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: • • • 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      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      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     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