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Summary of: A Patient's Guide to Spinal Stenosis (Narrow Lumbar Spine)
This comprehensive guide addresses lumbar spinal stenosis, a condition characterized by narrowing of the spinal canal, causing pain and numbness in the legs. It explores the causes, symptoms, as well as conservative and surgical treatments available, including innovative techniques such as the IntraSPINE implant. Patients are encouraged to discuss their options with healthcare professionals for a tailored care pathway.
Top 5 Tips to Remember
- Lumbar spinal stenosis can cause back pain and neurological symptoms in the legs.
- Conservative treatments include physiotherapy, medication and infiltrations.
- Neurovertebral decompression is an effective non-surgical option for pain relief.
- The IntraSPINE implant provides dynamic stabilization without fusion, preserving mobility.
- Consulting specialists in France can offer advanced solutions and reduce waiting times.
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Patient's Guide to Spinal Stenosis (Narrow Lumbar Canal)
1. Introduction to spinal stenosis: definitions, causes, symptoms
There spinal stenosis Narrow lumbar canal is defined as an abnormal narrowing of the spinal canal in the lower back. This narrowing compresses the nerve roots destined for the lower limbs, typically causing back pain radiating into the legs, numbness or muscle weakness, particularly when walking (known as neurogenic claudication). In other words, because the nerve canal is too narrow, the sciatic or crural nerves are «pinched» when standing and walking, leading to a variety of neurological symptoms in the legs.
Causes: There lumbar stenosis is most often of degenerative origin related to osteoarthritis. With age, the structures of the spine thicken and wear out: yellowish ligaments hypertrophy, small posterior joints (facets) develop osteoarthritis, and bony growths can reduce the space available for nerves. These changes progressively narrow the spinal canal. Occasionally, degenerative spondylolisthesis (slippage of one vertebra over another) is associated with stenosis, exacerbating nerve compression. More rarely, stenosis may be congenital (narrow canal at birth) or due to pathology (fracture, severe scoliosis, tumour), but in adults, ageing and osteoarthritis can lead to stenosis. are the cause principal.
Symptoms : The clinical signs of lumbar spinal stenosis are quite characteristic and should be well recognized by the informed patient:
Low back pain and radiculalgia Lumbago (lower back pain) may be present, often associated with pain radiating to the buttocks and legs. sciatica or cruralgia). Leg pain can extend to the back of the thighs and down to the calves.
Neurogenic claudication This is the most typical symptom. After a few minutes« walking or standing, the patient experiences cramps, heaviness or numbness in one or both legs, which may be accompanied by a feeling of weakness (a feeling that the legs are »giving out"). These neurological symptoms on exertion force the patient to stop walking after a certain distance. Characteristically, the resting in a seated position or leaning forward quickly alleviates these symptoms (known as the "caddy sign"), as this posture mechanically opens the spinal canal and temporarily reduces nerve compression.
Sensory and motor disorders Tingling or pins and needles (paresthesias) often run down the legs to the feet. Weakness in the legs may occur with exertion, reflecting the nerve damage. In advanced or severe cases, neurological deficits may be observed (reduced strength, persistent numbness, even urinary control problems in extreme forms), indicating severe compression.
Left untreated, severe lumbar spinal stenosis tends to gradually worsen. The patient's walking perimeter is reduced, pain increases and muscle weakness progresses, with a major impact on quality of life. Nevertheless, progression is generally slow, allowing time for appropriate treatment.
Here is a list of the main synonyms for «Spinal stenosis»:
2. Conservative treatments: physiotherapy, medication, infiltrations, complementary therapies
Before resorting to surgery, a well-conducted conservative treatment is always the preferred first-line treatment. This non-surgical treatment combines several approaches and is generally continued for at least 3 to 6 months before evaluating its benefits. The main conservative options for lumbar spinal stenosis include :
Physiotherapy : It's a cornerstone of conservative treatment. A program of physiotherapy to relieve pain and improve function through a variety of exercises and techniques. The physiotherapist can work on strengthening trunk muscles (abdominal sheathing, paravertebral muscles) to better stabilize the spine, on stretching (hamstrings, psoas, calves) to improve flexibility, and on learning relief postures (for example, adopting a slight trunk flexion when walking, which can reduce nerve compression). Walking endurance exercises are often suggested to gradually increase pain-free walking distance. Postural education and ergonomics (everyday gestures, techniques for bending over without accentuating lumbar lordosis, etc.) are an integral part of physiotherapy. Overall, rehabilitation aims to improve mobility and strength while teaching patients how to manage their backs on a daily basis, which can reduce symptoms in many mild to moderate cases.
Analgesic and anti-inflammatory medication Medication management helps control symptoms during the conservative phase. Analgesics (paracetamol, tramadol or mild opioids if necessary) are typically used to soothe pain, and non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation around the nerve roots. Muscle relaxants may be prescribed in the short term if paravertebral muscle contracture is contributing to the pain. In the presence of neurological pain (electric shocks, burning), certain neurotropic drugs such as gabapentin or pregabalin can help relieve sciatica. It is important to note that these drug treatments relieve symptoms but do not act on the anatomical cause of the problem. They should be used with caution, in consultation with your doctor, taking into account possible side-effects (notably gastric for NSAIDs, drowsiness for certain strong analgesics, etc.).
Epidural infiltration Corticosteroid infiltration of the spinal canal (epidurals) is a frequently proposed option for painful lumbar spinal stenosis. This involves injecting an anti-inflammatory corticosteroid into the immediate vicinity of the compressed nerve roots, under radiological guidance, to reduce the local inflammation caused by mechanical impingement. Infiltrations can provide temporary relief from pain and paresthesia over a period of weeks to months. They are a useful complement to physiotherapy and medication, particularly in enabling patients to carry out their exercises with less pain. Sometimes, targeted foraminal infiltrations (at the exit of a specific nerve root) or posterior facet joint infiltrations are performed if these structures contribute to the symptomatology. Although the results of infiltrations vary from patient to patient, a trial of 1 to 3 spaced infiltrations can be part of the standard conservative protocol. .
Complementary therapies In addition to the above conventional approaches, many patients seek relief through complementary methods. These do not «cure» stenosis, but can improve comfort. These include osteopathy and chiropractic treatment, which, when applied with care, aim to mobilize the spine and reduce certain tensions (but beware of forced manipulations in patients with severe compression, as these are generally not recommended). Acupuncture can help modulate pain in some patients. Swimming pool exercises (balneotherapy) enable walking to be practised in a supported environment, with less gravitational stress on the spine, which is often well tolerated. Wearing a soft lumbar belt can be considered during strenuous activities: it provides a proprioceptive and reassuring effect, and although it does not widen the canal, it can provide relief by limiting lumbar hyperextension. Last but not least, the adoption of hygienic and dietary measures, such as weight loss in case of excess weight, or the adaptation of activities (avoiding prolonged back extension), is an integral part of conservative treatment.
Balance sheet : In many cases of moderate stenosis, these conservative treatments bring relief sufficient to avoid or delay surgery. However, you need to be patient and assiduous: a therapeutic trial lasting at least a few months is required to judge its effectiveness. If, despite well-managed therapy including physiotherapy, medication and infiltrations, the symptoms persist and severely limit daily activities, then surgical evaluation is required.
Neurovertebral decompression: a highly effective technological approach
State-of-the-art conservative treatments include neurovertebral decompression stands out as a scientifically proven, non-surgical solution for relieving pain caused by spinal stenosis and various disc disorders. Specialized clinics such as TAGMED offer this technology an advance that directly addresses the biomechanical cause of pain, offering significant results where other treatments have sometimes shown their limitations.
The principle of neurovertebral decompression is based on the use of a motorized, computer-controlled traction table. Lying comfortably, the patient benefits from a decompression force applied with extreme precision along the spinal axis. This targeted, intermittent stretching generates a negative pressure (a «vacuum» effect) at the heart of the intervertebral disc. This phenomenon is crucial: it can help retract the nucleus of a herniated disc, This frees up pressure on nerve roots. What's more, this airflow promotes hydration. and traffic oxygen and nutrients, creating an optimal environment for the regeneration and natural healing of disc tissue. The procedure is generally painless; many patients even describe it as relaxing.
The benefits of decompression neurovertebral disorders and well-documented. The main advantage is a significant, lasting pain relief for a large majority of patients. Statistically speaking, several clinical trials report success rates ranging from 85% to 90% for patients suffering from low-back pain due to herniated or degenerated discs. Benefits include:
A complete treatment protocol generally lasts several weeks, with 15 to 25 sessions of around 30 minutes each. To maximize effectiveness and ensure stable results over the long term, decompression is often integrated in a comprehensive care program. This may include chiropractic adjustments, strengthening exercises and and stabilization, as well as postural advice to correct muscular imbalances and prevent recurrence. This holistic approach guarantees not only resolution of the painful crisis, but also promoting sustainable spinal health.
