Back pain: more exercise, less surgery

When drugs can no longer relieve back pain, surgery is sometimes the last resort. At least that's what we thought until doctors threw a stone into the pond ensuring that simple advice on postures and daily physical exercises were also effective. Since the first works published in 2003, experts and the High Health Authority have agreed that physical exercises are by far more advantageous than surgery. Doctissimo takes stock.

What if common sense prevailed over technique? A study by Dr. Jens Brox, presented at the congress of the European Rheumatology League in 2003  1 , questioned the only usefulness of surgery to stop back pain . Before starting the debate, a brief reminder of the main indications for surgical treatment.




What are the indications for back surgery?

Eight out of 10 French people know (or will know) pain in the lumbar region . For 10% of patients, the pain becomes chronic and very debilitating. When anti-inflammatory drugs and especially physical exercises become insufficient, surgery may be indicated, but only in degenerative type conditions to treat certain cases of herniated disc or severe pathology of the intervertebral disc.

Surgical techniques and their limits

The operation consists of removing all or part of the damaged disc, or performing a fusion between two lumbar spines ( arthrodesis). But the latter does not have 100% positive results and, like all surgical procedures, involves risks. Currently minimally invasive techniques exist and the patient is subjected to a shorter intervention. The approach can be done by an anterior or posterior route, the former requiring a longer operating time as well as a slightly longer hospital stay. However, whatever the technique, the intervention does not completely relieve the pain and presents risks such as infection, thrombosis, spinal cord injury, etc. For fifteen years, Pr Jacques Théron has been offering his patients an alternative: a treatment that consists of injecting a radiopaque ethanol gel (marketed under the name Discogel®) directly into the damaged discs in order to reduce the intradiscal pressure. With significant success rates, around 70 to 90%2.

Surgery: how much does it cost?

The price of an intervention on the lumbar spine for a degenerative anomaly of the disc or facet syndrome varies from 850 to 2500 euros, depending on the establishment chosen and the type of practice of the doctor (sector 1 or sector 2). Overall, Health Insurance reimburses 80% of the costs of the intervention, the rest being borne by the mutual insurance company or, failing that, by the patient. 

The facet joints are structures located in the posterior part of the vertebrae. They allow the spine to move at certain anatomical angles. Each vertebra has four facets: two to articulate with the vertebra above and two to articulate with the one below. These facets are covered with a very smooth and very soft cartilage which is constantly lubricated and which allows the vertebrae to slide freely during movement.

Exercises or surgery?

For Dr. J. Brox, there is no need to resort to such a radical method. This Norwegian specialist in low back pain compared the value of surgery to that of a cognitive method. He followed 64 patients, aged 25 to 60, suffering from chronic back pain for at least a year and from intervertebral disc atrophy:

  • A first group was treated by surgery (arthrodesis) and physiotherapy  (local treatment based on ultrasound and infrared rays);
  • The second group received advice on the movements to be favored in order not to damage the disc and followed three weeks of physical training three times a day.

Results: After a one-year follow-up, the success rate of the two methods was similar. On the other hand, the cognitive intervention presented a double advantage: first, it limited the fears of the patient to bend down or perform certain daily tasks; then, it had no side effects, unlike surgery where 18% of cases had post-operative complications.

Location: India

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