From the Guidelines
Spondylosis, a degenerative spinal disease, should be managed with a combination of pain relief medications, physical therapy, and lifestyle modifications to improve quality of life and slow symptom progression. The diagnosis of spondylosis involves identifying symptoms such as nonspecific low back pain, radiculopathy, sciatica, and spinal stenosis, which can be assessed through physical examination and imaging studies [ 1 ].
Diagnosis
The diagnosis of spondylosis can be challenging due to the nonspecific nature of degenerative changes on lumbar imaging, which correlate poorly with symptoms [ 1 ]. A thorough physical examination, including the straight-leg-raise test, can help identify nerve root tension and radiculopathy [ 1 ].
Treatment
Treatment typically involves a combination of pain management and physical therapy. For pain relief, start with over-the-counter medications like acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or NSAIDs such as ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily) [ 1 ]. Apply heat or cold packs to the affected area for 15-20 minutes several times daily. Physical therapy is crucial and should include gentle stretching exercises, core strengthening, and proper posture training [ 1 ].
Lifestyle Modifications
Lifestyle modifications are important: maintain a healthy weight, practice good posture, use ergonomic furniture, take regular breaks when sitting for long periods, and avoid activities that worsen symptoms [ 1 ]. In advanced cases where conservative treatments fail, interventional procedures like epidural steroid injections or surgery may be considered.
Key Interventions
- Pain management: Acetaminophen, NSAIDs, or muscle relaxants for severe pain
- Physical therapy: Gentle stretching, core strengthening, and proper posture training
- Lifestyle modifications: Healthy weight, good posture, ergonomic furniture, regular breaks, and avoidance of worsening activities
- Interventional procedures: Epidural steroid injections or surgery for advanced cases [ 1 ]
From the Research
Diagnosis of Spondylosis
- The diagnosis of spondylosis, also known as degenerative spinal disease, can be made based on a clinical history of back and lower extremity pain that is provoked by lumbar extension, relieved by lumbar flexion, and confirmed with cross-sectional imaging, such as computed tomography or magnetic resonance imaging (MRI) 2.
- Lumbar spinal stenosis, a prevalent and disabling cause of low back and leg pain in older persons, can be diagnosed based on a combination of clinical history, physical examination, and imaging studies 2.
Treatment of Spondylosis
- Nonoperative treatment for lumbar spinal stenosis includes activity modification, such as reducing periods of standing or walking, oral medications to diminish pain, such as nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy 2.
- Therapeutic exercise is the most important non-pharmacological intervention in patients with ankylosing spondylitis, and it plays an important role in improving spinal mobility and muscle strength 3.
- Epidural steroid injections can provide pain relief for patients with spondylolisthesis, but the effectiveness of these injections can vary depending on the type of spondylolisthesis, with degenerative spondylolisthesis (DS) patients experiencing better pain relief than isthmic spondylolisthesis (IS) patients 4.
- Surgical treatment, such as decompressive laminectomy, may be effective in carefully selected patients with back, buttock, and lower extremity pain who do not improve with conservative management 2, 5.
- Minimally invasive lumbar decompression (mild Procedure) is a common treatment option for lumbar spinal stenosis, and it can be effective in reducing pain and improving function, but the benefits of multiple epidural steroid injections prior to the mild Procedure are unclear 6.
Surgical Management
- Surgical treatment with decompression and fusion is recommended for patients with lumbar degenerative spondylolisthesis who do not respond to nonoperative treatment 5.
- Interbody fusion may improve arthrodesis rates and can be performed via numerous surgical approaches, and minimally invasive techniques continue to be developed 5.
- The precise indications for concomitant lumbar fusion in persons with lumbar spinal stenosis and spondylolisthesis remain unclear, and fusion is associated with greater risk of complications, such as blood loss, infection, longer hospital stays, and higher costs 2.