Lumbar spondylosis is a chronic, non-inflammatory disease caused by degeneration of lumbar disc and or facet joints. It can be described as all degenerative conditions affecting discs, vertebral bodies, and associated joints of lumbar vertebrae. The disease is said to be progressive and irreversible in older patients. Lumbar region is often the most affected because of the exposure to mechanical stress.
· Age: Large studies of osteoarthritis have recognized the aging process to be the strongest risk factor for bony degeneration, particularly for the spine.
· Activity and occupation: Retrospective studies site BMI (Body Mass Index), incident back trauma, daily spine loading (bending, lifting, twisting, and sustained nonneutral postures), and whole-body vibrations (such as vehicular driving) to be the factors which increase the likelihood and severity of spondylosis.
· Heredity: Genetic factors likely influence the formation of osteophytes and disc degeneration.
· Pain in axial spine.
· The location of degenerative changes is facet joints, intervertebral discs, sacroiliac joints, nerve roots dura and myofascial structures.
· Neurological claudication which includes lower back pain, leg pain, numbness when standing and walking.
· Disc bulging may affect descending rootlets of cauda equina, nerve roots exiting at the next lower intervertebral canal or the spinal nerve within its ventral ramus, if protruding centrally, poster laterally, and laterally respectively
For clinical diagnosis, a thorough investigation is necessary to ensure that other pathologies are excluded. Following tests are used in clinical practice:
· MRI: shows greatest detail of spine, and is used to visualize intervertebral discs including degree of disc herniation.
· X-rays: show bone spurs on vertebral bodies in spine, thickening of facet joints and thickening of intervertebral disc spaces.
· CT scan: able to visualize spine in greater detail and can diagnose narrowing of spinal cord (spinal stenosis) when present.
· SPECT: Single-photon emission computer tomography bone scintigraphy is used to further evaluate the patients with suspected spondylosis.
Other measures include:
· Numeric Pain Rating Scale (NPRS).
· Roland Morris disability questionnaire (RMDQ)
· Oswestry disability index (ODI)
· Pain self- efficacy questionnaire (PSEQ)
· The Pain-specific functional scale (PSFS)
Of all these questionnaires, the NRPS is recommended for assessing pain because of its ease of administration and responsiveness. The ODI and RMQD are recommended for assessing function.
· NSAIDS (Non- steroidal anti-inflammatory drugs). It is generally accepted to be first step in the management of spondylosis.
· Opioid medications are an alternative therapy for patients suffering from gastrointestinal side effects due to poor control of NSAID management.
· Antidepressants- used for treatment of lower back pain because of their analgesic value at low doses.
· Muscle relaxants- may provide benefit with regard to short-term pain relief and overall functioning.
· Epidural steroid injections, lumbar facet joint injections, SI joint injections.
2. Surgical Management:
· Lumbar fusion- used generally when conservative management has failed and patient still suffers from pain after 6 months. Two vertebrae are fused together and will subsequently work like one solid vertebrae. After two years the bony fusion can be considered high.
· Artificial Disc Replacement (ADR)- Artificial Disc replacement is the replacement of degenerated intervertebral disc with an artificial disc in people with degenerative disc disease of lumbar and cervical spine that has been unresponsive to non- surgical treatments for at least 6 months.
3.Physical therapy management- can be divided into various exercise-based and behavioral Interventions:
· Exercise therapy- therapy includes aerobics exercise, muscle strengthening, and stretching exercises. The exercises and programs have to be of various intensity, duration and frequency.
· Traction- helps to relieve chronic low back pain. The traction forces open intervertebral space and decreases spine lordosis.
· Manual therapy- it is conservation treatment, involves spine manipulation. There might be a risk using spine manipulation, there is a risk of calcifications in the spine.
· Massage- Even though massage therapy needs research for the effectiveness, it appears to have a potential role in beneficial pain relief.
· TENS (transcutaneous electrical stimulation)- frequently used, appears to give an immediate reduction in pain following the therapy. Nevertheless, there remains little evidence for long term relief.
· Taping- It helps to relieve pain in lower back. This tape could be standard tape or kinesiotape. It is important to note that taping alone is not enough, it should be used during therapy to improve the range of motion (ROM).
· McKenzie exercises- focuses on extension and has promising results concerning the prevention of further degeneration of lumbar spine.
· Lumbar back support- can be beneficial for patients suffering from lower back pain. It occurs to limit spine motion, stabilize, correct spine deformity and reduce mechanical forces.
· Lumbar support- with the help of braces are used for stabilization and reducing mechanical forces. They are also produced to limit spine motion and correct deformity of spine.
· Patient Education- educating patient must include reviews of lumbar anatomy, explanation of the concept of posture, ergonomics and giving appropriate back exercises.
1. Davidson’s principles and practice of medicine, page 864, ed.17.
2. Handbook of Physical Medicine and rehabilitation by Susan J Garisson Ed.2nd, page.62.