What is degenerative spondylolisthesis. How is it diagnosed. What are the treatment options for L4-L5 spondylosis. When is surgery necessary for spondylolisthesis. How is spondylolisthesis classified. What causes degenerative spondylolisthesis. What are the symptoms of L4-L5 spondylosis.

Understanding Degenerative Spondylolisthesis: A Common Spinal Condition

Degenerative spondylolisthesis is a spinal disorder characterized by the forward slippage of one vertebra over the vertebra below. This condition primarily affects the lumbar spine, with the L4-L5 segment being the most common site of occurrence. It results from degenerative changes in the vertebral structure, causing the joints between the vertebrae to slip forward. Predominantly affecting older females, particularly those over 60, degenerative spondylolisthesis can lead to significant discomfort and functional limitations.

Is degenerative spondylolisthesis different from other types of spondylolisthesis? Indeed, it is distinct from isthmic spondylolisthesis as it does not involve a bone defect. Instead, it is primarily attributed to age-related wear and tear on the spine, gradually breaking down vertebral components. Interestingly, spinal stenosis often accompanies the early stages of degenerative spondylolisthesis, further complicating the condition.

Recognizing the Symptoms of L4-L5 Spondylosis

The manifestation of degenerative spondylolisthesis can vary widely among individuals. Some may remain asymptomatic, only discovering the condition during unrelated medical examinations. However, for many, the symptoms can be quite pronounced and debilitating. Common signs and symptoms include:

• Low back pain, often exacerbated after physical activity
• Pain radiating into the buttocks and down the legs (sciatica)
• Muscle spasms in the affected area
• Leg weakness and tight hamstring muscles
• Irregular gait or noticeable limp

Can degenerative spondylolisthesis lead to neurological complications? In severe cases, particularly when the vertebral body slips significantly forward, it can result in spinal stenosis, nerve compression, and potential neurological injury. This underscores the importance of early diagnosis and appropriate management.

Diagnostic Approaches for Degenerative Spondylolisthesis

Accurate diagnosis is crucial for effective treatment of degenerative spondylolisthesis. Modern diagnostic approaches combine advanced imaging technologies with thorough clinical examinations. The diagnostic process typically involves:

1. Comprehensive medical history review
2. Detailed physical examination
3. Advanced imaging studies

During the medical history review, patients are questioned about their symptoms, their severity, and any previous treatments attempted. The physical examination focuses on identifying limitations in movement, balance issues, pain patterns, reflex changes, muscle weakness, and signs of neurological impairment.

What imaging techniques are used to diagnose degenerative spondylolisthesis? X-rays are usually the first line of diagnostic imaging, helping to rule out other conditions such as tumors or infections. For a more detailed view, CT scans or MRIs may be employed. In some cases, a myelogram might be necessary, involving the injection of a contrast dye into the spinal column to highlight nerve compression, vertebral slippage, and abnormal movement patterns.

Classification Systems for Spondylolisthesis: Understanding Severity

The severity of spondylolisthesis is typically classified using grading systems, with the Meyerding Grading System being one of the most widely adopted. This system categorizes the degree of vertebral slippage based on the percentage of forward displacement:

• Grade I: 1-24% forward slip
• Grade II: 25-49% forward slip
• Grade III: 50-74% forward slip
• Grade IV: 75-99% forward slip
• Grade V (spondyloptosis): Complete forward slip

How does the grade of spondylolisthesis affect treatment decisions? The grade of slippage, along with factors such as intractable pain and neurological symptoms, plays a crucial role in determining the most appropriate treatment approach. Generally, Grade I and II slips are more amenable to conservative treatments, while higher grades (III and above) may necessitate surgical intervention.

Non-Operative Management Strategies for Degenerative Spondylolisthesis

For the majority of degenerative spondylolisthesis cases, particularly those classified as Grade I or II, non-operative management is the initial treatment approach. These conservative strategies aim to alleviate symptoms, improve function, and potentially slow the progression of the condition. Common non-operative treatments include:

• Temporary bed rest during acute flare-ups
• Activity modification to avoid symptom-triggering movements
• Pain management with anti-inflammatory medications
• Steroid-anesthetic injections for targeted pain relief
• Physical therapy to improve strength and flexibility
• Spinal bracing for support and stability

Is non-operative treatment always sufficient for managing degenerative spondylolisthesis? While these conservative approaches are often effective, it’s important to note that degenerative spondylolisthesis can be progressive. This means that the condition may worsen over time, potentially leading to the development of spinal stenosis and cord compression. In such cases, or when conservative measures fail to provide adequate relief, surgical intervention may become necessary.