3. Important steps before surgery: failure of conservative treatment, necessary tests, selection criteria
When conservative measures have not brought satisfactory results, the surgical option should be considered. This section details when and how the preparation for possible intervention for lumbar stenosis.
When is conservative treatment considered to have failed? Non-surgical treatment is considered to have failed when, after 3 to 6 months of intensive physiotherapy, appropriate medication and possibly infiltrations, the patient no significant improvement in symptoms. In concrete terms, if at the end of this period of time the walking perimeter remains very limited (only a few minutes before the onset of painful claudication), whether the pain and numbness disrupt activities and sleep, despite correct compliance with conservative treatment, then treatment is considered insufficient. You don't necessarily have to wait 6 months if symptoms rapidly worsen or become intolerable: for example, the appearance of severe neurological signs (motor deficit, sciatic nerve compression with incipient paralysis, sphincter disorders) is an indication to accelerate surgical evaluation. Similarly, very advanced stenosis confirmed on imaging, with severe compression of the ponytail, is an indication not to wait too long. In short, it's the persistence of a significant handicap in spite of the which leads us to consider surgery.
Necessary pre-operative examinations: Before deciding to operate, a complete review is essential to confirm the indication and prepare for the operation in the best possible conditions:
Spine imaging : A lumbar MRI is the reference examination for evaluating a stenosis spinal canal. It can be used to visualize narrowing of the canal, pinpoint areas of nerve compression (central canal, lateral recesses, conjugation holes) and estimate severity. MRI also provides information on the intervertebral discs and the possible presence of a herniated disc associated. If MRI is contraindicated (e.g. pacemaker not compatible), a lumbar CT scan with myelography can be used to view the spinal canal. Dynamic X-rays (flexion/extension views of the lumbar spine) are often requested to detect instability or mobile spondylolisthesis. These standard profile X-rays can be used to check for vertebral slippage that increases with movement - which will guide the type of surgery (since the presence of clear instability may mean that fusion is preferred in some cases). Finally, static front and side x-rays of the lumbosacral spine are used to measure angles and sagittal alignment, and to identify any deformities (associated scoliosis, pelvic tilt, etc.). All this imaging assessment is the mapping which the surgeon will use to plan the operation.
Medical and surgical assessment : A consultation with the spine surgeon is performed to examine the patient, validate the indication for surgery and explain the procedure. The specialist reviews the images, confirms that the compression visualized corresponds to the symptoms (e.g. stenosis at L4-L5 consistent with L5 sciatica), and decides on the surgical plan (choice of level to be operated on, decompression technique alone or need for stabilization, etc.). The surgeon also checks that there are no remaining less invasive alternatives, and discusses with the patient the expected benefits vs. the risks of surgery. In addition, an anesthesia consultation is mandatory a few weeks before the operation: the anesthetist performs a health check-up (blood tests, ECG, etc.), assesses cardiorespiratory fitness, current medications (e.g., certain anticoagulants will have to be stopped before the operation), and anticipates postoperative pain management.
Selection criteria and contraindications: The aim is to ensure that the patient is medically fit and that his or her case meets the criteria for a spinal decompression with or without stabilization. Positive criteria include fairly healthy patient (co-morbidities need to be balanced), a compatible physiological age (over 80, risk/benefit is weighed more carefully, even if chronological age alone is not an absolute obstacle), and damage generally focused on one or two vertebral levels maximum. Factors such as morbid obesity, severe osteoporosis, or pronounced lumbar scoliosis are elements of caution. For example, insufficient bone density (osteoporosis with very low T-score) increases the risk of poor implant fit or fracture during surgery, and is therefore a relative or absolute contraindication, depending on the degree. Similarly, any active infection (systemic infection or local spondylodiscitis) should defer surgery until it has been treated. The surgeon will also check the extent of the disease: if several levels are severely affected, he or she may be able to treat the disease, the surgery will be more extensive and sometimes the strategy differs (we may opt for a two-stage operation, or, in certain cases of multi-stage narrow canals, for fusion of several vertebrae from the outset). Last but not least, the patient must have a realistic understanding of the procedure. surgery to relieve pain This means that, while the surgery may help to reduce leg pain and improve mobility, chronic low-back pain may not disappear completely after the operation. This careful selection ensures that we optimize the chances of success by operating on the right patient, at the right time, for the right indication.
In practice, once the decision to undergo surgery has been taken, the patient enters the pre-surgery phase: organization of the surgery date, logistical preparation (hospitalization booking), pre-surgery medical optimization (e.g. smoking cessation recommended, «pre-habilitation» physiotherapy to arrive in good shape on D-day, etc.). A pre-operative checklist is followed (stopping anticoagulants in good time, taking an antiseptic shower the day before, fasting on D-day, etc.). The patient must also anticipate his or her return home: arrange for help at home for a few days, adapt the environment (elevate everyday objects, prepare meals in advance) to facilitate convalescence. All these steps are an integral part of quality care, maximizing the patient's chances of recovery. safety and results of surgery to come.
4. IntraSPINE® implant treatment (non-fusional dynamic stabilization, procedure, rehabilitation, advantages, contraindications)
When surgery is necessary, one of the innovative options on offer (notably via the TAGMED program) is dynamic stabilization using the IntraSPINE® implant. This surgical technique aims to decompress the nerves by widening the lumbar canal, while stabilizing the spine without blocking it permanently (no conventional fusion arthrodesis). In the following, we explain the principle of IntraSPINE, the surgical procedure rehabilitation program as well as its advantages and contraindications.
Principle of non-fusional dynamic stabilization (IntraSPINE®)
IntraSPINE® is an implantable device for dynamic stabilization of the lumbar spine, designed as a modern alternative to spinal fusion. Unlike arthrodesis, which eliminates movement between two vertebrae by permanently fusing them together, the IntraSPINE philosophy is to maintain controlled mobility at the operated level. In other words, we don't block the spine, we assist it. The IntraSPINE implant acts like an elastic shock absorber, inserted at the back of the spine, which will simultaneously relieve the spinal column of pain. pressure on the discs and nerves, and support the lumbar curvature (lordosis) in a natural way. Technically, this is a implant interlaminal: positioned between the laminae of two adjacent vertebrae (just behind the spinal cord). This anatomical position is strategic, as it is very close to the axis of rotation of the lumbar spine. By being as close as possible to the pivot of vertebral movement, the IntraSPINE can accompany the movement of the segment in all directions (flexion, extension) without abruptly blocking it. This distinguishes it from the old interspinous spacers placed between the spinous processes, which merely limited extension by acting as a back wedge. Here, the IntraSPINE acts more physiologically on the whole range of motion: it slightly opens the intervertebral and foraminal space (where the nerves run) to decompress, while cushioning excessive micro-movements. The implant is made of high-tech, biocompatible materials: a triangular-shaped medical silicone (polydimethylsiloxane) wedge, covered with a woven polyester textile. The front part of the wedge (the “nose”) is firm to distract the space between the vertebrae and reopen the foramen (thus relieving nerve root compression), while the rear part (the “tunnel”) is softer and more compressible, acting as a shock absorber that absorbs shocks without blocking back extension. An optional polyester strap can be added around the spinous processes above and below to enhance stability if required. The silicone-textile assembly is radiolucent and MRI-compatible (absence of ferromagnetics), with only a small medical-grade titanium buckle used to lock the strap in place if fitted [7, 9]. IntraSPINE is manufactured by Cousin Surgery (France), with long-standing expertise in innovative spinal devices, and is CE-certified (class IIb) for the treatment of degenerative diseases lumbar segment. In short, IntraSPINE® stabilizes the affected lumbar segment while preserving much of its natural mobility. We thus obtain the benefits of nerve decompression (the nerves are freed up, which calms sciatica and improves walking) without the major disadvantage of fusion (which is the loss of mobility and the stress transferred to adjacent levels). It is therefore a «non-fusional» approach aimed at reducing pain while preventing the degenerative cascade on neighboring discs.
IntraSPINE® surgery procedure
IntraSPINE® is implanted during minimally invasive surgery under general anaesthetic. The procedure takes an average of 1 to 2 hours, depending on the number of levels to be treated. Here are the main steps in the procedure, from the patient's point of view:
Installation and anesthesia - Once in the operating room, the patient lies prone (decubitus ventralis) on the table, allowing posterior access to the lumbar spine. General anesthesia is induced by the anesthetist, putting the patient completely to sleep throughout the procedure.
Surgical incision - The surgeon makes a small skin incision (around 4 to 5 cm) in the lower back, usually in the midline. The opening is much smaller than for traditional open surgery. Thanks to this minimally invasive approach, muscular damage is limited: the paravertebral muscles are not cut, but simply gently spread apart using a tubular retractor. This preserves the surrounding tissue as much as possible.
