Have you read your MRI report recently and ended up more confused about your low back pain than before you began? If so, you are not alone. The medical terms for low back problems confuse many medical professionals who don’t deal with these issues on a regular basis. The purpose of this post is to help explain what is going on with your back, so that you can make a more informed decision on which treatments to choose.
The 3 main terms we are going to discuss are spondylosis, spondylolysis, and spondylolisthesis. Each is defined below and a general discussion of treatment options follows.
Spondylosis refers to degenerative osteoarthritis of the spine – essentially the space between adjacent spinal vertebrae narrows. Because this condition commonly occurs in the zygapophysial (facet) joints or the intervertebral discs, it is often referred to as facet syndrome or degenerative disc disease.
Spondylolysis is a defect of a vertebra in the pars interarticularis – most typically a stress fracture that is caused by repetitive trauma done to the lumbar spine from strenuous sports such as football, weightlifting, cheerleading, or gymnastics. Spondylolysis is also linked to certain inherited spinal anatomy (increased size and shape of the L4 superior articular process).
Spondylolisthesis is the displacement of a vertebra, most commonly occurring after a break or fracture. There are 2 common forms of spondylolisthesis.
Isthmic (spondylolytic) spondylolisthesis is the most common form, with a reported prevalence of 5–7 percent in the US population. It usually progresses from spondylolysis over time.
Degenerative spondylolisthesis develops as a long-term result of progressive spondylosis. Facet arthritis and ligamentum flavum weakness may result in slippage of a vertebrae. Degenerative forms are more likely to occur in women, persons older than fifty, and African-Americans.
Spondylosis, spondylolysis, or spondylolisthesis can cause stiffness and pain in the spine (lower back pain or neck pain), however, when severe, the narrowing may cause pressure or compression of the nerve roots. Compression of a nerve root emerging from the spinal cord may result in radiculopathy (sensory disturbances, such as severe pain, weakness, or tingling in the neck, shoulder, arm, back, and/or leg, possibly accompanied by muscle weakness).
Treatment begins with conservative therapy including: physical therapy (including yoga and pilates), anti-inflammatory medications, epidural steroid injections, facet joint injections, radiofrequency ablation, massage therapy, acupuncture, and chiropractic care. Often a back brace will help patients, especially those with spondylolisthesis to perform certain activities with less pain.
If there is nerve root irritation or nerve root compression causing radiculopathy that is not improved with conservative care, decompression surgery may be very effective in relieving the pain. Fusion surgery is a poor option for the treatment of spondylosis, but may be considered for severe cases of spondylolisthesis.
Regenerative medicine has recently emerged for spondylosis and spondylolysis. There are several reports of long-term successful treatment of low back pain with both PRP (platelet rich plasma) therapy or stem cell treatments.
For those interested, I have included a video with some excellent exercises for low back pain.