From the Guidelines
Management of the lumbar spine findings should focus on conservative treatments initially, prioritizing physical therapy and self-care options to improve spinal stability and reduce pain, as recommended by the American College of Physicians and the American Pain Society 1. The goal of treatment is to alleviate symptoms, improve function, and enhance quality of life, considering the mild degenerative changes and moderate foraminal narrowing at L3-L4 and L4-L5 levels.
- Conservative approaches include:
- Physical therapy to strengthen core muscles and improve spinal stability, with sessions 2-3 times weekly for 6-8 weeks
- Daily home exercises, such as gentle stretching and strengthening
- Pain management with over-the-counter NSAIDs, like ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily), for short-term use
- Heat therapy for 15-20 minutes several times daily
- Proper ergonomics, including maintaining good posture, using supportive chairs, and avoiding prolonged sitting
- Weight management is also advised if the patient is overweight, as excess weight increases spinal stress. According to the American College of Radiology 1, imaging is not necessary for patients with low back pain without red flags, and conservative therapy should be the first-line treatment.
- If symptoms persist after 6-8 weeks of conservative treatment, follow-up with a spine specialist may be warranted to consider interventional options, such as epidural steroid injections. The MRI findings of disc bulges, mild facet arthropathy, and moderate foraminal narrowing at L3-L4 and L4-L5 levels typically respond well to non-surgical interventions, and conservative management is the recommended initial approach.
From the Research
Management of Degenerative Changes in the Lumbar Spine
The provided evidence suggests that degenerative changes in the lumbar spine are a common and largely asymptomatic phenomenon in most cases 2. The management of these changes typically involves conservative, non-surgical approaches.
Conservative Management
Conservative management of lumbar degenerative changes includes physical therapy, exercise, and lifestyle modifications 3, 4. Studies have shown that directed exercise and manual therapy can be effective in improving short-term walking capacity, reducing back and leg pain, and improving symptom severity 3. Additionally, physical therapy interventions such as cycling and body-weight-supported treadmill walking have been shown to be beneficial for patients with degenerative lumbar spinal stenosis 5.
Surgical Intervention
Surgical intervention may be considered in cases where conservative measures have failed 2, 5. However, the evidence suggests that surgery may only be beneficial for pain and disability in the long term (2 years) and not for walking distance 5. Lumbar total disc replacement is also an option for treating degenerative disc disease, but its effectiveness and indications are still being studied 4.
Specific Considerations
In patients with axial spondyloarthritis, degenerative changes in the lumbar spine may be more prevalent and can contribute to an increased burden of disease 6. It is essential to consider these changes when managing patients with axial spondyloarthritis and to not overlook them as a potential cause of low back complaints.
Key Findings
- Degenerative changes in the lumbar spine are common and largely asymptomatic 2
- Conservative management, including physical therapy and exercise, is the mainstay of treatment 3, 4, 5
- Surgical intervention may be considered in cases where conservative measures have failed 2, 5
- Degenerative changes in the lumbar spine can contribute to an increased burden of disease in patients with axial spondyloarthritis 6