Degenerative Lumber Spondylosis: An Educational Radiographs and Expert Therapeutic Recommendation

Spondylosis or degenerative spondylosis which is also called spinal osteoarthritis osteoarthrosis is a disorder characterized by degeneration of the joints of the spine. Clinical the condition presents with low back pain of variable severity and the diagnosis is confirmed by X-ray [1,2,3].

A man who was born in 1967 presented with acute lumbago, lower back pain that was associated with restriction of movement because of pain.

At about the age of 55 years, a diabetic and hypertensive presented with acute lumbago, lower back pain that was associated with restriction of movement because of pain. The pain occurred suddenly while standing and was not associated with lifting a weight. Physical examination revealed no neurologic deficit. Because of the sudden onset of the condition, and the association with painful mobility radiographs of the lower spine was performed (Figure-1) and showed loss of the normal lordosis, marginal osteophytosis, subchondral sclerosis, and mild narrowing of the L4-L5 space. A radiologic diagnosis of degenerative spondylosis was made.

Initially, the patient was treated with oral diclofenac (Olfen) 50 mg daily, paracetamol. Oral baclofen was used in low dose, 10 mg once daily at night to avoid the occurrence of undesirable side effects, based on the evidence provided by Migliorini et al and Dapas et al [4,5], and treatment was associated with a beneficial effect on pain and mobility.

Supplementation with collagen and hyaluronic acid was recommended for few months with aim of improving the degenerative process, based on the evidence provided by Giacomo Farì and his research group [6] (Figures 1A,1B&1C).

• Degenerative spondylosis is a well-recognized condition as early as the year 1900[1].

• In 1923, Claude Gouldesbrough described the radiographic features of the condition which include early appearance of a small spike on the lateral borders of the articular margins of the spinal vertebrae [2].

• Seichi (2014) emphasized that lumbar degenerative spondylosis is a chronic, non-inflammatory disorder resulting from degeneration of multi-factorial etiology of lumbar disc and/or facet joints and in most patients, symptoms improve with treatment with non-steroidal anti-inflammatory drugs [3].

• Migliorini et al (2021) emphasized that the available scientific evidence suggest that baclofen and non-steroidal anti-inflammatory drugs can improve pain and disability in patients with low back pain [4].

• The use of baclofen in the treatment of acute low-back pain has been suggested as early as the 1980s.

• Dapas et al (1985) reported a double-blind placebocontrolled study which showed that baclofen was safe, effective, and well-tolerated when used in the treatment of acute lowback pain syndrome [5].

• Recently, Giacomo Farì and his research group suggested that oral visco-supplement which includes collagen peptides, hyaluronate, and other ingredient represents a new treatment option in degenerative spondylosis [6,7].

• In this case, Olfen was considered the preferable antiinflammatory medication bases on the evidence provided by Wagenitz et al (2007).

In the case of degenerative lumbar spondylosis presenting with acute lumbago, the current expert opinion recommends the addition of low dose baclofen to the analgesic-anti-inflammatory medication, based on the evidence provided by Migliorini et al and Dapas et al. Supplementation with collagen and hyaluronic acid is recommended for few months with aim of improving the degenerative process, based on the evidence provided by Giacomo Farì and his research group.

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1. Hoke M (1900) The Treatment of osteo-arthritis and rheumatoid arthritis of the feet, knees and spine. Atlanta J Rec Med 2(9): 577-597.
2. Gouldesbrough C, (1923) Osteo-arthritis of the Spine. Proc R Soc Med 16(Med Sect): 63-70.
3. Seichi A (2014) Lumbar spondylosis. Nihon Rinsho (Ed) Article in Japanese 72(10): 1750-1754.
4. Migliorini F, Maffulli N, Eschweiler J, Betsch M, Catalano G, et al. (2021) The pharmacological management of chronic lower back pain. Expert Opin Pharmacother 22(1): 109-119
5. Dapas F, Hartman SF, Martinez L, Northrup BE, Nussdorf RT, et al. (1985) Baclofen for the treatment of acute low-back syndrome. A double-blind comparison with placebo. Spine (Phila Pa 1976) 10(4): 345-349.
6. Farì G, Santagati D, Pignatelli G, Scacco V, Renna D, et al. (2022) in association with vitamin c, sodium hyaluronate, manganese and copper, as part of the rehabilitation project in the treatment of chronic low back pain. Endocr Metab Immune Disord Drug Targets 22(1): 108-115.
7. Wagenitz A, Mueller EA, Frentzel A, Cambon N (2007) Comparative efficacy and tolerability of two sustained-release formulations of diclofenac: results of a double-blind, randomised study in patients with osteoarthritis and a reappraisal of diclofenac's use in this patient population. Curr Med Res Opin 2007 23(8): 1957-1966.