Lumbar spine

Low back pain

What is it ?

Low back pain is defined as pain in the lumbosacral area, most often due to natural aging of the spine: wear of the disc (degeneration, disc disease etc.), and of the facet joints. Low back pain is frequently referred to as “acute” or “chronic”.

In reality, everyone suffers from low back pain at some point in life. A small proportion of patients will keep constant, but bearable, lower back pain, which will be referred to as “chronic” with sometimes severe pain reducing the daily, social and professional capacities, for a more or less long period (days, sometimes weeks).

These painful attacks can most often occur spontaneously or in relation with certain strenuous physical activity. The frequency of these acute pain phases can be limited by regular practicing of strengthening exercises (sheathing, Pilates, etc.) or sports activities.

Below, an MRI image of degeneration (natural wear) of the L5-S1 disc (yellow arrow). It should be noted that this is only a radiological image, whose clinical manifestations, again, are very variable: many people with such disks do not suffer pain!

Clinical presentation

Patients complain of low back pain. Your doctor will determine if it is “non-specific” or “common” low back pain, that is to say without medical seriousness, or “specific”, that is to say, requiring special attention and investigations.

Common LBP, the most frequent type, is NOT associated to pain radiating along a nerve path (your doctor may determine it), and is considered “non-specific”. Very frequently, however, there are NON-neurological radiating pain in one or both of the lower limbs. Typically, pain trajectory behind the thigh stopping before the knee, or a pain trajectory purely on the side of the leg, are not neurological.

When to consult a specialist?

Your doctor will determine whether the pain is “non-specific”, that is to say without medical seriousness, or “specific”, that is to say requiring special attention and investigations and possibly a specialized opinion. Most low back pain described as “common” or “nonspecific” do NOT require specialized radiological examinations such as MRI. These will become necessary in case of total failure of non-surgical treatment.

Non surgical treatment

Many studies over the past 20 years have shown that the pillars of treatment for “common” or “nonspecific” low back pain are: reassuring the patient, encouraging him to remain socially and professionally active, playing sports, etc. In case of acute pain phases, a short period of rest and medical treatment, associated to physiotherapy-osteopathy etc. is recommended.

We also know that in these cases of pure low back pain, many other factors come into play in the cause of pain, and not only degenerative disorders. A multi-disciplinary approach is recommended.

Surgical treatment

Surgical treatment of “common” or “nonspecific” low back pain is RARE. However, patients suffering from disabling pain may have to be operated on, despite 3 to 6 months of active non-surgical treatment, and no result. In these situations, and when disc degeneration is severe, limited if possible to 1 or even two levels (disks), we can consider either an instrumented fusion with graft (eg cage, see X-ray below, yellow arrow), or a disc replacement (artificial joint). These aspects are discussed with the surgeon.

Postoperative follow-up

Patients resume the same day or the day after the surgery and return home after a few days. An opioid treatment is often necessary for a few days after surgery. At home, patients are encouraged to resume a normal daily life without sports activities and without carrying heavy loads for approximately 6 weeks. More specific rehabilitation may be prescribed at the first follow-up visit.

Risks and complications

They depend on the surgical technique chosen. There are general risks associated with any surgery. The specific risks such as serious neurological complications are very low (close to 0%). The infection risk is 2 to 3%. All this is reviewed in a non-exhaustive manner with the surgeon during a pre-operative interview.