Lumbar Spondylosis

Abstract

In considering an approach toward the diagnosis, management, and prognosis of lumbar spine disease, a distinction can be made between acute lumbar disc herniation (“soft” disease) and degenerative lumbar spondylosis (“hard” or “bony” disease). The spectrum of the clinical manifestations of lumbar spine disease is broad, and includes back pain, with radiation into the leg (sciatica), lumbar radiculopathy (signs and symptoms of nerve irritation and/or radicular neurological deficit), and neurogenic intermittent claudication (pain and/or weakness that increases with walking and subsides with rest). The term spinal stenosis refers to any narrowing of the spinal canal, the nerve root canals, or the intervertebral foramina. Central (or canal) stenosis leads to impingement on the dura and cauda equina, whereas lateral (foraminal or lateral recess) stenosis results in compression of the nerve roots. Although there is no clear correlation between the nature of the underlying disease (i.e., soft vs hard disease) and the clinical symptomatology, it is useful to recognize these distinctions for the purposes of understanding the pathophysiology of lumbar spine disease because, at least in theory, different therapeutic approaches may be appropriate.