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Lumbar Spine Arthritis

Wear-and-Tear Arthritis of the Lumbar Spine

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Updated April 07, 2014

Arthritis is a common problem of the lumbar spine that can lead to a number of different symptoms. Lumbar spine arthritis is most commonly seen in older patients, but can be seen in all age groups. Patients who are at higher risk for developing lumbar spine arthritis include:
  • older patients
  • obese individuals
  • heavy laborers
  • those with previous injuries to the spine
Arthritis of the lumbar spine is a problem that occurs in the joints that connect each spinal segment, or vertebrae. The vertebrae are connected in three places. In front of the spinal cord, the vertebrae are separated by a cushion-like spinal disc. Behind the spinal cord, the vertebrae are connected by two small joints called facet joints. These facet joints, together with the spinal disc, allow movements of the spine including forward bending, arching your back, or sideways twisting.

The most common type of arthritis to occur in the spine is osteoarthritis, or wear-and-tear arthritis. When osteoarthritis occurs in the spine, doctors refer to this as spondylosis. When the spinal joints become arthritic, spine movements become painful and stiff. Lumbar spine arthritis often is seen together with other spinal conditions including:

  • Disc Degeneration
    As the facet joints wear out in arthritic conditions of the spine, the disc can also wear out over time. Facet arthritis often proceeds along with disc disease of the lumbar spine.
  • Spinal Stenosis
    Spinal stenosis is also often seen in patients with lumbar spine arthritis. As arthritis progresses, nerves become pinched, leading to symptoms of spinal stenosis. These symptoms may include leg pain, numbness, tingling, and difficulty walking.

Symptoms of Spinal Arthritis

Arthritis of the lumbar spine most often causes stiffness and pain of the low back. Patients often notice their back is especially stiff in the early morning after getting out of bed, and may loosen over the course of the day. Symptoms also often become worse with prolonged or strenuous activity.

When lumbar facet joint arthritis worsens, the joints form bone spurs, the tissue swells from inflammation, and the nerves around these joints can become pinched. This is a condition called spinal stenosis, which is often seen in patients with lumbar arthritis. These patients often experience the common symptoms of spinal stenosis.

Lumbar Spine Arthritis Treatment

Treatment of lumbar spine arthritis depends on the symptoms experienced by the patient. Treatments always begin with simple measures and become more involved if patients don't find relief with these simple steps.

Some of the treatments available for lumbar spine arthritis include:

  • Physical Therapy
    Physical therapy is used to strengthen the muscles of the lumbar spine. By better supporting the spine with stronger muscles, less of the burden is placed on the facet joints. Even in patients who are fit and active, muscles around the spine can be further strengthened to alleviate symptoms.
  • Weight Loss
    Losing weight is a difficult task in patients who have worn-out joints. However, losing even a small amount of weight is often a sufficient step to relieving pain. By removing even 10 pounds or more, the facet joints will support less of a load, and pain may be sufficiently relieved.
  • Anti-Inflammatory Medications
    Anti-inflammatory medications can decrease the amount of inflammation around the arthritic joints. By lowering the inflammatory response, pain is often alleviated. Always use anti-inflammatory medications under your doctor's supervision.
  • Ice & Heat Applications
    Ice and heat applications can be very effective at relieving pain in the back. Patients usually find that heat is most effective before activity to "loosen" the spine, and ice is best used after any strenuous activities.
  • Chiropractic Treatment
    Chiropractors treat spine alignment, often with a process called manipulation. These treatments do not alter the spinal alignment, but they can provide excellent relief of pain. Often the relief is temporary, but chiropractic treatments are a reasonable treatment to consider during a flare-up of lumbar arthritis.
  • Alternative Treatments
    Alternative treatments include acupuncture, massage, magnet therapy, natural remedies, and others. There is no doubt that many patients find significant relief from these types of treatments. While the scientific studies are lacking to support these treatments, most have few side-effects and are reasonable treatments to attempt.
  • Epidural Injections
    Epidural injections are a way to administer a steroid shot around the area of the arthritis. Cortisone is a powerful anti-inflammatory medication. Using a needle allows the medication to be delivered right to the area of the arthritis. In patients with arthritis of a single facet joint, an even more precise injection, called a selective facet joint injection, can be performed.
  • Spinal Fusion Surgery
    Spine fusion is a surgical procedure used to eliminate movement between adjoining vertebrae. When all other treatments fail to provide relief of symptoms, a spine fusion may be a reasonable option for the treatment of severe facet arthritis.

Sources:

AS Hilibrand and N Rand "Degenerative lumbar stenosis: diagnosis and management" J. Am. Acad. Ortho. Surg., Jul 1999; 7: 239 - 249.

HN Herkowitz and KS Sidhu "Lumbar Spine Fusion in the Treatment of Degenerative Conditions: Current Indications and Recommendations" J. Am. Acad. Ortho. Surg., May 1995; 3: 123 - 135.

Shen FH, et al. "Nonsurgical Management of Acute and Chronic Low Back Pain" J. Am. Acad. Ortho. Surg., August 2006; 14: 477 - 487.

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