Introduction
Lumbar spondylosis is the most common diagnosis you find when you approach a physician complaining about low back pain and stiffness. It is a degenerative condition affecting the discs, vertebral bodies and associated joints of the lumbar spine. Low back pain and other discomforts started from the time human beings started walking on two legs, with an erect posture and the spine had to bear the extra burden. In the earlier days, poverty and physical exertion caused deficiencies in most people which led to low backache and other problems. Nowadays, sedentary lifestyle and obesity cause most of the low back diseases. Lumbar spondylosis is enlisted in many of the postural problems, yet it can happen due to other reasons, though. Adults, mostly women suffer from lumbar spondylosis mostly.
Signs and symptoms
Most cases show no symptoms at all. In later stage, symptoms include:
- Intermittent back pain that may radiate to the extremities
- Joint or muscular stiffness upon awakening
- Muscle weakness and/or tingling in the back, buttocks, legs, and other affected areas
- Numbness or loss of sensation in the affected areas
- Tenderness in the area of nerve compression
- Loss of bowel or bladder control
Pathophysiology
Lumbar spondylosis (spondylosis deformans, lumbar osteoarthritis), is known to be bony overgrowths (osteophytes), mostly at the anterior, lateral margins of vertebral bodies. Lumbar spondylosis occurs as a result of new bone formation in areas where the anular ligament is stressed. Normal vertebral bodies have smooth margins. Growth of new bone projecting horizontally at these margins identifies osteophytes. Most osteophytes are anterior or lateral in projection. Posterior vertebral osteophytes are very rare. This process increases with age. Lumbar osteophytes have long been thought to cause back pain because of their frequency and size. But studies show that frequency of signs or symptoms among individuals with osteophytes is no greater than among those individuals without osteophytes.
The high incidence of simultaneous degenerative changes to the intervertebral disk, vertebral body, and associated joints suggests a progressive and dynamic mechanism, with interdependent changes occurring secondary to disk space narrowing. Intervertebral disks are believed to undergo what Kirkaldy Willis and Bernard first coined a “degenerative cascade” of three overlapping phases that may occur over the course of decades.
Phase I (Dysfunction Phase)
Beginning of repetitive microtrauma with the development of circumferential painful tears of the outer, innervated anulus, and associated end-plate separation that may compromise disk nutritional supply and waste removal. Such tears may coalesce to become radial tears, more prone to protrusion, and impact the disk’s capacity to maintain water, resulting in desiccation and reduced disk height. Fissures may become ingrown by vascular tissue and nerve endings, increasing innervation and the disk’s capacity for pain signal transmission.
Phase II (Instability Phase)
It explains the loss of mechanical integrity, with progressive disk changes of resorption, internal disruption, and additional annular tears, combined with further facet degeneration that may induce subluxation and instability.
Phase III (Stabilization Phase)
It is the time when continued disk space narrowing and fibrosis occur along with the formation of osteophytes and trans discal bridging.
The spectrum of pathological changes in facial joints & the disk and the interaction of these changes. The upper light horizontal bar represents dysfunction, the middle darker bar instability, and the lower dark bar stabilization
Osteophyte lipping is believed to form at periosteum through the proliferation of peripheral articular cartilage which subsequently undergoes endochondral calcification and ossification. Changing weight mechanics and pressure forces as well as alterations in oxygen tension and dynamic fluid pressure appear to be influential factors in osteophyte formation. Mesenchymal stem cells of the synovium or periosteum are likely precursors, with synovial macrophages and a milieu of growth factors and extracellular matrix molecules acting as probable mediators in this process.
Causes
Since the purpose of the lumbar spine is to support your body weight, over time the L1-S1 vertebrae become worn and compressed from repetitive motion, heavy lifting, and weight gain.
Common causes include:
- Herniated or bulging discs
- Bone spurs
- Spine abnormalities
- Arthritis of the spine
In most cases, lumbar spondylosis only causes noticeable symptoms when the spinal cord or nerves around the spine become irritated or compressed. When symptoms do occur, they can differ greatly from person to person.
