From the Guidelines
The most appropriate management for your condition, given the progressive degenerative changes in your spine, includes physical therapy focusing on core strengthening, pain management with NSAIDs, and lifestyle modifications. The imaging studies from 2018 and 2025 show progressive degenerative changes in your spine. In 2018, you had mild degenerative changes in the lower thoracic spine with a slight rightward curvature (dextroscoliosis), and mild degeneration at L5-S1 in your lumbar spine. By 2025, your condition progressed to include mild-to-moderate disc degeneration at L2-L3 with a small forward slippage of one vertebra over another (retrolisthesis), mild disc degeneration at L3-L4, L4-L5, and L5-S1, and moderate joint degeneration (facet arthropathy) at L4-L5 and L5-S1. These findings suggest normal age-related spinal degeneration that has progressed over the seven-year period, with the lower lumbar spine showing the most significant changes. According to the American College of Radiology Appropriateness Criteria 1, MRI of the lumbar spine is the initial imaging modality of choice for patients with low back pain, as it provides excellent soft-tissue contrast and accurately depicts lumbar pathology. However, as stated in the guidelines 1, imaging is typically not warranted for acute low back pain with or without radiculopathy, and no red flags, as it is considered a self-limiting condition responsive to medical management and physical therapy. Given that your condition has progressed over time, treatment should focus on managing symptoms and preventing further degeneration, rather than relying solely on imaging for diagnosis. Some key points to consider in managing your condition include:
- Physical therapy to strengthen core muscles and improve posture
- Pain management with NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) as needed
- Lifestyle modifications such as maintaining proper posture, weight management, and avoiding activities that worsen symptoms
- Heat therapy, gentle stretching, and potentially epidural steroid injections may be considered if pain becomes significant, as suggested by the guidelines 1. It is essential to note that these degenerative changes are common with aging and result from wear and tear on the spinal discs and joints over time, and a multidisciplinary approach to management, including physical therapy, pain management, and lifestyle modifications, is likely to provide the best outcomes in terms of morbidity, mortality, and quality of life 1.
From the Research
Degenerative Changes in the Spine
- The thoracic spine shows mild degenerative changes, particularly in the lower region, as well as mild dextroscoliosis [@\1@].
- The lumbar spine exhibits mild degenerative changes, primarily affecting the L5-S1 region.
- A follow-up examination revealed mild-to-moderate L2-L3 degenerative disc disease with minimal grade 1 retrolisthesis [@\1@].
- Additionally, mild degenerative disc disease was observed in the L3-L4, L4-L5, and L5-S1 regions.
- Moderate degenerative facet arthropathy was also noted in the L4-L5 and L5-S1 regions.
Impact of Degenerative Disc Disease
- Degenerative disc disease can have a significant socioeconomic impact on the healthcare system, particularly in terms of low back pain [@\1@].
- Current treatment options for degenerative disc disease are suboptimal and focus on symptomatic relief rather than addressing the underlying mechanisms of disc degeneration [@\1@].
- Novel treatment strategies, such as stem cells, growth factors, and gene therapy, are being explored to prevent, slow, or reverse disc degeneration [@\1@].