Channel decompression - Once the targeted vertebrae have been exposed, the surgeon performs the actual nerve decompression. This involves widening the spinal canal by removing the elements that compress the nerves: typically, a laminectomy or laminotomy (partial resection of the vertebral lamina) and a foraminotomy (widening of the intervertebral foramen) are performed to free the nerve roots. The thickened yellow ligament is resected, and if a small disc herniation is present, it may be removed in the process. The aim of this step is to free up enough space to prevent the nerves from being pinched.
Inserting the IntraSPINE® implant - After decompression, the surgeon prepares the posterior intervertebral space for implantation. A small distractor instrument is inserted between the two bone plates to create a suitable space. The surgeon first inserts a trial prosthesis (a dummy implant of calibrated size) to check that the chosen thickness is appropriate and achieves the desired distraction. Once the size has been validated, the definitive implant is inserted. IntraSPINE (silicone) is compressed using special forceps, then precisely slid into the cleared interlaminal space. Once in place, it returns to its original shape, adapting to the structures. The implant is positioned so that its firm “nose” faces forwards (to sheath the space and reopen the nerve canal) and the soft, cushioning part faces backwards.
Additional stabilization (if required) - If the surgeon feels that reinforcement is indicated (e.g. in the presence of slight instability or extensive joint resection during decompression), the polyester connecting strap is applied. This textile band is passed around the spinous processes of the vertebra above and below, then tightened through a titanium buckle to secure the whole. The strap acts like an artificial ligament to prevent the vertebrae from spreading too far apart in extension. In cases of pure stenosis without instability, the strap is not necessarily used (the implant alone may suffice).
Closing and waking up - The instruments are removed, the previously splayed muscles are repositioned (thanks to their natural elasticity), and the surgeon closes the skin incision with stitches or staples. A sterile dressing is placed over the wound. The anesthesia is then reversed, and the patient awakened in the post-interventional care room.
Once the operation is over, the post-operative recovery phase begins.
Rehabilitation and recovery surgery (care pathway post-operative)
Convalescence after IntraSPINE decompression + stabilization is generally faster and lighter than after surgery with arthrodesis traditional. Given the minimally invasive nature of the procedure, the post-operative period is often marked by less pain and an earlier rising. Here's a typical recovery timeline after this kind of procedure, which may naturally vary from individual to individual, but gives an idea of the post-surgical care pathway:
Post-operative phase | Evolution and key instructions |
First days in hospital | Pain controlled by self-controlled analgesia (PCA morphine pump) for the first 24-48 hours, followed by conventional oral analgesics. Early mobilization: a physiotherapist helps the patient to get up the day after surgery, so that he can walk a few steps. Sitting is gradually resumed. In most cases, no rigid corset is required (unless the surgeon advises otherwise). Hospital stay typically 3 to 5 days, considerably shorter than after lumbar fusion. |
Weeks 1 to 3 (at home) | Relative rest and back protection. Avoid bending forward or excessively flexing the lower back for around 3 weeks. Authorized activities are limited to light, frequent walking (a few minutes several times a day, gradually increasing the distance). Prohibited: twisting movements of the trunk and carrying loads >5 kg. Scar care is carried out by a nurse if necessary. |
Weeks 4 to 6 | Start of outpatient physiotherapy around week 4 post-op. The physiotherapist works gently at first: posture exercises (learning to turn en bloc without twisting the back - the “log roll” technique, etc.), light strengthening of deep muscles (transverse abdominis, multifidi). Driving can be resumed gradually after 4-6 weeks, if the surgeon authorizes it and the patient is no longer taking strong painkillers. A post-operative check-up visit with the surgeon takes place around the 6th week to assess recovery and perform follow-up imaging if necessary. |
Months 2 to 3 | Resumption of sedentary activities: many patients are able to return to a desk job at around 8 weeks post-op if progress is favourable. Physiotherapy continues, with a focus on progressive muscle strengthening (more intense sheathing, paravertebral muscle work) and exercise re-training. Daily walking is encouraged and lengthened as the weeks go by. |
Months 3 to 6 | Resuming moderate physical activity: if all goes well, the patient may consider resuming more physical activities or light sports from the 3rd month, subject to medical approval. Caution should be exercised with regard to high-impact sports and heavy lifting before 6 months. At 6 months post-operatively, in the absence of complications, most restrictions are gradually lifted. The patient then returns to an almost normal active life, with the only recommendations being to maintain good back hygiene (regular exercise, avoiding excesses that could damage other levels, etc.). |
Throughout this recovery period, medical monitoring continues, with follow-up consultations at 6 weeks, 3 months, 6 months and 1 year, to ensure that the implant is fusing properly and remaining effective. It's important to note that the IntraSPINE implant does not interfere with future examinations: it is fully compatible with MRI, facilitating radiological follow-up if necessary. What's more, in the event of failure or long-term problems, the technique remains reversible: the IntraSPINE can be removed and, if required, a traditional fusion can then be performed secondarily, without major difficulty. Fortunately, in the majority of cases, this operation offers a real boost to mobility and quality of life, drastically reducing leg pain and improving the patient's ability to walk.
Advantages and contraindications of IntraSPINE® versus fusion
Benefits of decompression + IntraSPINE Compared to conventional fusion surgery lumbar spine, the IntraSPINE approach offers several advantages for suitable patients:
Mobility preserved The IntraSPINE implant enables movement to be maintained at the operated level. Instead of a segment completely frozen by arthrodesis, a certain amount of flexion-extension (measured at ~3.4° in studies) is retained thanks to elastic stabilization. The back remains more flexible for everyday movements. This avoids the sensation of a “blocked back” and improves functional comfort (e.g. bending down is easier than with arthrodesis).
Protection of adjacent levels By maintaining clearance at the treated level, we avoid the phenomenon of stress transfer to adjacent discs and vertebrae. With fusion, neighboring segments are overstressed and may wear out more quickly (this is adjacent accelerated degeneration). IntraSPINE, on the other hand, does not increase the hyper-mobility of adjacent floors - on the contrary, the mobility of these segments remains close to pre-operative normality. The result: in a 12-month comparative clinical study, no cases of adjacent degeneration requiring re-intervention were observed with IntraSPINE, compared with several cases in the fusion group. In the longer term, this could mean fewer additional surgeries.
Pain relief equivalent or better Studies show that both techniques (fusion vs. IntraSPINE) effectively relieve pain and improve patients' functional capacity, with a clear reduction in pain and disability scores after surgery in both groups. However, a 12-month follow-up showed a slightly better pain reduction in the IntraSPINE group (lower mean VAS score) than in the arthrodesis group. The patients IntraSPINE quickly regain quality of life high, because not only is the sciatica relieved, but the remaining flexibility of the spine enables them to resume their activities more easily.
Less invasive surgery and faster recovery IntraSPINE is implanted through a small incision with little muscle breakdown, resulting in reduced intraoperative bleeding (average ~65 mL) compared to fusion with screws and cages (~82 mL). This shortens hospital stay (average ~9 days with IntraSPINE vs. 11 days for fusion in one study), and speeds return home. The fact that the patient is up and about the next day, and no brace is required, facilitates earlier rehabilitation. Overall, patients recover their mobility more quickly than after arthrodesis, where bone consolidation takes several months.
Easier re-intervention possible The dynamic approach is reversible in the event of subsequent pathological changes. If, for example, another level were to be operated on a few years later, or if it were necessary to convert to fusion (in the case of secondary major instability), this would still be relatively straightforward. Conversely, once a rigid arthrodesis has been performed, surgical revision is more complex (material may have to be removed, the fusion extended, etc.). The fact that no heavy rigid hardware is used initially leaves all options open for the future.
It should be noted that every technique has its limitations and is not indicated for all patients.
Contraindications for IntraSPINE® : Surgeons define strict exclusion criteria to ensure safety. The IntraSPINE implant is not recommended or allowed in the following situations (where conventional fusion would probably be more appropriate):
Allergy to materials: if the patient has a proven allergy to silicone, polyester or titanium (implant components), he or she cannot receive IntraSPINE.
Patients who are too young (growth): children or adolescents who are still growing, because their spine has not yet completed its development.
Active infection: any ongoing infection, whether local (spondylodiscitis) or systemic, temporarily contraindicates implantation. The infection must be treated first.
Pregnancy: for obvious safety reasons, surgery of this kind should be avoided during pregnancy, except in the case of neurological emergencies.
Severe osteoporosis: very low bone density compromises implant fixation and spinal strength, making dynamic stabilization unreliable. Reinforced arthrodesis would then be indicated if surgery is essential, or prior treatment of osteoporosis.
Major instability or deformity: for example, grade II+ spondylolisthesis (advanced slippage) or lumbar scoliosis > 25° are situations where IntraSPINE alone would not suffice. In these cases, a more rigid fixation (screws and bars) is generally required to stabilize the spine.
