Wear and Tear of the Lower Back
What is degenerative lumbar spine?
The lumbar spine includes 5 (L1-L5) vertebrae and associated intervertebral disks in the lower back. The vertebrae provide support and structure while the intervertebral disks act as shock absorbers between the vertebrae.
Flexible disks act as cushions between the vertebrae. As you age, these disks dry out, collapse and bulge. Your body also forms bone spurs around these collapsing disks. These degenerative changes to the intervertebral disks and formation of bone spurs is called degenerative disk disease of the lumbar spine.
How does it occur?
Degenerative disk disease of the lumbar spine occurs from wear and tear as you age.
As the disks in the spine age, they lose height and begin to bulge. They also lose water content, begin to dry out and weaken. This problem causes settling, or collapse, of the disk spaces and loss of disk space height. Eventually, the cushioning qualities of the disks begins to decrease.
As the facet joints experience increased pressure, they also begin to degenerate and develop arthritis, similar to what may occur in the hip or knee joint. The smooth, slippery articular cartilage that covers and protects the joints wears away.
If the cartilage wears away completely, it can result in bone rubbing on bone. To make up for the lost cartilage, your body may respond by growing new bone in your facet joints to help support the vertebrae. Over time, this bone overgrowth — called bone spurs — may narrow the space for the nerves and spinal cord to pass through (stenosis). Bone spurs may also lead to decreased range of motion in the spine.
These changes are normal and occur in everyone. Many older people have worn disks that do not cause painful symptoms.
Risk factors associated with arthritis of the neck include genetics, smoking, occupation (repetitive bending and twisting), prior injury to the lower back.
What are the symptoms?
Aching in the low back, pain radiating down the leg, weakness in the legs and the legs giving out or buckling. Pain is worse with prolonged sitting, bending or twisting. Pain is relieved by getting up and walking or frequently changing positions.
How is it diagnosed?
Diagnosis starts with a thorough history and physical exam. You will be evaluated for range of motion, strength, and sensation in your lower back and lower extremities. An X-ray will be taken to evaluate bony structures and alignment of the vertebrae. CT or MRI can give a greater detail image and provide 3D reconstruction of the bony and soft tissues.
How is it treated?
Most cases of DDD of the lumbar spine can be treated conservatively. Physical therapy to improve strength and flexibility in the lower back can help. Tylenol with an NSAID (Advil/ibuprofen, Aleve/naproxen, or a prescription arthritis medication) are usually tried first to relieve pain and inflammation. A stronger, short course of an oral steroid can be used to reduce inflammation in more severe cases. Muscle relaxers can be prescribed to relieve painful muscle spasms. Ice can be used for inflammation, and heat can be used for muscle spasms or soreness.
If these more conservative measures fail, the next step may be a steroid injection around the spine called an epidural block.
Rarely, in the most severe cases, surgery may be required. Lumbar fusion eliminates movement between two vertebrae, relieving any associated pain and symptoms.
If you experience severe pain, weakness or numbness in your legs, loss of coordination or balance in your lower extremities, or loss of bladder and bowel control you may need surgery.
What is the recovery time?
Conservative treatment of milder cases may take 6-8 weeks with medications and physical therapy.
Epidural blocks may be given in a series of up to 3 injections, spaced out a few weeks apart and can give weeks to months of relief.
Surgery may be done same day or require up to 2 days in the hospital, with lighter duty activity for 4-6 weeks, and a full recovery in 2-3 months.
We are here to help. If you believe you are suffering from one of these conditions, we would love to deliver a diagnosis, get you treated and get you moving again.