Surgical Interventions for Severe Degenerative Spondylolisthesis

Surgical treatment for degenerative spondylolisthesis is typically reserved for severe cases (usually Grade III or above), instances of neurological damage, disabling pain, or when all non-operative treatments have proven ineffective. The most common surgical procedure employed is a laminectomy combined with spinal fusion.

What does a laminectomy and fusion procedure involve? During a laminectomy, the surgeon widens the spinal canal by removing or trimming the laminae (the bony roof of the vertebrae). This creates more space for the nerves and alleviates pressure on the spinal cord. The fusion component of the surgery involves joining vertebrae together to enhance stability. Various devices, such as screws or interbody cages, may be implanted to support the fusion process and provide additional stability to the affected spinal segment.

Are there risks associated with surgical treatment for degenerative spondylolisthesis? As with any surgical procedure, there are potential risks and complications. These may include infection, bleeding, nerve injury, and failure of the fusion to heal properly. However, for appropriately selected patients, the benefits of surgery often outweigh the risks, leading to significant improvements in pain levels and overall quality of life.

Long-Term Outlook and Management of Degenerative Spondylolisthesis

The long-term prognosis for individuals with degenerative spondylolisthesis can vary significantly depending on factors such as the severity of the condition, the effectiveness of treatment, and the patient’s overall health and lifestyle. For many patients, a combination of conservative treatments and lifestyle modifications can lead to successful management of symptoms and maintenance of quality of life.

How can patients contribute to the long-term management of their condition? Engaging in regular exercise, maintaining a healthy weight, practicing good posture, and avoiding activities that exacerbate symptoms are all crucial components of long-term management. Additionally, ongoing communication with healthcare providers and adherence to recommended treatment plans can help prevent progression of the condition and minimize its impact on daily life.

Is complete recovery possible for patients with degenerative spondylolisthesis? While complete reversal of the structural changes associated with degenerative spondylolisthesis may not be possible, many patients experience significant improvements in pain levels and functional capacity with appropriate treatment. The goal of management is typically to alleviate symptoms, prevent further progression, and enable patients to maintain an active and fulfilling lifestyle.

Emerging Trends and Future Directions in Spondylolisthesis Treatment

As medical science continues to advance, new approaches to the treatment of degenerative spondylolisthesis are emerging. These developments aim to provide more effective, less invasive options for managing the condition and improving patient outcomes.

What are some promising areas of research in spondylolisthesis treatment? Current areas of interest include:

• Minimally invasive surgical techniques that offer faster recovery times and reduced risk of complications
• Regenerative medicine approaches, such as stem cell therapy, to potentially reverse or slow degenerative changes
• Advanced imaging technologies for more precise diagnosis and treatment planning
• Novel pain management strategies, including targeted drug delivery systems
• Improved spinal fusion materials and techniques for better long-term outcomes

How might these advancements impact patient care in the future? As these new technologies and treatments are developed and refined, patients with degenerative spondylolisthesis may have access to a wider range of treatment options. This could lead to more personalized treatment plans, improved outcomes, and potentially even preventive strategies to slow or halt the progression of spinal degeneration.

The Role of Patient Education in Managing Degenerative Spondylolisthesis

Patient education plays a crucial role in the effective management of degenerative spondylolisthesis. Understanding the nature of the condition, its potential progression, and the available treatment options empowers patients to make informed decisions about their care and actively participate in their treatment plan.

What key information should patients with degenerative spondylolisthesis be aware of? Important topics for patient education include:

• The anatomy of the spine and the mechanisms of degenerative changes
• The importance of maintaining good posture and proper body mechanics
• Strategies for pain management and activity modification
• The potential benefits and risks of various treatment options
• The significance of adherence to prescribed treatment plans
• Warning signs that may indicate a need for immediate medical attention

How can healthcare providers effectively educate patients about degenerative spondylolisthesis? Utilizing a combination of verbal explanations, written materials, and visual aids can help ensure that patients fully grasp the complexities of their condition. Additionally, encouraging patients to ask questions and express their concerns fosters a collaborative approach to care, potentially leading to better treatment outcomes.

