Spondylosis (OA) - Lumbar

Spondylosis (OA) - Lumbar

Spondylosis (OA) -LumbarDefinitionSpondy is Latin for spineLosis 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.

Referred to by many names

Lumbar arthritis Disc degenerationDegenerative disc diseasePathophysiologySymptoms more common in persons over 60 years of age (wear and tear)

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.Phases of degeneration3 PhasesPhase 1: Dysfunction phaseRepetitive micro traumaPainful tears of outer, innervated annulus fibrosis and associated end-plate separationThis compromises disc s nutritional supply and waste removalResult: dehydration and loss of disc height Phase 2: Instability phase

Characterised by loss of mechanical stabilityProgressive disc changes of resorptionInternal disruptionAdditional annular tearsFurther facet degeneration Result in sublaxation and instibility (ligament laxity due to deformities)Phase 3: Stabilization phaseDisc space narrowingFibrosis along with the formation of osteophytesTransdiscal bridging

CausesWear 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

Severe arthritis Degenerative disc diseaseSpinal stenosis

Risk factorsAdvancing agePast injury to spineHeredity factors Smoking

Most common signs and symptomsPain TinglingNumbnessWeakness start in lower back and then radiate through buttocks, hips, legs, feet and toes.Stiffness in backLoss of sensationLoss of balanceLoss of bladder and bowel controlMuscle spasmsComplicationsChronic painFaecal and urinary incontinencePermanent disability (rare)

Treatment

1. Pain managementIn order to help patient performing ADL with minimal discomfort.Short course pain medication (NSAIDs)VoltarenMuscle relaxantsNerve pain medicationsAntidepressants (low dosages)Traction

2. PhysiotherapyIce or heat modalitiesElectrotherapyStrengthening exercises AcupunctureMassage therapyMay also benefit for yoga

3. SurgeryOnly if conservative treatment failsSpinal fusion and spine decompression.

Article by K. Middleton and D.E. Fish Lumbar spondylosis: Clinical presentation and treatment approachesLower 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.Comparisons between different articlesAll 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 changesSpinal stenosis with the growth of osteophytes.Hypertrophy of the inferior articular process Disc herniationBulging of ligamentum flavum

These anatomical changes result in neurogenic claudication (NC).NC include:Lower back painLeg painNumbness and motor weakness of lower extremities that worsens with upright stance and walking andImproves with sitting and supine positioning

Impact of activity and occupationDrivingHigh body mass indexDaily spine loading twisting, turning and lifting heavy objectsPhysiotherapyCompared 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.

TerminologyArthritis 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.Referenceshttp://emedicine.medscape.com/article/249036-overview Retrieved on 15 May 2012K. 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/spondylosis/lumbar_symptoms/ Retrieved on 17 May 2012.

http://www.localhealth.com/article/spondylosis Retrieved on 17 May 2012