WILDERMAN MEDICAL CLINIC
Anatomy of the lumbar spine
The lumbar spine is located in the lower back, beginning after the twelfth thoracic vertebra and ending at the first sacral vertebra. Typically, the lumbar spine is comprised of five vertebrae, numbered L1-L5; however, some individuals have a sixth lumbar vertebra, named L6.
The vertebrae of the lumbar spine are larger than those of the cervical and thoracic spine, with a rounded portion of the bone at the front and several bony processes projecting backward to form a hollow called the vertebral arch, through which the lower portion of the spinal cord, the cauda equina, runs.
Bony projections called lamina also project backward on the lumbar vertebrae and serve as a protective shield for the nerves of the lumbar spine.
Each vertebra is separated from the one above and below it by a cushioning disc, called an intervertebral disc; this structure provides protection and shock absorption to prevent damage to the vertebrae during weight bearing and impacts caused by actions like jumping.
Additional bony projections on each vertebral body articulate with projections on the vertebral bodies above and below it to form facet joints; these joints allow for movement in the lumbar spine while still providing stability and support.
The bones of the facet joints are covered by cartilage, which provides protection for the bones as they move against each other, and a synovial membrane, which lubricates the joint, providing further protection.
How does osteoarthritis develop in the facet joints?
Osteoarthritis of the lumbar facet joints develops due to the breakdown of the protective cartilage covering the bony surface of the facet joints.
This cartilage destruction can be due to several factors, including day-to-day wear and tear, a previous injury to the lumbar spine, inflammatory conditions, and genetic predisposition.
As the cartilage wears away, movements of the spine cause friction in the facet joints, as the bony processes are no longer protected and the bones rub directly against each other.
This friction results in inflammation, which causes the synovial membrane to thicken, preventing the membrane from producing adequate lubrication to the facet joint. Lack of lubrication to the joint causes further friction, which in turn increases inflammation in the joint and provokes more degenerative changes.
These degenerative changes can also affect the bone itself, resulting in excessive growth of the bone, called bone spurs, which cause increased friction, reduced range of motion, and potential irritation or compression of the nerves of the lumbar spine as they intrude into the spaces where the nerves run.
Let’s find out what the symptoms are
The first degenerative changes to the cartilage typically go unnoticed, as cartilage lacks nervous tissue and, therefore, the breakdown of cartilage is a painless process.
As the breakdown progresses, however, damage to surrounding tissues occurs and symptoms begin to appear, ranging in severity from mild to severe. Some symptoms of this process include:
- Stiffness or reduced range of motion in the lower spine
- Pain or discomfort
- Numbness, tingling, weakness, or pain radiating to the legs due to irritation or compression of the nerves (called radicular symptoms)
- Cauda equina syndrome is a severe condition that can result due to degenerative changes to the lumbar spine; this syndrome is characterized by five features, including saddle anesthesia (numbness in the buttock, groin, and inner thigh areas), neurogenic sciatica, bladder dysfunction (eg: urinary incontinence, difficulty urinating), reduced anal tone, and sexual dysfunction. This condition requires urgent medical attention
How is osteoarthritis of the lumbar spine evaluated?
The severity of osteoarthritis of the spine is divided into four stages:
- Stage 1, Minor: This stage is associated with little to no pain and involves mild degenerative changes to the cartilage.
- Stage 2, Mild: In this stage, some changes to the bone, such as bone spurs, are visible on X-ray; some symptoms associated with this stage include stiffness and mild discomfort.
- Stage 3, Moderate: Moderate OA involves the sufficient breakdown of the cartilage surrounding the facet joints to cause inflammation in the area; this process is associated with pain and discomfort with activities of daily living.
- Stage 4, Severe: This stage involves the destruction of most of the cartilage surrounding the facet joints, as well as the development of multiple bone spurs and significant inflammation. These changes result in considerable pain and reduced mobility and range of motion.
How common can osteoarthritis of the lumbar spine be?
Lower back pain is a common condition, experienced by an estimated 80% of Americans at least once in their lifetime according to an article published in January 2022 in the National Library of Medicine.
The authors of the article noted that lower back pain accounts for an estimated 200 billion dollars in healthcare spending in the United States annually.
Osteoarthritis is a common cause of this lower back pain and can result in considerable pain and disability. Lindsey and Dydyk note that “[i]n patients over the age of sixty, 95% of men and 70% of women have at least one indicator of arthritis…Lumbar spine osteoarthritis affects approximately 30% of men and 28% of women from 55 to 64 in the United States” (Lindsey & Dydyk, 2022).
What are the risk factors for osteoarthritis of the lumbar spine?
Some common risk factors include:
- Poor posture
- Other inflammatory conditions, such as diabetes, gout, or other forms of arthritis, such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and reactive arthritis
- Poor diet and a sedentary lifestyle
- Previous trauma to the lumbar spine
- Family history of arthritis
How is this condition diagnosed?
Diagnosis of lumbar spine osteoarthritis typically involves 3 components:
A medical history –
A physician will take a detailed medical history, including what type of symptoms the patient is experiencing, how these symptoms affect their day-to-day functioning, what other medical conditions a patient has, any medications they are taking, and what lifestyle habits they have (including exercise, smoking, diet, alcohol consumption, and more).
A physical examination –
Following an interview to obtain a complete medical history, your physician will perform a physical exam to assess for pain or tenderness with palpation or certain movements and an assessment of a range of motion.
Diagnostic imaging/testing –
Bloodwork may be ordered to rule out other pathologies, such as rheumatoid arthritis, X-rays can be used to visualize the painful joints, and other diagnostic imaging, such as MRIs or nerve conduction studies, can asses for nerve involvement. Diagnostic injections may also be utilized to determine if injecting a numbing agent in the affected area provides temporary relief from pain.
How is the condition treated?
After a diagnosis of lumbar facet joint osteoarthritis, the approach to your treatment will depend on numerous factors, including your age, the severity of pain, the extent that your life is limited due to this pain, and any concurrent health concerns.
While arthritic changes are irreversible, there are treatments and strategies available to slow or even prevent further degenerative changes.
Some of these treatments and strategies include:
Acetaminophen to reduce pain
NSAIDs (non-steroidal anti-inflammatory drugs) to reduce pain and inflammation
Other oral medications specific to treating arthritis and inflammation
Aquatics or pool therapy program
Acupuncture and Acupressure
Occupational therapy (including improving the ergonomics of your workstation, if applicable)
Exercise to improve posture and reduce weight
Dietary changes to improve weight and reduce inflammation