Low back pain

Conservative treatment
At our back center, we begin by optimizing non-surgical treatment. In addition to medication, we place particular emphasis on an aggressive physiotherapy approach. The program will focus on muscle relaxation techniques, spinal mobilization, and, most importantly, strengthening the muscles that stabilize the back. These measures will be combined, whenever possible, with a program performed both on land and in a pool, as water is particularly effective in promoting patient relaxation.

Epidural and facet joint infiltrations
To maximize treatment and enhance the anti-inflammatory effect, epidural or facet joint injections are sometimes recommended, especially when the patient is experiencing degenerative changes and osteoarthritis in the lower back. These procedures are performed under local anesthesia. Under radiological guidance, a needle is inserted into the spinal canal (into the epidural space) or into the posterior facet joints, where small amounts of cortisone are injected to provide maximum anti-inflammatory relief. These injections are performed on an outpatient basis, and the patient can return home after a one-hour follow-up at the clinic. If the patient's symptoms improve, these injections can be repeated at intervals determined by the physician (3 to 6 weeks).

Surgical management
If lower back pain persists and is debilitating despite appropriate conservative treatment for at least two to three months, surgical treatment may be considered. In some particularly complex cases, selection for surgery will require further investigations (discography, specific injections) performed at our pain management and back pain diagnostic center to better identify the exact cause of the lower back pain. When lower back pain is caused by discopathy (severe disc degeneration, severe tear of the annulus fibrosus, following surgery for a herniated disc, etc.), the surgeon will need to perform a radical resection of the diseased disc combined with spinal fusion (spondylodesis) or the placement of an artificial disc (disc prosthesis).

Spinal fusion
Spinal fusion (spondylodesis) procedures are performed under general anesthesia via a posterior approach, through an incision of approximately 10 cm in your lower back. The exact location of the skin incision is determined radiologically before the procedure begins. The muscles covering the spine are then separated to allow the surgeon access to the posterior part of the spine, opening the spinal canal that carries the nerves and thus accessing the diseased intervertebral disc. Using a posterior approach and guided by an operating microscope, the entire disc structure is progressively removed with microsurgical instruments. The removed disc structure is then replaced with small cages, the same height as a normal disc, pre-filled with bone. These cages will provide axial support between the two vertebrae on one side and support for the bone graft (fusion) that will take place in the following months on the other. To provide immediate stability, spinal fixation (instrumentation) is used, allowing for rapid patient mobilization after surgery and offering optimal conditions for bone graft consolidation. These spinal fixations are achieved using titanium screws and rods. Implant placement is performed using computer-assisted navigation, ensuring ideal implant positioning and minimizing the risk of malposition.

Disc prosthesis
In certain selected cases (young patients with disc pathology without compression of nerve structures and without degenerative pathology of the posterior facet joints), the placement of an artificial disc (disc prosthesis) may be considered. This surgical procedure is performed via an anterior approach. It is a delicate operation, involving a 6- to 7-cm incision in the suprapubic region. The surgeon must first reposition the abdominal viscera and the major blood vessels (aorta and vena cava) to access the anterior aspect of the spine. Through this access, the diseased disc is radically resected and replaced with a disc prosthesis. The precise positioning of the implant is performed under fluoroscopic guidance to ensure it is perfectly centered in the intervertebral space created by the disc resection. The disc prosthesis is an implant consisting of a plate that can move in all directions on a spherical surface; it generally consists of two parts coupling a metal plate with a polyethylene part (extremely strong plastic) and allows a movement of about 5° in all directions, which is close to the natural mobility of the disc.

After the operation
Upon leaving the operating room (you will be awake and lying on your back), you will be transferred to the recovery room where you will stay overnight to ensure optimal monitoring and care. Visitors are generally allowed in the recovery room (approximately one hour after your discharge from the operating room, limited to one person at a time).
In the recovery room, you will be under the care of the anesthesia team, who will monitor you and administer pain medication. Every effort will be made to ensure your comfort and keep your pain under control. A urinary catheter may be inserted in the operating room (operation duration: 2 hours, for elderly patients).

It will be left in place for one to two days to avoid the discomfort of the vase, and is usually removed when you are able to use the toilet yourself. At the end of the procedure, the surgeon will insert a drain into the surgical wound to remove post-operative bleeding. This will be removed by your surgeon, usually 48 hours after the procedure.
To reduce the risk of thromboembolism (the formation of blood clots in the veins of the lower limbs and in the lungs), the patient will need to wear compression stockings on both legs for a few days. Subcutaneous injections of an anticoagulant will be administered every evening until discharge from the clinic.