Lumbar Spondylosis
Lumbar Spondylosis is a degenerative condition of the lower or lumbar area of the spine. It is a descriptive term that means degeneration of the spine is present, regardless of where in the spine it is located or what is causing the condition. For instance, a patient with lumbar spondylosis may have:
- - Pain after long periods of inactivity or when they are highly active, such as in facet joint arthritis
- - Spinal stenosis, which causes pain in the legs when walking due to the abnormal narrowing of the spinal canal
- - Pain due to degenerative disc disease, where spinal discs become dry and lose some of their function causing pain in the low back or neck, sometimes accompanied by the leg or arm pain
Lumbar spondylosis can also refer to degenerative changes in the spine like osteophytes. These are sometimes called "bone spurs." They are extra pieces of bone that grow along the edges of a bone.
Not all conditions leading to lumbar spondylosis cause pain. Once a physician determines the cause of pain, a more specific clinical diagnosis can then be assigned.
Prevalence
Lumbar spondylosis is a very common condition. In fact, more than 80% of people over the age of 40 in the United States have the condition. Only 3% of people in their twenties have the condition.
Bone spurs or osteophytes of the spine occur most frequently in the lumbar spine. Approximately 28% of women and 30% of men who are 55 to 64 years old have bone spurs of the lumbar spine.
Lumbar spondylosis is a degenerative condition. It has been seen in people as young as 20 years old, but it increases with age.
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The symptoms of spondylosis include pain in a localized area, typically in the lower or lumbar area of the back. If a ruptured disc is pinching or compressing a nerve, the pain may radiate into the leg. For instance, a herniation in a disc of the lumbar spine may cause pressure on a nerve resulting in lower back pain that shoots down one leg and travels into the foot. This is known as sciatica.
Back pain caused by a disc herniation is usually made worse by prolonged sitting, standing, and by bending forward. It is often relieved by walking and frequent changes in position.
Back pain or lumbar spondylosis that is due to facet joint osteoarthritis is usually worse with standing and walking, and is relieved by bending forward.
When a nerve is pinched, numbness and tingling result. When a nerve is severely compressed, muscle weakness may result in the affected leg and foot. If spinal stenosis is severe, and the spinal cord is compressed, myelopathy (injury to the spinal cord) can result. Symptoms of lumbar myelopathy include numbness, pain, and weakness in the lower back and leg. Gait disturbances can also result due to problems with balance and coordination.
Diagnostic procedures
In addition to a physical examination, imaging tests are used in the diagnosis of lumbar spondylosis. These may include:
X-rays: X-rays can reveal osteophytes in the spine, thickening in the joints, and narrowing in the disc spaces.
Computerized Topography: CT scans show the spine in more detail. These can be used to diagnose lumbar spondylosis and other disorders that may not be seen on standard x-ray films.
Magnetic Resonance Imaging: MRI scans are costly, but they can show the spine in greatest detail, including the soft tissues and the intervertebral discs, the nerves and ligaments and may be used to diagnose.
Lumbar Spondylosis cannot be reversed because it is a degenerative condition. Treatment is aimed at controlling neck and back pain. Treatments that are sometimes recommended for spondylosis include:
- Exercise: A regular exercise program may help you recover from the pain of lumbar spondylosis. Even if you have to modify some of your routines, activity helps increase circulation to vital tissues.
- Analgesics: Over-the-counter (OTC) pain medications that have anti-inflammatory properties, like ibuprofen and naproxyn, can help control swelling as well as relieve pain. If you can't tolerate these, try acetaminophen to relieve pain that is associated with lumbar spondylosis.
- Ice or heat: Try applying an ice pack or mild heat to the area affected by lumbar spondylosis, whichever feels the best.
If these conservative treatments aren't effective in relieving the pain of lumbar spondylosis, your doctor may recommend the following medications which are only available by prescription:
- Muscle relaxants: These medications can help control the pain of lumbar spondylosis by relieving muscle spasms. One example of a muscle relaxant is cyclobenzaprine (Flexeril).
- Anti-seizure medications: Some drugs used for epilepsy work to help pain caused by irritated or damaged nerves due to lumbar spondylosis. Examples of these medications are pregabalin (Lyrica) and gabapentin (Neurontin).
- Opioids: These drugs are also known as narcotics. They are usually only given in cases of extreme pain. They can cause severe side effects and have the potential to become addictive. Some examples of narcotics used to treat the severe pain of lumbar spondylosis are oxycodone (Percocet) and hydrocodone (Vicodin).
In some cases, physicians will recommend an injection of a corticosteroid to decrease the inflammation of lumbar spondylosis, combined with a medication that numbs the pain.
