Lumbar Spondylosis Induced Lower Back Pain - Diagnosis and Prevention

Lumbar Spondylosis Induced Lower Back Pain

Dr.Amith Jain profile Authored by Dr.Amith Jain on 4 Feb 2015 - 09:55.

Spondylosis is an age-related degeneration (wearing and tearing) or deformation of the joints between the spinal discs (vertebrae) in the neck region, middle back, causing cervical spondylosis and thoracic spondylosis respectively. Lumbar spondylosis is the degeneration of the cartilage and bones of the spine located in the lower back area.

Among all these, lumbar spondylosis is quite common (affecting almost 60–85% of the elderly population) as the lower back is majorly involved in a wide range of motions, twisting and bending actions and bears most of the body weight. Lumbosacral spondylosis, typically means, degeneration of the spinal joint connecting last spinal disc of the lumbar spine (L5) and first spinal disc of the sacral spine (S1). Although lumbar spondylosis is an age-related condition, it may begin as early as 20 years of age with risk increasing with growing age, among men and women. However, it is more common in an individual above 40 years old.

 

 

With aging, cartilages begin to dry resulting in loss of elasticity, lubrication, reduced motion range of the joints, etc. This may exert excess pressure causing deformities in the spinal discs. Deformities of the spine may include, broken discs (vertebrae), bulging in the discs, stenosis, bone spurs, arthritis, and so on.

 
 
 

In most of the cases, lumbar spondylosis may remain asymptomatic (asymptomatic cases may account to approx. 27- 37% cases) and remain undiagnosed, while others may produce mild symptoms that may go away within 6 weeks or so. However, symptoms of lumbar spondylosis are often associated with nerve compression (excessive pressure on the spinal nerves). Common symptoms of lumbar spondylosis may include:

  • Stiffness in the lower back, especially in the morning
  • Lower back pain
  • Worsening of the back pain with long term sitting, or movements like twisting or bending and improve on sitting in the supine position.
  • Imbalance while walking or standing still
  • Uncontrolled bladder or bowel movements (rare)
  • Tingling and numbness in the lower back, tailbone, hip joints, legs, toes, buttocks, calves, hamstrings and so on.
  • Weakness in the lower back, legs.

 

 

 

The first phase of diagnosis of lumbar spondylosis may involve assessment of medical history and detail physical examinations which is then followed by several imaging tests and other exams.

  • Assessment of medical history of high risk occupations, injury and range of symptoms presented.
  • Physical examination.
  • Imaging studies: Imaging modalities like pain film, CT scan, CT myelogram or MRI may be done to identify deformity in the spinal disc, lesion or region of nerve compression.
  • Electromyography studies: Electromyography (EMG) and nerve conduction velocity (NCV) may be considered to look for the signs and symptoms of the nerve compression.
  • Bone density scan: It uses dual-energy x-ray absorptiometry scan [DEXA] to confirm the absence of osteophytes. Presence of osteophytes may lead to misdiagnosis or may mask the osteoporosis.

 

 

While lumbar spondylosis is age related degeneration of bones and cartilages in the lumbar spine, several factors may trigger the onset of the condition such as:

  • Being older (above 40 years)
  • Being involved in specific activities or occupation that demands frequent movements like bending, twisting or bearing weight. E.g.  Continuous driving, sports, labor, cooli, etc.
  • Genetic alteration or heredity (an alteration in the gene regulating vitamin D and the process of inflammation).
  • Past spinal injury or trauma
  • Severe arthritis.

 

 

Those who present a range of symptoms, may be treated with interventions including physiotherapy, pharmacotherapy, surgical interventions, non pharmacotherapy approaches and alternative remedies. Based on the severity of the symptoms, single, or multiple therapies may be recommended. Commonly preferred interventions may include:

  • Physiotherapy: with an expert’s guidance is often effective to treat lumbar spondylosis with or without other interventions.
  • Drugs and medications: A variety of medications in addition to non-pharmacological interventions may be given to reduce pain, inflammation and to improve overall quality of life. Drugs such as Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), opiate medications, antidepressants, muscle relaxants, and so on may be prescribed.
  • Injection therapy may include:
  • Epidural steroid injections (ESI): It is corticosteroid injection that helps to relieve the chronic pain in the lower back caused due to lumbar spondylosis.
  • Facet or zygapophysial joint injections: It is given at the articulations between adjacent spinal discs in the lower back region to relive the pain.
  • Intradiscal nonsurgical therapies: These are mainly indicated to treat pain originating from a damaged vertebral disc. These may include:
  • Intradiscal electrothermal therapy (IDET): It is a recent minimally invasive treatment used for spinal disc related severe low back pain. It offers long term benefits in terms of pain relief but not immediately. It takes 5 to 6 months to regain strength after the IDET. Patients undergoing IDET often need other supportive therapies like physiotherapy. Like all other therapies, this also has some risks, including infection, nerve damage and disc damage.
  • Surgical interventions: It is mainly indicated in patients who do not respond to the other conservative interventions like medication and other therapies. Surgical procedure may be spinal fusion, spinal decompression (in case of nerve compression), or often both. The surgeon will choose the most appropriate procedure based on an individual’s condition and age.
  • Spinal fusion: It is a procedure of placing graft between the discs that further grow and corrects the alignment and/ or reduces the motion.
  • Spinal decompression: It is a procedure to relieve one or multiple pinched nerves causing neural impingement.

Other therapies

  • Exercise therapy: It is one of the most effective therapies for the treatment of chronic lumbar spondylosis. Recommended exercises may include stretching exercises, muscle strengthening, and various aerobic exercises. (Talk to your doctor / expert about choosing exercises, duration and intensity.)
  • Transcutaneous Electrical Nerve Stimulation (TENS): It is the non-invasive procedure or therapy of relieving the chronic back pain with the aid of electrodes (placed on the skin) that passes electrical stimuli to nerves regulating pain and reduces the pain.
  • Lumbar back support: These help to reduce spine motion, mechanical pressure and stabilize the spine by correcting deformity through massaging the painful area and applying heat.
  • Traction: It is the procedure of applying the force to the lumbar spine using specific mechanisms and equipments to relieve the chronic low back pain.
  • Spinal manipulation: It is performed on the synovial joints in the spine. It is believed to relieve the pain via several mechanisms such as relaxing muscles of the spinal joint, disrupting of adhesions, correcting displacement, reducing bulges in the disc, repositioning, altering the neurological function, reducing muscle spasm and so on.
  • Massage therapy: Appropriate massage by expert may offer some relief to the patients with chronic pain associated with lumbar spondylosis.

 

 

 

  • Prevent spinal injury
  • Exercise daily (4 times a day)
  • Manage conditions like arthritis effectively.
  • Ergonomics at office and home:
  • Sit properly while working and keep an eye on your posture
  • Avoid sitting too high from ground (16 to 21 inches from the ground is ideal)
  • Don’t keep your legs hanging all the day, rather use a footstool to rest your legs
  • Raise your work desk if you are unusually tall
  • Support your back
  • Keep the arms slightly lifted at the shoulders

 

 

 

*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.