What is Lumbar Spondylosis

Lumbar spondylosis  is a progressive and irreversible degenerative disorder of the lumbar vertebrae, where there will be stiffening and fixation of spine. People over the age of 40 are at the highest risk of developing symptoms of lumbar spondylosis.

Usual location ofLumbar spondylosis  is the last vertebra of the lumbar spine (L5) and the first vertebra of the sacral spine (S1). The lumbar region is mostly affected because this region is most exposed to mechanical stress due to the loading of the spinal segments while standing and during spinal motion.

When a patient suffers from lumbar spondylosis, osteophytes can be formed. These are bony overgrowths that occur due to the stripping of the periost from the vertebral body. The formation of these osteophytes can cause neural foraminal stenosis, which will produce pain. The patient can also experience joint stiffness, which will limit the motion.

How common is Lumbar spondylosis?

Low back ache is a common problem and the highest prevalence is seen in patients aged 45-65 years. Approximately 60–85% of adults suffer from low back ache during some point in their lives. Among musculoskeletal disorders in India, the prevalent morbidity of lumbar spondylosis is 4.16%.

Causes of Lumbar Spondylosis

• Aging – As the human body ages, spinal disc and cartilage deteriorate decreasing the amount of space present between each vertebra. Nerve exposure can lead to nerve inflammation or irritation.

• Genetic abnormalities – Due to genetic abnormality there may be thin and weak vertebra, making them more susceptible to lumbar spondylosis.

• Injury – Injury to the spine, may be due to a fall or an accident, leads to dislodgement of the vertebral disc causing lumbar spondylosis.

• Overuse –  Repetitive stress or strain due to heavy weight lifting, sports or physical exertion can result in vertebral injury such as fracture or slip disc, which precipitates lumbar spondylosis.

• Abnormal spinal movement – Increased abnormal spinal movement leads to development of bony spurs, known as Osteophytes. These spurs pinch the nerves causing nerve irritation.

• Other causes – includes prolonged sitting in front of computer in abnormal position, increased two-wheeler driving and travelling.

Signs and Symptoms of Lumbar Spondylosis

• Pain and stiff back in the morning
• Sitting for a long time increases pain
• Pain gets worse with repeated movements, such as lifting and bending
• Variation in sensation, maybe numbness and tingling sensation
• Radiating pain from lower back to legs
• Loss of balance
• Loss of bladder or bowel control (occurs only in very advanced stages)

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How is Lumbar Spondylosis diagnosed

By physical examination, X-ray or CT scan or MRI, your doctor will diagnose Lumbar spondylosis.

Management of Lumbar Spondylosis

The following methods are employed in mitigating Lumbar Spondylosis:

• Bed Rest: Severe cases of spondylosis may require bed rest for 1-3 days. Once the pain and stiffness has minimized, the patient is treated.

• Braces or Belt Use: Temporary bracing (1 week) may help relieve symptoms.

• Lifestyle Modification: Losing weight and maintaining a healthy weight, eating nutritious foods, regular exercise, and controlling smoking are important. In fact, lifestyle can be said to be the greatest reason for Lumbar Spondylosis.

• Muscle Relaxants: Muscle relaxant medication helps to alleviate muscle spasm and pain.

• Narcotics: Narcotics (opioids) may be prescribed for short periods of time to reduce acute pain.

• NSAIDs: Non-steroidal anti-inflammatory drugs (NSAIDs) relieve inflammation that often contributes to pain.

• Physical therapy: Helps to strengthen the muscles, increases flexibility and range of motion.

• Spinal Injections: There are many types of spinal injections including epidural steroid injections and facet joint injections. These injections combine a local anesthetic and steroid medication to reduce inflamed nerve tissues and thereby often help to reduce pain.

• Surgical procedure: Surgical methods include laminectomy (small portion of the bone compressing the nerve are removed) and spinal fusion.

Limitations of Modern Treatment of Lumbar Spondylosis

• Long-term bed rest is avoided as it puts patient at risk for deep vein thrombosis (DVT, blood clots in the legs).
• Prolonged use of braces is discouraged. Braces worn long-term weaken the spinal muscles and can increase pain if not constantly worn.
• NSAIDs cause adverse effects such as gastritis, renal toxicity, hypertension, liver abnormalities, and bleeding.

• Opioids may lead to addiction and mood disorders.

• Muscle relaxants are sedatives that can make you feel dizzy and drowsy.

• Spinal injections have potential side effects of steroids. Moreover it only manages the pain, does not cure lumbar spondylosis.
• Surgical procedure are costly. There are numerous risks and possible complications with surgery. Even after surgery there may be continued pain, nerve damage and degeneration of adjacent segment may occur.

In Ayurveda, Lumbar spondylosis is termed as kati shoola or kati graha or prushta or trika shoola. It is mainly caused due to vitiation of Vata dosha.

Lumbar Spondylosis Treatment in Ayurveda

The aim of Lumbar spondylosis treatment in Ayurveda is to rehydrate the dehydrated disc, reduce pain, inflammation and muscle spasm. The goal is also to strengthen the muscles and nerve roots, so that the problem is eliminated from its base.