Have you been diagnosed with lumbar spondylosis?

Have you been diagnosed with lumbar spondylosis?

Ross Hauser, MD
You have lower back pain, you go to your general practitioner who sees you have low back pain and sends you on  to a low back pain specialist. You may come back with a diagnosis of lumbar spondylosis. If you did, likely you will be told that you need try to manage your low back pain with conservative treatments such as anti-inflammatories, painkillers, muscle relaxants, therapy, etc.

Before you continue, do you have a question about lumbar spondylosis? You can get help and information from our Caring Medical staff.

But what if you have been trying to manage your lumbar spondylosis and now you are being recommended to more aggressive treatments such as spinal surgery? One option is to better understand your problem of lumbar spondylosis and explore non-surgical options for it. That is what we will do in this article, hopefully help you understand lumbar spondylosis and the non-surgical options for it.

Lumbar spondylosis has many diagnostic terms

The problem with a diagnosis of lumbar spondylosis is that lumbar spondylosis is really not a diagnosis, it is a description of problems of the lumbar spine.

In their 2009 paper, “Lumbar spondylosis: clinical presentation and treatment approaches.”, Dr. Kimberley Middleton of the University of Washington and Dr. David Fish of the David Geffen School of Medicine at UCLA give this description of the many diagnostic terms surrounding lumbar spondylosis. Here are some learning points of their research:

The bottom line is lumbar spondylosis is a degenerative condition that prevents the lumbar spine from doing its job of  bearing the tremendous loads and carry the weight of the body from the lower back to the head. The lumbar spine, in conjunction with the hips, is also responsible for the mobility of the trunk. It is not surprising, then, that the most common diagnosis given to people who have low back pain other than lumbar spondylosis is degenerative disc disease (DDD).

Lumbar disc degeneration is a loose hinge

The term degeneration denotes deterioration, the whole vertebral joint goes from a healthy state to an unhealthy or weakened one. Generally, when this occurs, the degenerated or deterioration is comprehensive, meaning it encompasses all the structures within the spine. That is the discs, the ligaments, the vertebral structure, etc.

It is logical then that treatment for a comprehensively degenerated joint or for degenerative disc disease should be geared towards comprehensive regeneration of the deteriorated tissues. At the beginning is the treatment idea is the spinal ligaments.

When the spinal ligaments are injured and weak, abnormal loading across the vertebral joint occurs, abnormal loading causes accelerated degeneration.

The two videos below explain what happens in a joint that has a “loose hinge.”

The Hinge is the Facet Joints

In other words, when the hinges of the spine become loose or wear out with normal use over time, symptoms develop

Using our “hinge model”, we can understand that when the ligaments fail, the joint cannot handle the management of weight load or stress bearing load. You put a lot of weight on a floor that is not reinforced to handle that weight, the floor bends and stress is put on the supporting structures, stretching them beyond capacity.

spinal ligament repair

The weakened bridge shows “stretching,” the injection shows where Prolotherapy is given, at the ligament attachments to the bone. The end result, a strengthened and supported bridge.

When symptoms do develop, they are most often complaints of low back pain and stiffness, or feelings of numbness and weakness in the legs, which worsen with standing or walking and improve with sitting or lying down.

Clinical symptoms may also arise after activities involving extremes of motion such as:

Should treatment begin with an MRI or scan?

When radiographs are taken of patients with low back pain, they often show one or more of the following findings that may be indicative for lumbar spondylosis:

While these findings may be diagnostic by x-ray, CT scan or MRI standards, they are not the true diagnosis since they are not what is actually causing a person’s symptoms: the likely diagnosis, instead, is spinal instability. For more discussion on this topic please see my article MRIs cause failed back surgery,

The degenerative cascade associated with lumbar spondylosis begins long before the above mentioned symptoms become evident and appears to evolve in stages. The traditional thinking regarding the spinal degenerative cascade was that the intervertebral discs were thought to undergo three phases of degeneration:

Disc degeneration Phase 1 : Dehydration, loss of disc height, heighten pain

First phase of degeneration: Dysfunctional Phase – whereby circumferential painful tears of the annulus occur in association with endplate separation. This leads to further radial tears that are more susceptible to protrusion and to the loss of the disc’s ability to maintain water, which causes dehydration in the disc and a reduction in disc height. Vascular tissue and nerve endings may also encroach upon fissures produced in the degenerating disc, increasing innervation and the disc’s capacity for pain signal transmission.

Disc degeneration Phase 2 : Subluxation and instability

Second phase of degeneration the Instability Phase, whereby progressive changes in disc resorption, internal disruption, and continuing annular tearing cause a loss in the mechanical integrity of the disc. This catastrophic event occurs in combination with facet degeneration, which can lead to subluxation and instability.

