From the Guidelines
The recommended treatment for a patient with multilevel degenerative disc disease and facet osteoarthritis should start with conservative measures, including exercise and physical therapy, as emphasized by the most recent guidelines 1. The initial approach should focus on core strengthening and spinal stabilization exercises, which can help alleviate pain and improve function.
- Adjunct non-pharmacological treatments, such as local heat or cold applications, manipulation, and stretching, may also be beneficial 1.
- Weight management is crucial, as excess weight increases spinal load, and patients should be encouraged to maintain a healthy weight through a combination of diet and exercise.
- Pharmacological treatments, such as NSAIDs (e.g., ibuprofen or naproxen) and acetaminophen, can be used to manage pain and inflammation, but their use should be carefully monitored and limited to the shortest duration necessary 1. If conservative measures fail after 6-8 weeks, interventional procedures, such as facet joint injections or medial branch blocks, may be considered, as they can provide targeted pain relief 1.
- For patients with persistent symptoms despite these treatments, minimally invasive procedures like radiofrequency ablation of medial branch nerves may provide longer pain relief.
- Surgery, such as decompression, fusion, or artificial disc replacement, should be reserved for patients with progressive neurological deficits, severe pain unresponsive to conservative treatment, or significant functional limitations, as it carries significant risks that must be carefully weighed against potential benefits 1.
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 may involve a combination of conservative and interventional management approaches 2.
- Conservative management may include physical therapy, pain management, and lifestyle modifications to alleviate symptoms and improve functional ability.
- Interventional management options may include facet joint injections, radiofrequency ablation, or cryoablation to target specific pain generators and provide relief 2.
Diagnostic Considerations
- Diagnostic positive facet joint block can indicate facet joints as the source of chronic spinal pain, and patients may benefit from specific interventions to eliminate facet joint pain 2.
- Imaging studies such as MRI or CT scans can help identify degenerative changes in the discs and facet joints, but there are no effective correlations between clinical symptoms and degenerative spinal changes 2, 3.
Pathophysiological Aspects
- Intervertebral disc degeneration and osteoarthritis affecting the facet joint of the spine are biomechanically interdependent and typically occur in tandem, with considerable epidemiological and pathophysiological overlap 4.
- The molecular pathways and processes of degeneration, including cartilage destruction, extracellular matrix degeneration, and osteophyte formation, are similar between the intervertebral disc and synovial facet joint 4.
Prevalence and Clinical Correlates
- Degenerative spinal pathology is often implicated as the primary reason for chronic low back pain in older adults, but radiographic severity of disc and facet disease is not associated with pain severity among those with chronic low back pain 5.
- The presence of degenerative disc and facet pathology in older adults is ubiquitous, regardless of clinical status, with greater than 90% demonstrating some level of degeneration 5.
Relationship between Facet Joint Osteoarthritis and Disc Degeneration
- Disc degeneration is more closely associated with aging than with facet joint osteoarthritis, and it may take 20 or more years to develop facet joint osteoarthritis following the onset of disc degeneration 6.
- No facet joint osteoarthritis was found in the absence of disc degeneration, and most facet joint osteoarthritis appeared at the intervertebral levels with advanced disc degeneration 6.