What is degenerative spondylolisthesis. How does it affect the lumbar spine. What are the common symptoms of L4-L5 spondylosis. Which diagnostic methods are used to identify spondylolisthesis. What non-surgical and surgical treatments are available for this condition.

Understanding Degenerative Spondylolisthesis: A Comprehensive Overview

Degenerative spondylolisthesis is a spinal condition characterized by the forward slippage of one vertebra over the vertebra below it. This condition typically occurs in the lumbar spine, with the L4-L5 segment being the most commonly affected area. It primarily results from age-related degenerative changes in the vertebral structure, causing the joints between the vertebrae to slip forward.

Predominantly affecting older individuals, particularly females over 60, degenerative spondylolisthesis can lead to various symptoms and complications. Understanding its causes, symptoms, and treatment options is crucial for those affected by this condition.

Recognizing the Symptoms of L4-L5 Spondylosis

Degenerative spondylolisthesis can manifest through a range of symptoms, which may vary in severity from person to person. Some individuals may be asymptomatic, only discovering the condition during unrelated medical examinations. However, for those experiencing symptoms, they may include:

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

In severe cases, the forward slippage of the vertebra can lead to spinal stenosis, a condition where the spinal canal narrows, potentially causing nerve compression and neurological complications.

Can degenerative spondylolisthesis cause permanent nerve damage?

While not always the case, severe or untreated degenerative spondylolisthesis can indeed lead to permanent nerve damage. The forward slippage of the vertebra can compress nerves in the spinal canal, potentially causing long-term neurological issues if left unaddressed. This underscores the importance of early diagnosis and appropriate treatment.

Unraveling the Causes of Degenerative Spondylolisthesis

Unlike isthmic spondylolisthesis, which involves a bone defect, degenerative spondylolisthesis is primarily attributed to the natural aging process and wear and tear on the spine. Several factors contribute to its development:

1. Age-related degeneration of spinal components
2. Weakening of ligaments and joints in the spine
3. Loss of elasticity in spinal discs
4. Arthritis in the facet joints
5. Repetitive stress on the lower back

It’s worth noting that spinal stenosis often occurs in the early stages of degenerative spondylolisthesis, further complicating the condition.

Is degenerative spondylolisthesis more common in certain populations?

Yes, degenerative spondylolisthesis shows a higher prevalence in certain demographic groups. It is more commonly observed in:

• Older adults, particularly those over 60 years of age
• Women, who are affected more frequently than men
• Individuals with a history of osteoarthritis or rheumatoid arthritis
• People engaged in occupations or activities that place repetitive stress on the lower back

Understanding these risk factors can help in early identification and management of the condition.

Diagnostic Approaches for L4-L5 Spondylosis

Accurate diagnosis of degenerative spondylolisthesis is crucial for effective treatment. Medical professionals employ a combination of clinical examination and advanced imaging techniques to confirm the diagnosis and assess the severity of the condition. The diagnostic process typically includes:

1. Comprehensive medical history review
2. Thorough physical examination
3. Imaging studies, such as X-rays, CT scans, and MRIs
4. In some cases, myelography to visualize nerve compression and vertebral slippage

During the physical examination, doctors assess limitations in movement, balance issues, pain patterns, reflex changes, muscle weakness, and signs of neurological impairment. Imaging studies help rule out other conditions like tumors or infections while providing detailed visualizations of the affected spinal segments.

How is the severity of spondylolisthesis graded?

The severity of spondylolisthesis is commonly graded using the Meyerding Grading System. This classification system categorizes the degree of vertebral slippage as follows:

• 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: Complete slip (spondyloptosis)

Most cases of degenerative spondylolisthesis fall into Grade I or Grade II categories. The grade of slippage, along with the presence of intractable pain and neurological symptoms, guides treatment decisions.

Non-Operative Management Strategies for Degenerative Spondylolisthesis

For the majority of degenerative spondylolisthesis cases, especially those classified as Grade I or II, non-surgical treatments are the initial approach. These conservative measures aim to alleviate symptoms, improve function, and prevent further progression of the condition. Non-operative management typically includes:

• Temporary bed rest during acute pain episodes
• Activity modification to avoid symptom-triggering movements
• Pain management with over-the-counter or prescription medications
• Anti-inflammatory drugs to reduce swelling and discomfort
• Steroid-anesthetic injections for targeted pain relief
• Physical therapy to improve strength, flexibility, and posture
• Spinal bracing for support and stability

It’s important to note that while these treatments can effectively manage symptoms, degenerative spondylolisthesis is often progressive. Regular monitoring and adjustments to the treatment plan may be necessary as the condition evolves.

