Lumbar Spondylosis

Question 1

What is lumbar spondylosis?

Answer 1

Degeneration of the spine that can occur in joints, discs, and bones of the spine with age, resulting in bony spurrs.

1. Degenerative cascade
2. Microtrauma
3. Intervertebral disc desication and reduced height
4. progressive disc changes
5. Approximation of pedicles
6. Instability
7. Altered weight mechanics and pressure forces.
8. Fibrosis of ligaments (flavum)
9. Ostelphyte formation, facet hypertrophy.

Question 2

Epidemiology of lumbar spondylosis?

Answer 2

1. More common in women
2. 39-70 years
3. High BMI

Question 3

Aetiolgy of lumbar spondylosis.

Answer 3

1. Aging
2. DDD
3. Abnormal.spinal movements
4. Genetics- more susceptible to wear and tear
5. High BMI
6. previous trauma
7. Smoking- affects discs degenerate faster, dehydates disc wear sooner

Question 4

What are the clinical features of lumbar spondylosis?

Answer 4

Stiffness
Pain
Reduced ROM
Creaking/clicking in back
Pain referred to buttock and/or leg

Question 5

What are the stages of lumbar spondylosis?

Answer 5

1. Degenerative cascade
2. Instability phase
3. Stabilisation phase

Question 6

What is the pathophysiology of lumbar spondylosis?

Answer 6

New bone formation in areas where the anular ligament is stressed. The margins of vertebral bodies are normally smooth. Growth of new bone projecting horizontally at these margins- osteophytes

Question 7

Pathophysiology linked to clinical features.

Answer 7

New bone areas where anular ligament stressed initiates from the intervertebral disc which cause progresssive biochemical and structural changes to take place, leading to modification in the physical properties of elasticity and mechanical resistance.

Disc lesions causes pathological chanages in the vertebral bodies, where osteocytes appear

Inflammation causes pain, chemical mediators sensitise the nocireceptors lowers the threshold for pain, not moving at night causes stiffness.

Muscle tension relationship is affected, posterior muscle short, gluteals long/inhibited and abdominal inhibited/ weakened= poor kyphotic posture

Extension limited due to a consequence are the narrowing disc/osteocyte formation, facet joint hypertrophy and degeneration.

Side flexion limited- osteocyte formation and vertebral bodies, thinning of disc.