Lumbar spondylosis is a condition which causes pain in the lower back due to age-related degenerative changes in the spinal discs and vertebrae. The lower back begins from the lowest rib to the upper portion of the buttock. It consists of 5 vertebral bones named L1 to L5, with 5 intervertebral discs located between them. This lower back region is known as the lumbar spine. Degeneration of the intervertebral discs, vertebrae and their facet joints in this lumbar region leads to lumbar spondylosis.
Causes and risk factors of Lumbar Spondylosis
The causes and risk factors of lumbar spondylosis includes:
- Increasing age: With increasing age the vertebrae, bones and joints, and intervertebral discs undergo natural wear and tear and become weak.
- Strenuous spinal movements: Activities with excess stress on the lower back can lead to formation of bone spurs, causing pain.
- Lower back injuries: Any previous injuries to the lower back have chances to eventually cause lumbar spondylosis.
- Prolonged sitting periods: Prolonged sitting positions can increase pressure on the lumbar spine, leading to lumbar spondylosis.
- Obesity: Being overweight increases the load on the lumbar region of the spine, leading to higher risk of developing lumbar spondylosis.
Other risk factors include:
- Smoking
- Genetics
- External injuries
- Lifestyle factors
- Occupational or physical activities involving additional strain on lower back.
Signs and symptoms of Lumbar Spondylosis
Signs and symptoms may vary due to the different causative factors of lumbar spondylosis. A few of the common signs and symptoms include:
- Lower back pain
- Stiffness after prolonged periods of inactivity
- Radiating pain from the lower back to legs or buttock region
- Reduced flexibility and movement in the lower back
- Abnormal sensations of tingling and numbness
- Weakness of leg muscles.
Diagnosis of Lumbar Spondylosis
Lumbar spondylosis is diagnosed based on medical history, physical and neurological examination and diagnostic scans.
Physical examination: The physical examination may include palpation to assess tenderness and muscle spasms, measurement of degree of motion, and neurological evaluation of reflexes to test the pain, tingling and numbness sensations.
Diagnostic scans: Diagnostic scans may include a CT scan and MRI. CT scan helps to identify any bone growths or spondylosis-related bone changes. MRI is a great diagnostic tool to clearly visualize minute details of spinal ligaments, nerves, vertebrae, facets and intervertebral discs to detect abnormalities.
Treatment of Lumbar Spondylosis
Management of lumbar spondylosis is divided into four categories. They include: Physical therapy, medications, injection therapy and surgical interventions.
Physical therapy: Physical therapy may include strengthening, stretching and aerobic exercises. Other approaches include massage therapy, spine manipulation and lumbar back support for spine stability and reduction of forces.
Medications: Pain relieving medications such as Non-Steroid Anti-inflammatory Drugs (NSAIDs) and muscle relaxants are given. Opioid medications are used as alternatives for patients with poor pain relief with NSAIDs and gastrointestinal symptoms.
Injection therapy: Symptomatic relief may be provided with epidural steroid injections, facet injections and sacroiliac (SI) joint injections. Epidural steroid injections are given in the epidural space at the desired vertebral area. Facet injections are given in the joint space between consecutive vertebrae. SI joint injections are given in the joint space between the spine and the pelvis.
Surgical interventions: Surgical interventions are considered in patients who have shown poor outcomes with conservative management. The two main aspects in surgical intervention for lumbar spondylosis are spinal fusion and decompression. Decompression is the removal of tissues to relieve nerve impingement followed by stabilization.
Transforaminal lumbar endoscopic interbody fusion is a minimal invasion endoscopic technique for spinal fusion. It uses smaller incisions and instruments with minimal blood loss, lesser trauma and faster recovery.
