The MYTH’s about Lumbar Spondylosis

There are so many patients who walk into my clinic and when asked what problem do they have and they say Spondylosis.

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It is actually is a face-palm moment for me. I will tell you why.

There are so many misconceptions about the word ‘ Spondylosis ’.

What is Spondylosis?

Spondylosis is degeneration of the vertebral bodies, mainly the lateral, anterior and rarely posterior vertebral bodies which on x-rays is seen as osteophytes (extra bony outgrowths from the vertebral bodies). I have shown it in the picture below.

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Lateral radiograph of lumbar spine showing anterior vertebral body osteophytes
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Anteroposterior radiograph of lumbar spine showing lateral vertebral body osteophytes

These are generally harmless and do not cause any symptoms, alone and are usually seen as a chance finding when an X-ray of lumbar spine is done. Its presence is of no clinical significance.

So how and why are they formed?

Our vertebral bodies have intervertebral discs in between and those discs have a fibrous/tough covering which is called as annulus fibrosus. It protects the spinal cord from direct contact of the disc with the spinal cord.

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This annulus is constantly under pressure so it’s wear and tear is common. Say for example the knuckles of a boxer- they harden which is due to constant pressure on them and subsequent wear and tear. This is how extra skin is formed on the knuckles, this is to protect them from further wear and tear. Similarly, the only hard substance inside our body is bone. So when the annulus undergoes constant wear and tear, our body forms bone to protect or stabilize the vertebral segments.

The only part of these osteophytes which may give problem are the posterior osteophytes which will directly press on the spinal cord. This phenomenon is rarely seen and is generally associated with long standing disc prolapse.

Terminology-

Synonyms- Osteoarthritis.

Spondylosis is often confused with other terms like

spondylitis,

spondylolisthesis,

facet joint degeneration,

degenerative disc disease,

Diffuse idiopathic skeletal hyperostosis (DISH),

All the above have different etiologies, presentations and treatment which may occur along with and thus complicating lumbar Spondylosis.

FAQs

What age do we get it?

There are cases of Spondylosis seen as early as 20 years of age. As it is a natural process of aging and is seen in 80% individuals above 40 yrs of age. It is seen in 27-37% of asymptomatic individuals with more male preponderance.

Is it activity related?

The studies have shown no correlation with increased activity or even obesity.

Over activity may cause degenerative disc disease but not Spondylosis.

How can I protect myself?

Sorry dear you cannot protect yourself. It’s a natural ageing process, and it’s harmless. So why worry.

Do they disappear?

This is a very intriguing question.

Many physiotherapists as well as therapy centres claim that they can make spondylosis disappear. It’s utter NON SENSE. They do not disappear.

There is a case where they do disappear.

It’s called aortic aneurysm (swelling in the wall of the artery). The vertebral artery is very close to the anterior surface of the vertebral body.

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CT angiogram showing abdominal aorta

An aneurysm is pulsatile and may erode the osteophyte. If an anterior vertebral osteophyte which was previously seen and has now dissapered, do NOT celebrate—rush to the nearest hospital immediately it’s a time bomb waiting to explode. (read about aortic aneurysms for more info).

So do not fall for false claims of making the osteophytes disappear.

Can I work out and do exercises?

Yes, sure you can. Do any amount of activity you like.

The general principles of back care apply to each and everyone irrespective of the spondylotic changes.

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There are none.

If you have any back pain or radicular pain to your lower limbs, investigate for any other causes for it as previously mentioned, as Spondylosis do not cause these symptoms.

I hope this clears the air over Spondylosis.

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So when asked what problem you have Please DO NOT MENTION SPONDYLOSIS.

Please, share your comments below and let me know if you have any queries or any topics that i must write about.

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