From the Guidelines
Lumbar spondylosis is a degenerative condition affecting the lower spine, characterized by wear and tear of the vertebral discs and joints, and is typically managed with conservative treatments such as pain management, physical therapy, and lifestyle modifications. It occurs naturally with aging as the discs between vertebrae lose water content and elasticity, becoming thinner and less effective as cushions. This degeneration can lead to bone spurs (osteophytes), facet joint arthritis, and narrowing of the spinal canal. Common symptoms include lower back pain, stiffness, and reduced flexibility, particularly in the morning or after periods of inactivity. Some patients may experience radiating pain, numbness, or tingling in the legs if nerve roots become compressed.
Key Points
- Lumbar spondylosis is a common condition, especially in people over 60, and many remain asymptomatic despite changes on imaging 1.
- Imaging is not typically warranted for acute low back pain without red flags, as it does not provide clinical benefit and may lead to unnecessary interventions 1.
- Treatment typically involves a combination of pain management with medications like NSAIDs, physical therapy to strengthen core and back muscles, gentle stretching exercises, and lifestyle modifications such as weight management and proper posture.
- Heat or cold therapy can help manage pain flares, and for severe cases unresponsive to conservative treatment, interventions like epidural steroid injections or, rarely, surgery might be considered.
Diagnosis and Treatment Approach
The diagnosis of lumbar spondylosis involves a focused history and physical examination to determine the likelihood of specific underlying conditions and measure the presence and level of neurologic involvement. A practical approach to assessment is to classify patients into categories such as nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, and back pain potentially associated with another specific spinal cause. Diagnostic triage into one of these categories helps guide subsequent decision making, including the potential need for imaging or referral to a specialist.
Management Strategies
Management strategies for lumbar spondylosis include:
- Pain management with medications
- Physical therapy to strengthen core and back muscles
- Gentle stretching exercises
- Lifestyle modifications such as weight management and proper posture
- Heat or cold therapy for pain flares
- Epidural steroid injections or surgery for severe cases unresponsive to conservative treatment.
It's essential to prioritize conservative management and reserve more invasive interventions for cases where conservative treatments have failed, given the potential risks and benefits associated with each approach 1.
From the Research
Definition of Lumbar Spondylosis
- Lumbar spondylosis is a chronic, noninflammatory disease caused by degeneration of the lumbar disc and/or facet joints 2.
- It is a common cause of low back pain, affecting a significant portion of the population, with approximately 11.5% of the United States population affected by degenerative lumbar spondylolisthesis 3.
- The etiology of lumbar spondylosis is multifactorial, leading to a broad variety of symptoms including discomfort in the low back lesion, radiating leg pain, or neurologenic intermittent claudication (lumbar spinal stenosis) 2.
Symptoms and Diagnosis
- Patients with lumbar spondylosis may complain of low back pain, leg pain, or neurologenic intermittent claudication 2.
- The diagnosis can generally be made based on a clinical history of back and lower extremity pain that is provoked by lumbar extension, relieved by lumbar flexion, and confirmed with cross-sectional imaging, such as computed tomography or magnetic resonance imaging (MRI) 4.
- Lumbar spinal stenosis, a condition related to lumbar spondylosis, affects approximately 103 million people worldwide and 11% of older adults in the US 4.
Treatment Options
- The majority of patients with spondylosis and stenosis of the lumbosacral spine can be treated nonsurgically 2.
- Nonsteroidal anti-inflammatory drugs, COX-2 inhibitors, prostaglandin, epidural injection, and transforaminal injection are helpful in controlling symptoms 2.
- Physical therapy and epidural steroid injections have been shown to be effective in improving pain and function in patients with lumbar spinal stenosis 5.
- Minimally invasive lumbar decompression (mild) is a procedure that may be an option for properly selected patients, with established efficacy and safety 6.
- Surgical management, including decompressive laminectomy and lumbar fusion, is reserved for patients who are totally incapacitated by their condition or who do not improve with conservative management 3, 4.