The Impact of Lifestyle Factors on Degenerative Spondylolisthesis

While age-related changes are a primary factor in the development of degenerative spondylolisthesis, various lifestyle factors can influence both the onset and progression of the condition. Understanding these factors can help individuals take proactive steps to maintain spinal health and potentially mitigate the effects of degenerative changes.

What lifestyle factors can affect the development and progression of degenerative spondylolisthesis? Key considerations include:

• Physical activity levels and exercise habits
• Occupational factors, such as jobs requiring heavy lifting or prolonged sitting
• Body weight and nutritional status
• Smoking and alcohol consumption
• Stress levels and stress management techniques

How can individuals modify their lifestyle to promote spinal health? Engaging in regular, low-impact exercise to strengthen core and back muscles, maintaining a healthy weight, practicing good posture, and avoiding activities that place excessive stress on the spine can all contribute to spinal health. Additionally, quitting smoking and managing stress through techniques such as meditation or yoga may have protective effects on spinal structures.

The Psychological Impact of Living with Degenerative Spondylolisthesis

The chronic pain and functional limitations associated with degenerative spondylolisthesis can have significant psychological impacts on affected individuals. Addressing these psychological aspects is an important component of comprehensive care for patients with this condition.

What psychological challenges might individuals with degenerative spondylolisthesis face? Common issues include:

• Depression and anxiety related to chronic pain and disability
• Frustration and anger due to limitations in daily activities
• Fear of movement or re-injury, leading to decreased physical activity
• Social isolation resulting from reduced mobility or activity avoidance
• Sleep disturbances due to pain or discomfort

How can healthcare providers address the psychological aspects of degenerative spondylolisthesis? Integrating psychological support into the treatment plan can be beneficial. This may involve referrals to mental health professionals, cognitive-behavioral therapy to address pain-related fears and behaviors, and teaching coping strategies to manage the emotional challenges of living with a chronic condition. Support groups can also provide valuable emotional support and practical advice for individuals navigating life with degenerative spondylolisthesis.

The Role of Nutrition in Managing Degenerative Spondylolisthesis

While nutrition alone cannot reverse the structural changes associated with degenerative spondylolisthesis, a healthy diet can play a supportive role in managing the condition and promoting overall spinal health. Proper nutrition can help maintain a healthy weight, reduce inflammation, and support bone and muscle strength.

What dietary considerations are important for individuals with degenerative spondylolisthesis? Key nutritional factors include:

• Adequate calcium and vitamin D intake for bone health
• Omega-3 fatty acids for their anti-inflammatory properties
• Antioxidant-rich foods to combat oxidative stress
• Protein for muscle maintenance and repair
• Hydration to maintain intervertebral disc health

How can individuals incorporate these nutritional principles into their daily diet? Focusing on a balanced diet rich in fruits, vegetables, lean proteins, and whole grains can provide many of the necessary nutrients. Some individuals may benefit from dietary supplements, particularly for calcium and vitamin D, but this should be discussed with a healthcare provider. Staying well-hydrated by drinking plenty of water throughout the day is also important for maintaining the health of spinal structures.

The Importance of Regular Follow-up and Monitoring

Given the potentially progressive nature of degenerative spondylolisthesis, regular follow-up and monitoring are crucial components of long-term management. This allows healthcare providers to track the progression of the condition, assess the effectiveness of current treatments, and make timely adjustments to the treatment plan as needed.

What should be included in regular follow-up assessments for degenerative spondylolisthesis? Key elements of follow-up care may include:

• Evaluation of pain levels and functional capacity
• Assessment of neurological function
• Review of current medications and their effectiveness
• Periodic imaging studies to monitor structural changes
• Discussion of any new symptoms or concerns
• Adjustment of treatment plans based on current status and patient goals

How frequently should individuals with degenerative spondylolisthesis have follow-up appointments? The frequency of follow-up visits can vary depending on the severity of the condition and the current treatment plan. Generally, patients may need to see their healthcare provider every 3-6 months, or more frequently if they are experiencing significant symptoms or undergoing active treatment. However, the specific follow-up schedule should be determined on an individual basis in consultation with the healthcare provider.

