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Lumbar Spondylosis


Presentation

The initial stages of the condition may seldom produce any symptoms. In the more advanced stages, patients experience the following signs and symptoms:

  • Lower back pain
  • Numbness and tingling sensation in the lower back region
  • Pain radiates to the lower legs
  • Pinch like sensation in the affected area
  • Decreased mobility
Difficulty Walking
  • If the spinal cord or nerve roots become pinched, you might experience: Tingling, numbness and weakness in your arms, hands, legs or feet Lack of coordination and difficulty walking Loss of bladder or bowel control When to see a doctor Seek medical attention[mayoclinic.com]
  • walking or maintaining proper posture Neck-Related Symptoms: Shoulder blade pain; headaches at the base of the head; dizziness; or “crunching” sensations while rotating the neck Emergency Symptoms: Seek urgent medical care if you experience debilitating[newyorkcityspine.com]
  • Common symptoms of thoracic spondylosis include: Pain and stiffness in the mid back, particularly in the morning after you get out of bed Tingling or numbness in the legs, arms, hands or feet Muscle weakness Loss of coordination or difficulty walking[laserspineinstitute.com]
Localized Pain
  • pain in the lower back and radiating pain in the extremities.[laserspineinstitute.com]
  • (b) For the purposes of this Statement of Principles, "lumbar spondylosis" means a degenerative joint disorder affecting the lumbar vertebrae or intervertebral discs with: (i) clinical manifestations of local pain and stiffness, or symptoms and signs[comlaw.gov.au]
Wound Infection
  • One patient required re-operation for a CSF leak, two patients encountered wound infections but neither required re-operation [ 16 ]. Humphreys et al. [ 22 ] compared TLIF to PLIF in a 74 patient series (40 TLIFs).[esciencecentral.org]
Aspiration
  • The most common of these was anaemia requiring a post-operative transufusion, which occurred in 8 patients (14.0% of our cohort). 2 patients (3.5%) had wound infections in the immediate post-operative period, only one of which required CT-guided aspiration[esciencecentral.org]
Back Pain
  • Stiffness index was associated with neither radiographic lumbar spondylosis nor low back pain.[ncbi.nlm.nih.gov]
  • Lower back pain was not significantly associated with incident radiographic LS, while a more severe KL grade at baseline was associated with incident lower back pain.[ncbi.nlm.nih.gov]
  • OBJECTIVES: Although lumbar spondylosis is a major cause of low back pain and disability in elderly people, few epidemiological studies have been performed.[ncbi.nlm.nih.gov]
  • Lower back pain and knee pain were independently associated with multiple falls in women after adjustment. CONCLUSION: Lower back pain and knee pain were significantly associated with multiple falls in women.[ncbi.nlm.nih.gov]
  • Back Pain can occur in the human body because of many reasons. The Acupressure Technique has several pressure points for healing Back Pain. These pressure points are very helpful to give relief in various symptoms of Back Pain.[modernreflexology.com]
Low Back Pain
  • Stiffness index was associated with neither radiographic lumbar spondylosis nor low back pain.[ncbi.nlm.nih.gov]
  • OBJECTIVES: Although lumbar spondylosis is a major cause of low back pain and disability in elderly people, few epidemiological studies have been performed.[ncbi.nlm.nih.gov]
  • Abstract Seventy-three patients presented with either chronic urinary symptoms such as incontinence, retention, and recurrent urinary infection or chronic low back pain and neurogenic claudication.[ncbi.nlm.nih.gov]
  • MATERIALS AND METHODS: Forty-eight patients with low back pain were studied with both a detailed four-sequence protocol and a two-sequence rapid screening protocol (acquisition time of 28 and 2.5 min for the detailed and screening protocols, respectively[ncbi.nlm.nih.gov]
  • Cases with degenerative low back pain and sciatica were assessed before and after therapeutic interventions with combined movement examination and a battery of self-report pain and disability questionnaires.[ncbi.nlm.nih.gov]
Spine Pain
  • Spondylosis (spine arthritis) is one of the most common causes of spine pain and stiffness once you are aged over fifty. Spondylosis is further categorised depending on the region of the spine that it is present.[physioworks.com.au]
Neurogenic Claudication
  • Abstract Seventy-three patients presented with either chronic urinary symptoms such as incontinence, retention, and recurrent urinary infection or chronic low back pain and neurogenic claudication.[ncbi.nlm.nih.gov]
Absent Ankle Reflex
  • However, one elderly woman presented with painless urinary retention, and absent ankle reflexes were the sole neurological abnormality.[ncbi.nlm.nih.gov]

