Spinal osteoarthritis, frequently referred to as spondylosis, is a common degenerative condition affecting the facet joints and intervertebral discs of the spine. This gradual wear and tear causes chronic pain, stiffness, and reduced flexibility in the back. Because the condition is complex, involving structural damage, inflammation, and potential nerve compression, effective management requires a coordinated, multidisciplinary treatment approach. Navigating this journey involves consulting several different types of medical professionals, each offering specialized diagnosis and treatment. This guide clarifies the distinct roles of the doctors a patient may encounter when managing back arthritis.
Starting Point: Primary Care and Initial Referral
The Primary Care Physician (PCP) serves as the first point of contact for new back pain. This physician performs the initial physical examination, takes a detailed medical history, and attempts to rule out non-arthritic causes of back pain. They are responsible for ordering initial diagnostic tests, typically starting with standard X-rays, to visualize the bony structures of the spine and look for signs of joint space narrowing or bone spur formation.
The PCP often initiates the first line of conservative treatment, which commonly includes prescribing nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation. They may also recommend basic physical therapy exercises and lifestyle modifications, such as weight management, to alleviate stress on the spinal joints. This initial management can be sufficient for mild cases of spinal osteoarthritis.
When conservative measures fail to provide relief, or if the physical exam suggests a more complex underlying issue, the PCP refers the patient to specialty care. They determine the most appropriate referral; for instance, signs of systemic inflammation may prompt a referral to a rheumatologist. Evidence of severe nerve root compression or unrelenting mechanical pain will likely lead to a referral to a specialist focused on structural or procedural interventions.
Medical and Rehabilitative Specialists
For patients whose back pain involves an inflammatory component or requires functional restoration, two types of specialists provide non-surgical, long-term care.
Rheumatologist
The Rheumatologist specializes in the diagnosis and treatment of systemic autoimmune and inflammatory conditions that can manifest as back pain. While most back arthritis is non-inflammatory osteoarthritis, the rheumatologist is consulted when conditions like ankylosing spondylitis or psoriatic arthritis are suspected. This specialist manages the underlying inflammatory process using advanced pharmaceutical agents. These medications may include disease-modifying antirheumatic drugs (DMARDs) or biologic agents, which target the immune system to slow disease progression and control inflammation. Their expertise ensures the patient receives appropriate systemic treatment rather than just localized pain relief.
Physiatrist
The Physiatrist, or Physical Medicine and Rehabilitation specialist, focuses on optimizing function and reducing pain through non-surgical means. This physician assesses the patient’s biomechanics, nerve function, and overall physical capacity to create a comprehensive rehabilitation plan. They frequently use diagnostic tools like electromyography (EMG) to pinpoint the exact source of nerve pain or muscle weakness. A physiatrist’s treatment plan centers on prescribing specific physical and occupational therapy regimens to improve strength, flexibility, and posture. They manage pain non-surgically, coordinating with therapists to restore mobility and maximize the patient’s independence and quality of life.
Surgical and Interventional Specialists
When conservative and rehabilitative treatments no longer provide adequate pain relief, procedural and surgical specialists are consulted for advanced interventions.
Interventional Pain Management Specialist
The Interventional Pain Management Specialist focuses on minimally invasive, image-guided procedures to target pain generators in the spine. These specialists are experts in precisely delivering anti-inflammatory medication or modifying nerve signals. Common procedures include epidural steroid injections (ESIs), where medication is delivered into the epidural space to reduce inflammation. They also perform facet joint injections, which target the small, arthritic joints in the back, and radiofrequency ablation (RFA). RFA uses heat to temporarily disable the small nerves transmitting pain signals from the facet joints.
Spine Surgeon
The Spine Surgeon, who may be an Orthopedic Surgeon or a Neurosurgeon, represents the final tier of treatment for back arthritis. Surgery is typically reserved for cases where severe structural issues, such as spinal instability or nerve compression, have not responded to any other treatment. These surgeons perform procedures designed to relieve pressure on the spinal cord or nerves, such as spinal decompression. Decompression procedures, which include a laminectomy or a foraminotomy, aim to create more space for the neural elements. In cases of significant instability caused by advanced arthritis, the surgeon may perform a spinal fusion, which permanently joins two or more vertebrae to eliminate painful motion.