Better known as the vertebral column, the spine forms an articulated series of 24 vertebrae, stretching from the skull to the pelvis. It supports the back in humans, as in all vertebrates, and carries the head. The ribs are attached to the spinal column. The vertebrae are separated by intervertebral discs, which house the spinal cord and nerve roots.
The surgeons at Clinique Paris Lilas treat the various pathologies of the spine, with the aim of being as minimally invasive as possible.
These pathologies range from infectious lesions to rheumatic conditions, intervertebral disc disorders (herniated discs), syndromes linked to narrowing of the lumbar or cervical canal, spinal deformities (scoliosis, kyphosis, etc.), and fractures and other compressed vertebrae.
A herniated disc is a degenerative condition in which the intervertebral discs protrude, compressing the nerve roots and caused by trauma, injury or osteoarthritis (degradation of joint cartilage).
In cases of herniated cervical, thoracic or lumbar discs, the choice of technique is decided on a case-by-case basis, depending on the severity of the herniation. In relatively young people with no osteoarthritis, cervical or lumbar arthroplasty is the preferred procedure.
This involves surgical repair, i.e. almost complete removal of the disc that is compressing the nerve root causing the pain, and insertion of an artificial mechanical disc, where the extent of disc damage allows.
The surgeon may also opt for disc arthrodesis. The aim is to fuse two vertebrae that are articulating with each other, in the event of abnormal intervertebral mobility, which is responsible for the painful symptoms experienced.
Disc arthrodesis is performed using a variety of minimally invasive surgical techniques, using a posterior, posterolateral or anterior approach, and sometimes an extreme lateral approach via a surgical incision in the abdominal wall in the lumbar region (lumbotomy).
Sometimes it is preferable to use a spinal endoscopy technique. This enables the inside of an organ or body cavity to be explored by inserting a thin, flexible tube (endoscope). This fibre-optic probe is used to obtain electronic images that can be viewed in real time on a screen by the operator. The operation is performed by inserting very fine surgical instruments through the endoscope.
Other solutions may also be proposed. At the Clinique de l'Alma, laser coagulation of the intervertebral disc or the injection of certain moisturising products can be used to postpone surgery.
In cases of bone fragility due to osteoporosis causing vertebral fractures ("vertebral compression"), or even tumours (bone marrow cancer or myeloma, for example), the surgeon injects a consolidation product percutaneously, i.e. through the skin, under fluoroscopic or scanner control. This technique, known as percutaneous cementoplasty or vertebroplasty, is performed using a cement composed of polymethylmethacrylate, capable of strengthening a pathological vertebral body.
The vertebral canal, which contains the spinal cord and nerves to the lower limbs and perineum, is sometimes too narrow. This stenosis of the vertebral canal - congenital or due to ageing - gradually compresses the nerves of the lower limbs.
In order to decompress the nerves, part of the bone or structure (joint surfaces, ligaments, parts of the intervertebral discs) is removed from inside the vertebral canal.
This is most often a uni or bilateral lumbar laminectomy, decided on the basis of symptomatology and the narrowness of the canal. In unilateral lumbar laminectomy, only the back of the vertebral arch is removed.
The operation is performed either openly or percutaneously, but always under general anaesthetic, unless there are personal contraindications, in which case the surgeon will have to operate under local anaesthetic.
The need for an arthrodesis may arise during the operation, in the event of instability pre-existing the surgery. This may be due to hypermobility of the vertebrae, a deformity such as scoliosis or kyphosis, or spondylolisthesis, when a lumbar vertebra slips forward and down in relation to the vertebra just below it, dragging the spinal column with it and creating a narrowing of the canal.
The spinal nerves branch off from the lumbar, cervical or thoracic canal to innervate the muscles, joints and ligaments. In the case of chronic pain linked to inflammation of these nerves, whether lumbar, cervical or sacral in origin, it is possible to perform rhizolysis (rhizotomy), i.e. to interrupt a nerve root that is solely sensitive, by means of coagulation using ultrasound or heat.
If kyphosis is an exaggeration of the convexity of the dorsal region (excessively rounded back), scoliosis is a deformity in all three planes of the spinal column affecting one, two or, more rarely, three vertebral segments.
Kyphosis and scoliosis can be treated surgically when three or fewer vertebral segments are involved. The principle is to correct the deformity by straightening the spine, in conjunction with arthrodesis, thus fusing the vertebrae in the correct position. By decompressing the nerves, this procedure relieves pain.
Under general anaesthetic, the surgeon uses an approach to the spine that is adapted to each patient (anterior, lateral or posterior), and may decide to combine them in the same operation.
To make an appointment online, it's quick and easy
click on the link below and let us guide you.
Tél : 01 43 62 22 22
41-49 Avenue du Maréchal Juin, 93260 Les Lilas
