylosis are easy to confuse. Both condition names start with “spondyl-”, which means the spinal column or vertebrae — the bones that make up your spine. Even though their names sound alike and they share some symptoms, they’re different diseases with unique symptoms and features.
Spondylitis is an inflammatory condition, as well as a type of arthritis. The suffix “-itis” means inflammation. This inflammation causes swelling in the spine and joints. Symptoms of spondylitis include stiffness and pain in the lower back and hips.
A common type is ankylosing spondylitis, which often begins in the sacroiliac joints, where the spine connects to the pelvis. People usually first notice symptoms in their 20s or 30s, and men are about two to three times more likely than women to get it, according to Brigham and Women’s Hospital.
To diagnose spondylitis, doctors may use blood tests to look for the HLA-B27 gene. This gene is linked to the immune system and how it responds to infections. The HLA-B27 gene raises your risk for the disease, but it doesn’t guarantee you’ll get it. And even if you don’t have the gene, you could still be diagnosed. It’s only one piece of the puzzle, though. Your medical history, a physical exam, and imaging tests are also used for diagnosis.
Spondylosis is a degenerative condition. It develops when the spinal discs and joints wear down over time or as a result of injury. This wear and tear can lead to common symptoms of spondylosis, like bone spurs, stiffness, and nerve compression.
Other symptoms include:
Changes from spondylosis can show up on X-rays in up to 90 percent of adults over age 60, though many people don’t have any symptoms. Many older adults have cervical spondylosis (in the neck). Imaging tests like X-rays or a CT scan can help doctors see these changes.
You may have also heard of another similar condition called spondylolisthesis. This condition occurs when one vertebra slips out of place onto the bone below it, which can press on nerves and cause back or leg pain.
In contrast, spondylitis is an autoimmune condition, where the immune system mistakenly attacks its own healthy tissue. And spondylosis is a degenerative condition caused by wear and tear on the spine.
While both conditions can cause significant discomfort, the way symptoms feel can vary. For some people, the pain may be sharp and sudden. For others, it may be dull and ongoing.
Spondylosis often leads to chronic (long-term) pain in the neck or lower back. This pain may get worse with activity and often improves with rest. Some people develop nerve compression, which can cause numbness, tingling, or weakness in the arms or legs. Severe pain, muscle spasms, and stiffness may also interfere with walking, gripping objects, or even sleeping.
If spondylosis causes narrowing in the spinal canal, it can lead to a related condition called spinal stenosis. This causes compression on the spinal cord and nerves, which may cause leg pain or tingling when standing or walking. Because spondylosis is linked to degenerative changes in the spine, the symptoms can range from mild stiffness to intense, disabling pain.
Spondylitis, on the other hand, comes with a different type of symptom severity. It causes inflammatory back pain, which is often worse in the morning or during rest. In addition to back and hip pain, inflammation can spread to other areas, such as the eyes (uveitis) or the gut. Even on good days, the stiffness and pain can limit the range of motion, making simple tasks difficult.
Spondylitis can also be linked to enthesitis, which is inflammation where tendons and ligaments attach to bone. This often affects the heel.
People living with spondylitis may also feel fatigue (extreme tiredness) that doesn’t improve with sleep.
Spondylitis can progress from early inflammation to more serious structural changes. In some people, new bone forms along the spine, leading to spinal fusion (vertebrae growing together). This spinal fusion reduces flexibility and may cause deformities, which can be debilitating. It can also stiffen the rib cage, leading to breathing issues.
Because spondylitis is an autoimmune disease, the inflammation can also extend outside the spine, affecting the eyes, skin, or heart. Over time, the combination of joint damage and bodywide inflammation can lead to long-term disability if it isn’t treated properly.
Usually, spondylosis progresses more slowly. Many people experience stable symptoms for years, managed with conservative treatments like physical therapy and pain relievers. However, in severe cases, wear and tear may lead to spinal stenosis or significant nerve compression. This can lead to weakness, poor coordination, or loss of bladder and bowel control.
Put simply, spondylitis can affect many parts of the body, whereas spondylosis is more often linked to pain and nerve problems in one area. Both can become severe, but through different disease courses.
While treatment can be very different depending on which condition someone has, both aim to reduce pain and protect mobility.
Spondylosis treatment often focuses on managing pain associated with the disease. Common options include:
In severe cases with nerve compression or spinal stenosis, surgery may be recommended. However, most people manage well with conservative treatments.
Since spondylitis is an autoimmune condition, treatment may be more complex. Pain relief with NSAIDs is often the first step, but many people also need medications that calm the immune system. These include biologics and disease-modifying drugs. The goal is to reduce inflammation directly and help prevent long-term complications that could make the disease more severe. In some cases, corticosteroids are used to control flares.
Lifestyle changes, like exercise and physical therapy, are also an important part of care.
Living with either condition can affect daily life in serious ways. However, each presents its own unique challenges.
Spondylitis often affects quality of life beyond the spine. Constant inflammation can cause fatigue, making it harder to keep up with work, family, or social activities. Morning stiffness may last for hours. This can limit one’s ability to dress, drive, or do household tasks.
If spinal fusion develops, bending, twisting, or even breathing deeply can become difficult. As an autoimmune disease, it can also affect other body systems, leading to further complications or disability.
Spondylosis affects quality of life differently for each person, but its effects can be just as severe. Chronic back or neck pain may interfere with sleep and reduce energy during the day. Nerve compression from spinal changes can make walking unsteady or increase the risk of falls. These changes may also limit physical activities like cooking, driving, or shopping.
In more severe cases, people may lose control of bladder or bowel function, which can be both disabling and isolating. While many manage spondylosis with surgery or more conservative treatments, the condition can still bring ongoing pain and make movement harder.
On MySpondylitisTeam, people share their experiences with spondylitis, get advice, and find support from others who understand.
Do you still have questions about the differences in severity between spondylitis and spondylosis? Let others know in the comments below.
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Is It Possible To Have Both Spondylitis And Spondylosis I Do Have Arthritis In My Spine Also?
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