Lumbar Spondylosis

What is Lumbar Spondylosis?

The progressive aging of the lower back’s vertebrae and disks is known as lumbar spondylosis. These changes are commonly referred to as degenerative disk disease and osteoarthritis. One or more of the disks that divide the spine’s bones are breaking down, which is a typical sign of the illness. By maintaining the space between the vertebrae, the disks reduce stress on the spinal column. Even though the majority of people age with some degree of degeneration of the spine, not everyone experiences back pain.

Anatomy:

• The lumbar spine

Located beneath the thoracic spine and superior to the sacrum, the lumbar spine represents the second-lowest segment of the vertebral column. L1 through L5, five lumbar vertebrae, are usually present. This area is the main region of the lower back.

• Discs between vertebrates

The discs act as a cushion between close lumbar vertebrae to transfer loads, allowing for flexibility, including the capacity to bend and twist. Every disc has an inner gel-like nucleus pulposus surrounded by a tough fibrous outer layer called the annulus fibrosus.

• Facet Joints and Vertebrates

An intervertebral disc above and below, a paired set of facet joints at the posterior, and a vertebra make up the functional unit of the lumbar spine. Stability and motion guidance are provided by these joints. As a result of osteophyte formation and arthritis, they alter in shape and function.

• Nerve Roots and the Spinal Canal

The cauda equina nerve roots pass by the spinal canal in the middle of the column after coming through the neural foramen. These structures become compressed and inflammatory, which results in neuropathic symptoms. A lateral or central anatomical narrowing may take place.

Pathogenesis:

The biological processes that cause the gradual loss of structure and symptom appearances of lumbar spondylosis are referred to as the pathogenesis. The cycle of neuropathic compression, inflammation, and joint degeneration is constant.

•  Phase I : Dysfunction phase

The term “dysfunction phase” refers to the early outcomes of repeated microtrauma, such as the formation of end-plate separation and circumferential, severe tears in the outer, innervated anulus. These effects may make it more difficult for the disk to eliminate waste and take in nutrients. These tears may combine to form radial tears, which are more likely to extend outward and reduce the disk’s ability to keep water, leading to drying out and a decrease in the height of the disk.

• Phase 2: Instability phase

The features of the instability phase include the loss of mechanical reliability, progressive disk alterations, including internal problems, more annular tears, and disk resorption, as well as additional joint degeneration that may result in instability and subluxation.

• Phase III : Stabilization phase

In addition to ongoing fibrosis and disk space reduction, osteophytes and transdiscal crossing are developing during the stabilization phase.

Lumbar Spondylosis Causes:

• Being overweight or obese

Overweight puts greater loads per unit area on the facet joints and lumbar discs, which eventually leads to breakdown. The breakdown of the supporting tissues is made worse by the inability to properly support the spine as a result of abdominal obesity.

• Degeneration and Aging

The intervertebral discs become less elastic and flexible with time as a result of losing their hydration and proteoglycan content.
Osteophyte-containing bony overgrowths appear in facet joints as the cartilage ages.
Cellular senescence reduces the spinal tissues’ capacity to maintain and restore their structural integrity.
One contributing factor is that two age-related conditions, diabetes and atherosclerosis, obstruct blood flow to discs and cells.

• Over Time, Poor Posture

The balance of forces is thrown off by constant postural mistakes like forward head transit, move back, and collapsed lumbar curve that result in joint surface friction and muscular strain. This raises the possibility of acute disc herniations, especially when paired with asymmetric rotation. Poor posture can speed up generative changes over a long period of time.

• Congenital Deformities

An increased genetic risk of developing early spondylosis happens to the spine in cases of birth abnormalities related to the intervertebral disc, facet configuration, or vertebrae. Furthermore, certain inherited connective tissue disorders have been associated with increased disc degeneration in some individuals.

Lumbar Spondylosis Sign and Symptoms:

The major complaint of patients with lumbar spondylosis is constant, progressive lower back pain that may radiate or refer to other regions. Which axial structures and nerve roots are being compressed or irritated determines which specific symptoms are present.

• Back Pain

Lower back pain that is dull and painful, usually centered over the lumbosacral junction, can occur on one or both sides. Activities such as prolonged standing, walking, bending forward, or arching backwards usually make pain worse. Lying down, heating up, and getting some rest release the pain. Lack of sleep may be caused by night pain.

• Stiffness and Muscle Spasms

The body experiences paravertebral muscle spasms and tightness in an attempt to splint and cover the inflammatory area. Tension and stiffness in the back muscles can lead to limited mobility.