Vertebral tumor at the level to be treated: the presence of a vertebral tumor lesion is a contraindication, as priority will be given to removal of the tumor, often followed by rigid stabilization.
Uncontrolled general pathologies: serious systemic diseases (e.g. unbalanced diabetes, uncorrected coagulation disorders) may preclude surgery until they are stabilized.
Morbid obesity: a very high BMI (>40) exposes the implant to high mechanical stress and an increased risk of surgical complications, making this lightweight technique inadvisable.
Addictions or unstabilized psychiatric disorders: an untreated patient with an active drug addiction or psychosis is not a good candidate, as the postoperative follow-up and compliance would be compromised.
Extreme physical demands: a high-level sportsman or woman, or a heavy-duty worker wishing to resume intense exertion, may not be suited to a soft implant, which could be stressed beyond its capacity. In such cases, a traditional solid fusion may be preferred to secure the spine in the face of severe stress.
Apart from these situations, many patients with moderate to severe lumbar spinal stenosis, with or without minor instability, can benefit from IntraSPINE. Each case is evaluated individually by the surgical team. The development of these dynamic techniques means that today, some active patients can continue to live without arthrodesis and with a more mobile back, which represents a significant advance in the care degenerative spine. (Note: Decompression with IntraSPINE does not preclude other complementary procedures if required. For example, it is possible to combine the release of several adjacent levels in the same operation, or to combine IntraSPINE on one level and fusion on another if the situation so requires. There are also implant variants - unilateral without strap vs. bilateral with strap - depending on the patient's degree of instability).
5. When to consider surgery in France: indications, access to specialized techniques (TOPS, B-Dyn, ESP), recognized expertise, advantages of a transatlantic route
The decision to undergo back surgery abroad (in France) can be motivated by a number of factors, including access to cutting-edge techniques unavailable locally, or shorter waiting times. France, in particular, enjoys a reputation for excellence in spinal surgery, with specialized centers at the cutting edge of innovation [10, 11, 12]. This section explains when a patient would benefit from surgery in France, what specific devices or techniques are available, which expert teams are recognized, and what are the advantages of having surgery in France. care pathway in terms of speed, quality and cost.
Clinical situations indicated for treatment in France: If you are suffering from a pathological condition lumbar If you're looking for a complex solution, or if you want to benefit from a particular technological solution not offered in your region, France can offer unique options. For example:
In case of lumbar stenosis associated with degenerative spondylolisthesis, in France there are alternatives to conventional fusion, such as the TOPS™ system (Total Posterior Spine). TOPS is a dynamic implant which, after decompression of the nerves, stabilizes the spine while preserving movement flexion/extension/rotation. This is a posterior arch prosthesis which replaces the facets and yellow ligament with an articulated titanium-polyurethane device. This innovative system has shown superior results to fusion in studies (better pain relief, faster recovery, protection of adjacent levels). TOPS is currently only available in certain expert centers (it recently obtained FDA approval in the United States, but its use remains limited). France, thanks to participation in clinical trials and more than 10 years' experience in a pilot clinic, is one of the places in the world where TOPS has been most widely used (over 400 patients operated on at the Centre des Cèdres in Toulouse for example). If your case qualifies for TOPS (single-level stenosis, grade I spondylolisthesis, good disc condition, etc.), going to France means you can benefit from it, although few surgeons elsewhere still offer it.
In case of lumbar degenerative disc disease (disc wear) associated with a moderately narrow lumbar canal, a solution developed in France is the ESP“ lumbar disc prosthesis” (Elastic Spine Prosthesis). It's a disc viscoelastic in polycarbonate-urethane and titanium, designed to replace a worn disc in preserving mobility of the segment (arthroplasty). The ESP is a French-designed disc (Laboratoires Spine Innovations, ex-Cousin Biotech). It offers an alternative to fusion for relatively young patients suffering mainly from discogenic pain. In North America, disc prostheses are well known (ProDisc, Mobi-C, etc.), but the ESP has the distinctive feature of incorporating a elastomer core unique shock absorber. The the world's largest ESP experience is in France: the Clinique du Pré in Le Mans has more than 1,500 patients operated with this disc over 15 years, with excellent results. If your case corresponds (involvement of 1 or 2 discs without extreme nerve compression, active age 30-60), you'll find unrivalled expertise in France for this type of lumbar arthroplasty.
In case of low segmental instability (mild spondylolisthesis, facet syndrome) or for a patients wishing to avoid arthrodesis, France has also developed dynamic stabilization other than IntraSPINE. For example, the B-Dyn is a system of pedicle screws coupled by a rod dynamic semi-rigid (made of elastomer material). It is fitted in the same way as a conventional fixation, but features a microgap to dampen movement. Here too, French surgeons have been involved in its development and evaluation (notably at Bordeaux University Hospital, which contributed to the development of the B-Dyn). A patient who has an indication for pedicle screw fixation but does not want a rigid fusion could benefit from this device, which is available in a number of French centers. What's more, for multi-stage or special cases, France has a wide range of innovative implants (e.g. interspinous devices, dynamic cages, etc.), enabling tailor-made solutions.
In short, everything patients seeking a surgical option Whether it's to avoid a fusion, to treat a complex case or to access a specific prosthesis, cutting-edge lumbar spine pathology will find centers in France with unique expertise and state-of-the-art implants. It goes without saying that indications are met, and that a French surgeon accepts the case after evaluating the file.
Centers of excellence and recognized expertise: France boasts a number of renowned establishments for the back surgery. Here are a few notable examples, each with its own particular area of expertise:
The Bordeaux University Hospital (Hôpital Pellegrin) France's largest, world-renowned university spine center. Multidisciplinary team led by professors, cutting-edge publications, high-tech equipment (surgical navigation, spinal endoscopy, etc.). Competent in the whole range surgeries (from the simplest to the most complex), including severe scoliosis, spinal tumors and delicate revision surgery. This is a public hospital, offering excellent value for money (public sector rates).
There Clinique du Pré in Le Mans state-of-the-art private center, renowned in particular for its ESP disc prostheses (a world pioneer). Dr. Jacky Vu developed ESP and treated hundreds of cases. All common spine surgeries are also performed here.
There Oréliance clinic in Orléans the international benchmark for’IntraSPINE - surgeon Dr. Jean-Charles Le Huec has implanted more than 5,000 IntraSPINE in 15 years, making it the world's most experienced center for this technique.
There Clinique des Cèdres, Toulouse a pioneering center for TOPS™ system, with more than 400 patients operated on over 10 years in clinical studies. The Toulouse team (Dr. D. Moreau and colleagues) has unique expertise in this motion-preserving implant.
There Clinique d'Occitanie (Toulouse) specializing in endoscopic surgery of the spine. Perfect for herniated discs or narrow canals treated by camera and micro-incision, a technique that is still relatively undeveloped in North America.
Other renowned centers include the Bizet clinic in Paris (a renowned private spine center), the Center du Dos de la Clinique Francheville, Périgueux, etc., as well as international collaborations (e.g. the Harley Street Hospital in London for outpatient spine surgery).
Many French surgeons are members of European learned societies and are involved in research, which guarantees a high level of expertise and the use of the most up-to-date techniques.
Advantages of the transatlantic route (Canada → France): Using France for its back surgery via a specialized program (such as TAGMED/NeuroMtl) offers several concrete advantages:
Shorter access times : The Quebec or Canadian system can involve long waits to consult a surgeon or obtain an operation date. By going through a private international network, you benefit from a priority access to French specialists of the spine. Delays for a consultation expertise and for the’intervention are considerably shortened. This means your problem can be dealt with in a matter of weeks/months, rather than waiting indefinitely.
High-level expertise and cutting-edge technologies : In France, you will be operated by orthopedic surgeons or neurosurgeons who perform a large number of such procedures every year. Their specific experience (e.g. over 100 TOPS cases, thousands of arthrodeses and dynamics) is a guarantee of safety. What's more, our technical facilities are ultra-modern: 3D navigation, intraoperative neurological monitoring, latest-generation implants... all of this ensures that you benefit from the most advanced technologies. best available techniques in the world.
Optimized costs : Compared to the cost of private surgery in North America, the cost of a intervention in France can be lower, even including travel. The transatlantic partnership allows for cost optimization, and French clinics generally charge lower rates than private U.S. hospitals. For a Canadian patient without private insurance, going to France can represent a significant saving for a level of care equivalent or better.
Personalized, comprehensive care Structures such as Neurothérapie Montréal/TAGMED offer a support from A to Z. This includes the’medical guidance (pre-op assessments, sending of images to French partner surgeons), the’logistics organization (flight bookings, accommodation near the clinic, airport transfers) and care coordination with the French team. You're not on your own: everything is planned for a smooth journey, including the post-operative follow-up upon your return. For example, after your surgery in France, the network ensures that you have follow-up appointments in Canada, and that surgical reports are forwarded to your local doctors. This continuum of care guarantees security and peace of mind.
