The treatment is, above all, medical and associates non-pharmacological and pharmacological measures.
- Non-pharmacological treatments
- lumbar support belt
Orthotic treatment
During acute crises, using an immobilization corset as standard or as a measure has an analgesic effect.
Out of crisis, during activities, using a lumbar support belt (CSL) increases the level of vigilance (avoids potentially painful movements). It should be noted that the use, even prolonged, of a CSL does not entail any risk of muscle loss (abdominal and dorsal muscles).
The "thermal environment" created by the CSL has a myorelaxing and analgesic action. The CSL has a proprioceptive function. Its psychological impact is important. Patient compliance depends on your comfort. An effective lumbar orthosis is an orthosis that allows the patient to be more mobile and has an analgesic effect.
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Patient education
Although no study demonstrates the efficacy of a slimming regimen in patients with lumbosteoarthritis, it is always good to make an overweight or obese patient lose weight. The participation of a nutritionist or a dietitian may be necessary. As in other chronic diseases, compliance depends on the patient's understanding of their disease, and requires an adapted education.
- Reeducation, exercises and sports
- During acute painful attacks, rest is essential.
Outside of the crisis, the re-educator will give joint savings advice and recommend kinesitherapy exercises whose main objective will be a strengthening of the abdominals.
Regular sports activities adapted to the patient's function will also be recommended, which will contribute to the maintenance of an "ad hoc" weight.
Pharmacological treatments
Analgesics, NSAIDs, muscle relaxants
If a long-term medication is necessary, an analgesic treatment such as paracetamol will be preferred. Myrelaxants can also be proposed. In case of failure, and especially in case of acute painful episode, anti-inflammatories associated with a gastroprotector, or a coxib, may be prescribed, respecting possible contraindications and for the shortest possible period due to potential side effects.
Raquidian infiltrations can be performed in some cases.
- Indications
- Epidural infiltrations have no indication in lumbalgias with lumbosteoarthritis, unless there is an associated radiculalgia.
- Subsequent zygapophyseal infiltrations can be made in case of posterior joint syndrome. They must be carried out under radiographic control to guarantee their intra-articular character.
- If there is a symptomatic narrow lumbar canal, epidural infiltrations of cortisoned derivatives may be proposed, or even an intradural infiltration, which requires a short hospitalization. It should be noted that some teams no longer perform this last gesture due to potential complications (cerebral thrombophlebitis).
- It has not been shown that these infiltrations in the indication "narrow lumbar canal" decrease the use of surgery, but often make the symptoms disappear for a few months. Usually, 2 or 3 epidural injections are performed.
- Possible complications
- The most frequent are the aggravation of rachialgia and vasovagal syncope. More rarely, a post-lumbar puncture syndrome, epidural hematomas, neurological injuries or even infections (epidural abscesses, meningitis) may occur.
- Precautions
- Due to the possible hemorrhagic complications, this gesture is contraindicated in patients treated with anticoagulants (AVK). If it is necessary to practice infiltration, the AVK will be interrupted, replacing it with a low molecular weight heparin (LMWH), and it will be performed when the INR is less than 1.5 and 24 hours after the injection of LMWH. If anti-coagulant treatment has been prescribed in cardiology, it is essential to have the agreement of cardiologists before stopping treatment.
- It is not recommended to perform an epidural infiltration in case of treatment with an antiplatelet drug. The infiltration will take place ten days after the abandonment of the antiplatelet drug.
Surgical treatment
The example of the narrow lumbar canal (CLE)
There are few indications for lumbosteoarthritis surgery other than CLE.
In case of CLE type affection and / or in case of medical treatment failure, it may be decided to perform a surgical treatment. However, medical treatment may be interrupted to perform early surgery, in case of motor and / or sphincter problems or severe restriction of the maximum perimeter of travel.
Its objective is to make the lumbar duct reach a sufficient diameter to eliminate any cause of root conflict. Normally, a lumbar recalibration is performed (extension of the stenosed sections). This intervention gives good results. In cases in which there is fear of a destabilization of the spine in the post-operative phase, it may be useful to associate an arthrodesis of the operated sections.
Complications of spinal surgery
Complications of lumbar recalibration surgery are rare. However, there are possible neurological complications. These may be the consequence of a direct trauma to the roots or the post-operative constitution of a compressive intracanal hematoma. The dural gap is the most frequent perioperative incident.
The other complications are those that are linked to any surgical act, such as phlebitis, embolism and infection. In the long term, a spinal destabilization can occur if an arthrodesis has not been performed.