LOW BACK PAIN
Definition and cause
While common lumbago (back pain) can have multiple causes (muscle, ligament, joint, psychological), severe, chronic, and disabling lumbago is almost always disc-related; it is lumbar discopathy, i.e., progressive degeneration of one or more intervertebral discs.
Course of the disease
Discopathy can occur through acute low back pain (lumbago), which often occur after a “wrong move”, or after physical exertion. The episode naturally tends to heal in a few days, or sometimes a few weeks. While in most people these episodes will remain isolated, or at least very spread out over time, in 5% of cases, the low back pain will intensify, occur with less and less significant exertion, until they become permanent. The disc will tear, dry out, and gradually pinch. Sometimes, a fragment of this disc is expelled and compresses the nerve roots located immediately behind it: this is the phenomenon of a herniated disc, responsible, among other things, for sciaticstrong> pain in the legs. In some cases, this herniated disc occurs suddenly at the outset of the discopathy, in people with absolutely no back pain up to that point, while in other cases the hernia appears after a long history of back pain. It must also be understood that the more the disc is pinched, the narrower the space around the nerve roots will become. Therefore, sometimes the simple removal of a herniated disc is not enough to completely release a compressed root.
Treatment of low back pain is always medical first. It can be handled by the treating physician, often in collaboration with a rheumatologist, a rehabilitation specialist, or a pain specialist. This treatment will combine rest during episodes, analgesic and anti-inflammatory drugs (prescribed in incremental steps), physical therapy and sometimes infiltrations or even immobilization by back brace. The majority of back pain will respond favorably to these treatments, even if the episodes do not disappear completely. A more comprehensive assessment and an opinion from a spinal surgeon is indicated when the pain does not respond well to all of these treatments, and the symptoms, which have gone on for at least 6 to 12 months and often longer, are responsible for a significant disability in everyday life.
Principle of surgical treatment
Surgery for chronic low back pain can only be considered after failure of a medical treatment as long and as complete as possible. Depending on the correlation between symptoms and abnormalities found on imaging tests, the spinal surgeon will or will not retain an indication for surgery. If there is no paralysis, this surgery will never be mandatory; instead, it will be an additional means offered to the patient to treat his or her low back pain. Like all other treatments used up to then, surgical treatment will have its own success and failure rate, and its benefits and risks, which will be clearly explained to you by the spinal surgeon, so you can make your choice as objectively as possible. Lumbar discopathy surgery, in combination or not with a herniated disc, involves total resection of the disc (including the hernia) and its replacement with a mobile implant (disc prosthesis) or a fixed implant (fusion cage). The choice of implant is based primarily on the significance of the disc degeneration, since after the onset of osteoarthritis, disc replacement is not recommended. Regardless of the implant chosen, the principles of the procedure are as follows: resection of the diseased disc(s) , restoration of the disc space as it was before the pinching, treatment of nerve root compression by resection of the herniated or bulging disc as well as by restoring the disc and the foramina , placement of an implant that will both preserve the space created and rebalance the back by increasing the lumbar curve (lordosis) to strain the other discs left intact as little as possible in the future.
Average hospitalization time
6 days (this is the duration most often reported).
Discharge can be directly to home or to a rehabilitation center for a 2- to 3-week stay. Transfer is by medical transport service in both cases. Management at the center will be multidisciplinary (rehabilitation specialist, pain specialist, physical therapist, ergotherapist). The total recovery period extends for at least 6 weeks after the surgery and in some cases may last for 3 to 6 months. Based on the severity of symptoms before the procedure, this period may last even longer. Recovery is not synonymous with bed rest. Physical exertion, carrying loads, and car trips must be limited during this period. Walking is often beneficial. Recurrence of pain during recovery is often the result of too much activity and will tend to disappear with rest. Follow-up consultations with your surgeon will be scheduled at regular intervals during the first two years after the surgery.