Quality of care and comfort : France's leading clinics and hospitals offer a hotel comfort (single rooms often available, etc.) and a high quality nursing know-how recognized. Rehabilitation can sometimes be initiated on site with physiotherapists familiar with post-op spine protocols. What's more, treatment in France can provide access to options such as intensive rehabilitation in a specialized center after the operation (2-3 week stay in a functional rehabilitation center, covered for European policyholders, and accessible to international patients for a fee). All this contributes to optimizing the results of your surgery.
By opting for treatment in France, you are opting for speed, medical excellence and technological innovation, at a potentially lower cost than staying in North America for an equivalent solution. It's an investment in your health, with the assurance of being treated by the best in the spine field. Naturally, such a project must be well prepared (complete medical file, opinion of fitness to travel, etc.), but the medical tourism organizations are here to help. Many patients have already opted for this transatlantic route, enabling them to regain their quality of life more quickly while benefiting from French surgical expertise. back.
In conclusion, the lumbar spinal stenosis is a common and potentially disabling condition, but one for which there is now a veritable arsenal of treatments. From rehabilitation to the most advanced surgical techniques, every patient can benefit from personalized treatment. This guide has provided you with a structured presentation of the steps and options available: understanding the disease, conservative treatments, criteria leading to surgery, description of a modern alternative with IntraSPINE and comparative elements with fusion, and finally international solutions if you want the ultimate in spinal surgery. Armed with this information, you'll be in a position to discuss your options with your doctors, in full knowledge of the facts. Don't hesitate to ask questions, to seek advice from several sources, and to draw on the data presented (from clinical sources and the experience of specialized centers) to make the most informed decision about your spine. The ultimate aim of your treatment, whether locally or in France, is to restore mobility and relief, so that lumbar spinal stenosis no longer dictates your daily life and you can once again “move without pain”. We wish you a speedy recovery on this road to well-being.
Sources: This guide is based on specialist publications and documents provided (TAGMED 2025 surgical services presentation, Cousin Spine 2023 catalog, technical data sheets, etc.). SOS Medical Tourism on TOPS™ and IntraSPINE® implants, documentation from Neurochirurgie Montréal and Medicia). For more information, refer to the references cited in square brackets in the text, or get in touch with your healthcare professional. Figures and statements are taken from these sources and the associated scientific literature.
Your most frequently asked questions (FAQ)
Surgical conditions
TLIF fusion is indicated for adolescent scoliosis when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
Endoscopic surgery to treat herniated lumbar discs offers a modern solution with better functional results than traditional surgery.
TLIF fusion used to treat degenerative disc disease offers a modern solution with better functional results than traditional surgery.
Spondylolisthesis can be treated with fusion (e.g. TLIF, ALIF) or, in some cases, with motion-preserving devices such as TOPS™, depending on the degree of slippage and symptoms.
For patients with foraminal stenosis, ALIF fusion is often proposed in specialized centers due to its proven efficacy on pain and recovery.
For patients suffering from cervicarthrosic myelopathy, ALIF fusion is often proposed in specialized centers due to its proven efficacy on pain and recovery.
Lumbar arthrodesis is indicated for vertebral fractures when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
For patients with vertebral fractures, ALIF fusion is often proposed in specialized centers due to its proven efficacy on pain and recovery.
Treatment of degenerative disc disease in France with ALIF fusion is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
In France, vertebral fractures can be treated with Intraspine® implants, a technique renowned for its clinical results and ability to preserve spinal function.
The TLIF fusion used to treat narrow lumbar canal offers a modern solution with better functional results than traditional surgery.
The Intraspine® implant used to treat narrow lumbar spinal canal offers a modern solution with better functional results than traditional surgery.
Lumbar spinal stenosis is a narrowing of the spinal canal that compresses the nerves. In France, it can be treated by decompression surgery, sometimes accompanied by an implant such as TOPS™ or Intraspine®, to relieve pain and preserve mobility.
Treatment of vertebral fractures in France with TLIF fusion is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
For patients suffering from spinal instability, the Intraspine® implant is often proposed in specialized centers due to its proven efficacy on pain and recovery.
In France, adolescent scoliosis can be treated with disc prosthesis, a technique recognized for its clinical results and ability to preserve spinal function.
In France, pseudarthrosis can be treated by endoscopic surgery, a technique recognized for its clinical results and ability to preserve spinal function.
In France, adolescent scoliosis can be treated by percutaneous surgery, a technique recognized for its clinical results and ability to preserve spinal function.
The Intraspine® implant is indicated for cervicarthrosic myelopathy when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
For patients with facet joint syndrome, endoscopic surgery is often proposed in specialized centers due to its proven efficacy on pain and recovery.
In France, pseudarthrosis can be treated by percutaneous surgery, a technique recognized for its clinical results and ability to preserve spinal function.
In France, degenerative disc disease can be treated by disc prosthesis, a technique recognized for its clinical results and ability to preserve spinal function.
In France, pseudarthrosis can be treated by endoscopic surgery, a technique recognized for its clinical results and ability to preserve spinal function.
The Intraspine® implant is indicated for cervicarthrosic myelopathy when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
In France, pseudarthrosis can be treated by percutaneous surgery, a technique recognized for its clinical results and ability to preserve spinal function.
Disc prostheses such as LP-ESP® or CP-ESP® are used to replace a degenerative lumbar disc while maintaining spinal segment mobility.
In France, the narrow lumbar canal can be treated by endoscopic surgery, a technique recognized for its clinical results and ability to preserve spinal function.
In France, foraminal stenosis can be treated by endoscopic surgery, a technique recognized for its clinical results and ability to preserve spinal function.
Lumbar arthrodesis used to treat degenerative disc disease offers a modern solution with better functional results than traditional surgery.
Yes, the cervical disc prosthesis is an alternative to fusion that maintains neck mobility while relieving the pain caused by cervical herniation.
Lumbar arthrodesis used to treat facet joint syndrome offers a modern solution with better functional results than traditional surgery.
For patients with vertebral fractures, ALIF fusion is often proposed in specialized centers due to its proven efficacy on pain and recovery.
For patients with degenerative disc disease, percutaneous surgery is often proposed in specialized centers, due to its proven efficacy on pain and recovery.
In France, facet joint syndrome can be treated with Intraspine® implants, a technique renowned for its clinical results and ability to preserve spinal function.
For patients with facet joint syndrome, the TOPS™ system is often proposed in specialized centers due to its proven efficacy on pain and recovery.
For patients with facet joint syndrome, ALIF fusion is often proposed in specialized centers due to its proven efficacy on pain and recovery.
In France, foraminal stenosis can be treated using the TOPS™ system, a technique renowned for its clinical results and ability to preserve spinal function.
In France, kissing spine can be treated by percutaneous surgery, a technique recognized for its clinical results and ability to preserve spinal function.
Yes, several centers in France offer surgery for adult scoliosis, including multi-stage fusion techniques or endoscopic approaches to decompress the nerves.
In France, kissing spine can be treated by lumbar arthrodesis, a technique recognized for its clinical results and ability to preserve spinal function.
In France, degenerative disc disease can be treated with the TOPS™ system, a technique recognized for its clinical results and ability to preserve spinal function.
In France, ASD (Adjacent Segment Disease) can be treated by percutaneous surgery, a technique renowned for its clinical results and ability to preserve spinal function.
For patients with facet joint syndrome, ALIF fusion is often proposed in specialized centers due to its proven efficacy on pain and recovery.
Kissing spine treatment in France by percutaneous surgery is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
In France, foraminal stenosis can be treated using the TOPS™ system, a technique renowned for its clinical results and ability to preserve spinal function.
The ALIF fusion used to treat narrow lumbar canal offers a modern solution with better functional results than traditional surgery.
In France, cervicarthrosic myelopathy can be treated by lumbar arthrodesis, a technique recognized for its clinical results and ability to preserve spinal function.
The TOPS™ system is indicated for vertebral fractures when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
The TLIF fusion used to treat ASD (Adjacent Segment Disease) offers a modern solution with better functional results than traditional surgery.
The Intraspine® implant is indicated for degenerative disc disease when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
Treatment of degenerative disc disease in France with Intraspine® implants is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
Spondylolisthesis can be treated with fusion (e.g. TLIF, ALIF) or, in some cases, with motion-preserving devices such as TOPS™, depending on the degree of slippage and symptoms.
For patients suffering from cervicarthrosic myelopathy, ALIF fusion is often proposed in specialized centers due to its proven efficacy on pain and recovery.
For patients with vertebral fractures, ALIF fusion is often proposed in specialized centers due to its proven efficacy on pain and recovery.
Disc prosthesis is indicated for degenerative disc disease when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
In France, facet joint syndrome can be treated by endoscopic surgery, a technique renowned for its clinical results and ability to preserve spinal function.