Disc degeneration Phase 3 : Bone spurs and sclerosis

Third phase of degeneration  – Stabilization Phase, whereby continued disc space narrowing and fibrosis take place, along with the formation of osteophytes and transdiscal bridging.

Is it the discs then causing the pain?

The main problem with thinking in terms of the traditional spinal degenerative cascade is the emphasis on the disc as the primary source responsible for causing chronic pain. The intervertebral disc is the largest avascular (no blood supply) structure in the body and has very few nerve endings. Like cartilage, which is also avascular and has no nerve endings, the disc does not normally cause pain, simply because pain cannot be transmitted without nerves.

Therefore, the pain being felt must be the result of something that does cause pain: spinal ligament laxity and injury. If a disc herniates and free disc material (not contained within the disc) is lying on top of a nerve, then of course it would cause pain,
but a degenerative disc typically causes very little pain itself.

Thus, symptomatic lumbar spondylosis from spinal instability can be difficult to diagnose. Although plain radiographs have shown that the vast majority of adults have some evidence of spinal degeneration as they age, there appears to be little clinical correlation between static x-ray or MRI findings and a person’s low back pain.

Since intervertebral discs can easily be seen on MRI and are thought to be the source of chronic spinal pain, back surgery has been the mainstay treatment and is often recommended for patients with  lumbar  spondylosis.  However,  there  is  no real consensus about the benefits of doing so, either economically or medically.

Prolotherapy for back pain

Spinal ligament laxity  fails into the realm of Prolotherapy treatments. Prolotherapy is an in-office injection treatment that research and medical studies have shown to be an effective, trustworthy, reliable alternative to surgical and non-effective conservative care treatments. There is plenty of research to support the use of Prolotherapy for back pain (especially lumbar pain), here are some of the research summaries.

Citing our own Caring Medical and Rehabilitation Services published research in which we followed 145 patients who had suffered from back pain on average of nearly five years, we examined not only the physical aspect of Prolotherapy, but the mental aspect of treatment as well.

If our study, mentioned above, was solely based on getting 75% of patients off their pain medications, that would be wildly successful in itself. But the fact that Prolotherapy was able to strengthen the patient’s spines and decrease overall disability and return these people to a normal lifestyle. That is not pain management, that is a pain cure.

The first step in determining in whether Prolotherapy will be an effective treatment for you

The first step in determining in whether Prolotherapy will be an effective treatment for the patient is to determine the extent of ligament laxity or instability in the lower back by physical examination. The examination involves maneuvering the patient into various stretched positions. If weak ligaments exist, the stressor maneuver will cause pain. Pain here is an indicator that Prolotherapy can be very effective for the patient.

Do you have a question about lumbar spondylosis? You can get help and information from our Caring Medical staff.

1 Middleton K, Fish DE. Lumbar spondylosis: clinical presentation and treatment approaches. Current reviews in musculoskeletal medicine. 2009 Jun 1;2(2):94-104.

2 Watson JD, Shay BL. Treatment of chronic low-back pain: a 1-year or greater follow-up. J Altern Complement Med. 2010 Sep;16(9):951-8. doi: 10.1089/acm.2009.0719.

3 Wilkinson HA. Injection therapy for enthesopathies causing axial spine pain and the “failed back syndrome”: a single blinded, randomized and cross-over study. Pain Physician. 2005 Apr;8(2):167-73.

4 Hauser RA, Hauser MA. Dextrose Prolotherapy for unresolved low back pain: a retrospective case series study. Journal of Prolotherapy. 2009;1:145-155. [JOP/CMRS]

Our Facebook Reviews
Our Facebook Reviews
Celebrating 25 years of Prolotherapy! Are you a good Prolotherapy candidate?
How Can We Help You?
First Name:
Last Name:

Enter code:

for your symptoms

Prolotherapy, an alternative to surgery

Were you recommended SURGERY?
Get a 2nd opinion now!

★ ★ ★ ★ ★We pride ourselves on 5-Star Patient Service!Come see why patients travel from all
over the world to visit our clinics.
Current Patients
Become a New Patient

Chicagoland Office
715 Lake St., Suite 600
Oak Park, IL 60301
(708) 393-8266 Phone
(855) 779-1950 Fax
Southwest Florida Office
9738 Commerce Center Ct.
Fort Myers, FL 33908
(239) 303-4069 Phone
(855) 779-1950 Fax Fort Myers, FL Office
We are an out-of-network provider.
© 2017 | All Rights Reserved | Disclaimer
National Prolotherapy Centers specializing in Comprehensive Prolotherapy,
Stem Cell Therapy, and Platelet Rich Plasma.

Meet our Prolotherapy Doctors and check out our Prolotherapy research.