Workup

Laboratory studies are not helpful in detection of lumbar spondylosis. Various imaging studies need to be conducted for differential diagnosis of the condition. An X-ray of the spine is done that reveals narrowing of the space between the discs. MRI studies may elucidate the spondylosis changes in static and mobile rendering [9]. A scan for the determining the bone density is also necessary.

Neurological examinations form an important part of diagnostic procedures. This test is done to assess any damage to the spinal canal. In case of any secondary complications, other tests such as electromyography and nerve conduction velocity are also required.

Treatment

Treatment regime greatly depends on the extent of damage to the discs and the severity of the symptoms as well as age of the affected individual. In the preliminary stages, when mild symptoms are present, medications are administered to help relieve the pain. In addition, physiotherapy along with medications has proved to be extremely beneficial for patients suffering from lumbar spondylosis. Physiotherapy is known to improve the flexibility and strength of the spine.

In situations of nerve root impingement the patient is put on complete bed rest for at least 2 days. If the symptoms subside then the bed rest is extended for few more days. However, if no relief is experienced then surgical intervention becomes inevitable. Surgery is carried out to correct the nerve impingement and relieve the spinal canal by lumbar spine fusion procedures [10].

Lumbar supports are also given to patients suffering from lumbar spondylosis. For this, supports are designed in a manner that would restrict spine movement, provide stability and correct the deformity.

Prognosis

With prompt initiation of treatment, the prognosis is usually favorable. However, when lumbar spondylosis is allowed to progress, it can cause the vertebrae to gradually stiffen paving way for development of various other conditions.

Complications

Complications of lumbar spondylosis arise when treatment is not initiated in the initial stages. When the disease progresses to more advanced stages, the following complications develop:

  • Onset of severe neurological problems
  • Poor bladder control
  • Unsteady gait
  • Reduced flexibility due to severe back pain [6]
  • Osteoporosis [7]
  • Height reduction [8]

Etiology

Lumbar spondylosis is a degenerative disease that adversely affects the spine causing narrowing of the space in between the spinal discs. Age is thought to be the greatest risk factor for this condition. As individual ages, the space between the discs narrows down. In addition, there is significant amount of degeneration taking place in the cartilage and disc which in turn contributes to narrowing down of the space.

Such events cause the vertebrae to gradually undergo wear and tear thereby exposing the nerves causing them to inflame and cause pain and discomfort. No relation so far has been noted between smoking, alcohol consumption, physical activity, height or weight of the individual [1].

Epidemiology

It has been estimated that about 80% of US population develop lumbar spondylosis after the age of 40 years. However, this condition is also known to affect individuals in the age group of 20 to 29 years.

There is a strong correlation between the transforming growth factor beta 1 and lumbar spondylosis among postmenopausal Japanese women [2]. There is a higher incidence of lumbar spondylosis grade KL>2 (Kellgren-Lawrence grading) among men while grade KL>3 is equal in both sexes [3].

Sex distribution
Age distribution

Pathophysiology

Lumbar spondylosis is a resultant reaction of narrowing of the space between the discs. Another theory which explains development of such a kind of condition is formation of new bone growth (osteophytes) in the areas where the anular ligament is under stress [4]. Such an event exerts pressure on the neighboring nerves giving rise to an array of associated complications. There is an associated disc space narrowing with spondylosis in degenerative bone disease of the spine [5]. If lumbar spondylosis is not treated on time it can lead to secondary complications.

Prevention

Adopting certain lifestyle factors can in some way help in prevention of lumbar spondylosis. These include:

  • Individuals are advised to take a careful note about their sitting posture and the lying position. It is also necessary that the bed and the chairs that are used on regular basis should not be too hard or flat.
  • It is also necessary to stay healthy by exercising regularly and eating a well-balanced diet.
  • Lastly, individuals who have developed lumbar spondylosis are advised against participating in sports or activities such as aerobics, basketball or jogging to avoid aggravating the condition.

