What is Lumbar Spondylosis
Lumbar spondylosis is a chronic, noninflammatory degenerative disease of the lumbar spine caused by progressive deterioration of the intervertebral discs and facet joints, affecting approximately 11.5% of the United States population. 1, 2
Pathophysiology and Etiology
- The condition results from multifactorial degenerative changes affecting the disc and facet joints of the lumbar spine 2
- Degenerative changes lead to structural alterations including disc space narrowing, osteophyte formation, facet joint arthropathy, and ligamentum flavum hypertrophy 2
- These degenerative processes can progress to cause spinal canal stenosis, foraminal narrowing, and in some cases degenerative spondylolisthesis (vertebral slippage without pars defect) 2, 3
Clinical Presentation
- Patients present with a broad spectrum of symptoms ranging from localized low back discomfort to more severe manifestations 2
- Common symptoms include chronic low back pain, stiffness, and mechanical pain that worsens with activity 2, 4
- Radiating leg pain (radiculopathy) occurs when nerve root compression develops from foraminal stenosis or disc herniation 2, 4
- Neurogenic intermittent claudication manifests as leg pain, weakness, or numbness that worsens with walking and improves with rest or forward flexion, indicating lumbar spinal stenosis 2, 4
- Severe cases may present with vesicorectal dysfunction, though this is uncommon 4
Natural History and Prognosis
- The prognosis for patients with lumbar spondylosis is generally favorable, with most patients improving with conservative management 5, 4
- Most patients experience symptom improvement within the first 4 weeks of appropriate conservative treatment 5
- However, patients with neurological symptoms such as intermittent claudication or bladder/bowel dysfunction are at higher risk for neurological deterioration without surgical intervention 4
- The condition typically follows a chronic course with periods of exacerbation and remission 2
Diagnostic Considerations
- Diagnosis is based on clinical presentation correlated with imaging findings 2, 4
- Degenerative changes on imaging (X-ray, MRI, or CT) often correlate poorly with symptoms—radiographic findings may not be the actual source of pain 6
- Dynamic imaging with flexion-extension radiographs can identify instability or spondylolisthesis 3
- MRI is the gold standard for evaluating neural compression, disc degeneration, and soft tissue pathology 4