ALIF fusion is indicated for adolescent scoliosis when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
The TOPS™ system used to treat ASD (Adjacent Segment Disease) offers a modern solution with better functional results compared to traditional surgery.
For patients with foraminal stenosis, percutaneous surgery is often proposed in specialized centers, due to its proven efficacy on pain and recovery.
In France, kissing spine can be treated by percutaneous surgery, a technique recognized for its clinical results and ability to preserve spinal function.
TLIF fusion used to treat degenerative disc disease offers a modern solution with better functional results than traditional surgery.
Kissing spine treatment in France with disc prosthesis is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
Treatment of narrow lumbar spinal canal in France by percutaneous surgery is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
Treatment of lumbar disc herniation in France by lumbar arthrodesis is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
Yes, the cervical disc prosthesis is an alternative to fusion that maintains neck mobility while relieving the pain caused by cervical herniation.
For patients with vertebral fractures, ALIF fusion is often proposed in specialized centers due to its proven efficacy on pain and recovery.
In France, facet joint syndrome can be treated with Intraspine® implants, a technique renowned for its clinical results and ability to preserve spinal function.
Treatment of degenerative disc disease in France with TLIF fusion is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
The TLIF fusion used to treat ASD (Adjacent Segment Disease) offers a modern solution with better functional results than traditional surgery.
The treatment of ASD (Adjacent Segment Disease) in France with Intraspine® implants is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
The Intraspine® implant is indicated for degenerative disc disease when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
Treatment of spinal instability in France with TLIF fusion is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
Treatment of degenerative disc disease in France with Intraspine® implants is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
In France, adolescent scoliosis can be treated with disc prosthesis, a technique recognized for its clinical results and ability to preserve spinal function.
The disc prosthesis used to treat kissing spine offers a modern solution with better functional results than traditional surgery.
Endoscopic surgery is indicated for ASD (Adjacent Segment Disease) when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
In France, vertebral fractures can be treated with ALIF fusion, a technique renowned for its clinical results and ability to preserve spinal function.
In France, facet joint syndrome can be treated by endoscopic surgery, a technique renowned for its clinical results and ability to preserve spinal function.
The TOPS™ system used to treat ASD (Adjacent Segment Disease) offers a modern solution with better functional results compared to traditional surgery.
In France, cervicarthrosic myelopathy can be treated by lumbar arthrodesis, a technique recognized for its clinical results and ability to preserve spinal function.
For patients with cervicarthrosic myelopathy, percutaneous surgery is often proposed in specialized centers, due to its proven efficacy on pain and recovery.
ALIF fusion is indicated for kissing spine when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
The Intraspine® implant is indicated for vertebral fractures when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
Disc prosthesis is indicated for facet joint syndrome when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
In France, cervicarthrosic myelopathy can be treated by disc prosthesis, a technique recognized for its clinical results and ability to preserve spinal function.
In France, facet joint syndrome can be treated using the TOPS™ system, a technique renowned for its clinical results and ability to preserve spinal function.
Lumbar arthrodesis used to treat degenerative disc disease offers a modern solution with better functional results than traditional surgery.
Percutaneous surgery to treat narrow lumbar spinal canal offers a modern solution with better functional results than traditional surgery.
Endoscopic surgery to treat spinal instability offers a modern solution with better functional results than traditional surgery.
Lumbar arthrodesis used to treat lumbar disc herniation offers a modern solution with better functional results than traditional surgery.
ALIF fusion is indicated for kissing spine when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
Disc prosthesis is indicated for facet joint syndrome when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
In France, facet joint syndrome can be treated using the TOPS™ system, a technique renowned for its clinical results and ability to preserve spinal function.
Treatment of pseudarthrosis in France with the TOPS™ system is part of a structured pathway with initial assessment, minimally invasive surgery and personalized post-operative follow-up.
The treatment of spinal instability in France with Intraspine® implants is part of a structured approach involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
Treatment of facet joint syndrome in France by lumbar arthrodesis is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
The ALIF fusion used to treat cervicarthrosis myelopathy offers a modern solution with better functional results than traditional surgery.
Percutaneous surgery to treat herniated lumbar discs offers a modern solution with better functional results than traditional surgery.
Treatment of lumbar disc herniation in France by lumbar arthrodesis is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
In France, ASD (Adjacent Segment Disease) can be treated by percutaneous surgery, a technique renowned for its clinical results and ability to preserve spinal function.
In France, the narrow lumbar canal can be treated with TLIF fusion, a technique renowned for its clinical results and ability to preserve spinal function.
In France, kissing spine can be treated with TLIF fusion, a technique renowned for its clinical results and ability to preserve spinal function.
The treatment of pseudarthrosis in France by endoscopic surgery is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
The treatment of spinal instability in France with Intraspine® implants is part of a structured approach involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
The ALIF fusion used to treat cervicarthrosis myelopathy offers a modern solution with better functional results than traditional surgery.
TLIF fusion is indicated for cervicarthrosis myelopathy when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
Kissing spine treatment in France by endoscopic surgery is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
Kissing spine treatment in France with disc prosthesis is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
TLIF fusion is indicated for adolescent scoliosis when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
Treatment of narrow lumbar spinal canal in France by percutaneous surgery is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
Endoscopic surgery to treat herniated lumbar discs offers a modern solution with better functional results than traditional surgery.
TLIF fusion is indicated for cervicarthrosis myelopathy when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
Disc prosthesis is indicated for degenerative disc disease when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
In France, kissing spine can be treated by endoscopic surgery, a technique recognized for its clinical results and ability to preserve spinal function.
Endoscopic surgery to treat adolescent scoliosis offers a modern solution with better functional results than traditional surgery.
Lumbar arthrodesis used to treat pseudarthrosis offers a modern solution with better functional results than traditional surgery.
The treatment of adolescent scoliosis in France by endoscopic surgery is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
The TOPS™ system used to treat narrow lumbar canal offers a modern solution with better functional results compared to traditional surgery.
In France, foraminal stenosis can be treated with ALIF fusion, a technique renowned for its clinical results and ability to preserve spinal function.
In France, narrow lumbar spinal canal can be treated by lumbar arthrodesis, a technique recognized for its clinical results and ability to preserve spinal function.
The disc prosthesis used to treat kissing spine offers a modern solution with better functional results than traditional surgery.
For patients with ASD (Adjacent Segment Disease), lumbar arthrodesis is often proposed in specialized centers due to its proven efficacy on pain and recovery.
Endoscopic surgery is indicated for ASD (Adjacent Segment Disease) when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
For patients suffering from spinal instability, endoscopic surgery is often proposed in specialized centers due to its proven efficacy on pain and recovery.
In France, vertebral fractures can be treated with ALIF fusion, a technique renowned for its clinical results and ability to preserve spinal function.
Treatment of degenerative disc disease in France with TLIF fusion is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
In France, adolescent scoliosis can be treated by percutaneous surgery, a technique recognized for its clinical results and ability to preserve spinal function.
For patients with facet joint syndrome, endoscopic surgery is often proposed in specialized centers due to its proven efficacy on pain and recovery.
The TOPS™ system used to treat adolescent scoliosis offers a modern solution with better functional results compared to traditional surgery.
Treatment of narrow lumbar spinal canal in France with disc prosthesis is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
TLIF fusion is indicated for kissing spine when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
Lumbar spinal stenosis is a narrowing of the spinal canal that compresses the nerves. In France, it can be treated by decompression surgery, sometimes accompanied by an implant such as TOPS™ or Intraspine®, to relieve pain and preserve mobility.
The treatment of adolescent scoliosis in France by endoscopic surgery is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
Treatment of vertebral fractures in France with TLIF fusion is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
The TOPS™ system used to treat narrow lumbar canal offers a modern solution with better functional results compared to traditional surgery.
For patients suffering from spinal instability, the Intraspine® implant is often proposed in specialized centers due to its proven efficacy on pain and recovery.
In France, foraminal stenosis can be treated with ALIF fusion, a technique renowned for its clinical results and ability to preserve spinal function.
For patients with cervicarthrosic myelopathy, percutaneous surgery is often proposed in specialized centers, due to its proven efficacy on pain and recovery.
Kissing spine treatment in France by percutaneous surgery is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
The ALIF fusion used to treat narrow lumbar canal offers a modern solution with better functional results than traditional surgery.
The TLIF fusion used to treat pseudarthrosis offers a modern solution with better functional results than traditional surgery.
Endoscopic surgery is indicated for facet joint syndrome when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
Treatment of facet joint syndrome in France with disc prosthesis is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
In France, vertebral fractures can be treated by lumbar arthrodesis, a technique renowned for its clinical results and ability to preserve spinal function.
Percutaneous surgery to treat narrow lumbar spinal canal offers a modern solution with better functional results than traditional surgery.
Treatment of pseudarthrosis in France with TLIF fusion is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
Endoscopic surgery to treat spinal instability offers a modern solution with better functional results than traditional surgery.
