You are in: eMedicine Specialties > Neurosurgery > Spine Lumbar SpondylosisArticle Last Updated: Feb 20, 2007AUTHOR AND EDITOR INFORMATIONSection 1 of 11
  Author: Bruce M Rothschild, MD, Professor of Medicine, The Northeastern Ohio Universities College of Medicine; Director, Arthritis Center of Northeast Ohio; Adjunct Professor, Department of Biomedical Engineering, University of Akron Bruce M Rothschild is a member of the following medical societies: American Association for the Advancement of Science, American College of Rheumatology, American Federation for Clinical Research, American Heart Association, American Society for Clinical Pharmacology and Therapeutics, International Skeletal Society, New York Academy of Sciences, and Sigma Xi Editors: Michael G Nosko, MD, PhD, Chief, Division of Neurosurgery, Director of Neurovascular Surgery, Medical Director of Neuroscience Unit, Associate Professor, Department of Surgery, University of Medicine and Dentistry at New Jersey; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc; Herbert H Engelhard III, MD, PhD, Director, UIC Neuro-Oncology Program, Chief, Division of Neuro-Oncology, Associate Professor, Department of Neurosurgery, University of Illinois at Chicago; Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc Author and Editor Disclosure Synonyms and related keywords: lumbar spondylosis, spondylosis deformans, bony overgrowths, osteophytes, degenerative joint disease, osteoarthritis, spondylitis, hypertrophic arthritis, spondylitis of the lumber vertebrae, spondyloarthropathy INTRODUCTIONSection 2 of 11
  Lumbar spondylosis describes bony overgrowths (osteophytes), predominantly those at the anterior, lateral, and, less commonly, posterior aspects of the superior and inferior margins of vertebral centra (bodies). This dynamic process increases with, and is perhaps an inevitable concomitant, of age. Spondylosis deformans is responsible for the misconception that osteoarthritis was common in dinosaurs. Osteoarthritis was rare, but spondylosis actually was common. Lumbar spondylosis usually produces no symptoms. When back or sciatic pains are complaints, lumbar spondylosis usually is an unrelated finding. Past teleologically misleading names for this phenomenon are degenerative joint disease (it is not a joint), osteoarthritis (same critique), spondylitis (totally different disease), and hypertrophic arthritis (not an arthritis). History of the ProcedureGiven the frequency and size of lumbar osteophytes (see Image 1), they have long been thought to cause back pain. This has led to many studies of the distribution of vertebral osteophytes, not all of which are pertinent. There is no greater frequency of signs or symptoms among individuals with osteophytes than among those without osteophytes. ProblemLumbar spondylosis usually is asymptomatic, with no diagnostic or prognostic significance. FrequencyLumbar spondylosis is present in 27-37% of the asymptomatic population. In the United States, more than 80% of individuals older than 40 years have lumbar spondylosis, increasing from 3% of individuals aged 20-29 years. Internationally, lumbar spondylosis can begin in persons as young as 20 years. It increases with, and perhaps is an inevitable concomitant of, age. Approximately 84% of men and 74% of women have vertebral osteophytes, most frequently at T9-10 and L3 levels. Approximately 30% of men and 28% of women aged 55-64 years have lumbar osteophytes. Approximately 20% of men and 22% of women aged 45-64 years have lumbar osteophytes. Sex ratio reports have been variable but are essentially equal. Spinal osteophytosis in postmenopausal Japanese women correlated with the CC genotype of the transforming growth factor b1 gene. Lumbar spondylosis occurs in animals with upright posture (eg, chimpanzees) and, possibly, in some domestic animals. EtiologyLumbar spondylosis appears to be a nonspecific aging phenomenon. Most studies suggest no relationship to lifestyle, height, weight, body mass, physical activity, cigarette and alcohol consumption, or reproductive history. Adiposity is seen as a risk factor in British populations, but not Japanese populations. The effects of heavy physical activity are controversial, as is a purported relationship to disk degeneration. PathophysiologySpondylosis occurs as a result of new bone formation in areas where the anular ligament is stressed. ClinicalLumbar spondylosis usually produces no symptoms. When back or sciatic pains are complaints, lumbar spondylosis usually is an unrelated finding. There usually are no findings unless a complication ensues. Other problems to consider include the following:
INDICATIONSSection 3 of 11
Surgery is indicated for complications only (eg, for impingement-documented sciatica that is unresponsive to 2 days of absolute bed rest). RELEVANT ANATOMYSection 4 of 11
The margins of vertebral bodies normally are smooth. Growth of new bone projecting horizontally at these margins identifies osteophytes. Most osteophytes are anterior or lateral in projection. Posterior vertebral osteophytes are less common and only rarely impinge upon the spinal cord or nerve roots. CONTRAINDICATIONSSection 5 of 11
Surgery is not indicated if no complications (eg, impingement) are present. WORKUPSection 6 of 11
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TREATMENTSection 7 of 11
Medical therapySeek the real cause of the patient's back or sciatica-type symptoms.
Surgical therapySurgical excision is performed for impingement-documented sciatica that is unresponsive to 2 days of absolute bed rest. COMPLICATIONSSection 8 of 11
OUTCOME AND PROGNOSISSection 9 of 11
Lumbar spondylosis is usually not a source of morbidity. For excellent patient education resources, visit eMedicine's Muscle Disorders Center. Also, see eMedicine's patient education articles Fibromyalgia and Chronic Pain. MULTIMEDIASection 10 of 11
REFERENCESSection 11 of 11
Article Last Updated: Feb 20, 2007 | |||||||
