Low Back Pain due to Degenerative Arthritis or Spondylosis, and Back Surgery
Low Back Pain or Lumbar Pain
Low back pain is very common. In fact, it is second only to the common cold for the frequency of medical office visits. Having specialized in sports medicine, medical orthopedics, joint pain, and arthritis for decades, Dennis M. Lox M.D., has seen and heard, many horror stories about low back pain, pain medications, and back surgery.
This low back story, was from an unfortunate 60 year old woman, who reported it to Dr. Lox recently. She had seen an orthopedic spine surgeon for chronic low back pain. An MRI of her lumbar spine was ordered.
It revealed spinal stenosis at the L4-5 segment, multiple level spondylosis, multiple level facet hypertrophic changes, degenerative disc disease.
The orthopedic spine surgeon told her she needed to have a spinal fusion, with plates and screws now, before the snowbirds get here. She replied, well what about the other levels? To which the surgeon then promptly replied, we can do another fusion at another time, but let’s fix this problem now, before the snowbirds arrive.
It was early October, she got out of his office quick. She clearly understood he wanted a surgical procedure that week. Unfortunately, we all know what that really means, and so did she.
Lumbar Spondylosis: What does It Mean?
Lumbar Spondyloysis is essentially a fancy word for degenerative arthritis of the spine. To understand lumbar Spondyloysis and degenerative arthritis, we must start with a basic statement of how the spine is interconnected.
A sometimes confusing aspect of dealing with spines, is all the medical terms, lay terms and sometimes overlapping confusing words.
The spine is not a separate neck and back. It is a interconnected low back, termed the lumbar region, composed of 5 segments. These connect with the middle back or thoracic region, which is 12 vertebrae, or segmental bones.
The thoracic spine again connects to the neck, or cervical spine, which is comprised of 7 vertebrae or boney segments. Each segment is separated by the intravertrabral disc, and 2 hinged facet joints at every level. Yes, that’s a lot of interconnecting parts. It is not a simple hinge joint like the knee, or ball and socket joint like the hip.
Lumbar Degenerative Arthritis and Degenerative Disc Disease
Now to get simple when the disc wears from trauma or aging it degenerates, loses water, pliability and shape. This alters the hinged facet changes perpetuating facet wear. This progression continues to escalate to adjacent segments, and a domino effect occurs. This is degenerative disc disease, degenerative arthritis of the spine, or the radiologist term Spondyloysis. All part of the same continuum of wear and tear of the spine.
This is why MRI’s and x-rays of the spine show changes at so many levels, and to different degrees at different segments. This is also why spine surgery is often so unsuccessful. In the United States, spine surgery is only approximately 50 % successful. That’s like flipping a coin and picking heads.
Terrible success rates, unless you become very specific on operating on very specific indications and individuals, not basing surgery on a picture of someone’s spine. Most people over 50 have degenerative arthritis of their spines. If it is in the low back it often is in the middle back or neck to some degree, even if they have have no pain.
We know this from very well documented studies of taking x-ray’s or MRI’s on people who don’t have low back pain, and finding frequently degenerative arthritis changes present in these people who have no pain.
Aging and lumbar Degenerative Arthritis
Confusing? Not really, we all age. Look at people over 50 and then look at a picture of them in their high school yearbook. Vastly different. Now, some 50 year old people look fantastic, while others show drastic changes in their 30’s to 40’s. Look at smokers, and those who kept living life in the fast lane; it catches up to you. Genetics do play a part in age appearance, as well as lumbar degenerative arthritis.
Prior lumbar trauma, prior back surgery, manual labor all are accelerators of the degenerative arthritis cascade in the back. Putting plates and screws in at the L4-5 segment as the orthopedic surgeon recommended for this woman, would naturally have led to an much greater probability of the need for possible further surgery, as he foretold. This is because fusing one segment places greater strain above and below the fusion level. Thus, if the spine already has degenerative lumbar spondyloysis with disc disease, facet hypertrophic changes, then you fuse one segment, the already worn adjacent segments get overloaded very quickly, and wear at an accelerated rate. Avoiding the first fusion, is a good start on avoiding the second or third.
Spinal Stenosis, Another Term for The Degenerative Spine
Finally, we must address another word that is another form of spinal degenerative arthritis, yet describes a specific area of the degenerative process and where. When the degenerative arthritis narrows the central spinal canal this is termed spinal stenosis. It can be from a variety of factors or combination of several at once.
A herniated disc can narrow the central canal. Often degenerative disc disease results in protrusion of disc material posteriorly into the central spinal canal. Frequently, this occurs with enlarged or overgrown facet joints. This is often described as facet hypertrophic changes or hypertrophy.
Hypertrophy literally means enlarged. A ligament surrounding the posterior aspect of the central canal in front of the facet joints is called the ligamentum flavum. The ligamentum flavum is often enlarged along with the facets, and degenerative disc disease all can contribute to overall spinal stenosis. There are many more aspects to this. This is a simplified version, not an all encompassing list. It is meant to help you understand a complex subject better.
A textbook is necessary to cover everything. Suffice it to say, trying to simplify lumbar spine degenerative arthritis, is like saying all low back pain is the same. That is why there is no miracle pill for low back pain, nor a miracle surgery that fixes all low back pain. If there was, it would be on the news show 60 minutes, and everyone would be fixed. It is not on 60 minutes, because it is not a simple fix problem.
About Dennis M. Lox, M.D.
Whether you are a professional athlete, weekend warrior, or have arthritis from aging, Dr. Lox can help.
Dennis M. Lox, M.D. is an internationally renown Sports and Regenerative Medicine specialist. Dr. Lox incorporates Regenerative Medicine techniques such as cell science applications, Platelet Rich Plasma (PRP), and Tissue Engineering aspects, to help patients from around the world with a vast array of problems. Dr. Lox is board certified in Physical Medicine and Rehabilitation. Dr. Lox lectures extensively and has edited two PM&R textbooks, the prestigious A State of the Art Review (Star) on Low Back Pain, and Soft Tissue Injuries: Diagnosis and Treatment.
Dennis M. Lox, M.D. maintains an active practice in the Tampa Bay, Florida area, and in Beverly Hills, California.