Lumbar Spondylosis-Causes, Symptoms, Diagnosis and Treatment

What is lumbar spondylosis?

Lumbar spondylosis is also known as spinal osteoarthritis. Lumbar spondylosis is an age-related deterioration of the bones of the lower back resulting in back pain and other symptoms. The vertebral bones of the spine in the lower back region are subjected to constant wear and tear throughout life. The wear and tear primarily affect the discs that are present between the vertebral bones and also the joints where two vertebral bones come into contact with each other. This aging-related wear and tear can result in the formation of some new bony growths known as bony spurs or osteophytes.

As the disease progresses, there is a narrowing of the spinal canal which carries the spinal cord and nerves of the lower back. The narrowing of the spinal canal exerts pressure and compresses the spinal cord and nerves resulting in the development of pain, stiffness, and other associated symptoms. The bony spurs also contribute to the development of pain and symptoms of lumbar spondylosis; however, the severity of lumbar spondylosis is not related to the number of bony spurs present.

Are there different types of lumbar spondylosis?

Lumbar spondylosis is a general term that refers to the wear and tear of the vertebrae of the spine in the lower back. The wear and tear and its consequences can present in many different ways, and more than one of these can be present in the same individual. The various degenerative changes that are seen include

• The gradual breakdown of the intervertebral discs that cushion the vertebrae in the spine. The formation of bony spurs may or may not always be present.
• The degeneration of the small joints that connect the vertebrae in the spine.
• Narrowing of the spinal canal and compression of the spinal cord and nerves.
• Forward abnormal positioning of one vertebra over another compressing the nerves in the spinal canal.
• Narrowing the small openings in the vertebrae through which the nerves exit the spine results in a compression of the nerves.

What are the causes of lumbar spondylosis?

Lumbar spondylosis is primarily a disease of aging and age-related changes in the spinal column. There are other factors that can contribute to the development of lumbar spondylosis and more than one factor can be responsible for the development of this condition. Some commonly seen causes include

• Aging: age-related wear and tear of the intervertebral discs and spinal joints can lead to lumbar spondylosis.
• Genetic factors: Genetic components in some people may predispose them to develop lumbar spondylosis.
• Being overweight and obese: excess body weight results in additional stress on the spine and this in turn can result in the development of lumbar spondylosis.
• Trauma and Injuries: fractures or dislocations of the spine can increase the risk of developing lumbar spondylosis.
• Repetitive Actions: performing the same motions such as bending, twisting, or lifting, repeatedly can increase the likelihood of developing lumbar spondylosis.
• Bad posture:  slouching or sitting for long periods of time in a poor posture, can cause the development of lumbar spondylosis.
• Smoking: Smoking affects the blood supply to the spine which results in an impaired ability to heal and repair itself, and this can cause or worsen lumbar spondylosis.

What are the risk factors for lumbar spondylosis?

• Age: the risk of developing lumbar spondylosis increases with age, especially after the age of 45-50 years.
• Family History: a family history of spinal arthritis increases the likelihood of lumbar spondylosis in an individual.
• Gender: lumbar spondylosis is more common in men than in women.
• Excess body weight: Obesity and being overweight puts additional stress on the spine and increases the risk of lumbar spondylosis.
• Occupational Risks: Occupations that require repeated lifting, bending, and twisting motions of the spine increase the risk of lumbar spondylosis.
• A lack of physical activity: sedentary lifestyle weakens the muscles supporting the spine, and this increases the risk of lumbar spondylosis.
• Smoking: damage to the blood vessels in the spine and the reduced blood flow to the spinal tissues due to smoking, increases the risk of lumbar spondylosis.
• History of spinal trauma: fractures or dislocations of the spine increase the risk of lumbar spondylosis.

What are the symptoms of lumbar spondylosis?

Lumbar spondylosis symptoms can vary depending on the extent and location of the damage in the lower spine. Some of the symptoms include

• Low back pain: This is the most common symptom and the pain may be sharp or dull. The pain may be present in only one part of the lower back or it may radiate into the buttocks and legs.
• Low back stiffness: there may be stiffness in the lower back making it very difficult or painful to bend or twist.
• Tingling or Numbness: the compression of the nerves in the spine causes numbness or tingling sensations in the legs or buttocks.
• Weakness in the legs causes problems with standing or even walking.
• Bladder or bowel problems: although a rare symptom of lumbar spondylosis, bladder, and bowel function may be affected when the nerves controlling these functions are compressed.
• Radiculopathy: radiation of pain, numbness, and weakness into the leg due to compression of the nerves in the spine. It is a commonly seen complication of long-term lumbar spondylosis.

How is lumbar spondylosis diagnosed?

Lumbar spondylosis is diagnosed by doctors through medical history, physical examination, and investigations such as imaging tests. The doctor will first inquire about the symptoms of the problem including the location of pain or stiffness, the duration, and any other problems being experienced.

This will be followed by a physical examination in which the doctor tests the range of motion in the affected area, strength of muscles and muscle reflexes in the lower back and the legs, etc. Some physical tests that are done include

• Range of motion of the lower back and lower limbs – assessed by bending forward, backward, and to the sides for the spine; straight leg raise, etc. for the legs.
• Reflexes – reflexes in the knees and the ankles are tested to assess the nerve function
• Leg muscle strength assessment – through tests such as standing on tiptoes, etc.
• Gait assessment – done by observing an individual as they are walking
• Pain assessment – through exerting pressure on the lower back
• Balance and coordination tests – such as walking in tandem, one-leg stand, etc.