Other treatments and therapies for Lumbar Spondylosis
If the pain of lumbar spondylosis does not resolve within a few weeks, physical therapy may be recommended. Physical therapy is often used in cases of chronic pain to help strengthen and stretch muscles. Trained therapists are knowledgeable of specific exercises that may be able to prevent pain by the strengthening and conditioning of abdominal and back muscles. Studies have shown that regular exercise, especially yoga and walking, can help relieve chronic back pain and symptoms of lumbar spondylosis.
Some people find relief from chiropractic treatments, especially during the first few weeks of the onset of pain. For some patients though, chiropractic spinal manipulation is not safe because it presents a serious risk of spinal cord damage. People with inflammatory arthritic conditions of the spine, such as ankylosing spondylitis and rheumatoid arthritis (in some circumstances) should not have spinal manipulation treatments.
Acupuncture is another possible treatment for pain caused by lumbar spondylosis. It involves the insertion of very tiny needles into specific regions of the body at various depths. Studies looking at the effectiveness of acupuncture for pain have not been conclusive. Other homeopathic treatments have not been shown by available research to be effective in improving lumbar spondylosis.
Procedures for Spondylosis
Epidural injections are sometimes recommended for the treatment of lumbar spondylosis. This procedure involves the injection of a medication (usually cortisone) into the space surrounding the spinal cord. This area is known as the epidural space. Injections of cortisone can be given directly into the disc spaces, into trigger points in soft tissues, or into the joints connecting the vertebrae. These injections are sometimes effective in helping to control acute pain and are especially beneficial in cases of radicular pain (pain that radiates into an arm or leg) caused by lumbar spondylosis.
Surgery for Spondylosis
Surgery is not often recommended in patients with acute episodes of back pain unless there are also neurological problems. In cases of chronic pain associated with lumbar spondylosis, surgery is controversial. This is because, in most research, surgery has not been shown to be more effective than conservative treatments such as pain management and physical therapy. Many surgical patients continue to experience lumbar spondylosis pain after surgery.
Most cases of acute back pain improve dramatically with conservative treatments like pain medication and physical therapy. Most patient's lumbar spondylosis pain resolves within a few days to a few weeks after the onset of symptoms. In cases of acute sciatica with symptoms of worsening nerve involvement, such as increasing numbness and weakness, when the symptoms of lumbar spondylosis do not improve and the patient's condition continues to deteriorate, surgery may be recommended. Surgery is also performed in cases of cauda equina syndrome. This is a condition in which the nerve bundle at the base of the spinal cord is compromised, causing severe neurological problems.
Spinal decompression procedures are used to relieve pressure from the nerves of the spine which occurs due to herniated intervertebral discs, spinal stenosis, or foraminal stenosis. Foraminal stenosis is a condition that occurs when bone spurs form on the vertebrae and narrow the openings between the facet joints. Spinal decompression can be performed using several different surgical techniques including:
- Discectomy: In this procedure, a portion of an intervertebral disc that is compressing a nerve root or obstructing the spinal canal is removed.
- Laminectomy: In this procedure, the lamina or bony arches of a vertebra are removed. This creates more room in the spinal canal and removes pressure on the nerves or spinal cord.
- Corpectomy: In this procedure, the vertebral body is removed.
- Foraminotomy: In this procedure, the openings in the vertebrae where the nerve roots exit the spinal canal are made larger. In a similar procedure, a foraminectomy, more tissue is removed.
Osteophytes or bone spurs can also be surgically removed from an area of the spine where they are causing nerve compression.
Fusion of the vertebrae can also be combined with these procedures to help add stability to the spine.
Prevention
Since lumbar spondylosis is a degenerative condition, there is no known way to prevent it. There is some way to prevent complications caused by the degeneration and to reduce your pain of lumbar spondylosis:
- Plan and stick to a regular pattern of exercise: Talk to your doctor about a workout routine that is safe for you. Try to incorporate flexibility exercises, aerobic exercises, and resistance training into your program.
- Maintain a healthy weight: Excess weight adds pressure and stress to your spinal joints (facet joints). This can accelerate the degenerative process of lumbar spondylosis.
- Eat a nutritious diet: Make sure you get adequate amounts of the essential vitamins and minerals every day by eating plenty of vegetables and fruits. Include whole grains in your diet, to prevent the early onset of lumbar spondylosis.
- Avoid prolonged sitting or standing: Change your position frequently. This gives your back time to recover from the stress and pressure exerted on it from being in one position
- Maintain good posture: Standing and sitting correctly helps keep your spine healthy and may help delay the early onset of lumbar spondylosis
- Lift properly: Never lift your back and get help with heavy loads
- Avoid alcohol: Excess alcohol intake may lead to dehydration which speeds up degeneration of tissues and lumbar spondylosis
- Don't smoke: Smoking accelerates degeneration of tissues and lumbar spondylosis
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