LUMBAR SPONDYLOSIS disc between Le and S, is commonly affected in 60% of cases, the disc between L and Ls in 30% of the cases and combined affection may take place in 10% of cases laterally or centrally.
CLINICAL FEATURES OF LUMBAR SPONDYLOSIS
Lateral disc protrusion
Patient complains of pain and tingling sensation over the lumbar region which radiates downwards to the foot. This pain is increased after coughing, sneezing or jolting. The pain is distributed in accordance with the myotome and dermatome supply. The clinical finding will vary according to the root affected as given below:
The following tests are also important:
1. Straight leg raising test Patient cannot raise the leg straight (S1 root).
2. Lasegue’s test Extension of the leg at the knee after flexing the thigh will induce pain.
3. Spasm of the sacrospinalis may give rise to scoliosis. When the S1 root is involved gluteii may show wasting and when L5 root is affected foot drop may develop.
4. Szabo’s sign There is anaesthesia below the lateral malleolus.
Central lumbar disc protrusion
This will result in compression of cauda equina which will give rise to paraparesis, sacral numbness, retention of urine, impotence, loss of reflex and back pain.
INVESTIGATIONS OF LUMBAR SPONDYLOSIS
1. X-ray of the lumbar spine, myelography and discography will show similar changes as with cervical spondylosis. MRI is very helpful.
2. CSF examination may show increased protein content (about 100 mg %).
This condition must be differentiated from spinal tumour, cauda equina syndrome, Pott’s disease of the spine, secondary deposits in the spine and ankylosing spondylitis.
Whenever the clinical course will found to be progressively downhill the above conditions should be thought of.
Rest in a flat bed is beneficial. Analgesics may be given for pain. Traction of the leg may be helpful. Epidural injection of Procaine or Lignocaine may be given when there is intractable pain. Plaster jacket or lumbar belt may be required.
Surgical operation is urgently required in central disc prolapse.