What is the recommended treatment for a patient with multilevel degenerative disc disease and facet osteoarthritis?

From the Guidelines

The recommended treatment for multilevel degenerative disc disease and facet osteoarthritis should prioritize conservative measures, including exercise and physical therapy, as the first line of treatment. According to the most recent guidelines, patients with chronic low back pain should be treated with conservative therapy, including both pharmacologic and nonpharmacologic treatments, such as exercise and remaining active 1.

Initial Treatment

Initial treatment should focus on:

• Core strengthening and flexibility exercises
• NSAIDs, such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily), for pain and inflammation
• Acetaminophen (up to 3000mg daily) for patients who cannot tolerate NSAIDs
• Adjunct non-pharmacological treatments, such as local heat or cold applications, manipulation and stretching, and transcutaneous electrical nerve stimulation (TENS) may be considered 1

Imaging and Further Treatment

Imaging, such as MRI, may be considered if the patient has failed 6 weeks of conservative therapy and is believed to be a candidate for surgery or intervention 1. If these measures prove insufficient, epidural steroid injections or facet joint injections may provide temporary relief. For patients with persistent, severe symptoms despite these interventions, surgical options, including decompression, fusion, or artificial disc replacement, may be considered.

Key Considerations

• A stepwise approach should be taken, beginning with conservative measures before considering more invasive options.
• The goal of treatment is to address both pain management and functional improvement, targeting the inflammatory processes and mechanical factors contributing to symptoms while minimizing progression of the condition.
• Recent studies suggest that SPECT/CT bone scan may help identify the source of low back pain in some patients, particularly when related to facet arthropathy or sacroiliac joint dysfunction 1.

From the FDA Drug Label

NSAID medicines are used to treat pain and redness, swelling, and heat (inflammation) from medical conditions such as: different types of arthritis Naproxen has been studied in patients with rheumatoid arthritis, osteoarthritis, juvenile arthritis, ankylosing spondylitis, tendonitis and bursitis, and acute gout

The recommended treatment for a patient with multilevel degenerative disc disease and facet osteoarthritis may include NSAID medicines such as naproxen, which has been shown to be effective in treating osteoarthritis and other conditions characterized by pain and inflammation.

• Key considerations for treatment include:
  • Using the lowest dose possible for the shortest time needed
  • Monitoring for potential side effects, such as gastrointestinal events and nervous system adverse effects
  • Considering alternative treatments or combination therapy if necessary 2 2

From the Research

Treatment Options for Multilevel Degenerative Disc Disease and Facet Osteoarthritis

The recommended treatment for a patient with multilevel degenerative disc disease and facet osteoarthritis depends on various factors, including the severity of symptoms, age, and overall health.

• Conservative management may be employed for mild cases, with careful observation and monitoring of symptoms 3.
• Surgical intervention may be considered for moderate to severe cases, with the goal of decompressing the cord, expanding the spinal canal, and stabilizing the spine 3.
• The optimal surgical approach is still under debate and may vary depending on the number of levels involved, location of the pathology, and baseline cervical sagittal alignment 3.

Association between Disc Degeneration and Facet Joint Osteoarthritis

Studies have shown that disc degeneration and facet joint osteoarthritis are interdependent and often occur together 4, 5.

• Disc degeneration is more closely associated with aging than with facet joint osteoarthritis 5.
• Facet joint osteoarthritis is often found at the intervertebral levels with advanced disc degeneration 5.
• The relationship between disc degeneration and facet joint osteoarthritis is complex, and further research is needed to fully understand the underlying mechanisms 6, 4.

Importance of Early Recognition and Treatment

Early recognition and treatment of multilevel degenerative disc disease and facet osteoarthritis are essential for optimal outcomes 3.

• Delayed treatment can lead to further degeneration and worsening of symptoms.
• A multidimensional approach to treatment, taking into account the complex relationships between disc degeneration, facet joint osteoarthritis, and other spinal phenotypes, may be necessary for effective management 7.