Diagnosis
Physical examination to assess the range of motion, reflexes, and fine motor skills.
Imaging and other tests to determine the exact cause of symptoms and what treatment is appropriate.
These tests include:
- X-rays of the back to discover any abnormalities
- CT scan for more detailed imaging of bones
- MRI to find any areas where nerves may be compressed
- Myelography in which a dye is injected into the spinal canal prior to imaging tests
- A nerve function test called electromyography (EMG) that tests electrical activity in nerves
- A nerve conduction study during which electrodes attached to the skin measures strength and speed of nerve signals
Treatment
Treatment for lumbar spondylosis depends on the severity of symptoms. Aim of the treatment is to relief from pain, avoid future damage, and help improve the quality.
This treatment plan may include nonsurgical options, including:
- Physical therapy
- Restorative yoga
- Lifestyle changes, such as weight loss
- Pain medication
In cases when nonsurgical treatment doesn’t relieve symptoms, minimally invasive surgery to decompress the spine can be performed.
Prognosis
Generally, the prognosis of spondylosis is favourable. Many people with spondylosis do not have any symptoms. Of those who develop back or neck pain due to spondylosis, most improve within a few weeks of the onset of their symptoms. Few people go on to develop chronic pain due to spondylosis.
Complications
Spinal stenosis if lumbar spondylosis projects into the spinal canal.
If osteophytes disappear, look for aortic aneurysm. Aortic aneurysms can cause pressure erosions of the adjacent vertebrae.
Disease & Ayurveda
Katigraha
Nidana
Physical
Dry, cold and old food items
Excess travelling & exertion
Trauma/injury
Exposure to wind
Loss of sleep
Psychological
Stress
Purvaaroopa
Not mentioned
Samprapti
Due to the causative factors, Vaatadosha vitiates and move irregularly all over the body and cause imbalance in circulation & metabolism. Due to either obstruction in the channels or degeneration of body tissues, the movement of Vaata gets in an unbalanced state. This vitiated Vaata gets lodged inside the spine in the lumbar area and causes pain and stiffness.
Lakshana
Pain in the lowback
Stiffness of the back especially in lumbar region
Restricted movements of spine.
- If Saama, loss of appetite, fatigue, swelling and hardness will be there.
- In niraama, only pain and associated symptoms will be present. Appetite and bowel movements will be normal.
Divisions
Saama
Niraama
Prognosis
Sukhasadya in new and with no restricted movements.
Yaapya in chronic cases
Chikithsa
The ayurvedic treatment depends upon whether the katigraha is saama or niraama. If aama is present, only rooksha therapies are done in the beginning. Application of Vaatahara oils and ghee preparations should wait until the aama is completely cleared and the srotas (channels) are open completely. If the Vaatakopa is due to obstruction, the pain will be relieved once the channels are open and the movement of Vaata is in normal balanced condition.
Samana
In Saama condition
Lepanam with Rookshana dravyas
Soolaharakwathaparisheka
Upanaha
Sodhana
Sneha-sweada
Virechana
Asthapanavasti
Anuvasanavasti
Commonly used medicines
Mustadi marmakashayam
Guggulutiktakam ghrutam
Murivenna
Dhanwantaram tailam
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
Over-the-counter pain medications can frequently alleviate the pain.
Take enough rest. Immobilisation is very important in relieving the pain.
Applying ice can help with pain and inflammation.
A hip or low back brace/belt can help immobilisation and support. It should not be tight and should be removed at night.
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, cause obstruction in channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, sesame oil, ragi.
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from cold climate.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle. Be active
Avoid lifting heavy weights
Yoga
In lowback pain, exercises are to be done only under supervision.
Exercises are contraindicated in patients with severe pain and stiffness.
Regular stretching and mild cardio exercises are advised in mild cases. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697338/#Sec6title
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697338/
https://pubmed.ncbi.nlm.nih.gov/24252032/