Lumbar Facet Arthropathy: Conservative Treatment Options for scared Patient

Patient

Q: Doctor I had an MRI done on my lower back in late January 2010. The results are foreign to me. The report line I am concerned with is,"Facet arthorpathy is seen causing along with the endplate degenerative changes abutment/impingment of the exiting right L4 nerve root. The symptoms I am having is numbness and total loss of feeling in my right leg. The symptoms used to occur only when I laid down but now occur while standing, sitting and laying. The occurances are becoming more prevalent. I am afraid this can cause perminent nerve damage. What should I do?

Doctor

A:   Lumbar facet arthropathy is one of the causes of chronic low back pain, but is usually not considered until conservative measures for treating low back pain (LBP) have been tried without success or an MRI confirm the diagnosis. The symptoms that you described, numbness, loss of sensation in your right leg are due to nerve compression, and you feel them worst in some positions because in those positions the intervertebral space gets smaller and compress the correspondent nerve.
Basically the conservative treatment of the Lumbar Facet Arthropathy is Physical Therapy aimed to recondition and stabilize the lumbar spine by re-educating the patient, teaching him/her a daily stretching routine for the lumbar area, strengthening of abdominal muscles, and other important general recommendations as follows: sleeping with a pillow between the knees lying on the side, avoid activities that place additional strain on the lumbar spine (example: weight lifting). All of the above, with the objective to keep the patient as far as possible from episodes of acute low back pain, and also to preserve his/her quality of life. If the conservative measures do not seem to work, the local corticosteroid injection may be considered.

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