Are bone spurs bad? Bone spurs inspire fear in the hearts and minds of most patients, kind of like The Blob from a bad ’60s horror movie. When they hear that they have them, they’re immediately freaked out. However, much like the title of Stanley Kubrick’s ’60s movie, Dr. Strangelove or: How I Learned to Stop Worrying and Love the Bomb, patients shouldn’t get immediately frightened when they hear they have bone spurs as most are there to provide stability to the spine (or a joint) and are an important part of you! Only every once in awhile do these bone spurs you should learn to love cause problems you should fear.
Far from the cement-like substance people assume bone to be, bone is alive! It’s an incredibly complex interactive system of tiny nanomachine-like activity, which is intrinsically connected to, and responsive to, its environment. One of the mechanisms of this response is the way that bones are affected by pressure. Bones exposed to pressure produce an electrical charge through what’s called the Piezoelectric effect. While this is not new information, as this principle was discovered over 50 years ago, we now understand the way that this works is through small electrical signals generated by the individual collagen fibers in the bone, so each collagen fiber acts as a biologic force sensor in a network of startling complexity. Amazingly, the same system powers your tendons as well.
In this incredible system, bone adheres to rules to make sure the necessary jobs are accomplished. For instance, cells called Osteoblasts lay down new bone inside the boundaries of the bone. Cells called Osteoclasts then clean up, or resorb, old bone or bone that’s no longer needed. They can eat off any bone they like as long as it’s not electrically charged due to stress. Finally, stem cells in the bone replace the worn-out Osteoblast and Osteoclast nanomachines and then also make a new copy of themselves.
Now that we understand a bit about what bone is and how it works, why do these extra bits of bone called bone spurs develop? When are bone spurs bad, or good? We’ve learned rather than being inanimate, bone is made up of mature cells called Osteoblasts and stem cells that react to their environment. It’s well known, for instance, that when the cushioning disc in the spine wears out, the bone underneath the disc makes itself thicker to handle the new forces. We know that people who don’t exercise or who pursue non weight-bearing exercise have more-brittle bones, and that people who lift heavy weights have more-dense bones.
These things are good illustrations of how bone reacts to its environment. But how quickly does it react? For many years most physicians were convinced that bone spurs in the spine took years to form. This was based on the theory that bone was more like dumb, inanimate cement. However, more recent research shows that when the lumbar discs are injured as part of an experiment, bone spurs begin to form in the one- to two-month time frame.
The same holds true for muscles, tendons, and ligaments. They all react to increased strain forces by making themselves thicker and stronger. This ability to react quickly to increased or decreased demands is mediated in part by adult stem cells. The switch from seeing bone and cartilage as inanimate filler or ligaments and tendons as pieces of inanimate duct tape to living tissues that react, is a key concept in understanding why alignment of the joints is so important in Orthopedics 2.0.
We’ve established that bone reacts to forces. I’ve spoken to many patients over the past few years who have been advised to have surgery to remove bone spurs. While I can think of a few situations where this makes a lot of sense, like when a bone spur is pressing on a nerve, most of the time, bone spurs are better off left where they are. The bone spurs that are causing mischief I call nonfunctional bone spurs. However, in many situations, bone spurs are functional. What does this mean?
Let’s take the example of bone spurs in the spine that need to be left intact. We’ve been conditioned to believe that the answer to the question “Are bone spurs bad?” is always yes. However, bone spurs develop in the presence of instability and grow to help stabilize the spine. If we remove these bone spurs, the spine becomes unstable and the body will just place more bone spurs in this location. I call these functional bone spurs in that they serve a purpose, and their removal doesn’t positively impact the patient. In fact removing them recreates the instability the body formed them to correct.
Instability in the spine can be particularly problematic, as movement in vertebrae can put pressure on spinal nerves and the spinal cord itself. This has been the rationale for the epidemic of spinal fusion surgery, which attempts to solve the problem by removing the disc and screwing the vertebra to the one above and below to stop the movement. Unfortunately, this simply increases the load on the vertebrae above and below the fusion, so ultimately nothing has been gained as preventing structures that were designed to move always has consequences.
What can you do about spinal bone spurs? Use your own body to heal itself. Avoid incredibly damaging steroid epidural injections by using safe autologous alternatives. Be examined by a doctor who can accurately diagnose the problem and treat the cause of the instability without removing or bolting together sections of your spine.
The upshot? Your bones are very much alive! Laying down more bone in areas of unacceptable stress and pressure signals, commonly called bone spurs, are a solution to correct a problem. Bone spurs are not exclusive to the spine and can form in any joint in need of “shoring up”. The key to treating bone spurs, wherever they form, lies in correct diagnosis of the underlying issue. Given that removing bone spurs leaves the patient with the same or worse instability than the bone spur developed to correct, it makes much more sense to address the actual instability itself. Whether spine, hip, knee, shoulder, ankle, foot, or hand, once diagnosed, joint instability and the weak or damaged tendons and ligaments that cause it can be successfully treated with biologics, like your own platelets or stem cells. Your joints will thank you with greater function, less pain, and none of the hidden bombs associated with removing them!
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About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…