Rams-49ers on Prime Video, NFL+: Four things to watch for on 'Thursday Night Football' in Week 15

• WHERE: Levi's Stadium (Santa Clara, Calif.)
• WHEN: 8:15 p.m. ET | Prime Video, NFL+

The 7-6 Rams know they need every victory possible down the stretch to catch the first-place Seahawks in the NFC West. The 6-7 49ers are even more desperate than they are.

The Rams head to Levi’s Stadium on Thursday night for a major divisional clash that will help shape the looming playoff picture. A loss would all but certainly knock the 49ers out of the playoff mix. They’re already clinging to life as it is now, having lost the first head-to-head matchup with the Rams in Los Angeles earlier this season.

That Week 3 game saw the Rams erase a 10-point deficit in the final seven minutes, beating the Niners in the waning seconds and preventing the Rams from falling to 0-3.

Both teams have undergone major changes since then -- and could look different Thursday, too. It’s possible that each team will have a key addition to the lineup, returning injured players for the 2024 season debuts, which is pretty remarkable for a Week 15 game.

This game could come down to health. Both teams are banged up, but the 49ers appear to be in worse shape -- and they have the most ground to make up to salvage this season. But they’re also coming off a 38-13 thrashing of the Chicago Bears just a few days ago.

Could the Niners play the role of spoilers, just as the Rams did to them in September?

Here are four things to watch for when the Rams visit the 49ers on Thursday night on Prime Video and NFL+:

1) Can Rams keep hot offense rolling in the short week? The Rams have been trending upward offensively since the returns of wideouts Puka Nacua and Cooper Kupp, but Sunday's 44-point showing was their offensive masterpiece of the season -- and perhaps their best effort in a few years. Matthew Stafford torched the Bills with elite ball placement, consistently dicing up Buffalo’s secondary in spite of tight-window coverage. Nacua was a monster, and Kupp did his thing, with both scoring touchdowns in the win. Neither Nacua nor Kupp played in the first matchup against the 49ers, so they’re sure to have their hands full defensively. They also must deal with running back Kyren Williams, who had two rush TDs in the first matchup and two on Sunday against the Bills. Stafford isn’t agile, but he can pick teams apart with a precision passing attack, although the Niners have intercepted him seven times in his past six games against them.

2) 49ers might have big backfield hole again. It feels like it’s always one step forward, two back for the 49ers’ offensive backfield. Christian McCaffrey missed the start of the season and now appears shelved for the remainder. Jordan Mason ably took his place but also is now on IR. Now the 49ers’ third lead back of the season, Isaac Guerendo, is banged up. Guerendo is coming off a terrific game in which he totaled a career-best 128 yards from scrimmage and two hard-charging rushing TDs, but he left that game late with a foot sprain. If Guerendo can’t go -- he's officially questionable -- it would leave the Niners with Patrick Taylor Jr. and recently claimed Izzy Abanikanda, who barely have 100 combined NFL carries between them. Left tackle Trent Williams (ankle) will also remain sidelined, leaving the offense shorthanded. Luckily, Brock Purdy has returned to the lineup and is coming off a brilliant game against Chicago. Even with Deebo Samuel held in check and complaining about a lack of touches, George Kittle was in rare form and Jauan Jennings stepped up as well. Jennings was a major thorn in the Rams’ side in Week 3, with career highs in TDs (three) and receiving yards (175).

3) Rams defense will be under fire again. In Week 12, the Rams’ defense had to contend with the Eagles’ dangerous offense and allowed 37 points. This past Sunday they locked horns with the high-flying Bills, giving up 42. On Thursday, it will have to find a way to slow down a 49ers offense that found its best rhythm of the season against the Bears, rolling to 452 yards and five TDs. The Rams actually kept Josh Allen in check early before breaking late. Once the Bills went into fast-break mode, the Rams allowed four straight TD drives of 70-plus yards in the second half. Kyle Shanahan surely will try to borrow from this approach, The Rams’ young defensive front didn’t generate enough of a pass rush, and poor tackling and angles to the ball led to Buffalo ripping off eight plays of 21-plus yards. The coverage on the back end was also lacking, as the Rams’ safeties were sometimes late in offering support. When they blitzed Buffalo, it often backfired. Coming up with a game plan in a short week will be a tough chore, even for an opponent the Rams know well.

4) 49ers hope to build on dominant performance. The 49ers had their hands full defensively against the Bills and Packers but rebounded with arguably their strongest performance of the season on that side of the ball this past Sunday. They held Chicago to four first-half yards and refused to allow a second-half comeback, even while giving up a few late touchdowns. How will this unit fare against a cooking Rams offense? It’s possible they could be without Nick Bosa, for what would be a fourth straight game; he's questionable to play with hip and oblique injuries. But the 49ers could welcome back linebacker Dre Greenlaw, who's also listed as questionable, for his first game of the season following his Super Bowl Achilles injury. The test vs. Stafford is a different one than Sunday than it was against Caleb Williams -- or Allen or Jordan Love, for that matter. Stafford has a quick release, getting the ball out fast and usually on target. Yetur Gross-Matos, Leonard Floyd and Maliek Collins were great pressure sources against Chicago, but their pass-rush opportunities must be maximized Thursday. Quick pressures are the 49ers’ best hope against the Rams’ precision passing attack.