What is the diagnosis for a patient with right lower back pain, given the presence of mild degenerative changes, ossific spurring, facet arthrosis, and mild degenerative disc disease in the lumbar spine, as seen on a lumbar spine X-ray (XR)?

From the Guidelines

The diagnosis for a patient with right lower back pain, given the presence of mild degenerative changes, ossific spurring, facet arthrosis, and mild degenerative disc disease in the lumbar spine, as seen on a lumbar spine X-ray, is nonspecific low back pain, which is commonly associated with normal age-related changes rather than acute injury. The patient's symptoms and X-ray findings are consistent with mild degenerative changes throughout the lumbar spine, including bone spurs and joint wear (facet arthrosis), and mild narrowing of the disc space between the L5 vertebra and sacrum (L5-S1), suggesting mild degenerative disc disease in the lower back. The following key points should be considered:

• The natural history of lumbar disc herniation with radiculopathy in most patients is for improvement within the first 4 weeks with noninvasive management 1.
• There is no compelling evidence that routine imaging affects treatment decisions or improves outcomes 1.
• Treatment typically includes over-the-counter pain relievers like acetaminophen (500-1000mg every 6 hours as needed) or ibuprofen (400-600mg every 6-8 hours with food), physical therapy focusing on core strengthening exercises, proper body mechanics when lifting, and application of heat or ice for comfort.
• Clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options 1.
• If pain persists or worsens, follow up with your doctor as additional treatments may be needed. The patient should be informed that these degenerative changes develop gradually over time due to normal wear and tear on the spine and often contribute to back pain, particularly with certain movements or activities. It is essential to note that the patient's symptoms and X-ray findings do not suggest any serious underlying conditions, and therefore, the recommended treatment approach is conservative management, focusing on symptom relief and improvement of function.

From the Research

Diagnosis of Right Lower Back Pain

The diagnosis of right lower back pain, given the presence of mild degenerative changes, ossific spurring, facet arthrosis, and mild degenerative disc disease in the lumbar spine, as seen on a lumbar spine X-ray (XR), can be approached through a combination of clinical examination and imaging studies 2, 3, 4.

Clinical Examination and History

A thorough history and physical examination are essential in diagnosing the cause of low back pain, including assessing for red, yellow, orange, black, and blue flags, and performing physical, neurological, sensory, and motor testing 3.

Imaging Studies

Imaging studies such as X-ray, MRI, or CT scans can help identify systemic disease as a cause of back or limb pain, but their use should be judicious and considered in the context of the patient's symptoms and physical examination findings 4.

Specific Conditions

• Degenerative Disc Disease: This is a common condition that can cause low back pain, characterized by changes in the mechanical properties of the disc leading to degenerative arthritis, osteophytes, and narrowing of the intervertebral foramen or spinal canal 2.
• Discogenic Pain: This type of pain is attributed to the disc itself and can be diagnosed using pressure-controlled provocative discography 5.
• Facet Arthrosis: This condition involves the zygapophysial (facet) joints and can be a cause of axial back pain, although the correlation between imaging findings and pain production is poor 4.

Diagnostic Criteria

The diagnosis of discogenic pain, for example, requires the reproduction of the patient's typical pain at an intensity of > 6/10 at a pressure of < 15 psi above opening pressure and at a volume less than 3.0 mL during discography 5.

Treatment Approaches

Treatment approaches for chronic low back pain may include conservative management with reassurance, patient education, exercise, and multidisciplinary biopsychosocial rehabilitation programs, as well as pharmacological and non-pharmacological interventions 3, 6.

Considerations

It's important to consider the patient's overall clinical presentation, including psychosocial factors, when determining the cause of their back pain and developing an appropriate treatment plan 3, 4.