I want to introduce you to Lumbar Spondylosis.
There are people who complain of back pain and leg pains. The back pain is in the lower back and can radiate to the waist or the hip. The pain is worse with activity: sitting, standing etc. it is often better at night though it can sometimes disturb sleep and wake some people up in the morning.
The pain can be sharp or dull and everyone feels it differently. For some people, walking aggravates the pain while for others it gets better as they move around sorting out their daily bread.
In some people, the pain is associated with leg pains. The leg pain can be in one or both legs. It can be around the hip or go down the leg to the ankle and the toes. The leg pain is often described as sharp: like a knife or electric shock sensation down the leg. It may be associated with walking or sitting. In this way, for some, standing and walking make the leg pain worse. For others, the pain is worse on sitting down. For those, they prefer to stand.
Age is not a barrier
This back and leg pain does not respect age. Often it starts at about 50 years but really, anyone can be affected. It can occur in teenagers where perhaps it follows an injury. In many people, however, there is no history of an injury. Many people wake up one day to realize they are battling with back pain and leg pains on a daily basis. Over the months and years, it gets worse and ‘managing’ does not quite work anymore.
In some people, they notice that their walking has changed. A man who walks straight and with pride suddenly finds himself bending forward while walking because bending forwards helps with the pain. Sitting down for a few minutes is also enforced by the pain after walking only a short distance. Some have to lean on a wall or sit as soon as possible to avoid the legs giving way leading to a fall.
Lumbar is the medical term for the lower back. Spondylosis is also the term referring to degenerative arthritis of the joints between the bones. Degenerative arthritis simply means ‘wear and tear’ due to the ageing process. Therefore, lumbar spondylosis is arthritis of the back due to increasing age.
The back supports the body and helps keep us upright. It is therefore affected by the weight of the body especially when standing, sitting and walking. Pain in the back can radiate to the hips, the legs and the private parts. With pressure on the nerves, it can lead to numbness in the legs and weakness causing difficulty in walking. It can be so bad as to cause problems with passing urine and stool. It can also affect sexual function.
Mild, moderate or severe
In mild cases, life is good and the person affected can still function without too much stress from the pain. There are little additional problems like numbness or leg weakness. In moderate cases, life is not totally happy as there are good days and bad days. The bad days become more frequent and the pains more and more unbearable. In severe cases, life is not worth living due to severe pains that cripple the sufferer. Some of these patients cannot sit, stand, lie down with pains and life is truly miserable.
What to do in your case?
You have to decide which category you belong to; mild, moderate or severe. The treatment of lumbar spondylosis depends largely on how this is affecting your legs or your life. Is it causing numbness, weakness or difficulty passing urine or stool? Is it affecting your sex life with numbness in the private parts or poor erection in men? Those may mean you are in the moderate or severe category and should see a doctor promptly.
Mild cases can be managed with simple sensible behaviour like losing weight, stop smoking and start some exercise program to keep the joints moving and lubricated. Drugs like Panadol and Paracetamol can also help with mild pains and can be taken once in a while. The key though is for a serious attempt at losing weight if you are even slightly overweight for your height.
Moderate and severe cases need the services of a spine surgeon: usually a neurosurgeon, for assistance. A test called the MRI scan is indicated and will help in confirming the diagnosis. We can determine what is wrong, where and how bad on the basis of the symptoms, clinical examination and what we see on the MRI scan.
Operations may be recommended for severe pains, leg weakness and disability. The operations are designed for each individual and depend on the problem shown in the MRI scan. Operations are safe and currently give over 95% good outcome for the usual problems in lumbar spondylosis.
The picture shows the pedicle screws and fixation we employ in some operations on the spine. Inbox me for more information and critically for information on where you can get help here in Nigeria.
By Dr Biodun Ogungbo, MBBS, FRCS, FRCSEd, MSc