Lumbar Spondylosis

Lumbar Spondylosis describes bony overgrowths also known as osteophytes, in medical term. These are predominantly at the anterior (front side of the body), lateral sides of the body), and, less commonly, posterior aspects (back side) of the superior and inferior margins of vertebral bodies. This dynamic process increases with, and is an unavoidable effect of the growing age.

Lumbar spondylosis usually produces no symptoms. When back or sciatic pains are complaints, lumbar spondylosis usually is an unrelated finding. Given the frequency and size of lumbar osteophytes they have long been thought to cause back pain. This has led to many studies of the distribution of vertebral osteophytes, not all of which are pertinent. There is no greater frequency of signs or symptoms among individuals with osteophytes than among those without osteophytes. Lumbar spondylosis usually is asymptomatic, with no diagnostic or prognostic significance. Internationally, lumbar spondylosis can begin in persons as young as 20 years. Approximately 80% of men and 70% of women have vertebral osteophytes, most frequently at T10-11 and L5 levels. Approximately 40% of men and 35% of women aged 50-60 years have lumbar osteophytes. Gender ratio reports are equal.

Lumbar spondylosis occurs in animals with upright posture (e.g. chimpanzees) and, possibly, in some domestic animals. Lumbar spondylosis appears to be a nonspecific aging phenomenon. Most studies suggest no relationship to lifestyle, height, weight, body mass, physical activity, cigarette and alcohol consumption, or reproductive history. The effects of heavy physical activity are controversial, as is a purported relationship to disk degeneration. Spondylosis occurs as a result of new bone formation in areas where the annular ligament is stressed. When back or sciatic pains are complaints, lumbar spondylosis usually is an unrelated finding. There usually are no findings unless a complication ensues.

The low back, or lumbar area, serves a number of important functions for the human body. These functions include structural support, movement, and protection of certain body tissues. When we stand, the lower back is functioning to hold most of the weight of the body. When we bend, extend or rotate at the waist, the lower back is involved in the movement. Therefore, injury to the structures important for weight bearing, such as the bony spine, muscles, tendons, and ligaments, often can be detected when the body is standing erect or used in various movements. Protecting the soft tissues of the nervous system and spinal cord as well as nearby organs of the pelvis and abdomen is a critical function the lumbar spine and its adjacent muscles.

Common causes of low back pain:

  1. Lumbar strain -- acute or chronic: A lumbar strain is a stretching injury to the ligaments, tendons, and muscles of the low back. The stretching incident results in microscopic tears of varying degrees in these tissues. Lumbar strain is considered one of the most common causes of low back pain. The injury can occur because of overuse, improper use, or trauma. Soft-tissue injury is commonly termed as acute if it has been present for days to weeks. If the strain lasts longer than three months, it is called as chronic.

    Lumbar strain can happen at any age. The condition is characterized by localized pain in the low back area after mechanical stress on the lumbar tissues. The severity of the injury ranges from mild to severe, depending on the degree of strain and resulting spasm of the muscles of the low back. The diagnosis of lumbar strain is based on the history of injury, the location of the pain, and exclusion of nervous system injury. Usually, x-ray testing is only helpful to exclude bone abnormalities.

    The treatment of lumbar strain consists of resting the back, medications to relieve pain and muscle spasm, local heat applications, massage, and eventual reconditioning exercises to strengthen the low back and abdominal muscles. Spinal manipulation for periods of up to one month has been found helpful in some patients that do not have signs of nerve irritation.

  2. Nerve irritation: The nerves of the lumbar spine can be irritated by mechanical impingement or disease any where along their paths from their roots at the spinal cord to the skin surface. These conditions include lumbar disc disease (radiculopathy), bony encroachment, and inflammation of the nerves caused by a viral infection like shingles.

  3. Lumbar radiculopathy Lumbar radiculopathy is nerve irritation that is caused by damage to the discs between the vertebrae. Damage to the disc occurs because of degeneration also known as wear and tear of the outer ring of the disc, traumatic injury, or both. As a result, the central softer portion of the disc can rupture and herniate through the outer ring of the disc and abut the spinal cord or its nerves as they exit the bony spinal column. This rupture is what causes the commonly recognized sciatica pain that shoots down the leg. Sciatica can be preceded by a history of localized low-back pain or it can be accompanied by numbness and tingling. The pain commonly increases with movements at the waist and can increase with coughing or sneezing. In more severe instances, sciatica can be accompanied by decreased control over urine and stool. Lumbar radiculopathy is suspected based on the above symptoms. Increased radiating pain when the lower extremity is lifted supports the diagnosis. Other tests include Electromyogram and Nerve Conduction Velocity of the lower extremities can be help to detect nerve irritation. The actual disc herniation can be detected with radiology testing, such as CT or MRI scanning

Treatment of lumbar radiculopathy ranges from medical management to surgery. Medical management includes patient education, medications to relieve pain and muscles spasm, cortisone injection around the spinal cord (epidural injection), physical therapy (heat, massage, ultrasound, electrical stimulation), and rest (not strict bed rest, but avoiding re-injury).

With unrelenting pain, severe impairment of function, or incontinence (which can indicate spinal cord irritation), surgery may be necessary.

Surgery is indicated for complications only (e.g., for impingement-documented sciatica that is unresponsive to 2 days of absolute bed rest). The margins of vertebral bodies normally are smooth. Growth of new bone projecting horizontally at these margins identifies osteophytes. Most osteophytes are anterior or lateral in projection. Posterior vertebral osteophytes are less common and only rarely impinge upon the spinal cord or nerve roots. Surgery is not indicated if there is no complication. Tests like radiographs, CT scans, MRIs Electromyography and nerve conduction velocity are used only in the event of complications.

Role of Homeopathy in Lumbar Spondylosis, acute and chronic Low back pain:

Homeopathic medicines have no powers to revert structurally irreversible changes occurring in any tissue of the body. Homeopathic medicines are best for getting relief in symptoms of pain occurring in cases of acute and chronic low back pain. With homeopathic medicines we can not treat lumbar spondylosis or disc herniation occurring in lumbar spine. But in such situation pain control is achieved with greater safety from side effects and for a sustained period of time. Even after months of homeopathic treatment for low back pain which has resulted from disc herniation or some other mechanical cause the radiographs will continue to show the same structural alterations in spine but even in this situation the pain relief is experienced of far greater degree. Regular mobilizing and strengthening exercises are strongly recommended along with homeopathic medicines.