Degenerative Spondylolisthesis Treatment & Surgery

Spondylolisthesis – Degenerative

Spondylolisthesis is a spinal condition in which one vertebra slips forward over the vertebra below. Degenerative spondylolisthesis, usually occurs in the lumbar spine, especially at L4-L5. It is the result of degenerative changes in the vertebral structure that cause the joints between the vertebrae to slip forward. This type of spondylolisthesis is most common among older female patients, usually those over the age of 60.

Symptoms
Symptoms of spondylolisthesis may include the following:

• Pain, especially after exercise, in the low back, thighs, and/or legs that radiates into the buttocks and/or down the legs (sciatica)
• Muscle spasms
• Leg weakness
• Tight hamstring muscles
• Irregular gait or limp

Some people with spondylolisthesis are symptom free and only discover the disorder when seeing a doctor for another health problem. However, the forward slip of the vertebral body in severe cases of degenerative spondylolisthesis often leads to spinal stenosis, nerve compression, pain and neurological injury.

What Causes Degenerative Spondylolisthesis?

Degenerative spondylolisthesis is usually the result of age and “wear and tear” on the spine that breaks down vertebral components. It is different from isthmic spondylolisthesis in that there is no bone defect. Spinal stenosis tends to occur in the early stages of degenerative spondylolisthesis.

Diagnosis

Correct diagnosis is obviously essential. Dr. Lonner utilizes the latest diagnostic technologies, combined with examinations by expert physicians, to ensure that the diagnosis is accurate. Diagnostic tools include:

• Medical history. You will be asked about your symptoms, their severity, and the treatments you have already tried.
• Physical examination. You will be carefully examined for limitations of movement, problems with balance, pain, loss of reflexes in the extremities, muscle weakness, loss of sensation or other signs of neurological damage.
• Diagnostic tests. Generally, we start with x-rays, which allow us to rule out other problems such as tumors and infections. We may also use a CT scan or MRI to confirm the diagnosis. In some patients a myelogram will be used. This is a test that involves the use of a liquid dye that is injected into the spinal column to show the degree of nerve compression, slippage between involved vertebrae, and abnormal movement.

Classification of Spondylolisthesis

There are several methods used to “grade” the degree of slippage ranging from mild to most severe. We will discuss with you the extent of your spondylolisthesis.

In general, physicians use the Meyerding Grading System for classifying slips. This is a relatively easy to understand system. Slips are graded on the basis of the percentage that one vertebral body has slipped forward over the vertebral body below. Thus a Grade I slip indicates that 1-24% of the vertebral body has slipped forward over the body below. Grade II indicates a 25-49% slip. Grade III indicates a 50-74% slip and Grade IV indicates a 75%-99% slip. If the body completely slips off the body below it is classified as a Grade V slip, known as spondyloptosis.

Dr. Lonner will consider the degree of slip, and such factors as intractable pain and neurological symptoms, when deciding on the most suitable treatment. Most degenerative spondylolisthesis cases involve Grade I or Grade II. As a general guideline, the more severe slips (especially Grades III and above) are most likely to require surgical intervention.

Non-Operative Treatment

For most cases of degenerative spondylolisthesis (especially Grades I and II), treatment consists of temporary bed rest, restriction of the activities that caused the onset of symptoms, pain/ anti-inflammatory medications, steroid-anesthetic injections, physical therapy and/or spinal bracing.

Degenerative spondylolisthesis can be progressive – meaning the damage will continue to get worse as time goes on. In addition, degenerative spondylolisthesis can cause stenosis, a narrowing of the spinal canal and spinal cord compression. If the stenosis is severe, and all non-operative treatments have failed, surgery may be necessary.

Surgical Treatment

Surgery is rarely needed unless the case is severe (usually Grade III or above), neurological damage has occurred, the pain is disabling, or all non-operative treatment options have failed.

The most common surgical procedure used to treat spondylolisthesis is called a laminectomy and fusion. In this procedure, the spinal canal is widened by removing or trimming the laminae (roof) of the vertebrae. This is done to create more space for the nerves and relieve pressure on the spinal cord. The surgeon may also need to fuse vertebrae together. If fusion is done, various devices (like screws or interbody cages) may be implanted to enhance fusion and support the unstable spine.

