Lumbar Spondylosis: Causes and Treatments

Lumbar spondylosis is a disorder that includes all degenerative processes in the vertebras, intervertebral disks, ligaments, and joints. The degenerative disease primarily affects the population of older adults. Spondylosis is one of the reasons for chronic lower back pain that can be managed by exercise and physical therapy.

What is lumbar spondylosis?

Lumbar spondylosis is a broad term covering many diseases related to back pain. The term spondylosis can be applied to vertebral bodies, disks, ligaments, and joints of the lumbar spine. In many cases, it is a degenerative disease diagnosed as one of the following:

• Lumbar osteoarthritis. This is a disease that affects vertebral bodies. The joint space is narrowed because bony outgrowths form around the vertebral end plate.
• Intervertebral osteochondrosis. It affects not only the vertebra body but also the intervertebral disks and, as a consequence, nerve roots.
• Degenerative disk disease. It affects intervertebral disks, which can bulge, fissure, desiccate, and narrow. Consequently, the degenerated disk squeezes nerve roots and presents as back pain, leg pain, or numbness in the leg.
• Spinal stenosis. It reduces the space for the nerves and vascular elements in the lumbar spine. Spinal stenosis can arise as radiating pain and numbness in the leg. Sitting or leaning forward reduces the symptoms and alleviates pain.
• Degenerative spondylolisthesis. Spondylolisthesis means that one vertebral body is slipped in relation to an adjacent vertebral body. This can cause pain and radiating pain in the legs.

Risk factors for lumbar spondylosis

Lumbar spondylosis can appear at a young age (20 years old) and be asymptomatic but does so only in a small percentage of cases. Degenerative lumbar diseases primarily affect older adults population >65 years old. Several risk factors can cause lumbar spondylosis, including the following:

• Age. Aging is the strongest risk factor that affects bones, especially the spine. Disk degeneration increases from 16% at 20 to 98% at 70. Increasing age is related to osteophyte (bony outgrowths) formation.
• Body mass index. Higher BMI impacts lumbar degeneration, too, because of the heavier weight load on the spine and intervertebral disks.
• Manual work and constant heavy weight lifting. Frequent twisting, lifting, bending, or whole-body vibration increases spinal loading and the risk for degenerative disease. All these movements are very important for the spine and are performed during training. However, continuous and asymmetrically performed movements during working hours negatively impact the spine.

Diagnosing lumbar spondylosis

The first step in diagnosis is reviewing previous patient history and conducting an examination. Afterward, that physician will direct you to do a radiological assessment. Firstly, an X-ray is taken. If there is a need for additional tests, an MRI and CT scan will be ordered. An MRI is a very good tool for examining soft tissue conditions. An MRI accurately detects degenerative disk disease, degenerative end plate changes, disk herniation, spinal compression, and the consequences of instability in degenerative lumbar spondylosis.

Treatment lumbar spondylosis

Patients with lumbar spondylosis feel mostly pain and stiffness and sometimes radiating leg pain. However, the initial phase of treatment starts with education about the diagnosis and what can be done to relieve the symptoms. If the degenerative disease is not or cannot be treated by exercises or other physiotherapy procedures, it progresses.

When the disease progresses, the symptoms progress too. Suppose you have a pinched nerve because of degenerative disk disease or stenosis. In that case, symptoms can worsen, and from the symptom “radiating pain,” symptoms can progress to numbness and motor weakness in the lower extremities. It affects our gait and balance and increases the risk of falls and other injury rates. Be patient and consider the following procedures; they can help your spinal issues.

Exercise therapy

Exercise therapy is one of the most important procedures that helps with chronic lumbar spine pain. Plenty of exercises and different types of physical activity strengthen the spine: aerobic exercises, strengthening exercises, stretching, and balance exercises. Most importantly, the exercise program should be designed to treat individual issues, including duration, intensity, and frequency. A variety of exercises is also important. These challenge your spine muscles and help them adapt to different conditions you'll encounter in your daily life tasks. For example, Pilates and yoga help greatly with lumbar spine problems.

Back school

These schools were created to minimize lower back pain symptoms. These schools have specially designed exercises for the lumbar spine. Moreover, they educate patients about spine ergonomics, posture, and lumbar anatomy. Literature shows that it is beneficial in handling lumbar pain.

Transcutaneous electrical nerve stimulation

Transcutaneous electrical nerve stimulation (TENS) stimulates peripheral nerves through the skin’s surface to relieve pain noninvasively. The long-term effect of relieving pain is still unclear.

Back aids

There is moderate evidence that lumbar supports can help to relieve pain. The idea of lumbar support is to stabilize and reduce mechanical forces on the spine. However, this is not more effective than other treatment forms.

Massage therapy

Massage may be helpful when you need quick relief from back pain; however, it is temporary and less effective than other procedures.

Pharmacotherapy

Medications might be helpful when used with non-pharmacological treatment such as exercise therapy or TENS. Reducing pain can help to do more exercises and achieve better results.

Spine manipulation

The study showed that spinal manipulation has an immediate effect on reducing pain. However, the long-term effect still needs more research.

Injection therapy

Studies showed that injection therapies into facet joints or epidural steroid injections showed short-term effects in pain reduction. However, injections in the sacroiliac joint showed a longer effect than spinal manipulation or pharmacotherapy.

Surgical intervention

Surgical interventions are proposed only for those who failed conservative treatment or have worsening symptoms such as radiating pain. However, the surgical procedure has criteria for the patient’s age, socioeconomic status, and activity level following a procedure. Furthermore, intensive rehabilitation starts after the surgery, and exercises must be performed consistently.

Spondylosis increases with age and affects neck and lumbar spine areas. The primary treatment is exercise therapy which can be combined with medications for better results. However, all medications should be prescribed to meet individual needs.