eMedicine Specialties > Neurosurgery > Spine

Lumbar Spondylosis: Treatment

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
Contributor Information and Disclosures

Updated: Apr 9, 2009

Treatment

Medical Therapy

Because back pain is an unrelated finding of lumbar spondylosis, seek the real cause of the patient's back or sciatica-type symptoms.

  • Do not assume that the patient's symptoms are related to osteophytosis. Look for an actual cause of a patient's symptoms.
  • If actual symptomatic nerve root impingement occurs, 2 days of absolute bed rest is indicated. If that does not solve the problem, then surgical excision is indicated.
  • Medication is not indicated in the absence of complications.

Surgical Therapy

Surgical excision is performed for impingement-documented sciatica that is unresponsive to 2 days of absolute bed rest.

Complications

  • Nerve compression from posterior osteophytes is a possible complication only if a neuroforamen is reduced to less than 30% of normal.
  • Posterior disk height reduction to less than 4 mm or foraminal height to less than 15 mm is compatible with diagnosis of osteophyte-induced nerve compression.7
  • If lumbar spondylosis projects into the spinal canal, spinal stenosis is a possible complication.
  • If osteophytes disappear, look for aortic aneurysm. Aortic aneurysms can cause pressure erosions of the adjacent vertebrae. If osteophytes are present, the first sign is often erosion of those osteophytes, so they are no longer visible.
  • An isolated report of a bony L4 mass pressing on the duodenum has been described.

More on Lumbar Spondylosis

Overview: Lumbar Spondylosis
Workup: Lumbar Spondylosis
Treatment: Lumbar Spondylosis
Follow-up: Lumbar Spondylosis
Multimedia: Lumbar Spondylosis
References
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References

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  2. O'Neill TW, McCloskey EV, Kanis JA, et al. The distribution, determinants, and clinical correlates of vertebral osteophytosis: a population based survey. J Rheumatol. Apr 1999;26(4):842-8. [Medline].

  3. Yamada Y, Okuizumi H, Miyauchi A, et al. Association of transforming growth factor beta1 genotype with spinal osteophytosis in Japanese women. Arthritis Rheum. Feb 2000;43(2):452-60. [Medline].

  4. Kramer PA, Newell-Morris LL, Simkin PA. Spinal degenerative disk disease (DDD) in female macaque monkeys: epidemiology and comparison with women. J Orthop Res. May 2002;20(3):399-408. [Medline].

  5. Yoshimura N, Dennison E, Wilman C, et al. Epidemiology of chronic disc degeneration and osteoarthritis of the lumbar spine in Britain and Japan: a comparative study. J Rheumatol. Feb 2000;27(2):429-33. [Medline].

  6. Miyakoshi N, Itoi E, Murai H. Inverse relation between osteoporosis and spondylosis in postmenopausal women as evaluated by bone mineral density and semiquantitative scoring of spinal degeneration. Spine. Mar 1 2003;28(5):492-5. [Medline].

  7. Nathan H. Compression of the sympathetic trunk by osteophytes of the vertebral column in the abdomen: an anatomical study with pathological and clinical considerations. Surgery. Apr 1968;63(4):609-25. [Medline].

  8. Borenstein D. Does osteoarthritis of the lumbar spine cause chronic low back pain?. Curr Rheumatol Rep. Feb 2004;6(1):14-9. [Medline].

  9. Jenis LG, An HS. Spine update. Lumbar foraminal stenosis. Spine. Feb 1 2000;25(3):389-94. [Medline].

  10. Pahl MA, Brislin B, Boden S, et al. The impact of four common lumbar spine diagnoses upon overall health status. Spine J. Mar-Apr 2006;6(2):125-30. [Medline].

  11. Rawat SS, Jain GK, Gupta HK. Intra-abdominal symptoms arising from spinal osteophytes. Br J Surg. Apr 1975;62(4):320-2. [Medline].

  12. Resnick D, Niwayama G. Diagnosis of Bone and Joint Disorders. Philadelphia:. WB Saunders Co;1988.

  13. Rothschild BM, Martin LD. Paleopathology. In: Disease in the Fossil Record. London: CRC Press; 1993.

  14. Schneck CD. The anatomy of lumbar spondylosis. Clin Orthop. Mar 1985;(193):20-37. [Medline].

  15. Weber J, Pusch CM. The lumbar spine in Neanderthals shows natural kyphosis. Eur Spine J. Sep 2008;17 Suppl 2:S327-30. [Medline].

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Further Reading

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Keywords

lumbar spondylosis, lumbar, spondylosis, spondylosis deformans, bony overgrowths, osteophytes, degenerative joint disease, osteoarthritis, spondylitis, hypertrophic arthritis, spondylitis of the lumber vertebrae, spondyloarthropathy, Barre-Lieou Syndrome, lumbar osteophytes

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Contributor Information and Disclosures

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, MD 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
Disclosure: Nothing to disclose.

Medical Editor

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
Michael G Nosko, MD, PhD is a member of the following medical societies: Academy of Medicine of New Jersey, Alpha Omega Alpha, American Association of Neurological Surgeons, American College of Surgeons, American Heart Association, American Medical Association, New York Academy of Sciences, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

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