Patient Story of Degenerative Spondylolisthesis

Spondylolisthesis Symptoms, Diagnosis, and Treatments

Spondylolisthesis is a Latin term meaning slipped vertebral body (spinal bone).

“Spondylo”= vertebrae
“listhesis”=slippage

Spondylolisthesis in the lumbar spine is most commonly caused by degenerative spinal disease (degenerative spondylolisthesis), or a defect in one region of a vertebra (isthmic spondylolisthesis).

ON THIS PAGE

• What are the types of spondylolisthesis?
• Which type is most common?
• Symptoms
• Diagnosis
• Treatment

WHAT ARE THE TYPES OF SPONDYLOLISTHESIS?

Spondylolisthesis can be classified by into five groups (Newman (1976)):

• Group 1: dysplastic
• Group 2: isthmic
• Group 3: traumatic
• Group 4: degenerative
• Group 5: pathological

WHICH TYPE IS MOST COMMON?

Degenerative spondylolisthesis is very common, and occurs as a result of due to degeneration or wear and tear of the intervertebral discs and ligaments. Osteoarthritis of the facet joints can also play an important role in the development of instability and slippage. Degenerative spondylolisthesis usually occurs in people over 60 years of age.

In degenerative spondylolisthesis, what usually happens is that ongoing degeneration weakens the facet joints and disc, and (typically) the L4 vertebral body slips forward on the L5 vertebral body. Under normal circumstances, the L4-L5 segment is the one in the lumbar spine with the most movement. It is therefore most likely to slip when this process occurs. The next most common levels affected by degenerative spondylolisthesis are L3-L4 and L5-S1.

Isthmic spondylolisthesis occurs most often at L5-S1, and is more often seen in younger adults than degenerative spondylolisthesis. The cause is a defect in an important bridge bone (the pars interarticularis) of L5.

HOW IS SPONDYLOLISTHESIS GRADED?

Spondylolisthesis is graded according to the severity of the slippage. This is known as the Mayerding classification:

• Grade 1: <25% slip
• Grade 2: 25-50% slip
• Grade 3 50-75% slip
• Grade 4: 75-100% slip

When one vertebra slips entirely off the one below (>100% slip), this is known as spondyloptosis (see picture).

SYMPTOMS

Spondylolisthesis doesn’t usually have any symptoms. In fact, it is commonly seen on X-rays and CT scans as an ‘incidental’ finding. It may, however, produce significant symptoms and disability.

Back pain is the most common symptom of spondylolisthesis. This pain is typically worse with activities such as bending and lifting, and often eases when lying down.

As the spine attempts to stabilise the unstable segment, the facet joints enlarge and place pressure on the nerve root causing lumbar spinal stenosis and lateral recess stenosis.

As one bone slips forward on the other, a narrowing of the intervertebral foramen may also occur (foraminal stenosis). Severe nerve compression can therefore occur with pain, numbness and weakness in the legs. Sometimes loss of control of the bladder and/or bowels can occur due to pressure on the nerves going to these important structures.

DIAGNOSIS

Imaging studies including MRI and CT can show a slip, as well as narrowing (stenosis) or compressed nerves in the spinal canal.

The CT and MRI scans are usually obtained with the patient lying flat, however sometimes a slip may only be obvious when standing or bending forwards. This is why your neurosurgeon or spinal surgeon will sometimes obtain flexion, extension and standing X-rays, and occasionally a CT myelogram.

TREATMENT

Treatment for spondylolisthesis is similar to treatments for other causes of mechanical and compressive back pain. It is usually non-operative, and surgery is only necessary in a small percentage of patients.

MODIFIED ACTIVITIES

Your specialist may suggest that you modify some of your usual physical activities, this will help to help settle symptoms from mechanical back pain. Special braces are occasionally prescribed to ease back pain. Short periods of bed rest can sometimes help with very painful episodes.