• Decreased Spinal Movement

Reduced range of motion becomes apparent when trying to rotate, bend sideways, and flex the trunk. This matches the alterations in disc space narrowing and joint surface morphology. It becomes difficult to take on regular, functional postures as stiffness and postural abnormalities develop as inflammation worsens.

Diagnosis:

The diagnosis of lumbar spondylosis is made using diagnostic scans, physical and neurological examinations, and medical history.

Medical history and physical examination:

• First, a neurological physical examination and an in-depth health history are taken to describe the symptoms and problems.
• A clinical pattern that is consistent with a compression of the L4/L5 or L5/S1 nerve root has been revealed.

Imaging Studies:

• MRI

Excellent visibility of the spinal ligaments, brain structures, and intervertebral discs makes this imaging method the gold standard. Capable of consistently recognizing disc bulging/herniation, central stenosis, and neuroforaminal reducing. represents the manner in which morphological alterations are caused due to spondylosis.

• CT Scan

Superior bone detail compared to MRI for evaluating small fractures and fine bone anatomy. Use in the event that surgery is being considered or an MRI is not advised. Not often used due to radiation exposure danger.

Differential Diagnosis:

It is important to rule out the following conditions since they may resemble or overlap the clinical presentation of lumbar spondylosis:

• Herniated Disc

Acute disc rupture that causes tension in the nerve roots, leading to pain that is primarily felt in one leg. Separate from spondylosis by acute severity and frequent pain during rest or supine positions. MRI confirms the diagnosis.

• Piriformis syndrome or sciatica

Resembles radicular pain, but the pyriformis muscle irritating the sciatic nerve is the main cause of the condition.
Symptoms are usually nocturnal, unilateral, and alleviated by stretching. Imaging shows no changes in spondylosis.

• Spine Infection

Indications of vertebral osteomyelitis/spondylitis include elevated inflammatory markers, characteristic changes in the MRI signal, and constitutional sepsis.

Treatment :

Depending on the specifics of each patient’s case,  treatment varies. Surgery is only required if other treatment options, such as lifestyle changes or medication, prove to be ineffective early on.

Non surgical treatment:

• Medicine

Anti-inflammatory medication that are not steroids both increase and decrease inflammation as well as pain. Certain medication called non-steroidal or NSAIDs, are available without a physician’s prescription while others must be got over-the-counter (OTC). You should never mix over-the-counter and prescription medications without your doctor’s approval. It might have very negative consequences.

• Spinal injections

Injections into the facet joints and epidural space of the spine come in a variety of forms. Injections for inflammation are administered through the use of a local anesthetic with steroid medication, which reduces pain.

• Opioids

Pain is treated with opioids for acute pain. It might be advised for just a short period of time.

Surgical Treatment:

Surgical intervention may be necessary for patients who do not respond to intensive conservative measures and who show severe neurological symptoms or functional impairment.

• Replacement of  Disc

includes taking out the damaged lumbar disc and putting in a prosthesis to maintain range of motion and lessen pressure on levels that are close.

• Spinal Fusion

Using implants and bone grafts to join multiple vertebrae together in order to remove motion at that segment. maintains composure and provides stability.

Regarding the procedure’s long-term effects on mobility, next segment disease, and complication risks, each one has a number of advantages and disadvantages. By carefully evaluating the patient prior to surgery and selecting the most conservative option appropriate for the illness, results are maximized. Even now, a lot of patients choose to postpone or skip surgery because of the risks.

Physiotherapy Treatment:

By providing a personalized treatment plan that targets musculoskeletal dysfunction and teaches self-management techniques, physiotherapists are essential in the conservative treatment of lumbar spondylosis.

Modalities for Pain Relief:

• Transcutaneous Electrical Nerve Stimulation (TENS)

Surface electrodes temporarily relieve symptoms by delivering tiny electrical impulses that, according to gate control theory, alter the way pain signals are transmitted.

• Heat Therapy

Before engaging in any activity, warm compresses, ultrasound, shortwave diathermy, and heat packs are used to ease tense muscles, increase blood flow, and relieve spasms.

Exercises:

Recommending particular lumbar and core musculature strengthening and flexibility exercises to maintain a flexible spine and reduce structural stresses.

Patients can resume normal functional activity levels with the help of aerobic conditioning, which improves circulation and back muscle endurance.

