Lumbar Spondylosis

(Low Back Arthritis)

Have you ever experienced low back pain? Did you know 80% of Americans will experience low back pain at least once in their lifetime? Did you also know that the bones in your low back (your lumbar spine) can become arthritic, just like your shoulders, knees and hips, and cause pain? Low back osteoarthritis (also know as lumbar spondylosis) will affect 40-80% of the population. Lumbar arthritis is often times forgotten or ignored as a source of low back pain.

Lumbar Spondylosis: What is it?

Just as your body’s joints (knees, hips, ankles, shoulders, etc.) can be arthritic and painful over time as you age, so can your low back. A part of the arthritic change of the spine happens when the facet joint (the joint that allows motion in your spine) loses the cartilage that coats it, which results in the joints rubbing together. Another part of the lumbar spine arthritic change comes from the intervertebral disc (which lies between each vertebral body) losing water, causing the bones to dehydrate and collapse over time. This forces your bones to move closer together and puts more pressure on the facet joints. This disc narrowing will contribute to the loss of a person’s overall height. It can also lead to the formation of bone overgrowth and bone spurs.

Symptoms: What does Lumbar Spondylosis feel like?

The symptoms of low back arthritis can vary person to person but the most common symptom is low back pain.
Periods of immobility and inactivity can cause feelings of back stiffness.
You may feel you have limited range of motion of the spine.
Aging and more arthritic changes may make the low back pain feel worsened.
The arthritis in your back can also lead to pinching of the nerves in your spine, which can cause leg pain (sciatica), numbness and tingling of your lower extremities, and sometimes leg weakness.
Some people may feel worse pain when standing or sitting for long periods of time or walking distances may become difficult due to back pain.
There also will be some people who will not have symptoms from the arthritic back changes.

Causes

The degenerative changes of your low back are often multifactorial and some people are at a higher risk of developing these changes.

Genetics/Anatomy: Your genetic make-up plays a role in your spine arthritis. If your parents or siblings have back arthritis, there is a likelihood you will also. Your anatomical make up can cause for a tighter spinal canal, which can lead to symptoms of arthritic changes sooner.

Age and Use: Using your body each day includes utilizing your spine. The stress of using your back will contribute to arthritic changes over time.

Previous Trauma or Surgery: Previous injury or surgery can add to stress of your spine and joints, which can cause breakdown more rapidly.

Obesity: More body weight will put more stress on your spine’s facet joints.

Autoimmune disorders: Diseases where your body is fighting against itself, such as rheumatoid arthritis and ankylosing spondylitis, can affect your spine and its joints causing degeneration or destruction.

Occupation: Repetitive motions of the spine or stress can play a role in spine degeneration.

Evaluation: How is Lumbar Spondylosis diagnosed?

To begin with, your doctor will ask you about your symptoms and evaluate your risk factors. A physical examination will also be performed so your back can be examined as well as your neurological function, i.e. testing the nerves in your back which allow you to have strength and sensation to your legs.

Radiographs: X-rays are a helpful tool in looking at bone changes. The joints and vertebral bones can be visualized and assessed for any visible changes such as facet arthritis, disc collapse, bone spurs, and spine curvature changes.

MRI: An MRI is an advanced image that not only allows the bones to be visualized, but also the intervertebral discs and nerves. The nerves may become pinched and cause leg symptoms if you have arthritis in your back.

CT: A CT looks closer are the bone make up of your spine and can give finer detail of bone changes or arthritis.

Bloodwork: If an autoimmune component is suspected, then labs may be drawn which can help diagnose different disorders.

Treatment

Non-operative treatment

These types of treatments do not take the arthritis away from your back, but can make the symptoms of the arthritis dissipate or subside.

Physical Therapy: Learning techniques to strengthen the musculature around your spine can help you offload or reduce the stress of daily use of your back. There are also techniques included that teach stretching, improving range of motion, and doing treatments with ultrasound and stim.
Anti-inflammatories: Medications can help with the inflammation around your arthritic joints and spine, which can ease or take away the pain.
Activity Modifications/weight loss: Changes in activities that stress your back, such as heavy lifting and repetitive bending and twisting can help symptoms. Losing excess weight can also help offload the pressure on your arthritic joints. Staying active is also very helpful in management of spine arthritic pain.
Chiropractic care: Chiropractors have multiple techniques and modalities to assist people with low back arthritis; some chiropractors also use stretches and exercises in their clinic.
Injections: There are different types of injections depending on the type of issue and symptoms your back arthritis is causing you.
1. Epidural steroid injections: This type of injection is good for people whose arthritis is causing nerve pinching and leg symptoms (pain, numbness/tingling, weakness, etc.). The injection is performed by a trained provider and a needle is placed into the epidural space near the nerve that is being pinched. A large dose of steroid is placed near the nerve in hopes of helping reduce inflammation.
2. Facet Injections: These injections are actually placed into the facet joint/joints that are thought to be causing pain from arthritis. The medication used is typically a steroid and/or numbing medication. The result is thought to help with the inflammation caused by the arthritic joints rubbing together.
3. Medial Branch Blocks and Rhizotomy: This is typically a step-wise procedure beginning with the medial branch blocks. This procedure is when numbing medication (think Novocaine like at a dental appointment), is placed into the arthritic facet joints to see if relief is obtained by numbing the nerve endings in the arthritic joints that allow you to feel the bones rubbing together. If the person gets hours to a day’s relief from the medial branch blocks then the second part of the process can take place. This is the rhizotomy, which entails burning of the nerves in your joints, so that you no longer feel the arthritic joints rubbing together. The nerves that are burned will regenerate, but very slowly, which allows for some lasting relief of pain.
Other treatment options: Acupuncture, dry needling, and water therapy are just some of the alternatives that can be utilized in treating symptoms of back arthritis. Other medication options that can be helpful include Tylenol for pain relief. If there is nerve involvement, there are nerve medications that can be used.

