Spondylosis and Spondylolisthesis in Cervical and Lumbar Spine Related to HEDS

Spondylosis and spondylolisthesis are common spinal conditions that can cause significant discomfort and mobility issues. When these conditions occur in people with Hypermobile Ehlers-Danlos Syndrome (HEDS), they present unique challenges.

What Is HEDS and Why Does It Matter for the Spine?

Hypermobile Ehlers-Danlos Syndrome is a connective tissue disorder characterized by joint hypermobility, skin elasticity, and tissue fragility. The spine, made up of vertebrae connected by ligaments and discs, relies heavily on strong connective tissue for stability. In HEDS, these tissues are more elastic and less stable, increasing the risk of spinal problems.

People with HEDS often experience joint pain and instability. The cervical (neck) and lumbar (lower back) regions are especially vulnerable because they support much of the body’s weight and allow for a wide range of motion. This vulnerability can lead to conditions like spondylosis and spondylolisthesis.

What Is Spondylosis?

Spondylosis refers to the degeneration of the spine’s discs and joints, often due to aging or wear and tear. It can cause bone spurs, disc thinning, and reduced flexibility. It can occur much younger in people with HEDS due to the frequent trauma from hypermobility placed on ligaments and tendons in the spine. In the cervical and lumbar spine, spondylosis may lead to stiffness, pain, and nerve compression.

How Spondylosis Develops in HEDS

In HEDS, the connective tissues that support the spine are weaker and more elastic. This means the vertebrae can move more than usual, causing extra stress on the discs and joints. Over time, this stress accelerates degeneration, leading to spondylosis at a younger age than in the general population.

Symptoms of Spondylosis in HEDS

• Neck or lower back pain that worsens with movement

• Stiffness and reduced range of motion

• Numbness or tingling in the arms or legs if nerves are compressed

• Muscle weakness in severe cases

  
  

What Is Spondylolisthesis?

Spondylolisthesis occurs when one vertebra slips forward over the one below it or one disc slips under the other one depending on which way the person is moving their neck or body. This slippage can cause pain, nerve compression, and spinal instability. It often affects the lumbar spine but can also occur in the cervical region.

Why Spondylolisthesis Is More Common in HEDS

The ligaments that hold vertebrae in place are looser in people with HEDS. This laxity allows vertebrae to slip more easily, increasing the risk of spondylolisthesis. The condition may develop after minor injuries or repetitive strain, even without major trauma.

Symptoms of Spondylolisthesis in HEDS

• Lower back or neck pain that may radiate to limbs

• Muscle tightness or spasms

• Difficulty standing or walking for long periods

• Numbness or weakness in the legs or arms

  
  

Differences Between Cervical and Lumbar Spine Involvement

The cervical and lumbar spine have different roles and structures, so spondylosis and spondylolisthesis affect them differently.

Cervical Spine

• Supports the head and allows for neck movement

• Spondylosis here can cause headaches, neck stiffness, and arm numbness

• Spondylolisthesis in the cervical spine is less common but can cause serious nerve issues

  
  

Lumbar Spine

• Supports the upper body and allows for bending and twisting

• Spondylosis often causes lower back pain and stiffness

• Spondylolisthesis is more common here and can lead to leg pain and walking difficulties

  
  

Managing Spondylosis and Spondylolisthesis in HEDS

Managing these conditions requires a careful approach that considers the unique challenges of HEDS.

Medical Evaluation

A thorough evaluation by a healthcare provider familiar with HEDS is essential. This may include:

• Physical examination

• Imaging tests like X-rays or MRI

• Neurological assessment

  
  

Treatment Options

• Physical Therapy: Focuses on strengthening muscles around the spine to improve stability without overstressing joints.

• Pain Management: Includes medications, heat/cold therapy, and sometimes injections to reduce inflammation.

• Lifestyle Adjustments: Avoiding activities that strain the spine, using ergonomic supports, and maintaining a healthy weight.

• Surgery: Considered only in severe cases where nerve compression or instability threatens function. Surgery in HEDS patients requires special care due to tissue fragility.

  
  

Practical Tips for Daily Life

• Use supportive pillows and chairs to reduce spinal strain

• Practice gentle stretching and low-impact exercises like swimming

• Avoid heavy lifting and sudden twisting motions

• Work with a physical therapist to develop a personalized exercise plan

  
  

Why Early Recognition Matters

Early diagnosis and management of spondylosis and spondylolisthesis in HEDS can prevent worsening symptoms and improve quality of life. Because these conditions may develop earlier and progress faster in HEDS, regular monitoring is important. It can often be frustrating for patients because they are told this is a degenerative process and they are not the age they expect to have the problems they are presented with. However, it is not the age, it is the connective tissue disorder that causes the earlier than normal degeneration. Pain management, PT, and massage are viable options for early treatments.