From the Guidelines
The initial treatment for lumbar spondylosis should focus on conservative, non-surgical approaches, prioritizing pharmacologic and nonpharmacologic therapies, such as exercise and remaining active, for at least 6 weeks before considering imaging or more invasive interventions. This approach is supported by the American College of Radiology's 2021 update on low back pain, which emphasizes the importance of conservative therapy as the first-line treatment for chronic low back pain 1. The goal of initial treatment is to manage symptoms, reduce inflammation, and improve functional ability, rather than immediately pursuing diagnostic imaging or surgical options.
Key components of conservative management include:
- Exercise and physical therapy to improve core strength, flexibility, and proper body mechanics
- Pharmacologic management with acetaminophen or NSAIDs, such as ibuprofen or naproxen, for pain relief
- Lifestyle modifications, including weight management, ergonomic adjustments, and avoiding prolonged sitting
- Heat therapy to relieve pain and stiffness
It is essential to note that imaging, such as MRI or CT, should only be considered if the patient has failed 6 weeks of conservative therapy or if there are red flags or diagnostic uncertainty 1. By prioritizing conservative management and delaying imaging or surgical interventions, patients with lumbar spondylosis can experience improved symptoms, reduced morbidity, and enhanced quality of life.
From the Research
Initial Treatment for Lumbar Spondylosis
The initial treatment for lumbar spondylosis typically involves conservative management strategies. These may include:
- Non-narcotic and narcotic pain medications 2
- Epidural steroid injections 2, 3, 4
- Transforaminal injections 2
- Physical therapy 2, 3, 4, 5
- Activity modification, such as reducing periods of standing or walking 5
- Oral medications to diminish pain, such as nonsteroidal anti-inflammatory drugs (NSAIDs) 5
- Bracing and flexion strengthening exercises 3
- Patient education 6
Nonoperative Treatment Options
Nonoperative treatment options are often the first line of treatment for lumbar spondylosis. These options may include:
- Analgesics and NSAIDs to control pain 3
- Physical methods, such as bracing and flexion strengthening exercises 3
- Epidural steroid injections, although long-term benefits have not been demonstrated 5
- Decompressive laminectomy, which may be considered for patients who do not improve with conservative management 5
Surgical Management
Surgical management may be considered for patients who fail conservative management strategies. Surgical options may include: