Lumbar Spondylosis -Samarth

Lumbar Spondylosis

By Dr.Ravindra Patil

It is a painful condition of area of the lower back above the buttocks. But first let us understand each term clearly. Let us see ‘Lumbar’ means and what ‘Spondylosis’ means.

Table of Contents

What is ‘Lumbar’ Spine?

It refers to that part of the spinal column which has five vertebrae and is located at the lower back but above the buttocks. Painful conditions occur in the lumbar spine because it carries the weight of the upper body and is prone to many stresses and injuries during routine work and severe hard exertions.

Understanding spondylosis

Spondylosis refers to the development of age-related arthritis that affects the spine. More specifically, it involves a number of different degenerative issues that affect the disks and joints of the spine. It may occur in any part of the spine, from the neck to the back to the lower back. In this article we focus on the lower back or the ‘Lumbar’ region. Hence we call it Lumbar Spondylosis.

Why does spondylosis occur? Over time, disks between two vertebrae [called intervertebral disks] may become dehydrated and become compressed, meaning their height is reduced as a result of dehydration. Thus, they provide less cushioning and can actually “crack,” which can lead to herniation. Herniation means a part of our body protrudes out of a normal or an abnormal opening.

Similarly, the cartilage in the spine’s joints can wear down, resulting in the formation of bone spurs.  

These arthritic changes can not only cause pain in the back but can also lead to a narrowing of the spinal canal (also known as stenosis), which may compress nerves. Nerve compression causes symptoms like pain and numbness, which slowly increases with the passage of time. Later there may be loss of vital functions like bladder and bowel control. Individuals with spinal stenosis may have neurologic symptoms in their extremities, such as numbness, tingling, or weakness radiating into their arms or legs. Loss of bladder or bowel control may lead to further complications. 

What causes spondylosis?

The most common cause of spondylosis is the cumulative joint stress that occurs as people age. It predisposes them to osteoarthritis, a common form of arthritis typically associated with progressive “wear and tear” on joint cartilage. 

Spondylosis may also arise as a result of previous trauma to the spine. For instance, patients who:

  • Have had car accidents, falls, or other spinal injuries
  • Play competitive sports
  • Perform strenuous physical activity at work
  • Have had a previous neck or back surgery

The lumbar region is most affected by spondylosis because of its exposure to mechanical stress.

What are the risk factors for spondylosis?

The risk factors for spondylosis include the following:

  • Age 60 or older
  • Osteoarthritis affecting other joints
  • Physically demanding jobs that may require heavy lifting or bending
  • High-level athletics
  • Neck or back injury
  • Previous spine surgery
  • Obesity
  • Smoking
  • Physical inactivity

What are the symptoms of lumbar spondylosis?

Many with spondylosis do not have pain or neurologic symptoms. Some people may experience symptoms. They are:

  • Neck or back pain that worsens when coughing or sneezing
  • Decreased flexibility in and range of motion of the neck or back
  • “Clicking” sounds from the spine
  • Pain radiating from the lower back into the legs
  • Numbness, tingling, or weakness in the arms or legs
  • Unsteady gait
  • Muscle spasms
  • Headaches
  • Bladder or bowel dysfunction in severe cases

How is spondylosis diagnosed?

A person can be diagnosed with lumbar spondylosis by a medical history, physical exam, and reviews of diagnostic tests. When providing your medical history, it is important to share any history of spinal injuries or previous surgeries. Physical activity information must also be shared.

Your doctor will observe your walking ability and assess the range of motion of your spine to determine if you have any pain or stiffness. Palpation of the neck and back can also help identify the location of any tenderness associated with spondylosis. Your neurologic function will also be evaluated, including your sensation, strength, and reflexes. Special tests may also be performed to check for any signs of nerve impingement (from a disk herniation, for example). 

Finally, imaging studies like X-rays, computed tomography (CT scan), and magnetic resonance imaging (MRI) may also be used to identify any arthritic changes in the spine. Lab tests may also be useful for ruling out more concerning diseases, such as an infection or cancer.

Differential Diagnosis

When a patient is suffering from low back pain, there are a lot of other possible diseases that have to be considered and ruled out:

  • Rheumatoid arthritis
  • Excessive exercise pain
  • Ankylosing Spondylitis
  • Coccyx Pain
  • Spinal Masses
  • Infection
  • Discitis
  • Lumbar Compression Fracture
  • Mechanical Low Back Pain
  • Overuse Injury

Lumbar Spondylosis’s degeneration can influence spinal alignment, potentially exacerbating pre-existing Spinal Deformities, emphasizing the need for comprehensive diagnosis and treatment.

How is spondylosis treated?

Different treatments are available to treat spondylosis, depending on the type and severity of symptoms. 

Treatments for milder spondylosis include:

  • Activity modification, such as avoiding activities that cause pain
  • Medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen and Diclofenac or Paracetamol
  • Hot/cold compresses, massage, and traction
  • Physical therapy, such as strengthening and flexibility exercises and ergonomic education
  • Spinal injections, such as an epidural around nerves and facet joints

In more severe cases, surgery might be the best course of action. It may involve the following procedures:

  • Decompression (laminectomy, discectomy), which involves the removal of bone spurs, disk herniations, and arthritis to relieve compression of the nerves and address neurologic symptoms
  • Fusion, which is the formation of bone across adjacent vertebral bodies to stabilize the spine and relieve pain

Other Surgical treatment for Lumbar Spondylosis

  • This surgery is used to relieve pain associated with a compressed nerve in the spine.
  • Disk replacement.
  • Interlaminar implant.
  • Physical Therapy Management
  • Educating the patient: may include reviews of lumbar anatomy, explanations of the concept of posture, ergonomics and giving appropriate back exercises.

Other non-surgical treatment modalities include

  • Lumbar Back Support: Can be beneficial for patients suffering from chronic LBP. It occurs to limit spine motion, stabilize, correct deformity and reduce mechanical forces. There is no consensus if it may function as a placebo or really improve pain and functional ability.
  • Special type of taping is done on the back to prevent moment in certain directions, but again it is thought to give more of a placebo effect of pain relief.

Clinical Bottom Line

Lumbar spondylosis can be described as a degeneration of the lumbar vertebrae.

  • It is a form of low back pain and is an important clinical, social, economic and public health problem affecting the worldwide population.
  • It is a disorder with many possible causes and many definitions.
  • Clinical diagnosis of lumbar spondylosis is done by MRI, CT, SPECT and X-ray and a general examination of the spine.
  • Mild cases are managed with medicines.
  • Severe cases need surgery.
  • The physical therapy has an important role, and may include lumbar traction, manipulation of the spine, massage therapy, TENS, back school and Lumbar back supports.
  • The choice of therapy depends on the individual wishes and the surgeons advice.

Lumbar Spondylosis’s degeneration can influence spinal alignment, potentially exacerbating pre-existing Spinal Deformities. This complexity was underscored when a patient, who had tumours in his spine twice, faced a critical situation. Here, surgical navigation emerged as a crucial factor in saving him. This advanced technique seamlessly complemented the comprehensive approach discussed earlier, highlighting the intricate nature of spinal health management.

Outlook for people with spondylosis?

Fortunately, most individuals with spondylosis will not experience symptoms and may never even realize that they have arthritis in their spines. However, for those who experience pain or neurologic changes due to nerve compression, safe and effective treatments are available.