PHYSICAL REHABILITATION

A comprehensive physical rehabilitation program can assist in settling pain and inflammation, as well as improving mobility and strength. A combination of physiotherapy, hydrotherapy and clinical Pilates typically works well and is often recommended.
The aims of these physical therapies are to assist you in:

• managing your condition and controlling your symptoms
• correcting your posture and body movements to reduce back strain
• improving your flexibility and core strength

Some patients also benefit from chiropractic treatment osteopathy, remedial massage, and acupuncture.

PSYCHOLOGIST REVIEW

Having a review by a clinical psychologist can be helpful in for creating strategies to manage pain. It is also important to address any associated feelings of depression or anxiety, as these conditions can heighten your experience of pain.

MEDICATIONS

Medication often plays an important role in controlling pain and easing muscle spasms. It can also help you to get back to a normal sleep pattern. Long-term medication usage should be closely supervised as problems such as tolerance and dependence (addiction) are known to occur.

SURGERY

Surgery is only needed only if other non-surgical treatments are not keeping your pain at a manageable level. Surgical treatment for spondylolisthesis need to take into account both mechanical (instability) and compressive (nerve pressure) issues.
Nerve pressure usually involves surgical decompression, also known as a decompressive laminectomy. In order to deal with the compressive issues by taking pressure off the nerves, your surgeon may need to remove some or all of one or both facet joints, as well as portions of the lamina.

As the facet joints typically provide stability to the lumbar spine, the spine can spine to become loose and unstable, especially after some slippage has already occurred. A fusion is usually therefore recommended.

Similarly, a fusion is necessary to adequately deal with the mechanical issues of instability in spondylolisthesis.

Six types of fusion surgery are commonly recommended for the treatment of spondylolisthesis, depending upon individual patient factors:

1. Transforaminal lumbar interbody fusion (TLIF)
2. Posterior lumbar interbody fusion (PLIF)
3. Instrumented posterolateral fusion (pedicle screw fixation and posterolateral bone graft)
4. Anterior lumbar interbody fusion (carried out through the abdomen, rather than from the back)
5. Extracavitatory lateral interbody fusion (XLIF)
6. Oblique lateral interbody fusion (OLIF)

Spondylosis of the lumbosacral spine, symptoms, causes and treatment

Spondylosis of the lumbosacral spine is a disease that is characterized by damage to the joints of the lower back, the growth of osteophytes. Bone formations appear mainly along the anterior edge of the vertebrae, and the lateral regions are also affected. The pathological process is associated with excessive loads, unsatisfactory physical condition of a person. In parallel with this, muscle spasm is observed, which limits mobility in the lumbosacral region. If there is no adequate treatment, then the bone growths become larger, infringe on the nerve roots and spinal cord.

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact a specialist.

Symptoms of the disease, signs

The initial stage of lumbar spondylosis proceeds almost imperceptibly. In the modern rhythm of life, many people do not pay attention to the slight stiffness in movement. The further the disease develops, the more noticeable the symptoms become:

• soreness in the loins, buttocks and legs;
• lameness, intense discomfort in calf muscles;
• inability to fully bend over.

The pain gets worse in the evening, and also when trying to move more or less actively. Often a person has to take forced postures. At 2-3 stages progress:

• paresthesia;
• loss of sensation of the skin of the buttocks;
• Difficulty in movements of the knee joints, leg abduction in the hip joints.

With an increase in the duration of the disease, the symptoms of spondylosis of the lumbosacral spine become more acute and interfere with a normal lifestyle. In some cases, the signs of pathology intensify when the weather changes.

It is important to distinguish osteochondrosis from spondylosis. With osteochondrosis, pain with pressure on the spinous processes is not noted. And for spondylosis, this is a characteristic manifestation. When it affects the lumbosacral spine, predominantly L3-L5 suffer. Osteochondrosis in most cases affects the L5-S1 vertebrae.

Causes of lumbar spondylosis

Pathological growth of bone tissue is caused by degenerative changes that lead to a deterioration in the mobility of the spinal column. They are provoked by:

• direct and indirect injuries of the local muscle-ligament apparatus;
• prolonged stay in a physiologically incorrect position;
• dynamic loads on the muscles with obvious hypodynamia;
• infectious lesions;
• neoplasms;
• genetic predisposition;
• overweight.

Cause the development of spondylosis age-related changes in the tissues of the spine, as well as constitutional predisposition. Abnormal growth of the bone structure can be observed under the influence of oncological diseases. Both hypo- and hyperdynamia pose a certain health hazard.

