Lumbar Spondylosis and Sciatica – Two Poorly Understood Terms

Low back pain is worldwide one of the biggest reasons for loss of work. Increasing sedentary lifestyle, lack of exercise, lack of awareness about normal physiologic posture and obesity has remarkably increased the prevalence of troublesome back pain. Back pain at one point or another affects everyone. However, back pain that is significant enough to cause loss of work, needs attention.

There are numerous causes of pain ranging from common muscle spasms, disc disease, to instability from weaknesses in ligaments or bony integrity. Covering different causes of back pain is beyond the scope of this article. The purpose of writing this is to explain the two terms used in common day parlance, lumbar spondylosis, and sciatica.

Lumbar spondylosis is commonly implicated for low backache. Lumbar spondylosis is used to describe degenerative changes in the spine, that occur with age. More than 80% of adults over 40 years will have radiological changes of degeneration, but not all have back pain. Lumbar spondylosis is therefore not a disease and does not require treatment. It is inevitable. However, the normal degenerative process can be hastened due to obesity, lumbar disc surgery, abnormal posture, or conditions that increase stress on the spine. Keeping paraspinal muscles strong with regular exercise and controlling weight can slow down the degeneration process.

Another poorly understood term is sciatica. Sciatica has become synonymous with any leg pain. Sciatica is again not a disease, but a symptom. Sciatica is pain, numbness or tingling that occurs in the distribution of the sciatic nerve. The pain occurs in the gluteal region, radiates down along the back of the thigh, and depending upon the nerve root involved may radiate to leg and foot as well. The specific area of leg pain represents the nerve root being compressed by the herniated disc, spinal stenosis, or degenerative listhesis. Let’s suppose the L5 nerve root is compressed, the pain would be mostly in the distribution of the area supplied by the nerve carrying fibers from L5 level, that is numbness would be in the outer aspect of the leg and foot, and weakness would be in the foot and big toe. Similarly, if the L4 nerve root is compressed the pain would be on the inner aspect of the leg, and weakness in the extensor muscles of the knee. Typical sciatica pain is sharp, shooting in nature and is aggravated by walking, turning, or climbing steps. The discomfort in legs may range from gnawing pain or deep ache, burning, tingling or numbness in the area of nerve distribution. So, sciatica is not a disease but just a symptom, or more specifically a type of pain caused by nerve compression.

The irony is not only these terms are poorly understood by the population at large, but also by most healthcare professionals. The real purpose is to educate all, about these two common terms. These two terms should not be used to misguide the patients, but rather specific diagnoses should be made and disease described to the patients.