A 68-year-old male presents with 2 years of bilateral axial low back pain without radicular features. Pain is rated 5-6/10, worse with prolonged standing, walking downhill, and transitioning from sitting to standing. Extension-based activities like reaching overhead aggravate symptoms. Pain does not radiate below the knees. He has tried physical therapy, chiropractic care, and NSAIDs with only modest relief.

Paraspinal tenderness bilaterally at L4-5 and L5-S1. Pain reproduced with lumbar extension and extension-rotation maneuvers. No radicular signs: strength 5/5 throughout, intact sensation, symmetric reflexes. Negative straight leg raise bilaterally. Negative SI joint provocation tests.

MRI lumbar spine shows multilevel facet arthropathy, most pronounced at L4-5 and L5-S1 bilaterally with facet joint effusions. Mild disc desiccation at L4-5 and L5-S1 without significant herniation or stenosis. No spondylolisthesis.