Lumbar spondylosis is an age-related degeneration of the vertebrae and disks of the lower back. These changes are often called degenerative disk disease and osteoarthritis. The common condition is marked by the breakdown of one or more of the disks that separate the bones of the spine. The disks provide cushioning between the vertebrae and absorb pressure put on the spine. This condition is progressive and irreversible in older patients and commonly occurs due to exposure to mechanical stress .
Degenerative changes can cause the weakening of the disc fibers, causing wear and tear. Constant wear and tear and injury to the joints of the vertebrae cause inflammation and the formation of mineral deposits within the discs. The water content of the disc decreases with age making the disc hard, stiff, and decreased in size. This, results in strain on the surrounding joints and tissues, causing stiffness.
Because there are many different causes of lumbar spondylosis, symptoms vary greatly. Signs and symptoms can include:
• Back pain
• Decreased range of motion and flexibility, either in the low back or legs, especially first thing in the morning or after periods of inactivity
• Stiffness or tenderness in the low back
• Numbness and tingling and/or shooting or radiating pain (known as lumbar radiculopathy) from the low back into the buttock or leg(s)
• Weakness in the leg or foot if a nerve is severely pinched
• Numbness, tingling and weakness can also be due to lumbar spondylosis that is injuring the spinal cord (myelopathy), for example, from a large herniated disc pushing on the spinal cord
There are many causes for lumbar spondylosis, some of them include:
• Back trauma
• Repetitive spine loading
• Repetitive bending, lifting, twisting
• Sustained postures.
• Loss of bladder or bowel control or numbness in the groin because of nerve dysfunction
• Lumbar spinal stenosis where the spinal canal narrows, putting pressure on the spinal cord and nerves and possibly pinching them, resulting in weakness, tingling, numbness or pain that radiates from the low back into the buttocks, thigh, or groin
• Cauda equina syndrome where nerves at the bottom of the spinal cord are pinched by an intervertebral disc or mass, causing severe nerve problems
• Neurologic dysfunction due to nerve compression, caused by bulging discs or bone spurs narrowing the holes where the nerve roots exit the spinal canal (called foraminal stenosis)
• Physical examination:
Physical examination of the patient is done thoroughly followed by the following diagnostic tests.
• Magnetic resonance imaging (MRI):
Magnetic resonance imaging (MRI) is used to show a detailed image of the spine, and visualize the degree of disc herniation.
X-rays are used to show bone spurs on vertebral bodies in the spine, thickening of intervertebral disc spaces and thickening of facet joints.
• CT scan:
CT scan helps to visualize a detailed image of the spine and also check the narrowing of the spinal cord.
Treatments aim to reduce the pain that can result from lumbar spondylosis and include:
▪︎ Physiotherapy (considered the main conservative treatment for lumbar spondylosis) which includes –
• Stretching, strengthening, and range of motion exercises
• Activity modification and functional retraining
• A personalized exercise routine
▪︎ Medications, including:
• Non-steroidal anti-inflammatory drugs (NSAIDs), either prescribed, or over-the-counter, such as Advil, Motrin or Aleve
• Topical medications such as creams, sprays, gels or patches
• Antidepressants due to their helpful analgesic properties
• Muscle relaxants
• Corticosteroid injections to relieve inflammation
Surgery is rarely used as a solution for chronic low back pain because of mixed results long-term.
However, surgery is sometimes necessary when lumbar spondylosis has caused a nerve problem or nerve damage.
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