Spondylosis (OA) - Lumbar

Definition “Spondy” is Latin for spine “Losis” is the Latin term for problem. Not only osteoarthritis of the lumbar spine, but also implies the degeneration of a intervertebral disc or even of the vertebra itself. Degeneration of the spine caused by wear and tear on the vertebral joints in the lumbar area.

Referred to by many names Lumbar arthritis Disc degeneration Degenerative disc disease

Pathophysiology Symptoms more common in persons over 60 years of age (wear and tear)

However degeneration can start at 30 years of age. Associated with several other phenomena: Spinal stenosis Osteoarthritis of spinal joints Degenerative disc disease Not life threatening, but can cause nerve damage with resultant devastating effects.

Phases of degeneration Phase 1: Dysfunction phase Repetitive micro trauma Painful tears of outer, innervated annulus fibrosis and associated end-plate separation This compromises disc s’ nutritional supply and waste removal Result: dehydration and loss of disc height

Phase 2: Instability phase Characterised by loss of mechanical stability Progressive disc changes of resorption Internal disruption Additional annular tears Further facet degeneration Result in sublaxation and instibility (ligament laxity due to deformities)

Phase 3: Stabilization phase Disc space narrowing Fibrosis along with the formation of osteophytes Transdiscal bridging

Causes Wear and tear is most NB cause!!!!!!!! Lumbar and cervical spine have to support the weight of the head and upper body. Increases with age. Extreme athletics Injury to vertebra (specifically lumbar region) Less common

Severe arthritis Degenerative disc disease Spinal stenosis

Risk factors Advancing age Past injury to spine Heredity factors Smoking

Most common signs and symptoms Pain Tingling Numbness Weakness – start in lower back and then radiate through buttocks, hips, legs, feet and toes. Stiffness in back Loss of sensation Loss of balance Loss of bladder and bowel control Muscle spasms

Complications Chronic pain Faecal and urinary incontinence Permanent disability (rare)

Treatment

1. Pain management In order to help patient performing ADL with minimal discomfort. Short course pain medication (NSAIDs) Voltaren Muscle relaxants Nerve pain medications Antidepressants (low dosages) Traction

2. Physiotherapy Ice or heat modalities Electrotherapy Strengthening exercises Acupuncture Massage therapy May also benefit for yoga

3. Surgery Only if conservative treatment fails Spinal fusion and spine decompression.

Article by K. Middleton and D.E. Fish Lumbar spondylosis: Clinical presentation and treatment approaches Lower back pain (LBP) affects 60-85% of adults at some point in life. 90%- symptoms disappear within 6 weeks. 15-45% develop chronic back pain. Sometimes difficult to determine the exact cause of LBP.

Comparisons between different articles All articles identified that disc degeneration can be established in most cases between the ages of 20-29. Most symptoms can appear at age 40, but normally appear at >60 years of age. Anatomical changes Spinal stenosis with the growth of osteophytes. Hypertrophy of the inferior articular process Disc herniation Bulging of ligamentum flavum

These anatomical changes result in neurogenic claudication (NC). NC include: Lower back pain Leg pain Numbness and motor weakness of lower extremities that worsens with upright stance and walking and Improves with sitting and supine positioning Impact of activity and occupation Driving High body mass index Daily spine loading – twisting, turning and lifting heavy objects

Physiotherapy Compared to pain medication and surgery = best intervention. Especially exercises that focus on stretching and strengthening. TENS – not for long term pain relief. Myofascial therapy and joint manipulation also very successful.

Terminology Arthritis of the spine: This affects the joints that connect the vertebrae, namely the facet joints. Degenerative disc disease: This affects the intervertebral discs, which begin to loose water and elasticity over time . Spinal stenosis: Gradual narrowing of the spinal canal of foramina, which are passageways between the vertebra that allow nerve roots to exit the spine.

References http://emedicine.medscape.com/article/249036- overview Retrieved on 15 May 2012 K. Middleton and D.E. Fish. Lumbar spondylosis: Clinical presentation and treatment approaches. 2009. Current revolution of musculoskeletal medicine 2(2):94-104. http://www.laserspineinstitute.com/back_problems/spond ylosis/lumbar_symptoms/ Retrieved on 17 May 2012.

http://www.localhealth.com/article/spondylosis Retrieved on 17 May 2012