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Many individuals can be treated conservatively with rest, weight reduction, body core exercise programs, anti-inflammatory drugs and use of a lumbar corset to aid in support during acute phases. Often there are acute and chronic phases of these disease and patients can sometimes modify their activities to minimize acute discomfort. Injection of epidural steroids can sometimes help with discogenic pain. Also if the pain is thought to come from a particularly degenerated facet joint, a facet block can be done under X-ray guidance similar to injecting a degenerative knee to help with pain.
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Facet arthropathy or mild joint degeneration | If the patient has failed conservative management and pain is intolerable limiting normal daily function then spinal fusion may be considered. Approaches to spinal fusion for degenerative disc disease as well as facet arthropathy have modified over the last decade due to advance in techniques and instrumentation. Previously a posterior spinal fusion was done from the back to place bone graft along the spine to create one bone from two and eliminate motion and therefore pain. This could be done with or without metal screws and rods which help stabilize the spine while it heals and often give quicker immediate relief. One advantage of the posterior approach is that it allows the surgeon to also do a laminectomy and decompress nerve roots which might be impinged on producing leg pain. This is caused by spinal or foramenal stenosis and is discussed separately.
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