Conservative treatment
The conservative (non-surgical) treatment options are either passive (done to the patient) or active (done by the patient). Usually a combination of treatments will be used, as passive treatments are rarely effective on their own—some active component is almost always required.

Common passive treatments include:

• Medications. Over-the-counter pain medicine such as acetaminophen (e.g. Tylenol) can help decrease pain and can be used in conjunction with an anti-inflammatory medication such as ibuprofen (e.g. Advil, Nuprin and Motrin).
• Chiropractic/osteopathic manipulations. These can be useful to relieve joint dysfunction that can be associated with the pain. Manipulations work best when combined with an active exercise program.
• Epidural injections. Epidural injections can be used to help decrease inflammation when there is severe pain. The injection is done by inserting a needle into the space around the thecal sac (epidural space) and then injecting a steroid medication. This helps reduce inflammation in the spinal canal and can reduce pain in about 50% to 70% of patients. The injection should be used as part of rehabilitation, as the pain relief can allow the patient to begin an exercise and physical therapy program. If the injection works, but the pain returns, it can be repeated up to three times in a 6-month period.
• Trigger point injections. Tender areas in the muscles can be injected with a small needle and lidocaine to relieve muscular stress and tension, which should relieve the tenderness.
• TENS units. Transcutaneous Electrical Stimulation (TENS) units can be used to provide electrical stimulation to the painful areas of the back. A low current electrical charge is transmitted to the skin. Although the mechanism for how this relieves pain is not exactly known, it has been proven effective for some patients and allows them to function better with less medication. It is suspected that the electrical signals help override the pain signals.

• Artificial disc for cervical disc replacement • Cervical, thoracic and lumbar interlaminar epidural injections • How a physical therapist can help with exercise

In addition, traction may be useful and a home traction unit may be prescribed for use at home.

Common active treatments include:

• Physical therapy. Exercises and stretching can be very helpful in strengthening and stabilizing the affected area, thus reducing pain. It is very important, however, to work with a professional health provider on the appropriate exercises as each person responds differently, and what helps one person may actually harm another.
• Quitting smoking. It has been proven that there is a link between smoking and the ability for the spine to heal. Since there is no benefit to smoking, quitting is highly advisable.

Surgical treatment
Rarely, a one (or possibly two) level fusion may be required to help control symptoms and allow a patient to function more fully. This should only be considered if non-surgical treatments have failed, and the pain the patient is experiencing is severe enough to limit his or her activity level or ability to function.

The goal of this surgery is to stop the motion at a painful motion segment. A small metal plate or a bone graft is placed between the affected vertebrae of the spine. As the bone fuses to the plate or graft, the spine stabilizes in that area and reduces or eliminates the movement that was causing pain.