What is the diagnosis for a patient with a normal thoracic spine alignment, small endplate osteophytes at T8-9 and T9-10, mild T10-11 disc degeneration, minimal convex leftward lumbar curvature, small endplate osteophytes throughout the lumbar spine, moderate L4-5 and mild multilevel degenerative facet arthropathy?

From the Guidelines

The patient's thoracic and lumbar spine show age-related degenerative changes without any acute abnormalities, and thus, conservative management with physical therapy, core strengthening exercises, and over-the-counter anti-inflammatory medications is recommended. The thoracic spine has small bone spurs (osteophytes) at T8-9 and T9-10 levels, along with mild disc degeneration at T10-11, while the lumbar spine has a slight leftward curvature with small osteophytes throughout, though disc heights remain normal 1. There is moderate degenerative arthritis in the facet joints at L4-5 and mild arthritis at other levels. These findings represent common degenerative changes that occur with aging and are not indicative of fractures, significant deformities, or acute injuries.

According to the American College of Radiology, initial imaging for low back pain should be considered after 6 weeks of conservative therapy if diagnostic uncertainty remains or if the patient is a candidate for surgery or intervention 1. However, in this case, since there are no red flags or indications for immediate imaging, conservative management is the most appropriate course of action. Treatment may include physical therapy, core strengthening exercises, proper posture maintenance, and over-the-counter anti-inflammatory medications like ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily) as needed for pain. Heat therapy and gentle stretching may also provide relief.

Key points to consider in management include:

• Conservative therapy as the first line of treatment
• Use of MRI or CT imaging only if diagnostic uncertainty remains or if the patient is a candidate for surgery or intervention after 6 weeks of conservative therapy 1
• The importance of physical therapy and core strengthening exercises in managing degenerative spine changes
• The potential benefits of over-the-counter anti-inflammatory medications and heat therapy in relieving pain and discomfort.

From the Research

Thoracic Spine Findings

• The thoracic spine is normally aligned with no identified fractures, vertebral deformity, or evidence of acute vertebral abnormality 2.
• Small endplate osteophytes are present at T8-9 and T9-10, and mild T10-11 disc degeneration is observed.
• Facets, posterior spinal elements, paravertebral soft tissue contours, and imaged portions of the ribs are normal.

Lumbar Spine Findings

• There is minimal convex leftward lumbar curvature with no subluxation, identified fractures, vertebral deformity, or evidence of acute lumbar vertebral abnormality.
• Small endplate osteophytes are present throughout the lumbar spine with preservation of normal disc heights.
• Moderate L4-5 and mild multilevel degenerative facet arthropathy are noted.
• Degenerative disorders in the spine, including the lumbar spine, are normal age-related phenomena and are largely asymptomatic in most cases 2.
• Conservative management of lumbar spondylosis is the mainstay of treatment, and most patients with symptomatic degenerative changes respond appropriately to nonsurgical management 2, 3, 4.

Treatment Options

• Conservative management strategies, including non-narcotic and narcotic pain medications, epidural steroid injections, transforaminal injections, and physical therapy, may be considered for patients with symptomatic lumbar spondylolisthesis 3.
• Surgical management is appropriate for well-selected patients who fail conservative management strategies 3, 5, 4.
• Degenerative lumbar spinal stenosis is a major cause of pain and impaired quality of life in the elderly, and nonsurgical management consists of nonsteroidal anti-inflammatory drugs, physical therapy, and epidural steroid injections 5.
• Surgery, most commonly laminectomy, is indicated if nonsurgical management is unsuccessful and neurologic decline persists or progresses 5, 4.