Surgery

Depending on your specific situation and symptoms, there may be different surgical options offered by your orthopedic spine surgeon. Most people who have surgery for their arthritis of their spine have better outcomes when it is performed for nerve pinching symptoms, rather than low back pain.

Recovery: What Can Be Expected?

This will depend on if a surgical intervention is offered and thought to be helpful in your specific case. There are a bevy of surgical interventions that can be performed when it comes to the lumbar spine and arthritic changes, thus recovery may vary. If spine surgery is offered, common restrictions and recovery periods may be as listed:

Follow up in clinic in 2-3 weeks for incisional check.
Back pain or abdominal pain may be present pending on the approach of the surgery. This pain is usually more prominent over the first few weeks while you are beginning your recovery period. The pain will dissipate over time as you continue your recovery.
Restrictions of no lifting greater than 10-15 lbs for up to three months.
No excessive bending and twisting during the recovery period.
No driving while on narcotic pain medications, which may be required for pain control over the first few weeks.
Physical therapy will be started when appropriate, which is usually at 2 weeks. The requirements initially consist of being able to walk distances and avoid sitting or standing in positions for longer than one hour periods.

Frequently asked questions about Lumbar Spondylosis

Is there anything I can do to reverse the arthritis in my low back?

Unfortunately no there is not anything that can reverse the damage to your discs or regrow your cartilage. There are different surgeries that can help with arthritic pains or nerve pinching by surgically removing bone and/or disc. There are also surgeries that the goal is to fuse your bones together so there is no longer motion at the arthritic joints.

Is there anything i can do to slow down arthritis from occurring?

Staying active may not necessarily slow arthritis down, but can help with keeping your symptoms at bay. It can also help if you keep your weight at a normal BMI, thus putting less pressure on your arthritic joints.

Can you replace my joints in my spine?

The joints are not replaced. For surgery, there is a fusion surgery that can occur to help stop the joints from moving and causing more pain and more arthritis.

Is glucosamine chondroitin beneficial to take for my arthritis?

There have been studies that state this supplement can help people have less joint pain and help prevent joint disease, but there are also studies that contradict this. If you do not have ill side effects and it is approved by your doctor to take, there is likely little harm in doing so. Supplements are not regulated by the FDA, thus always discuss this further with your physician.

Is chiropractor care recommended?

Many patients have found chiropractor care beneficial in treatment of their low back pain. If your pain is decreasing and you have a positive outcome with treatments, then it can certainly provide benefit. If there are concerns, you can always discuss this with your chiropractor and/or your orthopedic physician.

Physicians

The following physicians specialize in the treatment of Lumbar Spondylosis:

Matthew K. Wingate, MD

Matthew J. McKenzie, MD

Gregory F. Alvine, MD

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Testimonials

I first saw Dr. Chang 14 years ago …I had nerve conduction studies, followed by 8 acupuncture treatments, and was pain-free after years of chronic sciatica back pain. I then joined a local fitness center to continue the healing, as I was actually able to exercise again! I have never even had to go back for any more treatments for that health problem! His gifts of healing, experience, and expertise have changed my life forever for the better! He is compassionate, caring, kind, thorough, and so intelligent.

I returned to him years later for a very painful neck and shoulder, with the same successful results. I am now seeing him for the third time … once again for acupuncture for pain relief of a new problem area. All of my 3 treatment periods over the past 14 years have been consistent of the highest quality.

We are blessed to have Dr. Chang here in Sioux Falls. I tell others about him all the time, and try to help promote acupuncture as a viable option for pain relief. I had a “needle phobia” most of my life, so it took ALOT for me to decide to try this. If you are worried about the needles, don’t be! You will be fine!

My pain is so much better; I owe that to Dr. Baumgartner professional knowledge. He was most courteous, so was the entire staff. Even the X-ray nurse. Now my PT will get me back on track to more strength in my arms. Taking my shower, wiping off with a towel was so much easier, the very next day. I have better strength to do my daily walks, n chores, get dressed easier too. My immune system is not overwhelmed like it was when I had so much pain & inflammation in my arms, shoulders, & neck. I sleep better too.

I’ve only seen Dr. Wingate once. He was extremely thorough in studying my history with neck and back problems and the treatments I’d had over the years. While there are very few procedures available to me surgically, he offered me the possibility of some alleviation that had not been attempted previously. We are in the process of checking this out.

OI has outstanding staff and Dr’s. They are with you every step of the way-before and after surgery. It has been YEARS since I felt this good- Thanks to TEAM WINGATE (including the Spine Therapy dept) performing a successful ACDF C6/7. I definitely recommend. And… thank you Dr. Windgate!

Kelly Trapp

The staff at OI are very professional and helpful and the surgeons are the best at what they do. Had foot surgery a few years ago and have also been seen for my spine and my daughter was seen for a knee injury. They’re not knife-happy, they treat conservatively and do surgery when necessary. I appreciate the time they and their PAs take to answer questions and make sure the patient knows the plan of action. The PT staff is awesome too. Very thorough and they all know what they’re doing.

Liz Hansen

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