Management of Spondylosis

Assessment and Monitoring

Disease monitoring should include patient history, clinical parameters, laboratory tests, and imaging according to clinical presentation 1
Radiographic monitoring is generally not needed more often than once every 2 years, though exceptions exist for rapidly progressing cases 1
Assessment should consider disease activity/inflammation, pain levels, function, disability, structural damage, and comorbidities 3

Regular exercise and physical therapy are cornerstone treatments for spondylosis 2
Home exercise programs improve function in the short term compared to no intervention 2
Group therapy shows better patient global assessment outcomes than individual therapy alone 2
Patient education about the condition and self-management strategies is essential 2
Patient associations and self-help groups may provide additional support 2

NSAIDs are recommended as first-line drug treatment for patients with pain and stiffness 4
There is convincing level Ib evidence that NSAIDs improve spinal pain, peripheral joint pain, and function over short periods (6 weeks) 4
For patients with increased gastrointestinal risk, consider either non-selective NSAIDs plus a gastroprotective agent 5 or a selective COX-2 inhibitor 4
Analgesics such as paracetamol and opioids might be considered for pain control when NSAIDs are insufficient, contraindicated, or poorly tolerated 5
Corticosteroid injections directed to local sites of musculoskeletal inflammation may be beneficial 5
Anti-TNF treatment should be given to patients with persistently high disease activity despite conventional treatments 5

Total hip arthroplasty should be considered in patients with refractory pain or disability and radiographic evidence of structural damage 5
Spinal surgery, including corrective osteotomy and stabilization procedures, may be valuable in selected patients 5

Overreliance on imaging findings without correlation to clinical symptoms can lead to unnecessary interventions 1
Failure to incorporate both pharmacological and non-pharmacological approaches limits treatment effectiveness 6
Systemic corticosteroids should be avoided for axial disease due to lack of evidence and potential side effects 5
Regular monitoring is essential as disease progression can vary significantly between patients 1