Lumbar spondylosis is an age–related dystrophic process in the lumbar vertebrae. It is accompanied by dystrophy of the fibrous rings of the intervertebral discs, as well as gradual ossification of the anterior longitudinal ligament and the appearance of bone growths along the lateral and anterior surfaces of the spine. It usually develops as a result of natural aging, less often occurs in young people with severe posture disorders. Often it is asymptomatic. There may be pain, discomfort and restriction of movement. The diagnosis is made according to radiography, MRI and CT. Conservative treatment: physical therapy, physiotherapy, manual therapy. Operations are rarely required.
Lumbar spondylosis is a degenerative-dystrophic process in the lumbar spine. The process is based on the dystrophy of the lateral or anterior parts of the fibrous rings of the intervertebral discs and the formation of bone growths on the lateral and anterior surfaces of the vertebral bodies. It is manifested by stiffness, pain or a feeling of discomfort. In 27-37% of patients, it is not accompanied by clinical symptoms. It is observed in both men and women. The incidence rate increases dramatically with age.
Currently, specialists consider spondylosis, spondyloarthrosis and osteochondrosis as equal manifestations of the aging processes of the spine. Many patients have a combination of these diseases, while pain is often a consequence of spondyloarthrosis or osteochondrosis, and isolated spondylosis can be asymptomatic. Treatment of lumbar spondylosis is carried out by orthopedists, traumatologists and vertebrologists.
Modern specialists in the field of traumatology and orthopedics tend to evaluate lumbar spondylosis as a pathology that occurs under the influence of many factors, the main of which are natural age-related changes in the intervertebral discs, bones and ligaments of the spine. Along with this, the sedentary lifestyle of a modern person plays a certain role. The lumbar spine and surrounding muscles, deprived of normal physiological loads, gradually weaken. Against this background, one-time physical exertion with episodic attempts to “lead a healthy lifestyle” often cause microtrauma of the spinal ligaments and provoke increased replacement of damaged ligaments with bone tissue.
Factors provoking the development of spondylosis are metabolic disorders and spinal overload, including overweight (obesity), heavy physical labor, irrational nutrition and the presence of chronic diseases: atherosclerosis, diabetes mellitus, etc. Some authors note a constitutional predisposition. In addition, lumbar spondylosis can occur at various times after injuries and infectious diseases, or become a consequence of gross violations of posture – kyphosis, scoliosis and kyphoscoliosis.
The height of the discs in lumbar spondylosis remains unchanged for a long time, the ratio of the various elements of the spine is not disturbed, therefore, in the absence of spondyloarthrosis (osteoarthritis of small intervertebral joints) and osteochondrosis, the disease often proceeds asymptomatically. In the late stages or in combination with spondylosis with other degenerative-dystrophic processes, nerve compression is possible, which can manifest itself in pain, impaired sensitivity and movement.
Uncomplicated pathology is asymptomatic or manifested by local pain in the affected area. The pain is unstable, it increases with intense physical exertion and adverse weather conditions. Rapid fatigue and limited mobility of the lumbar spine are also possible. With the formation of a herniated disc and compression of nerve roots with the development of sciatica, pain can radiate into the buttock and spread along the posterior surface of the lower limb.
Pain with intervertebral hernia is characterized by increased bending forward, prolonged sitting or standing. If the pain syndrome is caused by osteoarthritis (arthrosis of the facet joints), the pain usually increases when standing and walking and decreases or disappears when the trunk is straightened. When compressing nerve roots, tingling and a feeling of numbness may appear in the lower extremities, sometimes muscle weakness is observed. With acute nerve infringement, acute pain in the lower back is possible in combination with impaired bowel or bladder function, pronounced muscle weakness in one or both extremities, numbness of the sciatic zone or inguinal region.
The diagnosis is confirmed using the data obtained by radiography of the spine. Based on radiographs, it is possible to judge the prevalence and severity of pathological changes. The presence of lumbar spondylosis is indicated by osteophytes located on the edges of the bodies of one or more vertebrae. In their appearance, bone growths can resemble beak-shaped protrusions, small sharp points or massive “brackets” that connect the bodies of neighboring vertebrae.
With spondylosis, there is often a discrepancy between clinical and radiological data. Both mild manifestations with gross pathological changes on radiographs and bright clinical symptoms with moderate or weakly expressed radiological signs of spondylosis are possible. The X-ray picture changes slowly, smoothly, over many years. With a significant prescription of the disease, extensive sprawl of osteophytes with the formation of fixing blocks between two or more vertebrae can be detected in the images.
In some cases, radioisotope scanning is used in the process of differential diagnosis. If spinal canal stenosis is suspected, a CT scan of the spine is prescribed in addition to radiography. If necessary, soft tissue formations (nerves, ligaments, discs) should be visualized and the compression of the nervous structures of the patient is directed to an MRI of the spine. Patients with neurological disorders are examined by a neurologist. Electromyography is used to assess the functional state of the nerves involved.
The treatment is carried out by orthopedists or vertebrologists. In the presence of neurological symptoms, patients are usually transferred to the care of neurologists or neurosurgeons. Patients are recommended to observe a rational motor regime, not to overcool and not to overload the spine. With pain syndrome and muscle spasm, muscle relaxants and drugs from the NSAID group are prescribed. Naproxen, meloxicam, ibuprofen are used among NSAIDs, tizanidine, cyclobenzaprine and other drugs are among muscle relaxants. With intense pain, tramadol and other narcotic analgesics are used in some cases. For chronic pain, small doses of tricyclic antidepressants (doxepin, amitriptyline) are sometimes used.
An important part of the treatment of lumbar spondylosis is therapeutic gymnastics performed during remissions. It allows you to strengthen the parotid muscles and, thereby, reduce the load on the spine. In addition, as a result of regular exercise therapy, pain decreases and the functionality of the spine improves. Physiotherapy procedures are actively used, including diathermy, electrophoresis with iodine and calcium, applications of paraffin and ozokerite. Ultrasound is used in the early stages.
To activate metabolic processes in the tissues of patients, they are directed to massage, to improve nerve conduction – to acupuncture. In the absence of contraindications, manual therapy is sometimes prescribed. In case of persistent pain, steroid drugs are injected into the epidural space or trigger points. Patients are given referrals for spa treatment (radon and hydrogen sulfide therapeutic baths, mud therapy, etc.).
Surgical operations for lumbar spondylosis are very rarely required. Indications for surgical intervention are pronounced neurological disorders with the ineffectiveness of conservative therapy. Usually, patients are operated with severe compression of the nerve root with osteophyte or herniated disc, as well as with ponytail syndrome. The operation is performed as planned, after a comprehensive examination, in the conditions of a vertebrological or neurosurgical department. During the surgical intervention, the doctor removes osteophytes, performs transpedicular fixation, interbody fusion, etc. if necessary.
Prognosis and prevention
The prognosis for lumbar spondylosis is relatively favorable. In the absence of other involutive processes in the lumbar spine, the disease often proceeds without pronounced pain and neurological disorders. Systematic observation and regular adequate treatment makes it possible to stabilize the patient’s condition and preserve the functionality of the spine for a long time, however, complete recovery is impossible, since modern medicine does not know medicines or non-medicinal techniques that can “reverse” degenerative changes in the spine.
In the presence of concomitant osteochondrosis and spondyloarthrosis, the likelihood of the formation of intervertebral hernias, increased pain syndrome and the appearance of neurological symptoms that negatively affect the ability to work and quality of life increases. Prevention includes moderate physical activity, exclusion of excessive loads and predisposing factors.