Lumbar Spondylosis

Lumbar spondylosis, also called degenerative lumbar disc disease, refers to wear-and-tear changes in the lower back that occur naturally with aging. Over time, the discs between the vertebrae lose hydration, flatten, and become less flexible. This can lead to changes in the surrounding joints and ligaments, such as bone spur (osteophyte) formation, thickening of spinal ligaments, and arthritis of the facet joints.

These changes may cause back pain, leg pain, or both. In most people, the condition progresses slowly and can be managed without surgery.

How Common It Is and Who Gets It? (Epidemiology)

Lumbar spondylosis affects nearly all adults over the age of 50 to some degree, although only a portion experience symptoms. It is more common in individuals with physically demanding jobs, repetitive spinal movement, or a family history of spine problems. Smoking, obesity, and diabetes can accelerate the degenerative process.

Why It Happens – Causes (Etiology and Pathophysiology)

The main cause of lumbar spondylosis is disc degeneration—a natural process of aging.
Over time, spinal discs lose water content and height, leading to:

• Disc bulging or herniation

• Facet joint arthritis and cyst formation

• Thickening or calcification of the ligaments in the back of the spine (ligamentum flavum)

• Formation of bone spurs along the vertebrae

• Instability or mild curvature (degenerative scoliosis)

These structural changes can narrow the spinal canal, compress nerves, and lead to symptoms such as pain, stiffness, or sciatica.

How the Body Part Normally Works? (Relevant Anatomy)

The lumbar spine consists of five vertebrae separated by intervertebral discs that act as cushions and allow movement. Facet joints behind the spine help stabilize it while permitting flexibility.
As discs and joints degenerate, they lose their ability to absorb shock, causing abnormal movement and pressure on nearby nerves.

What You Might Feel – Symptoms (Clinical Presentation)

Symptoms vary depending on the severity of degeneration and nerve involvement. Common signs include:

• Dull, aching lower back pain

• Pain radiating down the legs (sciatica) due to nerve compression

• Tingling, numbness, or weakness in the legs or feet

• Reduced flexibility or stiffness in the back

• Difficulty standing or walking for long periods (neurogenic claudication)

• Relief when leaning forward or sitting

In advanced cases, patients may lose normal spinal curvature or develop scoliosis (side curvature of the spine).

How Doctors Find the Problem? (Diagnosis and Imaging)

Diagnosis begins with a detailed history and physical examination. Your doctor may perform neurological tests to check muscle strength, reflexes, and sensation.
Imaging studies may include:

• X-rays: Show bone spurs, disc height loss, and spinal alignment.

• MRI: Detects disc degeneration, nerve compression, and ligament thickening.

• CT scan: Provides detailed bone images for surgical planning.

• EMG: Evaluates nerve and muscle function when symptoms are unclear.

Classification

Lumbar spondylosis is classified based on the structures affected:

• Disc degeneration: Loss of disc height, bulging, or herniation.

• Facet arthropathy: Arthritis and enlargement of the facet joints.

• Spinal stenosis: Narrowing of the canal due to bone or ligament overgrowth.

• Instability or listhesis: One vertebra slipping forward over another.

Other Problems That Can Feel Similar (Differential Diagnosis)

Conditions that may mimic lumbar spondylosis include:

• Herniated disc without degeneration

• Peripheral neuropathy

• Sacroiliac joint dysfunction

• Hip or knee arthritis

• Vascular claudication (poor circulation in the legs)

Treatment Options

Non-Surgical Care

Most patients improve with conservative treatment, which may include:

• Medications: Pain relievers, muscle relaxants, or anti-inflammatory drugs.

• Physical therapy: Strengthens back and core muscles and improves flexibility.

• Epidural steroid injections: Help reduce inflammation and nerve pain.

• Lifestyle modifications: Weight control, quitting smoking, and posture correction.

• Activity modification: Avoiding repetitive bending and heavy lifting.

Surgical Care

Surgery is considered when conservative treatment fails or neurological deficits develop.
Common surgical options include:

• Discectomy: Removal of herniated or damaged disc material pressing on a nerve.

• Laminectomy: Removal of part of the vertebra (lamina) to decompress nerves.

• Microdiscectomy or endoscopic surgery: Minimally invasive options for nerve decompression.

• Spinal fusion: Stabilizes the spine by permanently joining two or more vertebrae using rods, screws, and bone grafts.

The type of surgery depends on the location and extent of degeneration and whether instability is present.

Recovery and What to Expect After Treatment

• Conservative management: Improvement typically occurs over 6–12 weeks.

• After surgery: Patients often walk the same day or the next day and begin rehabilitation within weeks.
  Physical therapy helps restore strength, mobility, and posture. Full recovery may take several months depending on the procedure.

Possible Risks or Side Effects (Complications)

Potential surgical complications include:

• Infection or bleeding

• Nerve or spinal cord injury

• Dural tear (spinal fluid leak)

• Fusion failure or hardware loosening

• Persistent pain or recurrence

Careful planning and adherence to post-surgical care instructions reduce these risks.

Long-Term Outlook (Prognosis)

Most patients with lumbar spondylosis manage their condition successfully without surgery. For those who need surgery, outcomes are generally excellent—especially for nerve-related symptoms like sciatica or neurogenic claudication. Back pain may require ongoing therapy and lifestyle adjustments.

