Rheumatology

When medical treatment and rest do not improve spinal pain, whether it is due to disc-related back pain or sciatic or crural lower back joint pain, the decision may be made to perform a percutaneous laser disc nucleotomy as a nonsurgical treatment for this herniated disc. This treatment consists of repeatedly firing the laser at the center of the disc, which has the effect of vaporizing the center of the disk and thereby decreasing the pressure on the surrounding areas.

Prior to performing this intervention, a consultation with the anesthesiologist is necessary, because the procedure is performed under neuroleptanalgesia, which is not general anesthesia but enables complete insensitivity with enough awareness to guide the operation. The intervention takes place in the surgical suite with radiological monitoring. Performing a discography prior to the laser surgery will verify the presence of the herniated disc and the symptoms it is causing by exerting pressure on the disc. This injection is performed using a needle and does not require any incision. Immediately following the intervention, the patient spends an hour in the recovery room and then returns to his or her room in the outpatient ward.

In the afternoon, nursing care will be provided, and a physical therapist will come demonstrate the first movements and exercises to perform. The patient is discharged that evening with a prescription for pain medication and very specific instructions for the following days and weeks. The post-operative effects are most often minor and require taking pain medication for a few days, with patients being able to begin resuming normal activities depending on the level of pain they are experiencing, which will be assessed on an individual basis in the context of each patient’s needs and condition. A follow-up appointment will take place at one month to check on the patient’s progress and, if possible, begin rehabilitation as soon as possible so that the patient can resume a wider range of activities than in the preceding four weeks.

In 70 to 80% of cases, this noninvasive procedure is sufficient for treatment of herniated discs; and in cases where it is not, microsurgery is always an option.

When a collection of treatments has not provided adequate relief for posterior joint pain, facet joint thermocoagulation may be indicated. This technique consists of removing the sensitive areas of the involved joint using an electrode introduced through a guide needle that uses heat to selectively destroy the posterior branch that partly innervates this interverterbral joint. This technique is indicated after performing a series of clinical and radiological tests and an anesthetic test and determining the effectiveness or non-effectiveness of prior scope-guided posterior joint injection. Before this short intervention is performed, consultation with the anesthesiologist is required, as this procedure is carried out under neuroleptoanalgesia. The procedure is performed in the surgical suite with radiological monitoring. The patient checks in to the outpatient service and is discharged in the early afternoon with a prescription for painkillers if needed.

The post-operative effects are most often minor, and do not necessarily require taking time off work. A follow-up appointment will take place five weeks later to assess the patient’s condition and being rehabilitation as early as possible.

The most common reasons for consultation at the center are:

Lumbago, lumbosciatic pain and lumbosacral pain

We provide care for the various causes of lumbago, lumbosciatic pain and lumbosacral pain, which are:

• Mechanical discopathy
• Inflammatory discopathy
• Herniated disc
• Lumbar arthritis
• Lumbar spinal stenosis
• Scoliosis

These consultations enable us to administer or advise on the appropriate treatment: physical therapy, medication or infiltrative (cf. injections). The spine rheumatology service also provides the option of having recourse to interventional rheumatology techniques such facet joint thermocoagulation for posterior joint arthritis and disc-laser treatment for some herniated discs. These techniques are described in detail in the interventional radiology section above. Rheumatology consultation indicates whether the condition requires lumbar spinal stenosis surgery for discopathy or a herniated disc.

Thoracic pain (Scheuermann’s disease, thoracic arthritis)

Neck pain and cervicobrachial neuralgia

Rheumatology consultation allows investigation of the causes of neck pain and cervicobrachial neuralgia:

• Arthritis
• Herniated disc
• Cervical spondolytic myelopathy

Consultation enables us to administer or advise on the appropriate treatment:

• Physical therapy
• Medication
• Infiltrative (cf.)
• Recommendation for surgery if needed.

Vertebral fracture of vertebral collapse

A cause of thoracic pain or lumbago, vertebral fracture occurs due to trauma or a fall, or in some cases an awkward movement, in which case it is referred to as vertebral collapse. Vertebral fracture requires immediate pain management and the implementation of appropriate treatments including creating a brace, cementoplasty or orthopedic surgery. Vertebral fracture prompts screening for the relevant causes of bone fragility and specific management

Osteoporosis

Screening for osteoporosis is achieved by performing an etiological assessment based on biological and densitometry testing. The goal of this assessment is to start the appropriate baseline treatment for the bone disease.

Bone diseases other than osteoporosis

Joint diseases

• Inflammatory rheumatism
• Screening for inflammatory rheumatism and the implementation of appropriate treatments for:
• Rheumatoid arthritis
• Rheumatoid psoriasis
• Rhizomelic pseudo-polyarthritis
• Ankylosing spondyloarthritis
• Auto-immunity
• Associated with other conditions

Implementation of infiltrative treatments (cortisone injection into the joints) and immunomodulating therapies including new treatments such as biotherapy.

• Microcrystalline rheumatism (e.g. gout, chondrocalcinosis)
• Arthrosis management
• Arthrosis of the knee
• Arthrosis of the hip
• Arthrosis of the shoulder
• Arthrosis of the ankle
• Arthrosis of the hands, rhizarthrosis

This is primarily based on cortisone injection therapy, but may also included specific hyaluronic acid injection as well as rehabilitation

Bone-joint disease (e.g. algodystrophy)         

• Tendinitis or tendinobursitis: knee, shoulder, elbow, hip, wrist, ankle, Achilles’ tendon
• Carpal tunnel
• Morton’s disease
• Dupuytren’s disease