Lumbar Spondylosis

Question 1

Definition

Answer 1

A degeneration of the lumbar spine due to natural ageing

More likely to occur in ages 50-60 as degeneration will begin to take place

Occurs in 84% of men and 74% of women

Question 2

Aetiology

Answer 2

Due to ageing and constant loading throughout life, the intervertebral discs become drier, thinner and more stiff as they loose water. So they loose their cushioning ability

The cartilage protecting the facet joints begin to erode away causing friction between joints

The bone begins to grow osteophytes as a compensation
– 90% of cases occur at the L5 and 10% occur at L4

Question 3

Pathology

Answer 3

Degeneration due to repetitive microtrauma causes a decrease in the size and quality of the proteoglycan aggregates (the major structural component of the extracellular matrix of the cartilage) within the nucleus, which causes the vital glycosaminoglycans (GAG’s) to leach out, resulting in a loss of water and swelling pressure

A microscopic net amount of water is lost from the discs each day

This causes disc height to reduce meaning there is less cushioning so the facet joints rub together

The vertebrae will thicken due to wolfs law (a trabecular modification of bone under mechanical stress) in order to carry the load of the spine

Osteophytes form which causes lumbar facet joints to become stiffer and wider

The pars interarticularis can fracture

Question 4

Clinical presentation:

Answer 4

Often asymptomatic

pain located in the lower back

pain located in the axial spine (this is because nociceptive pain generators are present within the facet joint and intervertebral disc structures)

loss of movement and pain with rotation and extension

Question 5

Treatment

Answer 5

Lumbar spondylosis is not reversible and there is no cure, several treatment option are available to help ease pain and stop further progression of the disease

– exercise therapy
– physical therapy
– prescribed medications:
—- NSAID’s
—- Muscle relaxers (cyclobenzaprine) can help reduce painful muscle spasms
—- severe cases opioids can be used (oxycodone, hydrocodone, morphine) may help short term relief

– steroid injections
– alternative methods:
—- acupuncture
—- therapeutic massage
—- transcutaneous electrical nerve stimulation (TENS)

– surgery:
—- discectomy
—- fusion surgery