Lumbosacral Spondylosis

Lumbosacral spondylosis has many treatment options.

What is Lumbosacral Spondylosis?

Spondylosis is a degenerative problem, and when it occurs in the spine, it is commonly called osteoarthritis. Lumbar refers to the lower back, so lumbosacral spondylosis concerns “degenerative changes such as osteoarthritis…and degenerative disc disease” in that region of the spine.¹ Spondylosis of the neck is cervical spondylosis, of the lower back is lumbar spondylosis, and of the middle back is thoracic spondylosis. Any spinal degeneration is called spondylosis, but osteoarthritis of the spine is the situation most frequently referenced when discussing this term. It is important to note that “spondylosis is not a clinical diagnosis”, rather it is terminology that means a patient has “pain and spine degeneration”, although spondylosis itself may not be the cause of the pain. Instead, a related condition could be the culprit behind the patient’s symptoms. Therefore, once the source of the pain is located, the patient is then diagnosed with specific conditions, such as “osteoarthritis, lumbar degenerative disc disease or cervical degenerative disc disease, or lumbar spinal stenosis or cervical spinal stenosis”.²

Causes of Spondylosis

The causes of spondylosis pain include “pain from facet joint osteoarthritis”. The pain worsens after inactivity or during high activity. A patient may have a condition called spinal stenosis, which causes pain due to “an abnormal narrowing of the spinal canal”. Leg pain during walking is a frequent symptom. Degenerative disc disease is another source of patient pain. In this condition, a disc “becomes dehydrated and loses some of its function”. The pain may be in the neck, lower back, arm, or leg. If the facet joints are degenerating, the patient’s condition is most likely to be considered osteoarthritis of the spine. If the discs are degenerated, the diagnosis would typically be degenerative disc disease. Patients should also ask whether or not they have spinal stenosis or other related conditions. Because spinal degeneration often occurs as part of the aging process, it is not necessarily the cause of pain, so even seeing spondylosis evidence on a CT scan or MRI is not enough reason to believe the pain is caused by degeneration.³ Lumbar spondylosis may include osteophytes, or bony overgrowths. Lumbar spondylosis, however, “usually produces no symptoms”, and if a patient presents with sciatic or back pain, “lumbar spondylosis is usually an unrelated finding”.⁴ Lumbar spondylosis and lumbosacral spondylosis are often terms that are used interchangeably, and mechanical factors are widely believed to be the cause or at least the trigger of the development of lumbosacral spondylolysis”. In fact, just the “human erect posture and lumbar curve” are said to be related to lumbosacral spondylosis. There are no cases of this condition known in patients who are non-ambulatory, so “ambulation may have a role in the genesis of lumbosacral spondylolysis (lumbar spondylolysis)”. Even though it is an “acquired condition”, the factor of “heredity is also implicated”.⁵

Myelopathy

A patient could be told they have lumbosacral spondylosis with myelopathy or lumbosacral spondylosis without myelopathy. Myelopathy is “pathology of the spinal cord”, which can be caused by trauma or a “spinal cord injury”. When the spinal cord is involved, the patient may experience “hyperreflexia and weakness…sensory deficits…and bowel/bladder symptoms”. If the patient does not have myelopathy, the low back arthritis would not have nerve symptoms that radiate.⁶ Symptoms of spinal cord injury, or myelopathy, include tingling, weakness, and numbness. Cervical myelopathy, caused by a herniated disc in the cervical spine, for example, might result in arm and leg weakness, numbness, or tingling.⁷

Medical Treatments

In terms of medical treatments, it is necessary to remember that the cause of back pain is not really related to lumbar spondylosis, and the underlying cause of the sciatica or back pain should be explored. Osteophytosis should not be the automatically assumed cause. There might be nerve root impingement that would require bed rest for a couple of days. Surgical excision may ultimately be recommended for some patients who do not respond to bed rest and who have “impingement-documented sciatica”. Osteophytes may cause nerve compression, but if the “lumbar spondylosis projects into the spinal canal, spinal stenosis is a possible complication”. If the osteophytes actually disappear, there may be an aortic aneurysm, another complication.⁸ There is no real treatment available to reverse spondylosis, as it is degenerative. Mostly, the treatments are there to address the neck and back pain, so standard back and neck pain treatments may be employed. Typical medications would include analgesics, NSAIDs, and muscle relaxants. Some medicines are available over-the-counter and others may be prescribed. In extreme cases, narcotics could be recommended, but there are side-effect and addiction concerns with those types of medications. Fish oil is anti-inflammatory and may be useful. Some patients could benefit from antidepressants, while others may find that topical medications are beneficial, such as capsaicin cream.⁹

Self-Care and Alternatives

Medications, injections, and surgery are medical options, but there are also self-care and exercises and treatments, as well as chiropractic, acupuncture, and physical therapy. Bed rest actually prolongs recovery time, so it is important to do normal activities as much as is practical, while avoiding heavy lifting or other exacerbating actions. Ice and heat may also be helpful for some patients. Some may find it useful to sleep with a pillow between the legs to alleviate low back pain. Physical therapy could also be prescribed for chronic pain so that patients can strengthen and stretch their muscles. Physical therapists often prescribe exercises that the patient can do daily to make the abdominal and back muscles stronger. Exercises can also prevent recurring pain. Walking and yoga are especially helpful for chronic back pain. Some people have had symptoms improve with acupuncture. In that therapy, thin needles are inserted into specific areas of the body, at varying depths, “to balance the chi (or qi) which is thought to flow on meridians throughout the body”. Chiropractors generally perform spinal manipulation to treat back pain, and they can provide immediate relief, “especially within the first month of pain”.¹⁰ Chiropractors do not use surgery or prescribe medications, but they can, in addition to the spinal adjustments, use ice or heat, massage, ultrasound, and other therapies, and they can provide advice on lifestyle modifications, stretches, and exercises.¹¹ Some patients may consider herbal supplements for back pain such as Devil’s claw, ginger, glucosamine and/or chondroitin sulfate (glycosaminoglycans), SAMe (S-adenosylmethionine), or white willow bark. SAMe, in particular, is suggested to be helpful for “age-related ‘wear-and-tear’ conditions” as well as depression. It is important to consult with a healthcare professional about all supplements, as they may have side effects or can interfere with other medications. Massage is a popular therapy for back pain. It not only relaxes the muscles, but it calms the mind. Massage therapists can alleviate muscle spasms and tightness. Patients with spondylosis have tight muscles around the spine, and massage can reduce pain and inflammation. For those who do not want to have needles inserted into the body with acupuncture, acupressure is an alternative in which the practitioner “uses his/her thumbs, fingers, and elbows”. Yoga and Pilates are two forms of exercise that can help patients with the “mind-body connection” as they focus on controlled movements and breathing. The core and spine muscles become strengthened as the body relaxes. As with all exercises, it is important to consult with a healthcare professional before beginning any regimen.¹²