1. Spondylosis (OA) - Lumbar

2. 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.

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

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

6. 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.

7. 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

8. 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)

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

10. 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

11. Severe arthritis
Degenerative disc disease
Spinal stenosis

12. Risk factors Advancing age Past injury to spine Heredity factors
Smoking

13. 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

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

15. Treatment

16. 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

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

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

20. 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.

21. Comparisons between different articles
All articles identified that disc degeneration can be established in most cases between the ages of
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

22. 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

23. 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.

24. 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.

25. 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 Current revolution of musculoskeletal medicine 2(2):
ylosis/lumbar_symptoms/
Retrieved on 17 May 2012.

26.
Retrieved on 17 May 2012