Living with lumbar spondylosis: What are the do’s and don’ts?

Degenerative lumbar spondylosis is a very prevalent condition which varies in severity with some patients experiencing mild discomfort while others suffer from debilitating back pain and stiffness. In this informative, all-you-need-to-know guide to the condition, renowned consultant orthopaedic spinal surgeon Mr Stewart Tucker sheds light on the various approaches to treatment as well as giving advice on the do’s and don’ts of managing the condition.

What is degenerative lumbar spondylosis?

Lumbar spondylosis refers to osteoarthritis or wear and tear of the lumbar spine. It is pandemic in the normal population and symptoms vary from minor back pain or stiffness to severe, debilitating conditions where patients can be bedridden for days with agonising back pain and stiffness.

Sometimes it can also be superimposed on neurological symptoms such as sciatica, leg pain, numbness or pins and needles.

What is the best degenerative lumbar spondylosis treatment?

Conservative (non-surgical) treatments include medication, such as non-steroidal anti-inflammatory drugs provided they are not contraindicated. Other pain killers, such as codeine based or opiate based medication may also be prescribed along with physiotherapy.

More advanced techniques such as spinal injections may also be used depending on the severity of the patient’s symptoms. Most patients will settle with a combination of these treatments along with physiotherapy.

A very small percentage of patients get severe ongoing back pain despite conservative treatment and they will therefore be considered for surgery. Surgery for lumbar spondylosis for back pain generally consists of fusion surgery.

A small group of patients who have very specific symptoms or findings on their imaging may be candidates for lumbar disc replacement. Other patients may benefit from decompression of the spine without fusion if their predominant symptoms are related to nerve root compression rather than wear and tear.

What are the best exercises for degenerative lumbar spondylosis?

Key exercises for the treatment of lumbar spondylosis are those involving strengthening your core. Most physiotherapists will use Pilates-based exercises for core stability. This can be taken either on a one-to-one basis using reformer-type Pilates or within a class. It may take many weeks or months to achieve an optimal core depending on how long the back symptoms have been present and the level of fitness of the patient at the time.

What should be avoided?

The principal symptoms that aggravate lumbar spondylosis are lifting excessive loads, particularly where the back is unprotected. Lifting large loads away from the body and also any lifting which involves a rotational movement can be especially harmful. You can imagine how this mechanism works by thinking of lifting a suitcase from a carousel at an airport. Typically, you overstretch to reach the suitcase while the carousel is rotating so the spine is actually twisting. Additionally the distance away from the body will exaggerate the weight of the suitcase so this can be particularly harmful.

Impact can also cause aggravation and so can running long distances on roads, particularly with poor or worn out trainers which have no cushion can lead to increased back pain and stiffness.

How should you sleep with lumbar spondylosis?

It is very difficult to regulate the position in which you will sleep throughout the night as even if you go to bed with the best intentions, you can end up in a heap. The important thing is the quality of the mattress upon which you are sleeping, which should be firm but not excessively so and certainly not too soft.

It’s not necessary to buy an orthopaedic mattress as this simply adds to the cost but a good quality mattress that provides a firm support along with pillows which are neither too low nor too high to keep the head and neck in a very neutral position can help support the back during sleep.

When is surgery needed?

Surgery is restricted to those patients who have persistent ongoing symptoms which are debilitating and affect their day to day quality of life and where conservative management has failed to provide adequate symptomatic relief.

Fusion surgery is most often used for severe lumbar spondylosis but patients must be suitable for this type of procedure in terms of having only one or two levels of the spine which are affected. The more levels that you have to consider fusing, the lower the success rate in terms of the percentage relief of pain. Therefore ideally, one would not want to be fusing more than one to two motion segments within the spine and preferably at a L4-L5 and or L5-S1 level.

If you are seeking treatment for severe lumbar spondylosis and wish to discuss your treatment options, don’t hesitate to visit Mr Tucker’s Top Doctors profile.