Out-of-Pocket Costs

Medicare

CPT Code 63047 – Decompression (Lumbar Laminectomy): $271.76
CPT Code 22612 – Posterior Lumbar Fusion: $382.85
CPT Code 22558 – Anterior Lumbar Fusion (ALIF): $368.50
CPT Code 22842 – Instrumentation (Rods, Screws, Plates – 3–6 Segments): $185.26

Under Medicare, 80% of the approved cost for these spinal procedures is covered once your annual deductible has been met. Patients are responsible for the remaining 20%. Supplemental insurance plans—such as Medigap, AARP, or Blue Cross Blue Shield—typically cover this 20%, leaving patients with little to no out-of-pocket costs for Medicare-approved surgeries. These supplemental plans are designed to complement Medicare and provide full coverage for necessary spine procedures like decompression, fusion, and stabilization.

If you have secondary insurance—such as Employer-Based coverage, TRICARE, or Veterans Health Administration (VHA)—it functions as a secondary payer after Medicare. Once your deductible is satisfied, these plans may cover remaining balances, including coinsurance and uncovered costs. Deductibles for secondary insurance typically range between $100 and $300, depending on the specific policy and network of care providers.

Workers’ Compensation
If your spinal condition requiring decompression or fusion surgery resulted from a work-related injury, Workers’ Compensation will pay for all associated costs, including surgical, hospital, and rehabilitation expenses. You will have no out-of-pocket expenses under an accepted Workers’ Compensation claim.

No-Fault Insurance
If your spine injury or degenerative condition was caused or aggravated by an automobile accident, No-Fault Insurance will cover all necessary medical and surgical costs, including decompression, fusion, and instrumentation. The only potential expense may be a small deductible depending on your insurance policy terms.

Example
Thomas, a 69-year-old patient, underwent lumbar decompression (CPT 63047) and posterior spinal fusion with instrumentation (CPT 22612 + 22842) to relieve nerve compression and stabilize his spine. His total Medicare out-of-pocket costs were $271.76, $382.85, and $185.26. Because he had supplemental coverage through Medigap, the remaining 20% not covered by Medicare was fully paid, leaving him with no out-of-pocket expenses for the surgery.

Frequently Asked Questions (FAQ)

Q. What is lumbar spondylosis?
A. Lumbar spondylosis refers to age-related wear and tear of the spinal discs, joints, and ligaments in the lower back.

Q. Can lumbar spondylosis cause leg pain?
A. Yes. When nerve roots are compressed by disc bulges or bone spurs, it can lead to leg pain, numbness, or weakness (sciatica).

Q. When is surgery needed for lumbar spondylosis?
A. Surgery is considered if symptoms persist despite three months of conservative treatment or if there is progressive weakness or loss of bladder control.

Q. Can lumbar spondylosis be prevented?
A. You can’t stop natural aging, but maintaining a healthy weight, exercising regularly, and avoiding smoking can slow progression and reduce symptoms.

Summary and Takeaway

Lumbar spondylosis is a common, age-related condition that causes lower back pain, stiffness, and sometimes nerve compression. Most cases improve with conservative treatments such as physical therapy and medication. When necessary, minimally invasive surgery provides excellent long-term relief. Maintaining core strength, good posture, and a healthy lifestyle helps prevent recurrence.

Clinical Insight & Recent Findings

A recent case study explored the use of radiofrequency ablation (RFA) to manage refractory lower extremity pain associated with lumbar spondylosis. The patient, a 64-year-old woman with persistent lumbar and radiating leg pain unresponsive to medications, physical therapy, and epidural steroid injections, underwent diagnostic medial branch blocks followed by bilateral RFA of the L3, L4, and L5 medial branches.

The procedure provided near-complete pain relief and resolution of paresthesia, with sustained benefit reported two years post-treatment. The authors noted that while RFA is traditionally used for axial low back pain due to facet joint pathology, this case demonstrates its potential in treating lower extremity pain secondary to lumbar degeneration. RFA offers a minimally invasive, low-risk alternative to surgery, with rare complications such as temporary numbness or mild procedural discomfort.

The study supports careful patient selection and diagnostic testing before proceeding, highlighting RFA as a viable option for patients with facet-mediated lumbar pain refractory to conservative measures. (Study on radiofrequency ablation for lumbar spondylosis – See PubMed.)

Who Performs This Treatment? (Specialists and Team Involved)

Treatment is provided by orthopedic spine surgeons or neurosurgeons, assisted by physical therapists, pain specialists, and rehabilitation teams.

When to See a Specialist?

You should see a spine specialist if you experience:

• Persistent back or leg pain

• Numbness, tingling, or weakness in the legs

• Difficulty walking long distances

• Pain relief when leaning forward or sitting

When to Go to the Emergency Room?

Seek immediate care if you have:

• Sudden loss of bladder or bowel control

• Severe or worsening leg weakness

• Unexplained weight loss or fever with back pain

What Recovery Really Looks Like?

Most patients regain function and pain relief with conservative treatment or surgery. Recovery involves physical therapy, gradual return to activity, and continued posture and strength training.

What Happens If You Ignore It?

Untreated lumbar spondylosis may lead to chronic back pain, nerve damage, or spinal deformity. In severe cases, it can cause cauda equina syndrome, requiring emergency surgery.

How to Prevent It?

• Maintain strong back and core muscles.

• Practice good posture and safe lifting techniques.

• Avoid smoking and excessive sitting.

• Stay active with low-impact exercise.

Nutrition and Bone or Joint Health

A balanced diet with calcium, vitamin D, and protein supports bone and joint health. Staying hydrated keeps discs flexible. Avoid excessive alcohol or caffeine, which can weaken bone structure.

Activity and Lifestyle Modifications

Regular walking, swimming, or yoga helps keep the spine flexible and strong. Use ergonomically supportive chairs, avoid long periods of sitting, and take frequent movement breaks during daily activities.

Do you have more questions?