Lumbar Spondylosis

Lumbar spondylosis is age-related wear and tear of the discs and small joints of the lower back. It develops slowly over many years and is seen in most people as they grow older, often without causing trouble. In some people it leads to chronic back pain, or to narrowing of the spinal canal that presses on the nerves going to the legs.

Symptoms

• Stiffness of the lower back, especially in the morning or after sitting, that eases with gentle movement
• Aching pain after standing or working for long periods
• Pain, heaviness, tingling or weakness in the legs on walking that is relieved by sitting down or bending forward (neurogenic claudication, a sign of canal stenosis)
• Gradually reducing walking distance
• Pain spreading into the buttock or leg if a nerve root is pinched

Causes

• Ageing of the discs, which lose water and height
• Arthritis of the facet joints at the back of the spine, with bony spurs
• Thickening of the ligament inside the spinal canal
• Excess body weight, years of heavy manual work or a largely inactive lifestyle
• Smoking, previous back injury and family tendency

Sometimes the worn joints allow one vertebra to slip forward over another (degenerative spondylolisthesis), adding to nerve compression.

Diagnosis

Your doctor will ask how far you can walk and what relieves the pain, then examine the spine, leg nerves and pulses in the feet. Poor blood circulation to the legs and hip arthritis can cause similar symptoms and need to be ruled out. X-rays, including views taken while bending forwards and backwards, show wear and any abnormal movement between vertebrae. An MRI shows the degree of canal narrowing and nerve compression and is essential if surgery is being considered.

Treatment

Most people with lumbar spondylosis manage well without surgery. Regular low-impact exercise such as walking, stationary cycling or swimming keeps the spine flexible. A physiotherapy programme to strengthen the core and hip muscles, along with weight reduction, often reduces pain significantly. Pain-relieving medicines may be used during flare-ups under medical supervision, and heat packs help with stiffness. Avoid standing or sitting in one position for long. Injections around the nerves or into the facet joints can give relief in selected patients.

Surgery is considered when canal stenosis severely limits walking or daily activities despite proper treatment, when leg weakness is increasing, or when there is significant instability. The operation removes the bone and thickened ligament pressing on the nerves (decompression), and sometimes the spine is also stabilised with screws (fixation and fusion). In suitable patients, decompression can be done through minimally invasive or endoscopic techniques with smaller incisions and quicker mobilisation.

When to Seek Urgent Care

• New or worsening weakness in the legs, or foot drop
• Numbness in the saddle area around the private parts and buttocks
• Loss of control over passing urine or stools
• Back pain with fever, chills or unexplained weight loss
• Sudden severe back pain after a fall, especially in people with weak bones

If any of these occur, go to the nearest emergency department immediately.

If lower back stiffness or leg pain on walking is limiting your life, consult Dr. Prashant Sharma at Keshav Super Speciality Hospital, Meerut, to discuss the options that suit you.

Related Conditions

• Slip Disc
• Spinal Nerve Pain (Radiculopathy)
• Spinal Paralysis
• Spine Tumour
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