The diagnosis and treatment of degenerative changes of the lumbar spine

Certain specific degenerative changes of the lumbar spine call for a meticulous assessment of the patient's symptoms and of the findings on physical examination and diagnostic imaging. Degenerative disc disease, spinal canal stenosis, facet joint arthrosis, and the resulting deformities are discussed here, along with the appropriate treatment for each condition. This narrative review is based on information from pertinent publications retrieved by a search in PubMed. The history and physical examination are determinative. The findings of imaging studies are not necessarily correlated with the clinical manifestations. In the absence of red flags such as a new neurologic deficit or a suspected tumor, the patient can be treated conservatively with analgesics, physiotherapy, or specific infiltrations. If no improvement ensues, or if there is an absolute indication for surgery, decompressive and/or fusion techniques are used, depending on the particular abnormality that is present. A randomized controlled trial has shown the superiority of decompression over nonsurgical management for lumbar spinal canal stenosis (Oswestry Disability Index [ODI] mean difference 7.8, 95% confidence interval [0.8; 14.9]). On the other hand, a study of pooled data on fusion procedures yielded a mean difference of -7.39 points in the ODI score favoring surgery [-20.26; 5.47] [p = 0.26]). For many surgical techniques, the supporting scientific evidence is sparse. The authors recommend treatment in a specialized center.