What is the diagnosis and explanation for a patient with mild-to-moderate Lumbar (L) 2-3 degenerative disc disease, mild L3-L4, L4-L5, and L5-Sacrum (S) 1 degenerative disc disease, and moderate L4-L5 and L5-S1 degenerative facet arthropathy?

From the Guidelines

I would explain to the patient that their MRI shows age-related changes in their lower spine, which are common and represent normal degeneration of the spine, and that treatment typically includes physical therapy, over-the-counter pain medications, maintaining a healthy weight, and staying active with low-impact exercises. The MRI findings indicate mild to moderate wear and tear of the discs between their vertebrae, particularly at the L2-L3 level where there is also a slight forward slippage of one vertebra over another (retrolisthesis) [ 1 ]. Additionally, there are mild disc changes at three other levels (L3-L4, L4-L5, and L5-S1), and moderate arthritis in the small joints (facet joints) at the L4-L5 and L5-S1 levels.

• These findings are common as we age and represent normal degeneration of the spine.
• Many people with similar findings have no symptoms at all, while others may experience back pain or stiffness.
• Treatment typically includes:
  • Physical therapy to strengthen core muscles
  • Over-the-counter pain medications like acetaminophen or ibuprofen as needed
  • Maintaining a healthy weight
  • Staying active with low-impact exercises such as walking, swimming, or cycling
  • Heat or ice packs may also help manage discomfort According to the American College of Radiology [ 1 ], MRI is the initial imaging modality of choice for patients with subacute or chronic low back pain who have failed 6 weeks of conservative therapy, as it accurately depicts lumbar pathology, including disc degeneration. However, it is essential to note that many MRI abnormalities can be seen in asymptomatic individuals, and imaging patients in this category is often not beneficial [ 1 ]. The patient's treatment plan should focus on conservative management, and they should be reassured that these changes do not necessarily mean they will have severe problems in the future, and most people can manage well with conservative treatments.

From the Research

Explanation of Medical Condition

• The patient has been diagnosed with degenerative disc disease, which is a condition where the spinal discs lose their strength and flexibility due to wear and tear.
• The diagnosis includes:
  • Mild-to-moderate degenerative disc disease at the L2-L3 level, with minimal grade 1 retrolisthesis, which means that one of the vertebrae is slightly out of place.
  • Mild degenerative disc disease at the L3-L4, L4-L5, and L5-S1 levels.
  • Moderate degenerative facet arthropathy at the L4-L5 and L5-S1 levels, which is a condition where the joints between the vertebrae become inflamed and worn out.

Understanding Degenerative Disc Disease and Facet Arthropathy

• Degenerative disc disease is a common condition that can cause back pain and stiffness, as the spinal discs lose their ability to cushion and support the vertebrae 2.
• Facet arthropathy is a condition that can occur as a result of degenerative disc disease, where the joints between the vertebrae become inflamed and worn out, leading to pain and stiffness.
• According to a study published in 2012, degenerative disc disease and facet arthropathy can develop at similar frequencies in patients who undergo surgery or rehabilitation for chronic low back pain and degenerative disc disease 2.

Implications for Patient Care

• The patient's diagnosis suggests that they may be experiencing back pain and stiffness due to the degenerative disc disease and facet arthropathy.
• The patient's treatment plan may include a combination of physical therapy, pain management, and lifestyle modifications to manage their symptoms and slow down the progression of the disease.
• Further evaluation and monitoring may be necessary to determine the best course of treatment and to assess the patient's response to treatment.