Lumbar spondylosis results from age-related wear and tear in the lower spine (lumbar region). This degenerative process involves changes like the formation of bone spurs (osteophytes) and the deterioration of intervertebral discs and facet joints. This often causes chronic pain, stiffness, and nerve compression symptoms that radiate into the legs. Treatment typically follows a structured, stepwise progression, beginning with the least invasive methods to address symptoms and improve function.
Initial Non-Surgical Management
Conservative, non-surgical treatment is the first line of defense for managing lumbar spondylosis, and most patients find it provides sufficient relief. This approach is often recommended for at least six weeks before considering more aggressive interventions. Structured physical therapy is a primary component, focusing on specific exercises to stabilize the spine and alleviate pressure.
Physical therapy emphasizes core strengthening to support the lumbar spine and incorporates stretching to improve range of motion and reduce stiffness. Maintaining a consistent home exercise routine is important for long-term symptom control.
Pharmacological management begins with over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, to target pain and inflammation. For persistent symptoms, a physician may prescribe stronger NSAIDs or muscle relaxants. Acetaminophen addresses pain but lacks the anti-inflammatory benefit of NSAIDs.
Activity modification involves avoiding movements that aggravate the condition, such as repetitive bending or heavy lifting. Maintaining general activity is encouraged over complete rest, which can lead to deconditioning. Lifestyle adjustments, including maintaining a healthy body weight and using proper body mechanics, reduce mechanical stress on the lower spine.
Targeted Pain Relief Injections
If conservative management fails to provide lasting relief, targeted interventional procedures are the next step. These minimally invasive injections serve both diagnostic and therapeutic purposes, pinpointing the source of pain while delivering anti-inflammatory medication.
Epidural Steroid Injections (ESI) are used when pain radiates into the legs (radiculopathy). This procedure delivers a corticosteroid directly into the epidural space surrounding the spinal nerves. The medication reduces inflammation around compressed nerve roots, offering temporary relief that allows patients to better participate in physical therapy.
Facet Joint Injections are used when the small, stabilizing joints between the vertebrae are the primary source of pain. These arthritic joints become inflamed due to spondylosis. The injection, typically a combination of a local anesthetic and a corticosteroid, is delivered directly into the joint capsule or near the medial branch nerves.
Radiofrequency Ablation (RFA) may be considered for longer-lasting treatment if facet joint pain responds well to the initial diagnostic injection. RFA involves heating the medial branch nerves with a radiofrequency current to temporarily interrupt pain signal transmission. While the nerve eventually regenerates, the pain relief can often last for six months to over a year.
When Surgery Becomes Necessary
Surgical intervention is reserved as a last resort, considered only after non-surgical treatments have failed over six to twelve months. Urgent indications include severe neurological deficits (muscle weakness or foot drop) or the rare cauda equina syndrome involving bowel or bladder dysfunction.
The goal of surgery is decompression, which relieves pressure on the spinal nerves. Procedures like laminectomy or foraminotomy involve removing bone or soft tissue to widen the spinal canal and nerve root openings. This widening alleviates the compression causing radiating leg pain and neurological symptoms.
If spondylosis has caused spinal instability or vertebral slippage (spondylolisthesis), a spinal fusion may be performed. This procedure permanently joins two or more vertebrae using bone grafts and metal instrumentation, eliminating movement at the painful segment. Fusion stabilizes the spine and prevents further nerve compression.
Patients must be prepared for a significant recovery period, particularly following spinal fusion. While the objective is to alleviate leg symptoms, surgery carries risks, including infection and the possibility of symptoms not fully resolving.