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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.

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Spondylosis (OA) - Lumbar

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  1. Spondylosis (OA) -Lumbar

  2. 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.

  3. Referred to by many names • Lumbar arthritis • Disc degeneration • Degenerative disc disease

  4. Pathophysiology • Symptoms more common in persons over 60 years of age (wear and tear)

  5. 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.

  6. Phases of degeneration • 3 Phases • Phase 1: Dysfunction phase • Repetitive micro trauma • Painful tears of outer, innervated annulus fibrosis and associated end-plate separation • This compromises disc s’ nutritional supply and waste removal • Result: dehydration and loss of disc height

  7. Phase 2: Instability phase • Characterised by loss of mechanical stability • Progressive disc changes of resorption • Internal disruption • Additional annular tears • Further facet degeneration • Result in sublaxation and instibility (ligament laxity due to deformities)

  8. Phase 3: Stabilization phase • Disc space narrowing • Fibrosis along with the formation of osteophytes • Transdiscal bridging

  9. 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

  10. Severe arthritis • Degenerative disc disease • Spinal stenosis

  11. Risk factors • Advancing age • Past injury to spine • Heredity factors • Smoking

  12. 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

  13. Complications • Chronic pain • Faecal and urinary incontinence • Permanent disability (rare)

  14. Treatment

  15. 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

  16. 2. Physiotherapy • Ice or heat modalities • Electrotherapy • Strengthening exercises • Acupuncture • Massage therapy • May also benefit for yoga

  17. 3. Surgery • Only if conservative treatment fails • Spinal fusion and spine decompression.

  18. 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.

  19. 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 ligamentumflavum

  20. These anatomical changes result in neurogenicclaudication (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

  21. 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.

  22. 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.

  23. 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/spondylosis/lumbar_symptoms/ Retrieved on 17 May 2012.

  24. http://www.localhealth.com/article/spondylosis Retrieved on 17 May 2012

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