Everyone of us has suffered from back pain at one point or another. Globally it remains one of the most important causes of loss of work and disability. Lumbar spondylosis is a loosely used term, that is used for all back pains. The truth is that it is a a poorly understood term, not just by the common man, but also by medical fraternity.
What is lumbar spondylosis?
Lumbar spondylosis is used to describe degenerative changes in the spine associated with ageing, or certain factors that increase stress on the spine. Lumbar spondylosis prevalence is very high, and roughly 80% of adults will be affected by these degenerative changes.
Spondylosis occurs at other levels of the spine, but is commonest in the lumbar spine. This is simply because lumbar spine bears the maximum load in the entire spinal column.
Is lumbar spondylosis a disease?
Lumbar spondylosis is not a disease. These are normally occurring changes that are associated with ageing, just like osteoarthritis. These changes are inevitable, and The changes keep progressing with time. However, certain factors are associated with an increased rate of degeneration, like obesity, abnormal posture, and disc herniation.
What are the changes that our spine undergoes with ageing?
Vertebrae in our spine are connected to the vertebra above and below at facet joints, and in front a disc, which acts like a cushion separates two adjacent vertebra. With time the facet joints lose their lubrication and get damaged. The damage increases with repeated movements. This is the reason why mobile segments of our spine like cervical and lumbar spine are more affected as compared to relatively immobile thoracic segment of the spine.
Ageing also causes loss of disc hydration and cushioning effect. When the inter vertebral disc is damaged, or removed surgically for disc prolapse, it increases stress on the joints and increases rate of degeneration. Similarly factors like obesity or abnormal posture also increase stress on the spine joints.
Above X-ray shows osteophytes(Arrowhead), the bony outgrowths seen at edges of vertebra representing degenerative changes.
What are the symptoms of lumbar spondylosis?
Lumbar spondylosis per se does not cause any symptoms. However, back pain is often attributed to it. Roughly 80% of adults over 40 years of age will have lumbar spondylosis changes on radiology. Not all individuals with these radiological changes have back pain. The radiological changes are often found incidentally, and will not produce any symptom in a majority of individuals.
What x-ray changes are seen in spondylotic spine?
Over time new bone formation occurs at areas of insertion of ligaments in to bones. These bony protuberances are called osteophytes. These are the most easily recognisable changes on radiology. Some clinicians attributed pain to these osteophytes, but it is not so. Osteophytes are mostly asymptomatic. Sometimes osteophytes growing towards foramen carrying nerve roots may impinge and cause pressure effects, presenting as pain along the distribution of that nerve root.
Disc space height reduces with age, and facet joints become larger. These changes also do not produce any symptoms, unless they compress on nerve roots.
What is the treatment of lumbar spondylosis?
Lumbar spondylosis does not require any treatment. It is inevitable with ageing. The rate of degeneration can be slowed by regular exercise, weight control and maintenance of physiological posture of spine to avoid putting excess stress on the spine joints.
How is it different from Lumbar Spondylolysis?
Lumbar spondylolysis or medically also known as Spondylolisthesis is a specific cause of back pain. It is caused by a defect in the pars of the vertebra which joins the anterior body with the posterior bony structures of the vertebra. This defect results in relative motion of one vertebral body over another, causing back pain. It can be diagnosed on plain X-ray films, with bending forward and backward views showing relative motion. Since the exact mechanism of the pain is known in such cases, surgical stabilisation will yield good results in such patients.
Arrow points to the visible defect in the pars of the fifth lumbar vertebra. The dotted lines show the loss of alignment between the two adjacent vertebra due to relative motion.
Disclaimer: This is not a medical text and should not be used to substitute medical advice. This article is only meant for general public awareness. Contact a qualified spine doctor in case of any significant back pain.