Lumbar Spondylosis - Causes, Symptoms, Diagnosis, and Management

Introduction

Lumbar spondylosis, also known as spinal osteoarthritis, is a degenerative condition that is more common in older adults. It develops slowly over a period of time. It occurs due to the normal wear and tear of the joints and bones that occur with everyday movement. The vertebral column comprises small bones called vertebrae, the bones that make the spine. The vertebrae are joined by joints lined by a layer of smooth, rubbery cartilage that makes any movements smooth and painless. Also, tough fibrous intervertebral disks that act like cushions and shock absorbers are present between the vertebrae. This entire setup in the spine allows smooth movements. It helps the neck and back withstand movements in all directions without causing any discomfort.

However, over a period of time, due to the regular wear and tear of the vertebrae and the connecting joints, it leads to lumbar spondylosis, or degeneration of the spine, which may be further accompanied by a slipped disk, disk prolapse, or disk herniation.

The term spondylosis encompasses all other degenerative conditions that affect the lumbar spine, like:

• Low Back Osteoarthritis: Osteoarthritis of the spine is a condition in which the cartilage surrounding the vertebral joints breaks down, causing inflammation. Painful bony spurs form as a result of bone rubbing over the bone. These bone spurs or osteophytes can also cause the narrowing of the spinal canal leading to nerve compression and damage.

• Spondylosis Deformans: A condition in which bone spurs develop in the region of degenerating intervertebral disks.

• Lumbar Degenerative Disk Disease: There is degeneration of intervertebral disks in this condition.

• Bulging Disks: Bulging disks cause inflammation and make the spinal nerves sensitive.

• Herniated Disks: They cause pain by pushing the ligaments in the lower back.

• Spondylolisthesis: A condition in which a vertebra slips over another vertebra, causing misalignment of the spine.

What Are the Causes and Risk Factors for Developing Lumbar Spondylosis?

Lumbar spondylosis does not occur suddenly. It develops over a period of time due to the wear and tear of the vertebrae and joints. The minor trauma that occurs throughout one’s life presents with symptoms of lumbar spondylosis after a point in time. The causes and risk factors of the condition include:

1. Age: Age is the most common factor in developing the condition. As age progresses, there can be irreversible and progressive changes in the bones of the body, especially the vertebrae. This makes a person more prone to develop lumbar spondylosis. People above the age of 40 are at an increased risk.

2. Abnormal Spine Movement: Frequent and vigorous spine movement that occurs, especially in sports players, can damage the bones in the spine. Repeated stress on the backbone can result in injury.

3. Genetics: People who are genetically predisposed to weak ligaments and bones are more prone to lumbar spine injuries.

4. Lifestyle: Certain lifestyle habits like smoking can affect the integrity of bones. Smoking reduces the amount of water in the disks, affecting the shock-absorbing potential. Prolonged sitting can also put pressure on the lumbar spine.

5. Obesity: Excess weight causes wear and tear of the lumbar spine by putting extra load on the joints.

6. Previous Injuries or Surgeries: Previous injuries or surgeries to the spine can increase the chances of lumbar spondylosis.

What Are the Symptoms of Lumbar Spondylosis?

About 37 % of patients with lumbar spondylosis do not have any symptoms initially. However, when the symptoms appear, they present with pain and morning stiffness that ranges from mild to severe. The morning stiffness may last for more than 30 minutes. The other signs and symptoms may include:

• Localized pain.

• Regional tenderness.

• Muscle spasms.

• Pain after prolonged sitting or repeated movement.

• Tingling and numbness in the limbs.

• Weakness in one of the limbs due to nerve compression.

What Are the Complications of Lumbar Spondylosis?

Some rare but severe complications of lumbar spondylosis include:

• Loss of bladder or bowel control due to nerve dysfunction.

• Lumbar spinal stenosis puts pressure on the spinal cord and corresponding nerves. This pinches the nerves causing pain, tingling, and numbness that radiates to other parts like the thighs, buttocks, or groin.

• Cauda equina syndrome is a condition where nerves at the bottom of the disk get pinched, causing complications.

• Neurologic dysfunction that occurs due to nerve compression.

How Is Lumbar Spondylosis Diagnosed?

The doctor takes a complete history and does a physical and neurological examination. Physical examination is done to check the range of motion, whereas neurological examination assesses nerve and muscle strength and reflexes. Imaging tests may also be performed for a more detailed diagnosis, which includes:

• X-Ray: An X-ray can detect bone spurs, thickening of the joints, and narrowing of the intervertebral disks.

• CT Scan: A computed tomography gives a clear and detailed view of the spine and can detect the narrowing of the canal.

• MRI: An MRI (magnetic resonance imaging) can help detect herniation of the intervertebral disks.

• SPECT: Single-photon emission computed tomography is a test that uses a radioactive tracer and CT scan to diagnose lumbar spondylosis.

How Is Lumbar Spondylosis Managed?

The main aim of treatment is to reduce pain. The various components of pain management include:

Physiotherapy:

Physiotherapy is the main form of conservative treatment for lumbar spondylosis. It is a type of treatment that focuses on decreasing pain, preventing chronic pain, regaining the strength of the muscles, and improving joint mobility and functioning. The following techniques may be employed for the treatment:

• Stretching, strengthening, and range of motion.

• Activity modification and functional retraining.

• Traction.

• Bracing.

• Personalized exercise routine.

• Postural and ergonomic patient education.

• Cross-disciplinary therapies like:

  • Interferential current therapy, a treatment that uses electric current to stimulate tissues and provide pain relief.

  • Acupuncture includes inserting thin needles into specific points in the skin for pain relief.

  • Manual therapy, or manipulation therapy, is used by physiotherapists to manipulate muscles and joints.

  • Massage therapy enhances wellness by manipulating soft tissues of the body.

  • Occupational therapy emphasizes maintaining health by focusing on necessary action items.

  • Chiropractic therapy involves manipulating the spine to correct alignment issues and ease the pain.

Medications:

Medications may be prescribed to relieve severe pain, that includes:

• NSAIDs (non-steroidal anti-inflammatory drugs) like Advil or Motrin.

• Topical medications in the form of creams, sprays, patches, or gels.

• Muscle relaxants.

• Steroid injections.

Surgery:

Surgery is often rarely performed for lumbar spondylosis as it usually responds well to medications, physiotherapy, and an active lifestyle. Also, it is less preferred due to its long-term mixed results. However, surgery may opt for cases with nerve involvement and damage. Also, physiotherapy is an important part of rehabilitation after surgery.

Does Lumbar Spondylosis Subside on Its Own?

No, lumbar spondylosis is a chronic condition that requires appropriate treatment. Things that help in easing day-to-day activities in patients with the condition include:

1. Minimizing activities like bending or lifting heavy weights that put pressure on the back.

2. Switching from activities like jogging to walking or swimming.

3. Using a supportive pillow or mattress.

4. Trying heat and cold therapy.

5. Using an ergonomic chair for long hours at work.

6. Intake of fish oil supplements that help in relieving inflammation.

Conclusion

Lumbar spondylosis is a condition that develops with time. It is a degenerative disease that affects the vertebrae in the lower back. It can cause discomfort like pain, stiffness, and an inability to carry out daily activities. However, medications, physiotherapy, and an active lifestyle can help manage the condition without complications. It is recommended to avoid strenuous activities to prevent further deterioration of the spinal joints.