Prevalence of Coexisting Lumbar Spondylosis and Knee Osteoarthritis on the rise

In patients with either knee osteoarthritis (KOA) or lumbar spondylosis (LS), the odds of having a concurrent knee-spine presentation are significantly increased. This may have implications for clinical decision-making and treatment regimes.

In 2018, a study estimated that 266 million individuals worldwide suffered from lumbar degenerative diseases, whereas it was estimated that 654.1 million persons suffered from KOA. However, recent studies suggest that LS and KOA are risk factors for one another because of the compensatory adjustments in weightbearing and posture in response to the disruption of the body’s mechanical alignment. In fact, both conditions can coexist in a single patient, with worse clinical and surgical outcomes in LS patients who undergo knee surgery. The prevalence of coexisting LS and KOA has clinical implications on the screening, diagnosis, and management of orthopedic patients.

The rising trend of ageing populations and increasing prevalence of obesity suggest that the number of affected patients is likely to increase substantially. Thus, there is a need to elucidate the true association between LS and KOA, as well as quantify the extent of their association.

Betzler et al conducted a meta-analysis of nine studies consisting of 5,758 patients. They found that the odds ratio of having KOA due to LS was 1.75, while the combined odds ratio of having LS due to KOA was 1.84, which was significantly high.

LS and KOA are multifactorial pathologies that are influenced by both mechanical deformities and biological abnormalities. An association between spondylosis and KOA has been examined and established in current literature , and has even been referred to as “knee-spine syndrome” . In this review article published in Asian Journal of Neurosurgery, studies reported a 100% increased odds of exposure to both LS and KOA, which is in line with existing literature on the positive correlation between the two diseases.

“By presenting preliminary quantitative evidence for the association between LS and KOA, this study helps in the evaluation of orthopedic patients with either LS or KOA for the possibility of knee-spine pathologies. This data can hopefully aid in early detection and preventive strategies, reduce public health burden, and improve the patients’ quality of life” said the authors. Evidence for the coexistence of LS and KOA can also affect the surgical management of patients. It was concluded that the severity and type of knee deformity determined the sequence of treatment in both specialties.

Reference: Betzler BK, Ng FYC, Huang Y, Hr BAR. The Prevalence of Coexisting Lumbar Spondylosis and Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Asian Spine J. 2022 Dec;16(6):839-847. doi: 10.31616/asj.2021.0405.