Lumbar Spondylosis

Anatomy of the Spine

The spinal column is made up of small bones (vertebrae) stacked on top of one another, creating the natural curves of the back. Between the vertebrae are flat, round, rubbery pads (intervertebral disks) that act as shock absorbers and allow the back to flex or bend. Muscles and ligaments connecting the vertebrae allow motion while providing support and stability for the spine and upper body. Each vertebra has an opening (foramen) in the center and these line up to form the spinal canal. Protected by the vertebrae, the spinal cord and other nerve roots travel through the spinal canal. Nerves branch out from the spinal column through vertebral openings, carrying messages between the brain and muscles. Facet joints align at the back of the spinal column, linking the vertebrae together and allowing for rotation and movement. Like all joints, cartilage covers the surface where facet joints meet.

The spine contains three segments: lumbar, thoracic and cervical.

Lumbar—The lumbar spine consists of five vertebral bones located in the lower back (L1 to L5) with 5 intervertebral discs located between them; lumbar vertebrae are larger because they carry more of the body’s weight. Disks in the lumbar spine are composed of a thick outer ring of cartilage (annulus) and an inner gel-like substance (nucleus).

Thoracic—The thoracic spine consists of 12 vertebrae and begins at the upper chest, extending to the middle back and connecting to the rib cage.

Cervical—The cervical spine includes the neck and consists of seven small vertebrae, beginning at the base of the skull and ending at the upper chest.

What is Lower Back Arthritis or Lumbar Spondylosis?

Lumbar spondylosis is a degenerative condition that affects the small joints in the lower back, also known as facet joints. Like the rest of the body, the bones in the lumbar spine, or lower back, slowly degenerate as we age, often resulting in lumber spondylosis, or arthritis of the lower back. Also referred to as osteoarthritis, these changes don’t always produce symptoms, but they are a common cause of spine issues ranging from mild to severe.

What Are the Causes and Risk Factors?

The intervertebral disks of children and young adults have a high water content. As the body ages, they dry out, causing them to stiffen and weaken. The disks settle, or collapse, and lose height and begin to bulge. Space between disks grows smaller and the vertebrae shift closer together. The facet joints experience increased pressure and begin to degenerate and develop arthritis. The body responds to degeneration and lost cartilage by growing new bone to strengthen and support the vertebrae. This bone overgrowth is also known as bone spur formation.

Risk factors include:

  • Advancing age
  • Occupational or physical activities that place repetitive and/or excess stress on the lower back
  • Lower back injuries
  • Poor posture
  • Prolonged periods of sitting
  • Obesity
  • Genetics
  • Trauma or damage to the spine
  • Smoking

What Are Symptoms of Arthritis of the Lower Back?

Symptoms may vary depending on causative factors and don’t always appear. Back pain and stiffness are most common, and these are usually worse in the morning and improve throughout the day. If bone spurs push against a nerve root or the spinal cord, you may experience numbness, tingling, weakness, aching, or shooting pain in the buttock and leg.

Common signs and symptoms include:

  • Lower back pain
  • Stiffness after prolonged inactivity
  • Radiating pain from the lower back to legs or buttock region
  • Reduced flexibility and movement in the lower back
  • Abnormal sensations of tingling and numbness

How is Lumbar Spondylosis Diagnosed?

Lower back arthritis is usually diagnosed based on your history of symptoms, complete medical history, and a thorough physical examination. The physical exam may include palpation to assess tenderness and muscle spasms, measuring degree of motion, and neurological evaluation of reflexes to test any pain, tingling and numbness sensations. Diagnostic imaging studies, such as X-rays, magnetic resonance images (MRI), computed tomography (CT), myelography, or electromyography (EMG) may be necessary to fully assess your condition and confirm your diagnosis. Your physician may also consult with other medical specialists.

Nonsurgical Treatment

Lumbar spondylosis is commonly treated with nonsurgical options.

Ice, heat other modalities—Careful application of ice, heat, massage and other local therapies can help relieve symptoms.

Physical therapy—Strengthening and stretching weakened or strained muscles and aerobic exercises are often among the first treatments advised. Other approaches include massage therapy, spine manipulation and lumbar back support for spine stability and reduction of forces. Physical therapy programs vary, and your physician and physical therapist will recommend what’s most appropriate for you.

Medications—During the first phase of treatment, several medications may be used together to address both pain and inflammation. Acetaminophen may be used to relieve mild pain. Nonsteroidal anti-inflammatories (NSAIDs) such as ibuprofen and naproxen are often prescribed for several weeks in combination with acetaminophen to address both pain and swelling. If you have serious contraindications to NSAIDs or your pain is not well-controlled, other types of pain medication can be considered, depending on your specific problem. Painful muscle spasms may be treated with muscle relaxants, such as cyclobenzaprine or tizanidine.

Nerve blocks and radiofrequency ablation—During a nerve block for lumbar spondylosis, your doctor injects a local anesthetic near the medial branch nerve (the nerve that sends pain signals from the facet joints) to provide temporary relief from pain. If the pain is at least 80% improved for the length of the local anesthetic, your physician will have identified the source of your back pain. Next, your physician will block the pain more permanently by damaging the nerve with radiofrequency, a procedure called radiofrequency ablation.

Steroid-based injections—Many patients find short-term pain relief from steroid injections. Although less invasive than surgery, steroid-based injections are prescribed only after a complete medical evaluation. Epidural steroid injections, facet injections and sacroiliac (SI) joint injections may provide symptomatic relief. The risks and benefits of each should be discussed with your physician.

Surgery

Surgical options such as spinal fusion or decompression are reserved for patients who have severe pain that has not been relieved by other treatment. Unfortunately, some patients with severe pain are not candidates for surgery due to the widespread nature of their arthritis, additional medical problems, or other causes for their pain, such as fibromyalgia. Patients with progressive neurologic symptoms, such as weakness, numbness, or falling are more likely to be helped by surgery.

Complications

As with any surgery, there are some risks, and these vary from person to person. Complications are typically minor, treatable and unlikely to affect your outcome. For most people, surgery can provide relief of symptoms and return to function with relatively low risk of complications. Overall, elderly patients have higher rates of complications from surgery, as do patients who are overweight, diabetics, smokers, or suffering from multiple medical problems. Among the general, potential risks associated with surgery are infection, bleeding and blood clots, and reactions to anesthesia. Be sure to discuss the potential risks and benefits with your surgeon prior to surgery.