For patients with spinal instability, TLIF fusion is often proposed in specialized centers due to its proven efficacy on pain and recovery.
Lumbar arthrodesis used to treat lumbar disc herniation offers a modern solution with better functional results than traditional surgery.
Treatment of pseudarthrosis in France with the TOPS™ system is part of a structured pathway with initial assessment, minimally invasive surgery and personalized post-operative follow-up.
The treatment of ASD (Adjacent Segment Disease) in France with Intraspine® implants is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
Treatment of spinal instability in France with TLIF fusion is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
For patients with foraminal stenosis, ALIF fusion is often proposed in specialized centers due to its proven efficacy on pain and recovery.
Lumbar arthrodesis is indicated for vertebral fractures when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
Treatment of degenerative disc disease in France with ALIF fusion is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
Disc prostheses such as LP-ESP® or CP-ESP® are used to replace a degenerative lumbar disc while maintaining spinal segment mobility.
The TOPS™ system used to treat adolescent scoliosis offers a modern solution with better functional results compared to traditional surgery.
In France, the narrow lumbar canal can be treated by endoscopic surgery, a technique recognized for its clinical results and ability to preserve spinal function.
Treatment of narrow lumbar spinal canal in France with disc prosthesis is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
In France, foraminal stenosis can be treated by endoscopic surgery, a technique recognized for its clinical results and ability to preserve spinal function.
TLIF fusion is indicated for kissing spine when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
Kissing spine treatment in France by endoscopic surgery is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
Treatment of facet joint syndrome in France by lumbar arthrodesis is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
Percutaneous surgery to treat herniated lumbar discs offers a modern solution with better functional results than traditional surgery.
Lumbar arthrodesis used to treat facet joint syndrome offers a modern solution with better functional results than traditional surgery.
For patients with degenerative disc disease, percutaneous surgery is often proposed in specialized centers, due to its proven efficacy on pain and recovery.
In France, degenerative disc disease can be treated by disc prosthesis, a technique recognized for its clinical results and ability to preserve spinal function.
The treatment of pseudarthrosis in France by endoscopic surgery is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
In France, the narrow lumbar canal can be treated with TLIF fusion, a technique renowned for its clinical results and ability to preserve spinal function.
The TLIF fusion used to treat pseudarthrosis offers a modern solution with better functional results than traditional surgery.
In France, kissing spine can be treated with TLIF fusion, a technique renowned for its clinical results and ability to preserve spinal function.
For patients with ASD (Adjacent Segment Disease), ALIF fusion is often proposed in specialized centers due to its proven efficacy on pain and recovery.
The treatment of pseudarthrosis in France by endoscopic surgery is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
In France, narrow lumbar spinal canal can be treated by lumbar arthrodesis, a technique recognized for its clinical results and ability to preserve spinal function.
For patients with ASD (Adjacent Segment Disease), lumbar arthrodesis is often proposed in specialized centers due to its proven efficacy on pain and recovery.
For patients suffering from spinal instability, endoscopic surgery is often proposed in specialized centers due to its proven efficacy on pain and recovery.
ALIF fusion is indicated for adolescent scoliosis when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
For patients with foraminal stenosis, percutaneous surgery is often proposed in specialized centers, due to its proven efficacy on pain and recovery.
For patients with facet joint syndrome, the TOPS™ system is often proposed in specialized centers due to its proven efficacy on pain and recovery.
Yes, several centers in France offer surgery for adult scoliosis, including multi-stage fusion techniques or endoscopic approaches to decompress the nerves.
The TLIF fusion used to treat pseudarthrosis offers a modern solution with better functional results than traditional surgery.
In France, kissing spine can be treated by lumbar arthrodesis, a technique recognized for its clinical results and ability to preserve spinal function.
Endoscopic surgery is indicated for facet joint syndrome when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
In France, degenerative disc disease can be treated with the TOPS™ system, a technique recognized for its clinical results and ability to preserve spinal function.
Treatment of facet joint syndrome in France with disc prosthesis is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
In France, vertebral fractures can be treated by lumbar arthrodesis, a technique renowned for its clinical results and ability to preserve spinal function.
Treatment of pseudarthrosis in France with TLIF fusion is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
For patients with spinal instability, TLIF fusion is often proposed in specialized centers due to its proven efficacy on pain and recovery.
The Intraspine® implant is indicated for vertebral fractures when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
In France, cervicarthrosic myelopathy can be treated by disc prosthesis, a technique recognized for its clinical results and ability to preserve spinal function.
The TOPS™ system is indicated for vertebral fractures when conservative treatment has failed. It provides effective relief while reducing the risk of post-operative complications.
In France, vertebral fractures can be treated with Intraspine® implants, a technique renowned for its clinical results and ability to preserve spinal function.
In France, kissing spine can be treated by endoscopic surgery, a technique recognized for its clinical results and ability to preserve spinal function.
The TLIF fusion used to treat narrow lumbar canal offers a modern solution with better functional results than traditional surgery.
Endoscopic surgery to treat adolescent scoliosis offers a modern solution with better functional results than traditional surgery.
The Intraspine® implant used to treat narrow lumbar spinal canal offers a modern solution with better functional results than traditional surgery.
Lumbar arthrodesis used to treat pseudarthrosis offers a modern solution with better functional results than traditional surgery.
The treatment of pseudarthrosis in France by endoscopic surgery is part of a structured pathway involving initial assessment, minimally invasive surgery and personalized post-operative follow-up.
The TLIF fusion used to treat pseudarthrosis offers a modern solution with better functional results than traditional surgery.
For patients with ASD (Adjacent Segment Disease), ALIF fusion is often proposed in specialized centers due to its proven efficacy on pain and recovery.
Your most frequently asked questions (FAQ)
Spinal stenosis
The numbness associated with spinal stenosis can cause significant functional limitations, and targeted laminotomy represents an effective and lasting solution in many cases.
Targeted laminotomy is used to widen the spinal canal and relieve nerve compression caused by neurogenic claudication.
Narrowing of the spinal canal can cause significant functional limitations, and minimally invasive spinal decompression represents an effective and lasting solution in many cases.
In patients suffering from neurogenic claudication, endoscopic surgery of the spinal canal can reduce pain, numbness and gait disorders.
Endoscopic spinal canal surgery is often indicated when spinal canal narrowing no longer responds to conservative treatments such as physiotherapy or infiltrations.
In cases of resistant, incapacitating pain, severe claudication or onset of sphincter disorders (incontinence).
In patients with spinal canal narrowing, posterior fusion with decompression reduces pain, numbness and gait disorders.
Posterior fusion with decompression is often indicated when neurogenic claudication no longer responds to conservative treatments such as physiotherapy or infiltrations.
Recalibration surgery is often indicated when neurogenic claudication no longer responds to conservative treatments such as physiotherapy or infiltrations.
In patients suffering from numbness associated with spinal stenosis, targeted laminotomy can reduce pain, numbness and gait disorders.
Thanks to a targeted approach, canal recalibration surgery enables decompression of the spinal cord or nerve roots without compromising spinal stability.
Canal recalibration surgery is used to widen the spinal canal and relieve nerve compression caused by pain on walking due to stenosis.
Laminectomy or laminoplasty to widen the canal, sometimes combined with arthrodesis if instability is present.
Laminectomy is used to widen the spinal canal and relieve nerve compression caused by multisegmental stenosis.
In patients suffering from neurogenic claudication, canal recalibration surgery helps reduce pain, numbness and gait disorders.
Laminectomy is often indicated when multisegmental stenosis no longer responds to conservative treatments such as physiotherapy or infiltrations.
Posterior fusion with decompression is often indicated when lumbar spinal stenosis no longer responds to conservative treatments such as physiotherapy or infiltration.
Minimally invasive spinal decompression is used to widen the spinal canal and relieve nerve compression caused by spinal cord compression.
Minimally invasive spinal decompression is used to widen the spinal canal and relieve nerve compression caused by narrowing of the spinal canal.
Early walking the next day, return to work within 4 to 6 weeks and sporting activities after 3 months.
Thanks to a targeted approach, posterior fusion with decompression allows the spinal cord or nerve roots to be decompressed without altering spinal stability.
Posterior fusion with decompression is often indicated when spinal canal narrowing no longer responds to conservative treatments such as physiotherapy or infiltration.
Targeted laminotomy is often indicated when neurogenic claudication no longer responds to conservative treatments such as physiotherapy or infiltrations.
Posterior fusion with decompression is often indicated when pain on walking caused by stenosis no longer responds to conservative treatments such as physiotherapy or infiltration.
Narrowing of the spinal canal can cause significant functional limitations, and laminectomy represents an effective and lasting solution in many cases.
The numbness associated with spinal stenosis can cause significant functional limitations, and endoscopic spinal canal surgery represents an effective and lasting solution in many cases.
