LUMBAR

SPONDYLOSIS
Presented by:- Abdulhamid saidu,
BPT 3rd year.
Guided by:- Dr, Rashmi mam.
Definition/Description.
-A lumbar spondylosis is described as all
degenerative conditions affecting the
intervertebral disk, body, and associated
joints of the spine.

-It's characterized by insidious onset of pain,

stiffness, and radiographically by
osteophyte formation.
- Its associated with numerous spinal
conditions such as, spinal stenosis
(narrowing of spinal canal) , degenerative
spondylolisthesis (forward slippage of one
vertebrae over another) and osteoarthritis.
 Clinically Relevant
Anatomy.
- Spondylosis generally initiates from
the intervertebral disk. At this level,
progressive biomechanical and
structural changes take place leading to
a modification in the physical properties
of elasticity and mechanical resistance.
Disk lession cause pathological
changes in the vertebral bodies, where
osteophyte appear, most osteophyte are
are anterior or lateral in projection.
Epidemiology /Etiology.
Spondylosis is a form of lower
back pain and is an important
clinical , social , economic and
public health problem affecting
the worldwide population. It is a
disorder with many possible
etiologies and many definitions.
 The incidence of lumbar spondylosis is
27-37% of the asymptomatic lower back pain
population. For example, In the United States,
more than 80% of individuals older than 40
years have lumbar spondylosis, increasing
from 3% of individuals aged 20-29 years.[7]

Approximately 84% of men and 74% of

women have vertebral osteophytes, most
frequently at T9-10 and L3 levels.
Approximately 30% of men and 28% of
women aged 55-64 years have lumbar
osteophytes.
 CAUSES AND RISK FACTORS
Spondylosis is an aging phenomenon.
With age, the bones and ligaments in
the spine were, leading to bone spurs
(osteoarthritis). Also, the
intervertebral discs degenerate and
weaken, which can lead to disc
herniation and bulging discs.
Spondylosis is common.
Direct trauma to the spine can also
be a significant cause of Spondylosis,
if a potential measures failed.
 Symptoms are often first reported
between the ages of 20 and 50. Over
80% of people over the age of 40 have
evidence of spondylosis on X-ray
studies. The rate at which spondylosis
occurs is partly related to genetic
predisposition as well as injury history.
 Signs and symptoms
Pain and stiffness in the lower back
Pins and needles or other abnormal sensation
in the legs
Muscle weakness in the legs
Bladder incontinence
 DIAGNOSIS.
- MRI: expensive, but shows the greatest details
in the spine and is used to visualize the
intervertebral discs, including the degree of disc
herniation, if present. MRI is also used to
visualize the vertebrae, the facet joints, the
nerves, and the ligaments in the spine and can
reliably diagnose a pinched nerve
 - X-rays: show bone spurs on
vertebral bodies in the spine,
thickening of facet joints (the joints
that connect the vertebrae to each
other), and narrowing of the
intervertebral disc spaces.
 - CT scan: able to visualize the spine in
greater detail and can diagnose narrowing
of the spinal canal (spinal stenosis) when
present
- SPECT: Single-photon emission
computed tomography bone scintigraphy
is used to further evaluate patients with
suspected spondylolysis. Controversy
surrounds the designation of one of these
tests as most useful in the evaluation of
spondylolysis.
 PT. EXAMINATIONS
When a physical therapist performs
an examination for lumbar
spondylosis, it is advised to follow the
principles of the general spine
examination and apply them to this
specific pathology. [25]
General examination of the spine
• The examination should begin as
soon as you first see the patient and
continues with careful observation
during the whole consultation.
• It is essential to observe the patient's
gait and posture.
Inspection
• Inspection of the entire spine.
• Look for any obvious swellings or
surgical scars.
• Assess for deformity: scoliosis,
kyphosis, loss of lumbar lordosis or
hyperlordosis of the lumbar spine.
Look for shoulder asymmetry and
pelvic tilt.
Palpation
• Palpate for tenderness over bone and
soft tissues.
 • The normal ranges of movement are
outlined in the relevant sections below.
• Examination of the spine must also
include examination of the shoulders
and examination of the hips to exclude
these joints as a cause of the symptoms.
-> Range of motion is full.
Neurovascular examination
• A thorough examination of sensation,
tone, power and reflexes should be
performed
• Always consider the possibility of
acute spinal cord compression, which is
a neurosurgical emergency
 Medical treatment
The condition is not 100%
medically curable....But
 A lot of research has been done to explore
the efficacy of different oral medications in
the management of lumbar spondylosis to
complement non-pharmacological
interventions.
- NSAIDS (=non-steroidal anti-inflammatory
drugs) are analgesics and anti-inflammatory.
It covers wide range selectivity. From the
nonselective cyclooxygenase (COX)
inhibitors to the preferential COX-2. It is
generally accepted to be the first step in
management of lumbar spondylosis.
 -Muscle relaxants may provide
benefit with regard to short-term pain
relief and overall functioning
-Antidepressants: have been used
for treatment of LBP because of
their analgesic value at low doses.
The use of antidepressants has
also been explored for their dual
role in treatment of depression that
accompanies lumbar spondylosis
syndrome.
 -Epidural steroid injections are the most
common injections and target the epidural
space (space surrounding the membrane
that covers the spine and nerve roots).
These are strong anti-inflammatory
(combination of a corticosteroid with a
local anesthetic pain relief medicine) and
give an immediate pain relief.
Physical Therapy Management
Due to the limited knowledge of the causative
sources of chronic lower back pain, there is a no
definitive treatment approach for lumbar
spondylosis
Lumbar spondylosis cannot be cured, but
physiotherapy and movement play an important
role in improvement of the living conditions and in
slowing down or even avoiding further
degeneration.
The conservative therapy can be divided into
various exercise-based and behavioral
interventions:
1.Exercise therapy :-Exercise therapy includes Spinal
manipulation, aerobic exercises, strengthening of
muscles and lumbar supports play a vital role in
enhancing the movement and pain management.
Stretching of sot tissues also play a role in
improving the extensibility of soft tissues.

2.Electrotherapy:- Electrical modalities like TENS,

LASER AND US THERAPY e.t.c play a vital role to
relieve the onset of pain.

3Lumbar back supports: can be benefit for patients

suffering of chronic LBP. It occurs to limit spine
motion, stabilize, correct deformity and reduce
mechanical forces. 
 SURGICAL MANAGEMENT.
Surgical management is indicated
in a severe case or when conservative
management persist. The common
surgeries for lumbar spondylosis
includes :-
1.Lumbar fusion
2.Artificial Lumbar Disk replacement.
 References
Lumbar Spondylosis – Wordpress:http://www.
lumbarspondylosis.net/
Better Medicine – Healthgrades:http://www.localhealth.
com/article/spondylosis
Bone and Spine – Studiopress:http://boneandspine.
com/spine/what-is-lumbar-spondylosis/
Medscape:http://emedicine.medscape.com/
article/249036-overview#a0104