Summary

Lumbar spondylosis is a condition characterized by development of bony growths in the lower spinal region. It is a degenerative disease of the spine. The condition is also known as spinal osteoarthritis.

Lumbar spondylosis is usually asymptomatic in nature; however some patients have reported that they experience back pain and morning stiffness as the preliminary signs of the disease. Significant number of individuals fall prey to this disease. Such a condition can strike any individual above the age of 20 years. Males and females are at an equal risk of contracting this disease condition.

Patient Information

Definition

Lumbar spondylosis is a degenerative disorder of the spine that narrows down the space between the discs. It is a common condition, affecting about 80% of the individuals of United States. Such a disorder commonly strikes adults as the spine degeneration takes place when the individual ages.

Cause

Age is known to be the major factor contributing to lumbar spondylosis. With advancing age, spine degeneration takes place paving for development of lumbar spondylosis. Physical stature and smoking or alcohol consumption have no relation to such degenerative spine disease.

Symptoms

Development of lower back pain is the most common sign of lumbar spondylosis. In addition, majority of the individuals also complain of stiffness in the lower back when they get up in the morning. All these give rise to decreased mobility and sensation of pinch like feeling in the lower back and legs. In some cases, pain in the lower back region can also radiate to the legs.

Diagnosis

Diagnosis of lumbar spondylosis can be made by X-ray examination of the spinal canal. In addition, imaging studies such as MRI and CT scan are also carried out. Bone density tests also form an important part of diagnostic procedure.

Treatment

Mild cases of lumbar spondylosis can be treated with medications to relieve pain and physiotherapy to improve mobility by strengthening the spinal column. In severe cases of nerve impingement, the individuals are advised complete bed rest for 2 days. When the symptoms don’t resolve by bed rest then surgical intervention becomes inevitable.

References

Article

  1. Yoshimura N, Dennison E, Wilman C, et al. Epidemiology of chronic disc degeneration and osteoarthritis of the lumbar spine in Britain and Japan: a comparative study. J Rheumatol. Feb 2000; 27(2):429-33.
  2. Yamada Y, Okuizumi H, Miyauchi A, et al. Association of transforming growth factor beta1 genotype with spinal osteophytosis in Japanese women. Arthritis Rheum. Feb 2000; 43(2):452-60.
  3. Muraki S, Yoshimura N, Akune T. Prevalence, incidence and progression of lumbar spondylosis by gender and age strata. Mod Rheumatol. 2014; 24(4):657-61 
  4. O'Neill TW, McCloskey EV, Kanis JA, et al. The distribution, determinants, and clinical correlates of vertebral osteophytosis: a population based survey. J Rheumatol. Apr 1999; 26(4):842-8.
  5. Kramer PA, Newell-Morris LL, Simkin PA. Spinal degenerative disk disease (DDD) in female macaque monkeys: epidemiology and comparison with women. J Orthop Res. May 2002; 20(3):399-408.
  6. Pahl MA, Brislin B, Boden S, et al. The impact of four common lumbar spine diagnoses upon overall health status. Spine J. Mar-Apr 2006; 6(2):125-30.
  7. Miyakoshi N, Itoi E, Murai H. Inverse relation between osteoporosis and spondylosis in postmenopausal women as evaluated by bone mineral density and semiquantitative scoring of spinal degeneration. Spine. Mar 1 2003; 28(5):492-5.
  8. Nathan H. Compression of the sympathetic trunk by osteophytes of the vertebral column in the abdomen: an anatomical study with pathological and clinical considerations. Surgery. Apr 1968; 63(4):609-25.
  9. Tan Y, Aghdasi BG, Montgomery SR, Inoue H. Kinetic magnetic resonance imaging analysis of lumbar segmental mobility in patients without significant spondylosis. Eur Spine J. 2012; 21(12):2673-9
  10. Umeta RS, Avanzi O. Techniques of lumbar-sacral spine fusion in spondylosis: systematic literature review and meta-analysis of randomized clinical trials. Spine J. 2011; 11(7):668-76 

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Last updated: 2018-06-22 06:16