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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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definition
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
Referred to by many names
  • Lumbar arthritis
  • Disc degeneration
  • Degenerative disc disease
pathophysiology
Pathophysiology
  • Symptoms more common in persons over 60 years of age (wear and tear)
slide6

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
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
slide8

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)
slide9

Phase 3: Stabilization phase

          • Disc space narrowing
          • Fibrosis along with the formation of osteophytes
          • Transdiscal bridging
causes
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
slide11

Severe arthritis

  • Degenerative disc disease
  • Spinal stenosis
risk factors
Risk factors
  • Advancing age
  • Past injury to spine
  • Heredity factors
  • Smoking
most common signs and symptoms
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
Complications
  • Chronic pain
  • Faecal and urinary incontinence
  • Permanent disability (rare)
1 pain management
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
2. Physiotherapy
  • Ice or heat modalities
  • Electrotherapy
  • Strengthening exercises
  • Acupuncture
  • Massage therapy
  • May also benefit for yoga
3 surgery
3. Surgery
  • Only if conservative treatment fails
  • Spinal fusion and spine decompression.
article by k middleton and d e fish
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
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
slide22

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
physiotherapy
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
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
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.