How effective is physical therapy in managing degenerative spondylolisthesis?

Physical therapy plays a crucial role in the non-operative management of degenerative spondylolisthesis. It can be highly effective in:

• Strengthening core and back muscles to provide better spinal support
• Improving flexibility and range of motion
• Enhancing posture and body mechanics to reduce stress on the affected area
• Teaching pain management techniques and exercises for home practice
• Educating patients about ergonomics and lifestyle modifications

While the effectiveness can vary among individuals, many patients experience significant symptom relief and functional improvement through consistent physical therapy.

Surgical Interventions for Severe Degenerative Spondylolisthesis

In cases where non-operative treatments fail to provide adequate relief, or when the condition is severe (usually Grade III or above), surgical intervention may be necessary. Surgery is also considered when there is evidence of neurological damage, disabling pain, or progressive worsening of symptoms. The most common surgical procedure for degenerative spondylolisthesis is laminectomy with spinal fusion.

What does a laminectomy with spinal fusion entail?

A laminectomy with spinal fusion is a surgical procedure that involves two main components:

1. Laminectomy: This part of the surgery involves removing or trimming the laminae (the bony roof of the vertebrae) to widen the spinal canal. This creates more space for the nerves and relieves pressure on the spinal cord.
2. Spinal Fusion: Following the laminectomy, the surgeon fuses the affected vertebrae together. This stabilizes the spine and prevents further slippage. Various devices such as screws, rods, or interbody cages may be used to enhance fusion and provide additional support to the unstable segment.

The goal of this procedure is to decompress the nerves, stabilize the spine, and alleviate pain and neurological symptoms associated with severe degenerative spondylolisthesis.

Emerging Treatments and Future Directions in L4-L5 Spondylosis Management

As medical research advances, new treatment options for degenerative spondylolisthesis continue to emerge. Some of the promising areas of development include:

• Minimally invasive surgical techniques that offer faster recovery times and reduced complications
• Artificial disc replacement as an alternative to fusion in select cases
• Stem cell therapies aimed at regenerating damaged spinal tissues
• Advanced imaging technologies for more precise diagnosis and treatment planning
• Personalized treatment approaches based on genetic and biomechanical factors

These innovative approaches hold the potential to improve outcomes and quality of life for individuals affected by L4-L5 spondylosis and other degenerative spinal conditions.

Are there any promising non-surgical treatments on the horizon?

Indeed, several non-surgical treatments are currently being researched and show promise for managing degenerative spondylolisthesis:

• Platelet-rich plasma (PRP) injections to promote healing and reduce inflammation
• Targeted exercise programs utilizing advanced biomechanical analysis
• Novel pain management techniques, including neuromodulation
• Regenerative medicine approaches using growth factors and bioengineered tissues
• Advanced bracing systems that provide dynamic support while allowing natural movement

While these treatments are still in various stages of research and development, they represent exciting possibilities for future non-surgical management of L4-L5 spondylosis.

Living with Degenerative Spondylolisthesis: Lifestyle Modifications and Self-Care

For individuals diagnosed with degenerative spondylolisthesis, adopting certain lifestyle changes and self-care practices can significantly improve quality of life and potentially slow the progression of the condition. Some key strategies include:

• Maintaining a healthy weight to reduce stress on the spine
• Practicing good posture and ergonomics in daily activities
• Engaging in low-impact exercises like swimming or cycling
• Using proper lifting techniques to avoid excessive spinal strain
• Quitting smoking, as it can accelerate spinal degeneration
• Managing stress through relaxation techniques or mindfulness practices
• Getting adequate sleep on a supportive mattress

These lifestyle modifications, when combined with appropriate medical treatments, can help manage symptoms and maintain spinal health over the long term.

How can individuals with degenerative spondylolisthesis safely engage in physical activities?

Engaging in physical activities with degenerative spondylolisthesis requires careful consideration and often guidance from healthcare professionals. Here are some tips for safe physical activity:

1. Focus on low-impact exercises that don’t jar the spine, such as swimming, stationary cycling, or elliptical machines
2. Incorporate core-strengthening exercises to support the spine
3. Practice gentle stretching and flexibility exercises, avoiding extreme bending or twisting
4. Use proper form and technique during all activities
5. Listen to your body and stop if you experience increased pain or discomfort
6. Consider working with a physical therapist to develop a tailored exercise program
7. Gradually increase activity levels to avoid sudden strain on the spine

By following these guidelines and consulting with healthcare providers, individuals with degenerative spondylolisthesis can maintain an active lifestyle while minimizing the risk of exacerbating their condition.

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

A neurologist treats this disease.

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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.