[The place of invasive approaches to the treatment of low back pain].

Abstract

The prevalence of chronic low back pain is high and rising. Chronic low back pain is «non-specific» in approximately 90 % of cases. In addition to age, risk factors include smoking, obesity, physical and psychological stress, as well as demographic factors. The initial treatment approach involves non-steroid anti-inflammatory medications in the absence of contraindications, and active rehabilitation. If this conservative treatment fails, infiltrative and/or surgical techniques may be considered. A thermocoagulation, or denervation by radiofrequency, can be performed after a positive result has been obtained from a diagnostic block of the medial branch of the dorsal ramus, and can be used to relieve pain associated with a facet syndrome. An epidural or radicular infiltration can be used to relieve radicular pain. Surgical approaches such as lumbar canal decompression or arthrodesis are the most common. There are, however, abandoned or less common techniques such as nucleolysis or nucleotomy. In conclusion, when it comes to the treatment of chronic low back pain, conservative methods are preferred, with infiltrative options available if necessary. Indications for surgical interventions should be carefully evaluated during a multidisciplinary consultation.