What is Lumbar Spondylosis
Lumbar spondylosis is a degenerative condition of the lumbar spine characterized by age-related wear and tear of the vertebrae, intervertebral discs, and facet joints, which can lead to chronic low back pain, spinal stenosis, and in some cases, spondylolisthesis (vertebral slippage). 1, 2
Definition and Pathophysiology
Lumbar spondylosis represents the natural aging process of the lumbar spine involving multiple degenerative changes 2:
- Degenerative disc disease: Progressive deterioration of the intervertebral discs, resulting in loss of disc height and hydration 1
- Facet joint arthropathy: Degeneration of the facet joints that can contribute to both axial back pain and referred lower extremity pain 3
- Spinal stenosis: Narrowing of the spinal canal or neural foramina due to degenerative changes, causing neurogenic claudication 1
- Degenerative spondylolisthesis: Forward or backward slippage of one vertebra over another without a pars defect, occurring secondary to degenerative changes 4, 5
Clinical Presentation
The clinical manifestations vary depending on which structures are affected 1, 4, 5:
- Axial low back pain: Chronic pain localized to the lumbar region, often worsened with activity and improved with rest 1
- Neurogenic claudication: Activity-related low back and leg pain that worsens with prolonged standing or ambulation, typically improving with sitting or forward flexion 1, 5
- Radiculopathy: Radiating leg pain following a dermatomal distribution due to nerve root compression 1, 4
- Lower extremity paresthesias: Numbness, tingling, or burning sensations in the legs and feet 3
Epidemiology
Lumbar spondylosis is extremely common in the aging population 6, 2:
- Degenerative lumbar spondylolisthesis affects approximately 11.5% of the United States population 6
- The condition is a natural consequence of aging and becomes increasingly prevalent with advancing age 1, 5
Natural History and Prognosis
The prognosis for patients with lumbar spondylosis is generally favorable, though specific subgroups require closer monitoring 5:
- Most patients with degenerative changes can be managed conservatively without progressive deterioration 5
- Patients with neurological symptoms such as intermittent claudication or bladder/bowel dysfunction are at higher risk for neurological deterioration without surgical intervention 5
- The condition does not always correlate with symptom severity—many patients with significant radiographic changes remain asymptomatic 1
Important Clinical Caveats
MRI findings lack specificity: Degenerative changes visible on MRI do not necessarily correlate with the actual source of pain, making treatment planning challenging 1
Distinguish between pain sources: Determining whether pain originates from the disc, facet joints, or neural compression is critical for appropriate treatment selection 1, 3
Not all spondylosis requires intervention: The presence of degenerative changes on imaging alone does not mandate treatment—clinical correlation with symptoms is essential 1, 2