Spinal Osteoarthritis

For many people with mild spinal osteoarthritis, therapies that avoid surgery are sufficient to reduce pain and stiffness. Our doctors try these approaches first to see if they are beneficial for you.

Lifestyle changes

Your doctor may recommend certain steps you can take on your own to relieve spinal osteoarthritis symptoms, such as:

• Achieving and maintaining a healthy weight.
• Avoiding smoking, which causes damage to the blood vessels and can increase the risk of degenerative diseases of the spine.
• Getting regular physical activity, including cardiovascular workouts and strength training. Walking, swimming, and water aerobics are gentle exercises that may help relieve your symptoms.
• Maintaining good posture when you are sitting, standing, working, and moving
• Sleeping in positions that do not aggravate your symptoms.

Heat/ice therapy

Applying a heating pad, hot compress, or ice pack to the painful areas of your back for 15-20 minutes at a time may bring relief. Warmth can soothe achy muscles, and a cold compress can help reduce inflammation. Speak with your doctor to determine which might be best for you.

Physical therapy exercises

Physical therapy is a common treatment for spinal osteoarthritis. Physical therapists help patients learn about proper alignment of the spine and approaches to move safely while teaching ways to improve strength, posture, range of motion, and flexibility.

Components of physical therapy may include exercises you learn with your therapist and do at home to stretch and strengthen your muscles. Your therapist will choose the exercises that are most effective for you. During a physical therapy session, your therapist may also perform manual therapy to enhance your mobility and alignment. Over time, increased strength and range of motion in your spine can provide support and ease the stress on arthritic joints.

Medications

Over-the-counter and prescription medications are widely used to relieve the pain caused by spinal osteoarthritis. The medication recommended by your doctor will depend on the type, location, duration, and severity of your back pain. These medications include:

• Acetaminophen
• Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen
• Pain-relieving creams that are applied to the skin at the site of discomfort
• Prescription muscle relaxants or anti-inflammatory drugs; gabapentin or pregabalin may be prescribed if nerve pain is present

Injection therapies

Some people with osteoarthritis receive injections into the spine to see where the pain is coming from and to relieve it, often enabling them to participate in physical therapy more comfortably. Your doctor may recommend these treatments to relieve your pain if other non-surgical therapies are not working well to reduce your neck or lumbar pain, or if you cannot take oral pain medications. These treatments are given using X-ray guidance to direct their placement and include:

• Medial branch block. The doctor injects a numbing medicine (anesthetic) near the small medial nerves connected to a specific joint in the spine, ​called the facet. If the patient feels pain relief immediately ​and it is sustained for a few hours, then the doctor knows that ​the facet joint is the source of the pain. Usually, a confirmatory block is done on another day, and if that is temporarily helpful, you and your doctor may elect to pursue radiofrequency ablation.
• Radiofrequency ablation. Also called radiofrequency neurotomy, this treatment can relieve pain for a longer period of time ​(typically 6 months to a year) than other injection therapies. The doctor applies radiofrequency energy (focused heat) through a special needle to the affected nerve. This energy creates a "heat lesion" in the nerve that inhibits its ability to send pain signals to the brain.
• Intra-articular steroid injection. An injection of a medication such as a corticosteroid is applied into an arthritic spinal joint and works to reduce inflammation.