Lumbar Spondylosis

Lumbar Spondylosis is really a condition associated with degenerative alterations in the intervertebral discs and facet joints. Spondylosis, also called spinal osteoarthritis, can impact the lumbar, thoracic, and/or the cervical parts of the spine. Although aging may be the primary cause, the place and rate of degeneration is individual. Because the lumbar discs and associated ligaments undergo aging, the disc spaces frequently narrow. Thickening from the ligaments that surround the disc and people who surround the facet joints develops. These ligamentous thickening may eventually be calcified. Compromise of the spinal canal or from the openings through which the spinal nerves leave the spinal canal can happen.

Spondylosis often affects the lumbar spine in quickly the age of 40. Pain and morning stiffness are typical complaints. Usually multiple levels are participating (eg, more than one vertebrae). The lumbar spine carries the majority of the body's weight. Therefore, when degenerative forces compromise its structural integrity, symptoms including pain may accompany activity. Movement stimulates pain fibers within the annulus fibrosus and facet joints. Sitting for prolonged amounts of time may cause pain along with other symptoms due to pressure around the lumbar vertebrae. Repetitive movements for example lifting and bending (eg, hard physical work) may increase pain.

Definition of Spondylosis 

SPONDYLO is really a Greek word meaning vertebra. Spondylosis generally mean alterations in the vertebral joint seen as a increasing degeneration from the intervertebral disc with subsequent alterations in the bones and soft tissues. Disc degeneration, spinal canal stenosis, spondylolisthesis would be the resultant pathological changes.

Lumbar spondylosis encompasses lumbar disk bulges, herniations, facet joint degeneration, and vertebral bony overgrowths (osteophytes). Degenerative changes, including osteophyte formation, increase as we grow older but are often asymptomatic. Disk herniation is symptomatic if this causes nerve root compression and spinal stenosis. Common symptoms include back pain, sciatica, and restriction at the spine movement. Treatment is usually conservative, although surgical treatment is indicated for spinal-cord compression or intractable pain. Relapse is typical, with patients experiencing episodic lower back pain.

Causes Lumbar Spondylosis

Spondylosis is principally caused by aging. As people age, certain biological and chemical changes cause tissues through the body to degenerate. Within the spine, the vertebrae (spinal bones) and intervertebral disks degenerate with aging. the intervertebral disks are cushion like structures that behave as shock absorbers between the vertebral bones.

Among the structures that make up the disks is known as the annulus fibrosus. The annulus fibrosus consists of the 60 or even more tough circular bands of collagen fiber (called lamellae). Collagen is a kind of inelastic fiber. Collagen fibers, together with water and proteoglycans (kinds of large molecules made from a protein and a minimum of one carbohydrate chain) assistance to form the soft, gel-like center a part of each disk. This soft, center part is called the nucleus pulposus and is encompassed by the annulus fibrosus.

Risk factors for developing lumbar spondylosis

• Age: Like a person ages the healing ability from the body decreases and developing arthritis in those days can make the disease progress considerably faster. Persons over 4 decades of age are more vulnerable to developing lumbar spondylosis.
• Obesity: Overweight puts excess strain on the joints because the lumbar region carries the majority of the body’s weight, making a person vulnerable to lumbar spondylosis.
• Sitting for prolonged periods: Relaxing in one position for prolonged time which puts pressure around the lumbar vertebrae.
• Prior injury: Trauma constitutes a person more susceptible to developing lumbar spondylosis.
• Heredity or Genealogy

Pathology

The degenerative effects of aging may cause the fibers from the discs to weaken, causing deterioration. Constant wear and tear and problems for the joints from the vertebrae causes inflammation within the joints. Degeneration from the discs leads to the development of mineral deposits inside the discs. The water content from the center of the disc decreases as we grow older and as a result the discs become hard, stiff, and decreased in dimensions. This, in turn, leads to strain on all the surrounding joints and tissues, resulting in the sensation of stiffness. With less water in the heart of the discs, they've decreased shock absorbing qualities. A heightened risk of disc herniation also results, that is when the disc abnormally protrudes from the normal position.

Each vertebral body contains four joints that behave as hinges. These hinges are classified as facet joints or zygapophyseal joints. The task of the facet joins would be to allow the spinal column to flex, extend, and rotate. The bones from the facet joints are engrossed in cartilage (a type of flexible tissue) referred to as end plates. The task of the end plates would be to attach the disks towards the vertebrae and to supply nutrients towards the disc. When the facet joints degenerate, how big the end plates can decrease and stiffen. Movement can stimulate pain fibers within the facet joints and annulus fibrosus. Furthermore, the vertebral bone beneath the end plates may become thick and hard.

Degenerative disease may cause ligaments to lose potency and efficacy. A ligament is really a tough band of tissue that attaches to joint bones. Within the spine, ligaments connect spinal structures for example vertebrae and prevent them motionless too much. In degenerative spondylosis, one of many ligaments (known as the ligamentum flavum) can thicken or buckle, which makes it weaken.

Knobby, abnormal bone growths (referred to as bone spurs or osteophytes) can build in the vertebrae. These changes may also cause osteoarthritis. Osteoarthritis is really a disease of the joints that's made worse by stress. In additional severe cases, these bones spurs can compress nerves appearing out of the spinal cord and/or decreased circulation to the vertebrae. Parts of the body supplied by these nerves can become painful or develop lack of sensation and function.

The Signs of lumbar spondylosis

Symptoms of lumbar spondylosis follow those related to each of the various facets of the disorder: disc herniation, sciatica, spinal stenosis, degenerative spondylolisthesis, and degenerative scoliosis. Pain related to disc degeneration might be felt locally within the back or far away away. This is called referred pain, because the pain is not felt at its site of origin. Back arthritis may be felt as pain within the buttock, hips, groin, and thighs. Just like spinal stenosis or disc herniation within the lumbar region, it is important to be familiar with any bowel or bladder incontinence, or numbness within the perianal area. These signs or symptoms could represent an essential massive nerve compression needing surgical intervention (cauda equina syndrome).

Physical Examination

An intensive physical examination reveals much concerning the patient's health and general fitness. The physical area of the exam includes a overview of the patient's medical and genealogy. Often laboratory tests for example complete blood count and urinalysis are ordered. The physical exam can include:

Palpation (exam by touch) determines spinal abnormalities, regions of tenderness, and muscle spasm.
Flexibility measures the degree that a patient can perform movement of flexion, extension, lateral bending, and spinal rotation.
A neurologic evaluation assesses the patient's symptoms including pain, numbness, paresthesias (e.g. tingling), extremity sensation and motor function, muscle spasm, weakness, and bowel/bladder changes. Particular attention might be given to the extremities. Whether CT Scan or MRI study are usually necesary if there is evidence of neurologic dysfunction.
X-rays along with other Tests

Radiographs (X-rays) may indicate lack of vertebral disc height and also the presence of osteophytes, however is not as useful like a CT Scan or MRI. A CT Scan might help reveal bony changes sometimes related to spondylosis. An MRI is a sensitive imaging tool able to revealing disc, ligament, and nerve abnormalities. Discography seeks to breed the patient's symptoms to recognize the anatomical supply of pain. Facet blocks operate in a similar manner. Both of them are considered controversial.

The doctor compares the patient's symptoms towards the findings to formulate an analysis and treatment plan. The outcomes from the examination give a baseline from which the doctor can monitor and appraise the patient's progress.