Managing LS Facet Arthritis

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Clinicians Corner

John is 48 years old. He has a very long history of Low Back Pain.

He says he had Chiropractic care for about 6 weeks 10 years ago, with no lasting relief. He wants to try a new appraoch, and heard we do things “different”. He wants to avoid Surgey and Epidural Blocks.

His medical Hx is significant for excission of basal cell skin cancer.
He is not diabetic.
He takes NSAIDS, only when very acute. Family Hx is positive for LBP, disabling in 2 siblings.

His exam is remarkable for a paucity of findings. Stiff ROMS, no root signs, extension is very uncomfortable.

Plain Films show very marked facet disease at L5-S1. Lets assume for this discussion his primary Dx is severe facet joint DJD.

Whats are rational Tx plans, expectations and reasoable goals to tell John on Case Review Day? How would you substantiate the need for care beyond the initial stages?

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