Follow your doctor’s treatment plan

Consultant Rheumatologist and Specialist in Sports Medicine attached to Nawaloka Hospitals PLC Dr. Harindu Wijesinghe (MBBS, MD, MRCP), speaks to T n' C about Lumbar Spondylosis, the second type of Spodylosis, an ailment that affects many in our society.

Q : What is Lumbar Spondylosis?

A : Lumbar Spondylosis is a general term for degenerative changes of the Lower spine. Most degenerative changes of the spine are part of the normal aging process, much like developing grey hair. Everyone is expected to have some evidence of spondylosis as they get older. These degenerative changes most commonly occur at the intervertebral disk and the vertebral body and openings for nerve roots. Changes can also occur at special joints called facet joints; this is referred to as facet syndrome.

Spondylosis occurs as the intervertebral discs lose moisture and volume with age, which decreases the disc height. This causes wear and tear in surrounding bones and joints. Also the GEL like material in the disc can leak out and irritate the nerves going down in to the legs. Because of all these reasons spondylosis leads to various types of pain. Back pain due to spondylosis is a very common disease. Low back pain is second only to the common cold as a cause of lost days at work. It is also one of the most common reasons to visit a doctor's or a emergency department.

Q : What are the symptoms and how do doctors diagnose it?

A : Many people with spondylosis will describe stiffness or localized aching in the lower back. Pain in the lower part of the back is the primary symptom of low back pain. The pain may radiate down the front, side, or back of your leg, or it may be confined to the low back. The pain may become worse with activity. Occasionally, the pain may be worse at night or with prolonged sitting.

In severe cases, changes may place pressure on the nerves travelling into the legs. Pinching of the nerve causes pain, which is felt as a shooting type pain radiating down the leg (sciatica). If the nerve is damaged weakness of the affected foot can occur with difficulty in walking (Foot Drop).

Degenerative changes can cause spinal stenosis (narrowing of the spinal canal). A person with spinal stenosis may have pain radiating down both lower legs while standing for a long time or walking even short distances causes tightness in the calves.

Diagnosis is based on the description you give about the disease (History) and the doctors examination of you. The doctor will watch for signs of nerve damage while you walk on your heels, and toes of the feet. Reflexes are usually tested using a reflex hammer. This is done at the knee and behind the ankle. As you lie flat on your back, one leg at a time is elevated, both with and without the assistance of the doctor. This is done to test the nerves, muscle strength, and assess the presence of tension on the sciatic nerve.

Usually the cause of the back problem can be diagnosed with history and examination only. However if the pain doesn't get better or if the doctor wants more information he may request blood tests, X-rays and MRI.

Q : What are the conditions that require immediate medical treatment

A : The presence of any of the above would justify a visit to the hospital immediately. Anyone with back pain and the inability to raise or lower your foot at the ankle. Also included would be the inability to raise the big toe upward or walk on your heels or stand on your toes. These might indicate an acute nerve injury or compression.

Loss of bowel or bladder control, including difficulty starting or stopping a stream of urine or incontinence, can be a sign of an acute emergency and requires urgent evaluation in an emergency department.

Q : Who are in the high risk category?

A - Anyone can get spondylosis as it's related to aging. Occupations which involve sitting or standing in the same position for long periods or jobs involving heavy lifting or manual work may also predispose to spondylosis. Among sportsmen cricket fast bowlers are a particular high-risk group.

Q : What treatments are available?

A : Low back pain will usually settle by itself. And thus the initial management is usually conservative (non medical) unless someone is in severe pain.

Many different treatment options are available. Home care is recommended for the initial treatment of low back pain. Bed rest remains of unproven value, and most experts recommend no more than two days of bed rest or decreased activity. Application of local ice and heat provide relief for some people and should be tried. Paracetamol and pain killers (NSAIDs)are useful for controlling pain.

These treatments help with pain relief. It is important not to take NSAIDs long term for back pain due to their side effects. If you need long-term pain medication your doctor will prescribe tablets such as paracetamol and other analgesics, which have less side effects than NSAIDs. It is important not to take medicine long term unless your doctor has prescribed it.

Q : What Medications are used to treat Spondylosis?

A : No medication has been proven to reverse the degenerative process of spondylosis. This is very important to understand as people waste large amounts of money on these therapies.

Treatment of pain from spondylosis commonly includes anti-inflammatory medications, analgesics (?pain medications?), and muscle relaxants. Non-steroidal anti-inflammatory medications, or NSAIDs, can be very effective in relieving back and neck pain from spondylosis. Ice and heat fermentation and topical applications help some people.

Physical therapy is often prescribed for chronic back or neck pain for muscle strengthening and stretching. Physical therapists can demonstrate specific exercises which, when performed daily, may help strengthen the back and abdominal muscles and prevent recurrent pain. Physical ? exercise? ?o?n a regular basis, specifically walking and Yoga?, have been shown in studies to be beneficial for chronic back pain.

Q : What are the Surgical Treatment Options for Spondylosis ?

A : Spondylosis is a chronic condition. Surgery for patients with chronic low back pain is controversial, as most studies do not show improvement as compared to nonsurgical treatment such as physical therapy and pain management. Also, many patients continue to have chronic back pain after the surgery. However, surgery is sometimes necessary when spondylosis or spinal stenosis causes a nerve problem that is severe or worsening, progressive ? nerve damage?, or difficulty walking.

Q : Do you have any advice for patients suffering from Lumbar Spondylosis?

A : If you have back pain which is not settling it is wise to see a specialist for back pain. He will first make a diagnosis and then help you to get pain relief. It may not always be possible to get rid of back pain completely as there is no medicine to re-grow the damaged tissues. However with a combination of exercise, proper postures and weight control and sometimes tablets for pain relief you can live a pain free life. Also it is important to realize that a large part of the management (Exercise, postures, weight loss) has to be done by the patient.

Q : Any preventive measures?

A :You cannot stop your body from growing older, but you can do a lot to improve the health of your spine. By following the tips listed below, you can enjoy the benefits of a healthy spine at any age!

* Follow your doctor's treatment plan and continue your home exercise plan (if you were in physical therapy).

* Sit and stand properly.

* Learn to lift correctly.

* Exercise regularly. (Aerobic exercise is especially good.)

* Attain and maintain a healthy body weight.

* Eat healthy (a well-balanced, low-fat diet rich in fruits and vegetables).

* Stop smoking.

* Avoid excessive use of alcohol.

* Get plenty of rest.

The slump (left), attention (center) and poised (right) standing positions require very different
muscular activity to maintain. Which position do you think requires the least effort? Wrong positions in
sleeping sitting standing lifting cause joint pain