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Lumbar Osteoarthritis

What is Osteoarthritis?

Osteoarthritis (OA) or just “Arthritis” of the low-back, called lumbar spondylosis, are age-related changes of the spine. In OA, the cartilage between the vertebrae degenerates. Since cartilage is essentially a cushion between the vertebrae, the breakdown of the cushion will cause joint damage over time.

The cartilage cushions between the vertebrae are the discs in the front of the spine and the facet joints in the back of the spine.

OA of the low-back can take on many different forms, such as disc degeneration, facet joint degeneration, a change in the curvature of the mid-back (kyphosis), or the development of bone spurs.

While spine specialists may use the term “Arthritis”, they usually classify the problem by a specific condition such as disc degeneration or facet joint degeneration.

What is the difference between Osteoarthritis of the Spine and other Arthritis forms of the spine?

Osteoarthritis is generally related to aging and wear and tear, rather than a specific disease of the body. Rheumatoid arthritis is a condition which is part of a disease process where the body believes that the joint lining (synovium) is foreign material and attacks it.

Is Osteoarthritis of the Spine inherited?

Osteoarthritis of the spine does not have to be inherited. It is often related to aging and wear and tear, rather than just genetics.

How common is Osteoarthritis of the Lumbar Spine?

This condition is often present in patients over the age of 50. By the age of 60, most people will have signs of OA of the spine on X-Rays. Over the age of 60, 85% of the population has signs of OA on a spine image. However, most patients have either no symptoms or mild symptoms. The presence of Osteoarthritis changes on an X-Ray does not mean that pain has to be present.

Which part of the spine is affected by Osteoarthritis?

Osteoarthritis can affect any part of the spine. It is most often seen as degeneration of the spinal discs, facet joints, and ligaments. The disease can also affect the spinal nerves or spinal cord depending on the degree of degeneration. Examples of that are when bone spurs form or discs herniate into the spinal canal, compressing the spinal nerves or spinal cord.

What are some of the specific spine conditions seen in patients with Osteoarthritis of the Lumbar Spine?

Spinal Osteoarthritis is usually classified by specific conditions of the Lumbar spine. Here are some of the most common ones:

  1. Lumbar Degenerative Disc Disease
  2. Lumbar Facet Joint Degeneration
  3. Lumbar Spinal Stenosis

What are some risk factors for Spinal Osteoarthritis?

Here are some risk factors for getting OA:

  1. Being Overweight
  2. Lack of Exercise
  3. Being exposed to frequent heavy lifting, twisting and bending
  4. Prior low-back injuries
  5. History of disc disease
  6. Prior lumbar spine surgery

What are the symptoms from Spinal Osteoarthritis?

Here are some common symptoms of OA in the spine:

  1. Stiffness of the spine
  2. Spine pain that is worse after standing or sitting
  3. Pain in the low-back which spreads to the hips, buttocks or legs
  4. Pain, numbness or weakness in legs
  5. Difficulty with gait

How is Lumbar Osteoarthritis diagnosed?

Spine specialists use information from the patient history, physical examination and special tests to diagnose this condition.

  1. History

A history of spine stiffness and aching which has progressed slowly over the years and is relieved by rest is often suggestive of Osteoarthritis of the spine.

      2. Physical Examination

Here are some tests done by doctors to assess for OA of the lumbar spine:

  1. Back mobility (range of motion)
  2. Tenderness to touch and pressure over the spine
  3. Muscle strength testing of the legs
  4. Sensation testing of the legs
  5. Gait testing
  6. Reflex testing of the legs

      3. Imaging

  a. X-Rays                      

Basic spine X-Rays are often used to look for OA. They can often show the presence of the disease and the severity. The height of the disc, presence of bone spurs, facet joint degeneration and the spinal curvature can be evaluated.

   b. CT Scans

A CT scan can show the wear on spinal bones and joints in more detail than X-Rays. It can be useful to assess the degree of OA, but is not commonly used to find out if a patient has OA due to the high radiation exposure.

   c. MRI scans        

MRI is usually not needed to diagnose the presence of OA. However, patients who have     severe symptoms or show signs of nerve involvement often need an MRI to assess the discs, spinal nerves and spinal cord in detail.

What is the treatment of Osteoarthritis of the Lumbar Spine?

Here are some of the Non-Surgical and Surgical treatments of the mid-back for this condition:

  1. Non-Surgical

The diagnosis of OA of the spine does not mean patients have to experience constant pain. Typically the symptoms fluctuate depending on the level of activity, small injuries and weather changes amongst others. The treatments below are for the times when symptoms worsen, or the pain becomes more persistent.

A. Alternative Health Care

Alternative Health care options can often complement conventional medical care. Massage Therapy, Acupuncture, Meditation exercises and Herbal Remedies can all help with the pain from this condition. Massage Therapists can provide relief of the muscle component of Osteoarthritis pain.

B. Nutrition and Weight Loss

Proper nutrition and weight loss can have a positive impact on many spine conditions. Excess weight on the spine often contributes to the symptoms of pain and spasms (Spine and Obesity).

C. Chiropractic Care

Chiropractic care including manipulation and adjustments of the spine can help with the pain and spasms from this condition.

D. Spine Exercises

Spine exercises can help with the muscle pain and tightness from this condition. Exercise also increases the amount of oxygen delivered to the spine which can help with healing. Pilates, Yoga and T’ai Chi can help maintain the spine’s flexibility.

E. Physical Therapy (PT)

PT has many modalities to offer for this condition. They can range from Manual Therapy and Exercises to Traction and Ultrasound Treatments.

F. Self Help Tools

Self Help Tools are items which can be purchased to help with back pain. They range from Back Braces to Back Mattresses and Ergonomic Devices such as chairs and computer accessories.

G. Spine Medications

Here are some of the common groups of medications which are available for this condition:

  1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
  2. Muscle Relaxants
  3. Pain Killers
  4. Nerve Pain Medications
  5. Antidepressants

H. Injections

Depending on the exact spine condition which is causing pain from Spinal Osteoarthritis, a specific spine injection can offer significant help. Here is a list of some of the available injections:

  1. Lumbar Interlaminar ESI
  2. Lumbar Transforaminal ESI
  3. Lumbar Nerve Root Block
  4. Lumbar Facet Joint Injection
  5. Lumbar Facet Joint Radiofrequency Rhizotomy
  6. Lumbar Intradiscal Electrothermal Therapy (IDET)
  7. Lumbar Trigger Point Injection

      2. Surgical Care

Surgical treatment is reserved for patients with severe conditions who have a poor quality of life due to severe pain or nerve dysfunction.

Here are some surgical options:

  1. Lumbar Fusion
  2. Lumbar Artificial Disc Replacement
  3. Lumbar Dynamic Stabilization
  4. Lumbar Interspinous Process Spacers
  5. Lumbar Laminotomy and Foraminotomy
  6. Lumbar Discectomy