Effective treatments

The prescribed therapy should take into account the special properties of the human body. Treatment methods for lumbar spondylosis are aimed at: restoring a full blood supply; improvement of the condition of cartilage tissue; elimination of pain; strengthening muscles and ligaments.

Therapy includes pharmacological and non-pharmacological methods. Among medicines positive effect is exerted by:

• NSAIDs;
• muscle relaxants;
• preparations of natural cartilage components.

If the lumbar region is affected, spondylosis responds well to physiotherapeutic methods:

• acupuncture;
• ultrasound;
• paraffin packs;
• manual therapy;
• massage.

After relief of acute pain, exercise therapy is started. Therapeutic gymnastics has a restorative and healing effect.

What if the disease is not treated?!

With timely diagnosis and treatment, the prognosis is quite favorable. However, attempts to independently stop the pain syndrome or ignore the symptoms lead to the progression of the pathology. Over time:

• limbs become numb;
• mobility is sharply limited;
• muscles atrophy;
• partial or complete immobilization occurs.

Lumbar spondylosis responds well to treatment. It is important to contact a competent specialist who will make an accurate diagnosis and individually select a comprehensive treatment regimen.

Lumbar spondylosis – symptoms, causes, treatment

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Spinal spondylosis is a chronic disease resulting from degenerative-dystrophic processes of the fibrous ring of the intervertebral disc. Spondylosis is one of the types of osteopathies – diseases grouped according to common characteristic features: dystrophy of the structures of the spine, pain syndrome, limitation of mobility. It affects all parts of the spinal column, but most often the lumbosacral.

CMRT specialist tells

Kuchenkov A.V.

Orthopedist • Traumatologist • Surgeon • Phlebologist • Sports doctor • 25 years of experience

Publication date: May 18, 2021

Verification date: January 10, 2023

All facts have been verified by a doctor.

Contents of the article

Causes of spondylosis

Symptoms of spondylosis of the lumbosacral spine

The initial stage of the disease is characterized by a latent course. As the pathological process progresses, symptoms appear:

• Limited mobility in the lumbar spine.
• Unpleasant sensations in the buttocks and thighs after prolonged exertion on the legs
• Pain in the back after prolonged static posture

Deforming spondylosis of the lumbar spine gives the following symptoms:

• Lumbar pain when turning the body, when walking down stairs
• Lameness when pain radiates to the lower extremities

Antespondylolisthesis (displacement of the vertebrae relative to each other) causes pinching of the nerves of the “cauda equina”, which is located in the lower parts of the spinal cord. In the clinical picture, neurological symptoms come to the fore:

• Severe pain in the perineum, in the legs
• Development of paresthesia – a feeling of numbness, tingling, burning below the level of damage to the spinal segment: lower back, buttocks, legs
• Increasing weakness of the muscles of the lower extremities
• Disorder of the pelvic organs: violation of the process of urination, defecation

Stages of development of spondylosis

The process of degenerative changes in intervertebral discs with the formation of osteophytes successively goes through several stages:

I stage. There are initial changes in the fibrous tissues of the intervertebral disc: cracks, fractures, decreased elasticity. Single spiny bone growths (osteophytes) do not extend beyond the vertebral bodies. Symptoms characteristic of spondylosis of the lumbosacral spine are absent, the patient may sometimes be bothered by minor pain in the lumbar region.

Stage II. Active proliferation of osteophytes continues. Mobility in the damaged spinal segment decreases, pains join, the intensity of which increases with physical exertion, hypothermia.

Stage III . Complete destruction of cartilage. Bone growths, increasing in size, merge into rough osteophyte complexes connecting two or more vertebrae. This disrupts the normal mobility of the lumbar spine. When osteophytes compress the nerve roots of the spinal cord, neurological disorders develop, aggravated by a severe pain syndrome.

How to diagnose

If spinal spondylosis is suspected, diagnostics include:

• Collection of patient complaints, as well as information about the onset and course of the disease
• Clinical examination by a doctor with assessment of neurological status
• Instrumental examination: X-ray in frontal and lateral projection x, CT, MRI can detect pathological changes in bone, cartilage, soft tissues in the early stages.