Osteophyte Removal: Osteophytectomy
What are osteophytes?
Osteophytes are bone spurs, and the procedure to remove them is called an osteophytectomy or osteophyte surgery. Most of the time bone spurs do not cause severe pain, and many people who have them are not even aware of them. In some cases though, bone spurs can cause significant pain in addition to other problems, so surgical removal of them becomes necessary. There are two types of surgical procedures to remove bone spurs, depending on their location and the severity of the condition. The two procedures are open osteophytectomy or arthroscopic osteophytectomy.
Even though in many situations bone spurs do not need any treatment, osteophytectomy is sometimes necessary if the spurs cause damage or irritation to other tissues. For instance, if osteophytes are located on the spine and neck, they can pinch or put pressure on the nerves or on the spinal column. This can cause tingling or numbness in other areas, like the hands and feet. Bone spurs in the neck area can also cause more severe problems such as difficulty breathing or swallowing.
Bone spurs have a tendency to form in the joints. This can possibly lead to tendinitis, a condition that can cause immobility and severe pain. Knee and shoulder joints are most often affected, and when osteophytes occur here, osteophytectomy may be required to enable a person to move his lower leg or arm. Bone spurs that form on the toes or fingers can cause pain as well as disfigurement. Often surgery to remove osteophytes called osteophytectomy is done at the same time as some arthritis surgeries.
Risk Factors of Osteophytes
Risk factors for the development of osteophytes include:
- body mass index
- physical activity
- other genetic and environmental factors
Osteophytes can cause pain, limit a range of motion, affect the quality of life, and cause multiple symptoms at the spine. The primary aim during osteophytectomy for degenerative spine has been either removal of osteophyte for direct decompression of the neural structures or indirectly to perform surgical procedures that will increase the spinal canal dimension and reduce the pinching effect of the osteophyte.
Presence of Osteophytes
Presence of osteophytes anywhere in the spine can be a clear evidence of the presence of local vertical spinal instability. Presence of osteophytes by themselves has no clinical relevance unless it has associated symptoms.
A symptom of local neck pain can be due to several causes that include muscle stress, ligamental tear, and similar such cause. However, when symptoms are progressive, are related to neck movements, are long-standing and when associated with radicular pain, suspicion of instability can be on the mind. And when radiological images show the presence of osteophytes, the suspicion of instability can be strengthened.
Presence of osteophytes can provide any evidence of instability and when the symptoms of radiculopathy or myelopathy co-exist, the need for treatment of instability becomes necessary. The need for directly handling and osteophytectomy can be avoided.
Osteophytes arise and grow secondary to local spinal instability as soon as the issue of instability is addressed, there is a potential of osteophyte regressing in size.
Osteophytes are frequently observed in spinal imaging of an elderly. The primary aim of osteophytectomy treatment is to resect the osteophytes as widely as possible and to decompress the cord of indentation. Osteophyte formation is usually at multiple levels and essentially circumferential around the entire spinal and root canal, around the vertebral body and around the facets.
Osteophytes result in focal neural compression and as a consequence of wide and circumferential presence, in the spinal canal stenosis. Osteophyte formation is related to the vertical height reduction related to the telescoping effect on spinal segments. Disc space height reduction results in buckling and subsequent separation of intervertebral ligaments from the bone.
Bone neoformation or osteophyte formation in the region is similar to "callous-formation" related to periosteal separation or reaction in long bone fractures. Osteophyte formation is a relentlessly progressive process that develops over several months and years.
The slow and progressively increasing phenomenon of osteophyte formation results in deformation of spinal cord and roots. Frequent identification of large and indenting osteophytes without any neural symptoms is the testimony of the slow and long-standing pathogenic process and demonstrates the accommodation of the compression by the natural neural elasticity.
- Open osteophyte surgery is typically used to remove large bone spurs or in more serious cases, and it may require a short hospital stay. In this procedure, the tissue around the bone spur is cut, the osteophytes are removed and the bone surrounding the area is filed until it is smooth.
- Arthroscopic osteophyte surgery is less invasive and can often be performed under local anesthesia in a doctor's office. Small osteophytes and uncomplicated cases are successfully treated with this procedure. Small incisions are made in the skin, and delicate instruments are used to remove the osteophyte and smooth the remaining bone with the assistance of a very tiny camera to guide the surgeon.
It typically takes a few to several weeks to recover from osteophytectomy, depending on what procedure was completed. Osteophytectomy requires a longer time to heal. Rest of the area is recommended in most cases to ensure proper healing and surgeons usually request the area be kept clean and dry to prevent infection.