From the Guidelines
Your X-ray shows age-related changes in your lower back, including mild to moderate wear and tear in several areas of your spine, which can cause symptoms like stiffness or back pain. You have mild to moderate degenerative disc disease at the L2-L3 level, with a slight forward slippage of one bone over another, known as grade 1 retrolisthesis 1. Similar but milder wear is present at the L3-L4, L4-L5, and L5-S1 levels. Additionally, the small joints at the back of your spine (facet joints) show moderate arthritis at the L4-L5 and L5-S1 levels.
Key Findings
- Mild to moderate degenerative disc disease at L2-L3, L3-L4, L4-L5, and L5-S1 levels
- Grade 1 retrolisthesis at L2-L3
- Moderate degenerative facet arthropathy at L4-L5 and L5-S1 These findings are common as we age and often explain symptoms like stiffness or back pain, as noted in the 2021 update of the ACR Appropriateness Criteria for low back pain 1.
Treatment Options
- Physical therapy
- Core strengthening exercises
- Over-the-counter pain relievers like ibuprofen (400-800mg three times daily with food) or acetaminophen (500-1000mg every 6 hours as needed)
- Muscle relaxants for flare-ups
- Heat therapy
- Maintaining good posture It's essential to note that while we can't reverse these changes, we can effectively manage any symptoms they cause, and the goal of imaging is to identify potential actionable pain generators that could be targeted for intervention or surgery 1.
From the Research
Explanation of X-Ray Results
The X-ray results indicate several conditions affecting the lumbar spine:
- Mild-to-moderate L2-L3 degenerative disc disease with minimal grade 1 retrolisthesis, which means that the disc between the L2 and L3 vertebrae is showing signs of wear and tear, and the L3 vertebra is slightly displaced backwards 2.
- Mild degenerative disc disease at L3-L4, L4-L5, and L5-S1 levels, indicating that the discs at these levels are also showing signs of wear and tear 3.
- Moderate degenerative facet arthropathy at L4-L5 and L5-S1 levels, which means that the joints between the vertebrae at these levels are showing signs of osteoarthritis 4.
Implications of the Conditions
These conditions can cause back pain and impaired function, although the presence of retrolisthesis was not found to be associated with increased back pain or impaired function in a study of patients with lumbar disc herniation 2. The degenerative changes in the spine can be asymptomatic or not consistent with symptoms, and imaging helps determine the most likely anatomical nociceptive source, thereby enhancing the therapeutic approach by targeting a specific lesion 5.
Key Points to Discuss with the Patient
- The X-ray results show degenerative changes in the lumbar spine, which are common with aging and can cause back pain.
- The presence of retrolisthesis and degenerative facet arthropathy may contribute to back pain, but the relationship between these conditions and symptoms is not fully understood 2, 4.
- Imaging studies, such as X-rays and MRIs, can help identify the underlying causes of back pain and guide treatment decisions 3, 5.