Transcript Spondylosis (OA) - Lumbar

Spondylosis (OA) Lumbar
Definition
 “Spondy” is Latin for spine
 “Losis” 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 degeneration
 Degenerative disc disease
Pathophysiology
 Symptoms 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:
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Spinal stenosis
Osteoarthritis of spinal joints
Degenerative disc disease
 Not life threatening, but can cause nerve damage with
resultant devastating effects.
Phases of degeneration
 3 Phases
 Phase 1: Dysfunction phase
o Repetitive micro trauma
o Painful tears of outer, innervated annulus fibrosis and
associated end-plate separation
o This compromises disc s’ nutritional supply and waste
removal
o Result: dehydration and loss of disc height
 Phase 2: Instability phase
o Characterised by loss of mechanical stability
o Progressive disc changes of resorption
o Internal disruption
o Additional annular tears
o Further facet degeneration
o Result in sublaxation and instibility (ligament laxity due
to deformities)
 Phase 3: Stabilization phase
o Disc space narrowing
o Fibrosis along with the formation of osteophytes
o Transdiscal bridging
Causes
 Wear 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 disease
 Spinal stenosis
Risk factors
 Advancing age
 Past injury to spine
 Heredity factors
 Smoking
Most common signs and
symptoms
 Pain
 Tingling
 Numbness
 Weakness – start in lower back and then radiate through
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buttocks, hips, legs, feet and toes.
Stiffness in back
Loss of sensation
Loss of balance
Loss of bladder and bowel control
Muscle spasms
Complications
 Chronic pain
 Faecal and urinary incontinence
 Permanent disability (rare)
Treatment
1. Pain management
 In order to help patient performing ADL with minimal
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discomfort.
Short course pain medication (NSAIDs)
• Voltaren
Muscle relaxants
Nerve pain medications
Antidepressants (low dosages)
Traction
2. Physiotherapy
 Ice or heat modalities
 Electrotherapy
 Strengthening exercises
 Acupuncture
 Massage therapy
 May also benefit for yoga
3. Surgery
 Only if conservative treatment fails
 Spinal fusion and spine decompression.
Article by K. Middleton and
D.E. Fish
 Lumbar spondylosis: Clinical presentation and
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treatment approaches
Lower 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 articles
 All 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 changes
 Spinal stenosis with the growth of osteophytes.
 Hypertrophy of the inferior articular process
 Disc herniation
 Bulging of ligamentum flavum
 These anatomical changes result in neurogenic
claudication (NC).
 NC include:
 Lower back pain
 Leg pain
 Numbness and motor weakness of lower extremities that
worsens with upright stance and walking and
 Improves with sitting and supine positioning
Impact of activity and occupation
 Driving
 High body mass index
 Daily spine loading – twisting, turning and lifting heavy
objects
Physiotherapy
 Compared 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.
Terminology
 Arthritis 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.
References
 http://emedicine.medscape.com/article/249036-
overview
Retrieved on 15 May 2012
 K. 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/spond
ylosis/lumbar_symptoms/
Retrieved on 17 May 2012.
 http://www.localhealth.com/article/spondylosis
Retrieved on 17 May 2012