Investigations that are done can include

• Imaging tests such as X-rays, CT scans, or MRI may be advised to look for degenerative changes, the presence of bony spurs, and spinal canal compression.
• Electromyography or EMG – using electrical impulses and internal electrical activity, the damage to nerves and muscles is assessed.
• In some cases when imaging tests are inconclusive, the injection of steroids into the spine joints is done to evaluate the cause of pain.

What is the treatment for lumbar spondylosis?

Lumbar spondylosis treatment depends on the severity of the condition and the location of the problem within the spine. The aim of treatment is to provide relief from symptoms and prevent further damage. Treatment for lumbar spondylosis can include

• Pain relieving medications: Depending on the severity of symptoms and pain medications such as paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), or muscle relaxants may be prescribed to provide relief from pain and muscle spasms. In severe cases, stronger prescription medications such as opioids may be needed.
• Local Injections: corticosteroids or local anesthetic injections are sometimes used to reduce inflammation and provide relief from pain in the problem area.
• Surgical Interventions: When conservative treatments have been unable to provide relief and are ineffective, surgical interventions may be needed to reduce pressure on the affected nerves or spinal cord. Surgical procedures may include surgeries such as laminectomy, spinal fusion, or discectomy.
• Physiotherapy: Physiotherapy helps to improve strength, flexibility, and range of motion in lumbar spondylosis. Exercise, manual therapy, or other physiotherapy techniques to reduce pain and improve overall function.
• Lifestyle Modifications: Lifestyle modifications such as losing excess weight, regular exercise, and maintaining proper posture can help reduce symptoms and prevent further progress of the disease.
• Assist devices: Devices such as back braces or canes may be advised for additional support and to reduce pain and other symptoms.

What kind of physiotherapy helps with lumbar spondylosis?

The type of physiotherapy that is needed varies between individuals and is based on the severity of the problem and the symptoms present. In general lumbar spondylosis, physiotherapists employ the following

• Manual physiotherapy: massage, joint mobilization, and spinal manipulation to improve mobility, reduce pain, and restore function.
• Exercises: Exercises specifically designed to improve strength, flexibility, and range of motion in the affected area. Exercises are developed individually based on individual fitness level, and severity of the problem.
• Heat therapy and cold therapy: Heat therapy is done through hot packs or warm towels to improve circulation and reduce muscle tension. Cold therapy is done through ice packs or cold compresses to reduce inflammation and swelling.
• Electrical stimulation: Using electrical currents the muscles and nerves in the affected area are stimulated and this helps to reduce pain, improve circulation, and promote better repair and healing.
• Traction: The spine is gently stretched with the help of mechanical devices and this helps to decompress the discs and reduce the pressure on the nerves that are being compressed.

Are there any specific exercises one can do for lumbar spondylosis?

There are specific exercises that can help improve the strength, flexibility, and range of motion of the spine. However, these exercises should only be done in proper form and manner to avoid injury or exacerbation of an existing problem. It is therefore important to consult a doctor and a physiotherapist before starting any new exercise program or incorporating these exercises into an existing program for lumbar spondylosis management. Some exercises that are of benefit include

• Knee-to-chest stretch: while lying on the back with the knees bent and the feet flat on the floor, bring one knee towards the chest, holding it with both hands. Hold for several breaths, then release and switch sides. This should be repeated several times as comfortable in a set.
• Pelvic tilt: Lie on the back with your knees bent and your feet flat on the floor. Inhale and tilt the pelvis forward, pressing the lower back into the floor. Exhale and tilt the pelvis back, lifting the lower back off the floor slightly. This should be done several times as comfortably in a set.
• Seated spinal twist: Sit on the floor with the legs extended in front. Bend one knee and place the foot on the outside of the opposite knee. Inhale and lengthen your spine, then exhale and twist towards the bent knee, using your opposite hand for support. Hold for several breaths, then release and change sides. This should be repeated several times as comfortable in a set.
• Bridge pose: Lie on the back with your knees bent and feet flat on the floor. Inhale and lift the hips towards the ceiling, pressing the feet and shoulders into the floor. Hold for several breaths, then release. This should be repeated several times as comfortable in a set.

What lifestyle changes help in getting relief from lumbar spondylosis?

Lumbar spondylosis greatly benefits from simple lifestyle modifications. Some of these include

• Maintaining a healthy weight:  reduces stress on the spine and reduces symptoms.
• Regular Exercise: Low-impact exercises such as walking, swimming, or cycling help to improve strength, flexibility, and range of motion in the affected area
• Maintaining a good posture: reduces stress on the spine and prevent further damage. One should always attempt to sit with the back as straight as possible and with the feet planted flat on the floor. One should also avoid standing or sitting in one position for too long.
• Using ergonomic furniture: ergonomic adjustments at work or home reduce stress on the spine. Some examples include using a supportive chair or pillow, keeping the work desk or computer monitor at a proper height, etc.
• Stopping Smoking: Smoking reduces blood flow to the spine and speeds up the degeneration process while slowing down healing. Stopping smoking promotes healing and slows down degenerative changes.
• Reducing Emotional Stress: Stress increases symptoms of lumbar spondylosis, and taking measurements such as deep breathing, meditation, or yoga can help reduce symptoms.
• Getting sufficient sleep: Sufficient rest and sleep is essential for overall wellbeing and also reduces the stress on the spine.