Lumbosacral Spondylosis without Myelopathy

What is Lumbosacral Spondylosis?

The spine is made up of numerous separate bones called vertebrae, with the spinal cord running through the middle. The vertebrae are separated by cushiony discs of cartilage which allow some movement and also act as shock absorbers. With age, these discs can wear down and become herniated (bulge out), and the vertebrae begin to rub against each other when they move. The result is a form of osteoarthritis called spondylosis, which can cause pain and stiffness.

The spine is divided into five regions according to the shape and size of the vertebrae: the two largest regions that make up the lower back are called the lumbar spine and the sacrum. Thus, "lumbosacral spondylosis" is osteoarthritis in the lower back area.

What is Myelopathy?

If herniated discs happen to press on the spinal cord, this may cause damage to the cord, which is called myelopathy. "Spondylosis without myelopathy" means spondylosis where spinal cord damage has not occurred.

How do I know if I have it?

More than 80% of people aged over 40 have some form of spondylosis, but it does not always cause symptoms. Because the condition progresses with age, symptoms are more likely to appear in older people. For patients with lumbosacral spondylosis, symptoms include pain and stiffness in the lower back, often most noticeable on getting up in the morning or after sitting still for a period of time. Unfortunately, activity may cause further pain, especially repetitive movements such as bending and lifting.

Bone changes and thinning of the intervertebral discs can result in pinching of the nerves which branch out from the spinal cord (even when the cord itself is unaffected.). If this happens in lumbosacral spondylosis the effect may be numbness, tingling, weakness or shooting pains in the legs.

What treatments are available?

The degenerative changes that cause lumbosacral spondylosis cannot be reversed, so treatment focuses on relieving symptoms and improving quality of life.

• Self-care and lifestyle changes: There are some simple steps that patients can take to alleviate their symptoms and help their body withstand and adapt to their condition. For example, losing weight and maintaining a sensible weight will reduce strain on the back, and continuing with normal activities as much as possible will keep the spine mobile.
• Exercise: Beyond normal physical activity, such as regular walking, doctors recommend stretching and muscle strengthening exercises. Yoga is also beneficial for back pain.
• Physical therapy: This may include massage, hot and cold treatments and electrical stimulation, as well as further exercises and posture correction.
• Medication: Analgesics, non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants are all used to combat painful symptoms.
• Injections: Steroids or anaesthetics (or both) may be injected into different parts of the spine, depending on the source and type of pain.
• Alternative and adjunctive therapies: Acupuncture, acupressure, chiropractic and herbal remedies have all been found to benefit some patients.
• Surgery: Non-surgical interventions are usually successful, so operations are not routine. Two situations where one might be required are to relieve pressure on spinal nerves because of severe neurological complications; and to stabilise the spine in cases where the vertebral joints have become so mobile (e.g. because of loss of cartilage) that there is a risk of further damage occurring.