Lumbar Spondylosis -Degenerative Disc Disease (DDD)

In this condition the intervertebral discs lose their water content and start degenerating due to abnormal stresses. Tears occur in the outer annular fibres. The disc height reduces and abnormal movements occur between vertebrae. The facet joints also degenerate. All this can cause low back pain.

The patient presents with back pain, which may be referred to posterior part of thigh. Pain is aggravated with activities such as walking and bending. There are no neurological symptoms.

This is a very common condition with 60% of the population suffering from back pain at some stage of their life. The predisposing factors for back pain are obesity, sedentary lifestyle, depression, stress and smoking.

The back pain evaluation includes a detailed history and allocating the patient into one of the “diagnostic triage”

  • Mechanical Back Pain ? which is the one described above
  • Nerve root pain ? leg pain more significant than back pain. This happens due to either prolapsed intervertebral disc or lumbar canal stenosis.
  • Sinister pathologies such as infections and tumours. These patients have symptoms called as ?red flags?. This include symptoms such as fever, loss of weight, pain at rest, thoracic pain and history of previous cancer or tuberculosis

Low back pain is primarily treated by modifying lifestyle, improving work ergonomics, weight reduction, exercises physiotherapy, medications and local facet joint blocks.

Patients who do not respond to non-operative treatment may need surgery. Pre-operative investigations include MRI Scan and discography. Surgical options include either spinal fusion or artificial disc replacement. The long-term success rate for these procedures is 70% – 80%.