What Is Lumbar Spondylitis?
Lumbar spondylitis is a general term for degenerative changes causing pain in the lower spine. It's a progressive condition that can lead to a limited range of motion in your back.
Lumbar spondylitis, also called lumbar spondylolysis, can lead to a limited range of motion in the back and problems with other joints, such as the ribs, shoulders, or hips. Symptoms typically develop in early adulthood, but they can also develop in teens or children.
Back trauma, chronic repetitive loading, or hyperextension of the back can cause lumbar spondylitis. Ankylosi ng spondylitis is a type of arthritis that can also cause this condition.
Ankylosing spondylitis most commonly affects the lower spine. When it involves your lower back, it's sometimes called lumbar spondylitis. This term can also refer to any degenerative changes in your lower spine, such as those caused by osteoarthritis.
Symptoms of lumbar spondylitis
Lumbar spondylitis symptoms can vary between people. They tend to onset slowly over months to years.
The main symptoms are lower back pain and stiffness. Your upper back or neck may also be affected as the condition progresses.
Your pain may:
get better with exercise, but stay the same or get worse with rest
be worse in the morning and evening
wake you up at night
be felt around your buttocks
improve with warmth, such as in a warm shower
Pain can range from mild to debilitating. Symptoms tend to flare up and then go through periods where they're reduced or disappear altogether.
Other symptoms
Other potential symptoms include:
pain, stiffness, and warmth in joints, such as the:
ribs, which may cause problems with deep breathing
shoulders
knees
hips
enthesitis, pain where a bone connects to a tendon
abdominal pain and diarrhea
loss of appetite
weight loss
fatigue
uveitis, which can cause:
vision changes
eye pain
light sensitivity
Lumbar spondylitis causes and risk factors
Researchers do not fully understand why some people develop lumbar spondylitis. It's thought that genetic and environmental factors both play a role.
People who have the HLA-B27 gene seem to be at an increased risk. More than 90% of people with lumbar spondylitis have this gene. However, most people with this gene never develop lumbar spondylosis.
Other risk factors for lumbar spondylitis include:
family history
age, with most people developing symptoms before age 45
having Crohn's disease
being assigned male at birth, occurring about two times more often in males (however, it's believed that AS has been under-recognized and under-diagnosed in biological females)
Lumbar spondylitis complications
Lumbar spondylitis can compress your spinal cord and lead to neurological symptoms like chronic lower back or leg:
pain
numbness
tingling
weakness
In rare cases, it can also cause loss of bowel control or loss of bladder control.
Other complications can include:
reduced joint mobility
increased fracture risk
increased risk of cardiovascular disease
How is lumbar spondylitis treated?
Lumbar spondylitis does not have a cure, but a combination of natural remedies, medications, and sometimes surgery can help you slow its progress.
Natural remedies and lifestyle modifications
Natural remedies or lifestyle modifications that may help you manage your symptoms include:
physical therapy, which may include:
posture exercises
strengthening exercises
stretches and mobility work
massage
exercising regularly
focusing on having good posture
using assistive devices like walkers or canes
minimizing your stress levels
eating a nutritious, balanced diet that includes foods like fruits, vegetables, whole grains, and lean protein
quitting smoking (this can be difficult, but a doctor can build a cessation plan that works for you) or not starting
Medications
A doctor may recommend or prescribe the following types of medications:
nonsteroidal anti-inflammatory drugs like ibuprofen or celecoxib
biologic medications like TNF inhibitors to modify immune system activity
janus kinase inhibitors if your condition does not respond to other treatments
corticosteroids to decrease inflammation and help with pain (these are used sparingly due to their cumulative side effects)
Surgery
Because of potential complications, surgery is performed infrequently. Your doctor may recommend surgery if you have trouble with daily activities or neurological complications. Some of the most commonly performed surgeries include:
Laminectomy: A laminectomy involves removing a part of the vertebra called the lamina to decompress your spine.
Spinal osteotomy: A spinal osteotomy is a procedure used to correct structural abnormalities in your spine.
Spinal fusion: Spinal fusion is a procedure where two or more of your vertebrae are permanently fused together.
Hip joint replacement: A hip joint replacement involves replacing the ball, socket, or ball and socket of your hip joint with an artificial replacement.
When to contact a doctor
It's a good idea to contact your primary healthcare professional if you have persistent symptoms that may be a sign of lumbar spondylitis. If your doctor suspects ankylosing spondylitis, they may refer you to a doctor called a rheumatologist who specializes in joints for further evaluation.
It's also a good idea to visit your doctor if you've previously been diagnosed with ankylosing spondylitis and you notice a change in your symptoms.
How is lumbar spondylitis diagnosed?
Lumbar spondylitis can be difficult to diagnose. Doctors will typically consider your personal and family medical history, conduct tests, and order a number of tests to help them make a diagnosis, including:
performing a physical exam, which might include:
examining your joints
watching your movement
checking for rib stiffness by having you breathe deeply
blood tests to check for inflammation and to see if you have the HLA-B27 gene
imaging, such as:
X-rays
magnetic resonance imaging (MRI)
ultrasound
You may receive an ankylosing spondylitis diagnosis if you have inflammation in the joints between your lower back and pelvis and at least one of the following symptoms:
lower back pain that improves with exercise and gets worse with rest
limited movement in your lower back
limited ability to expand your chest compared to what would be expected for your age and sex
What is the outlook for people with lumbar spondylitis?
Lumbar spondylitis generally has a good outlook. There's no cure, and symptoms tend to progress, but in most instances, the condition responds to conservative treatment. Your doctor may recommend surgery if you have neurological complications.
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