5 to 15 % of recurrence due to osteoarthritic progression or remaining ligament thickening.
Thanks to a targeted approach, minimally invasive spinal decompression enables the spinal cord or nerve roots to be decompressed without altering spinal stability.
Posterior fusion with decompression is often indicated when spinal cord compression no longer responds to conservative treatments such as physiotherapy or infiltration.
Neurogenic claudication can cause significant functional limitations, and targeted laminotomy represents an effective and lasting solution in many cases.
In patients suffering from gait pain caused by stenosis, posterior fusion with decompression reduces pain, numbness and gait disorders.
Thanks to a targeted approach, endoscopic surgery of the spinal canal enables decompression of the spinal cord or nerve roots without affecting spinal stability.
Recalibration surgery is often indicated when neurogenic claudication no longer responds to conservative treatments such as physiotherapy or infiltrations.
Maintenance of good posture, muscle strengthening, weight management and regular radiological monitoring.
For patients suffering from gait pain caused by stenosis, canal recalibration surgery can reduce pain, numbness and gait disorders.
Canal recalibration surgery is used to widen the spinal canal and relieve nerve compression caused by cervical spinal stenosis.
Targeted laminotomy is used to widen the spinal canal and relieve nerve compression caused by multisegmental stenosis.
Thanks to a targeted approach, minimally invasive spinal decompression enables the spinal cord or nerve roots to be decompressed without altering spinal stability.
Posterior fusion with decompression is used to widen the spinal canal and relieve nerve compression caused by neurogenic claudication.
The numbness associated with spinal stenosis can cause significant functional limitations, and laminectomy represents an effective and lasting solution in many cases.
Thanks to a targeted approach, minimally invasive spinal decompression enables the spinal cord or nerve roots to be decompressed without altering spinal stability.
Pain on walking caused by stenosis can result in significant functional limitations, and posterior fusion with decompression represents an effective and lasting solution in many cases.
Posterior fusion with decompression is used to widen the spinal canal and relieve nerve compression caused by neurogenic claudication.
In patients with multisegmental stenosis, minimally invasive spinal decompression reduces pain, numbness and gait disorders.
Targeted laminotomy is used to widen the spinal canal and relieve nerve compression caused by spinal cord compression.
In patients suffering from spinal cord compression, surgery to recalibrate the canal can reduce pain, numbness and gait disorders.
Posterior fusion with decompression is used to widen the spinal canal and relieve nerve compression caused by neurogenic claudication.
Neurogenic claudication can cause significant functional limitations, and laminectomy represents an effective and lasting solution in many cases.
Targeted laminotomy is often indicated when spinal cord compression no longer responds to conservative treatments such as physiotherapy or infiltrations.
Thanks to a targeted approach, canal recalibration surgery enables decompression of the spinal cord or nerve roots without compromising spinal stability.
Thanks to its targeted approach, laminotomy allows decompression of the spinal cord or nerve roots without compromising spinal stability.
In patients with spinal canal narrowing, surgery to recalibrate the canal can reduce pain, numbness and gait disorders.
In patients with lumbar spinal stenosis, laminectomy can reduce pain, numbness and gait disorders.
Endoscopic spinal canal surgery is used to widen the spinal canal and relieve nerve compression caused by spinal cord compression.
The numbness associated with spinal stenosis can cause significant functional limitations, and canal recalibration surgery represents an effective and lasting solution in many cases.
Posterior fusion with decompression is used to widen the spinal canal and relieve nerve compression caused by neurogenic claudication.
Thanks to a targeted approach, minimally invasive spinal decompression enables the spinal cord or nerve roots to be decompressed without altering spinal stability.
Posterior fusion with decompression is often indicated when the numbness associated with spinal stenosis no longer responds to conservative treatments such as physiotherapy or infiltrations.
Posterior fusion with decompression is often indicated when pain on walking caused by stenosis no longer responds to conservative treatments such as physiotherapy or infiltration.
Cervical spinal stenosis can cause significant functional limitations, and laminectomy represents an effective and lasting solution in many cases.
Targeted laminotomy is often indicated when spinal cord compression no longer responds to conservative treatments such as physiotherapy or infiltrations.
Endoscopic spinal canal surgery is used to widen the spinal canal and relieve nerve compression caused by numbness related to spinal stenosis.
Laminectomy is often indicated when lumbar spinal stenosis no longer responds to conservative treatments such as physiotherapy or infiltrations.
The numbness associated with spinal stenosis can cause significant functional limitations, and laminectomy represents an effective and lasting solution in many cases.
Thanks to a targeted approach, endoscopic surgery of the spinal canal enables decompression of the spinal cord or nerve roots without affecting spinal stability.
In patients with spinal canal narrowing, minimally invasive spinal decompression reduces pain, numbness and gait disorders.
Thanks to a targeted approach, minimally invasive spinal decompression enables the spinal cord or nerve roots to be decompressed without altering spinal stability.
Posterior fusion with decompression is used to widen the spinal canal and relieve nerve compression caused by cervical spinal stenosis.
Thanks to a targeted approach, laminectomy enables the spinal cord or nerve roots to be decompressed without compromising spinal stability.
Endoscopic spinal canal surgery is often indicated when cervical spinal stenosis no longer responds to conservative treatments such as physiotherapy or infiltrations.
Spinal cord compression can cause significant functional limitations, and canal recalibration surgery represents an effective and lasting solution in many cases.
Laminectomy is often indicated when pain on walking caused by stenosis no longer responds to conservative treatments such as physiotherapy or infiltrations.
Neurogenic claudication can cause significant functional limitations, and endoscopic spinal canal surgery represents an effective and lasting solution in many cases.
Thanks to a targeted approach, posterior fusion with decompression allows the spinal cord or nerve roots to be decompressed without altering spinal stability.
Narrowing of the spinal canal can cause significant functional limitations, and endoscopic spinal canal surgery represents an effective and lasting solution in many cases.
This is a narrowing of the central or lateral spinal canal, leading to compression of the spinal cord or nerve roots.
Pain on walking caused by stenosis can result in significant functional limitations, and minimally invasive spinal decompression represents an effective and lasting solution in many cases.
Pain on walking caused by stenosis can result in significant functional limitations, and posterior fusion with decompression represents an effective and lasting solution in many cases.
Lumbar spinal stenosis can cause significant functional limitations, and posterior fusion with decompression represents an effective and lasting solution in many cases.
Posterior fusion with decompression is used to widen the spinal canal and relieve nerve compression caused by spinal cord compression.
In patients with cervical spinal stenosis, laminectomy reduces pain, numbness and gait disorders.
Lower back pain radiating to the lower limbs, weakness, numbness, neurogenic claudication (fatigue on walking).
Recalibration surgery is often indicated when cervical spinal stenosis no longer responds to conservative treatments such as physiotherapy or infiltrations.
Minimally invasive spinal decompression is used to widen the spinal canal and relieve nerve compression caused by narrowing of the spinal canal.
Minimally invasive spinal decompression is often indicated when the numbness associated with spinal stenosis no longer responds to conservative treatments such as physiotherapy or infiltrations.
Neurogenic claudication can cause significant functional limitations, and laminectomy represents an effective and lasting solution in many cases.
Posterior fusion with decompression is often indicated when pain on walking caused by stenosis no longer responds to conservative treatments such as physiotherapy or infiltration.
MRI of the spine to visualize the reduction in canal caliber, sometimes supplemented by CT scan or myelography.
Thanks to a targeted approach, canal recalibration surgery enables decompression of the spinal cord or nerve roots without compromising spinal stability.
In patients with multisegmental stenosis, endoscopic spinal canal surgery can reduce pain, numbness and gait disorders.
Targeted laminotomy is often indicated when spinal cord compression no longer responds to conservative treatments such as physiotherapy or infiltrations.
Cervical spinal stenosis can cause significant functional limitations, and canal recalibration surgery represents an effective and lasting solution in many cases.
Minimally invasive spinal decompression is often indicated when spinal canal narrowing no longer responds to conservative treatments such as physiotherapy or infiltration.
Disc degeneration, facet joint hypertrophy, thickened ligamentum flavum, spondylolisthesis or congenital anomalies.
Endoscopic spinal canal surgery is often indicated when cervical spinal stenosis no longer responds to conservative treatments such as physiotherapy or infiltrations.
Canal recalibration surgery is used to widen the spinal canal and relieve nerve compression caused by multisegmental stenosis.
Thanks to a targeted approach, laminectomy enables the spinal cord or nerve roots to be decompressed without compromising spinal stability.
Minimally invasive spinal decompression is used to widen the spinal canal and relieve nerve compression caused by lumbar spinal stenosis.
Recalibration surgery is often indicated when multisegmental stenosis no longer responds to conservative treatments such as physiotherapy or infiltration.
Physiotherapy, stretching, neurovertebral decompression, epidural infiltrations and appropriate analgesic management.
