What is the initial treatment for spondylosis disc disease?

Initial Treatment for Spondylosis Disc Disease

The initial treatment for spondylosis disc disease should begin with NSAIDs as first-line pharmacological therapy combined with patient education and regular exercise programs. 1, 2

Non-Pharmacological Management (Foundation of Treatment)

Non-pharmacological interventions form the cornerstone of initial management and should be implemented immediately:

• Patient education about the condition and self-management strategies is essential and should be provided at the first visit 1, 2
• Regular exercise programs are mandatory, with home exercise programs showing improvement in function compared to no intervention 1, 2
• Group physical therapy demonstrates better patient global assessment outcomes than individual therapy alone, though both are acceptable 1
• Gentle isometric strengthening exercises that minimize movement of affected joints should be prescribed 2
• Activity modification and avoiding aggravating positions should be discussed 3, 4

The evidence supporting exercise and physiotherapy is Level Ib, with systematic reviews of randomized controlled trials demonstrating functional improvements. 1

Pharmacological Management (First-Line Drug Therapy)

NSAIDs are the recommended first-line drug treatment for patients presenting with pain and stiffness:

• NSAIDs provide Level Ib evidence for improving spinal pain, peripheral joint pain, and function over 6-week periods 1, 2
• For patients with gastrointestinal risk factors, use either non-selective NSAIDs plus gastroprotective agents OR selective COX-2 inhibitors 1, 2
• COX-2 selective NSAIDs may be preferred for long-term treatment due to reduced gastric side effects 1
• Comparative studies show no single NSAID preparation is clearly superior to others 1

Analgesics such as paracetamol and opioids can be considered for pain control when NSAIDs are insufficient or contraindicated 1

Additional Conservative Measures

• Epidural steroid injections and transforaminal injections are helpful for radiating leg pain and neurogenic intermittent claudication 3, 5
• Prostaglandin therapy may provide symptomatic relief for leg symptoms 3
• Neck immobilization (for cervical spondylosis) or bracing (for lumbar disease) can be beneficial, with 30-50% of patients showing improvement 4, 5
• Flexion strengthening exercises are specifically recommended for lumbar degenerative spondylolisthesis 5

Important Clinical Considerations

The majority of patients with spondylosis can be managed non-surgically. 3 Conservative treatment should be the initial course of action in most cases, even in those with neurologic symptoms. 5

Common pitfall to avoid: Do not rush to surgical intervention. Operative therapy is reserved only for patients who are totally incapacitated by their condition or who demonstrate progressive neurologic deficits despite adequate conservative management. 3, 4

Monitoring approach: While regular assessment of disease activity, pain, function, and disability is important, radiographic monitoring is generally not needed more frequently than every 2 years unless rapid progression is suspected. 2

The prognosis with conservative management is favorable for most patients, though those with neurological symptoms like intermittent claudication may experience deterioration without surgical intervention if symptoms progress. 5