Lumbar thermocoagulation
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Thermocoagulation involves using a needle to heat the ligaments and capsules of your posterior lumbar joints, which are largely the cause of your pain. What is posterior joint osteoarthritis? The spine is made up of a stack of vertebrae. The five lower vertebrae make up the lumbar spine, which ends in the sacrum. Between each vertebra is a disc that serves as a shock absorber. Behind the spine are the posterior joints (AP), which connect the vertebrae together and contribute to both the stability and mobility of the spine. Like all joints, they can be the site of osteoarthritis and become the cause of lower back pain. On the other hand, due to the constraints that the spine undergoes, discopathies appear over time due to "wear" of this shock absorber disc. The posterior joints and the discs of the lumbar spine wear out and it is sometimes difficult to distinguish between pain linked to discopathy or osteoarthritis of the posterior joints. It is estimated that around 45% of lower back pain is linked to this osteoarthritis. These pains are transmitted to the brain by small nerves coming from a branch of the spinal nerve, the medial articular branch ( What are the therapeutic alternatives? Painful attacks are treated with rest and medication (anti-inflammatories, analgesics and muscle relaxants). Even if they are sometimes very painful, acute attacks never justify surgical treatment. When permanent pain sets in between attacks, we say that the pain becomes chronic. The treatment then remains medical as a first-line treatment. We also combine rehabilitation by physiotherapy and back hygiene advice to learn how to limit the constraints on the spine. It is also possible to consider corticosteroid injections under radiological or scanner control. What are the indications for this procedure? Thermocoagulation is an interesting option because it is minimally invasive. The treatment decision is never an emergency and must be discussed between the patient and their surgeon. What does this procedure involve? Hospitalization is done on an outpatient basis (admission in the morning, discharge 5 hours later). The procedure lasts about 30 minutes. Local anesthesia and neuroleptanalgesia help to eliminate the pain without you being completely asleep, so you can answer the questions asked by the operator to better cooperate. You are placed on your stomach, with the X-ray positioned facing forward in order to locate the joints. A needle is lowered under X-ray control until bone contact is obtained against the joint, while injecting a local anesthetic. Then an electrode is placed through this needle, to perform a thermolesion of the nerve branches "a rhizolysis" against these joints, one minute at 80°C (drawing below). In general, two to three lesions are performed per joint, in order to increase the chances of success, at the L4-L5 and L5-S1 levels and on each side.
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