Pelvic tilt

• With your knees bent and your feet flat on the ground, take a position on the floor (or a mat placed there).
• Extend your arms at your sides, palms down by it.
• Neutral posture is maintained by keeping your neck in line with your spine and your back touching the mat.
• To allow your back to continue curved naturally, leave space between your low back and the mat.
• Your hand ought to be able to slide into this opening.
• Breathe in. Then, as you release the breath, contract your abdominal muscles, allowing your tailbone to tilt upward and compressing the area between your low back and the mat or floor.
• Your low back will feel slightly stretched.
• Hold this position for a few seconds.
• Then return to your neutral position.
• Then relax.

Single knee to chest

• Start by spreading your legs when lay flat on your back.
• Bring one knee up to your chest with your hands until your lower back stretches a bit.
• Keep your back flat on the floor and take a relaxed posture for the duration of the stretch.
• Hold this position for a few seconds.
• Then return to your neutral position.
• Then relax.

Bridging

• Take a comfortable position on your back.
• This is something you might want to do on a yoga mat or some other soft surface.
• Keeping your feet flat on the ground and your knees bent, push through your feet to raise your hips off the floor.
• In the highest point of the exercise, contract the lower back muscles.
• Hold this position for a few seconds.
• Then return to your neutral position.
• Then relax.

Hamstring stretch

• Stretch your legs wide while still keeping your back straight as resting on your back.
• Maintain your lower back on the floor and your hips at the same height.
• Holding onto the back of your leg with both hands, progressively lift your right knee.
• Gently bring your leg towards you while maintaining both hips on the ground.
• Hold this position for a few seconds.
• Then return to your neutral position.
• Then relax.

How Can Lumbar Spondylosis Be Prevented?

Although lumbar spondylosis may not be totally preventable, there are a number of steps you can take to lower your risk or slow the condition’s progression.

Here are a few methods of prevention:

• Regular exercise

Exercises focused on strengthening the core muscles are recommended because they support the spine. Exercises with little impact, such as yoga, walking, and swimming, can help build stronger and more flexible back muscles.

• Keep a healthy weight

Being overweight increases the strain on your spine and raises your risk of developing spondylosis.

• Use right body mechanics

Use proper body mechanics when exercising or lifting heavy objects. Keep the object close to your body and bend your knees instead of twisting.

• Stay away of repetitive motions

Spine degeneration can be worsened by repetitive motions or activities. If your job requires you to perform repetitive tasks, change your work schedule or take breaks to reduce the amount of stress on your spine.

Summary:

A degenerative disorder of the lumbar spine called lumbar spondylosis causes persistent back pain and stiffness. Particularly harmed by ageing and trauma are the intervertebral discs which connect the spinal vertebrae to the corresponding facet joints. The disc space height and spinal canal diameter narrow as a result, compressing the nerve roots.

Lower back pain that affects gradually, loss of movement, and pain referred to the legs or buttocks are the typical symptoms. Nerve compression may cause neurological symptoms such as tingling, numbness, or weakness in the lower limbs later on. A primary cause of the disease is persistent inflammation surrounding the injured structures.

The first course of treatment is conservative and focuses on anti-inflammatory medicine, activity modification, physiotherapy, pain management, and strengthening exercises for the lumbar and core muscles to increase mobility and stability of the spine. Procedures to decompress irritated nerves or stabilize symptomatic segments may be necessary if non-surgical treatments prove ineffective.

FAQ:

References:

• M. M. School (2024, February 9). Degeneration of the Lumbar Spondylosis | UTHealth Neurosciences. The UTHealth Neurosciences offers spine care, neurology, and neurosurgery. [#:~:text=Lumbar%20spondylosis%20is%20an%20age,the%20bones%20of%20the%20spine]; this link describes the degeneration of the lumbar spine.

• E. Lunardo (2018) 16 July. Treatment options, symptoms, and causes of lumbar spondylosis. Breaking Health News and Health Information from Bel Marra Health. Treatment for lumbar spondylosis: https://www.belmarrahealth.com/causes-symptoms-treatment/

• A. Virani (2024c, Feb. 12). The causes, signs, and treatments of lumbar spondylosis. Exercise and Physical Therapy Treatment. http://physical-therapy.us/spondylosis-of-lumbar-bone

• Image 1, Themes, U. (22 September, 2016b). The lumbosacral spine’s clinical anatomy. The clinical anatomy of the lumbrosacral spine can be found at Neupsy Key.

• Image 2, (2020, December 29) Sunorthopaedic. Lumbar Spondylosis – Sun Orthopaedic. Sun Orthopaedic. What is lumbar spondylosis? https://sunorthopaedic.com/