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Spondylosis (OA) - Lumbar
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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.
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Referred to by many names Lumbar arthritis Disc degeneration
Degenerative disc disease
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Pathophysiology Symptoms more common in persons over 60 years
of age (wear and tear)
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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.
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Phases of degeneration 3 Phases Phase 1: Dysfunction phase
oRepetitive micro trauma oPainful tears of outer, innervated
annulus fibrosis and associated end-plate separation oThis
compromises disc s nutritional supply and waste removal oResult:
dehydration and loss of disc height
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Phase 2: Instability phase oCharacterised by loss of mechanical
stability oProgressive disc changes of resorption oInternal
disruption oAdditional annular tears oFurther facet degeneration
oResult in sublaxation and instibility (ligament laxity due to
deformities)
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Phase 3: Stabilization phase oDisc space narrowing oFibrosis
along with the formation of osteophytes oTransdiscal bridging
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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
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Severe arthritis Degenerative disc disease Spinal stenosis
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Risk factors Advancing age Past injury to spine Heredity
factors Smoking
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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
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Complications Chronic pain Faecal and urinary incontinence
Permanent disability (rare)
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Treatment
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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
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2. Physiotherapy Ice or heat modalities Electrotherapy
Strengthening exercises Acupuncture Massage therapy May also
benefit for yoga
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3. Surgery Only if conservative treatment fails Spinal fusion
and spine decompression.
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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.
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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
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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
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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.
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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.
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References http://emedicine.medscape.com/article/249036-
overview 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/
http://www.laserspineinstitute.com/back_problems/spond
ylosis/lumbar_symptoms/ Retrieved on 17 May 2012.
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http://www.localhealth.com/article/spondylosis Retrieved on 17
May 2012