The Back Centre The Back Centre at Valais Hospital
Most people are affected by back pain at various points in their lives. Luckily, this pain is often harmless, and disappears following a short period of rest, or thanks to exercise and following a few simple rules about posture and behaviour.
If the pain does not disappear, the team from the Orthopaedics Clinic and the expanded team from the Back Pain Centre are here to help you with a range of tried and tested treatments.
The basis of any therapy is to establish as precise a diagnosis as possible in collaboration with colleagues from the various practices and specialist disciplines in the hospital.
Different people experience back pain in different ways. This is why the cause of this pain and its treatment must be determined specifically for each individual.
Acute pain can often be successfully relieved using the targeted infiltration of the painful structures, of the nerve fibres which communicate the pain, of the facet joints, and nerve root infiltration using X-ray or CT monitoring.
Infiltrations do not just act as a treatment, but also help with diagnosis and with identifying the cause of the pain.
Using radio frequency treatment, it is possible to achieve long-term, gentle relief of pain connected to irritated arthritic facet joints, and this procedure can be carried out on an outpatient basis, so that the patient is able to leave hospital after a few hours. Pain in the sacroiliac joint and in the pelvis can also often be treated in this way.
Persistent pain connected to swelling and lesions affecting the intervertebral discs can be relieved percutaneously using Nucleoplasty®, i.e. through the skin and without any surgical incision.
If your intervertebral disc tissue is worn down, this can lead to an inflammation of the nerves. If it is not possible to relieve the pain through injections and conservative procedures, then microsurgical intervertebral disc surgery using a microscope may be possible. This procedure has now been accepted as standard for some time. It is often possible for the patient to leave hospital very quickly following such an intervention. Depending on the type of prolapse and where it is located, the operation can also be carried out completely endoscopically.
The innovative Orthopaedics Department in Brig is the first department in the Valais region to have introduced 3D intraoperative imaging, in order to increase precision during operations. This advanced technique will soon be combined with a navigation device that uses infrared rays, in order to reduce levels of exposure to radiation. Here too, the Orthopaedics Department is carrying out trailblazing work.
Growing older is accompanied by an increase in arthritic changes in the small vertebral joints and compression of the intervertebral discs. Do you experience pain when straightening up, relief when you stoop, difficulties walking at a brisk pace, are you walking ever shorter distances? All of these could be symptoms of a constriction of the vertebral canal, also known as lumbar spinal stenosis. Thanks to an operation to enlarge it (decompression), the canal (or the individual nerve) can be freed up, allowing normal function to return. Depending on their stability, an implant may be inserted between the spinal processes, in order to prise open the space further and improve stability.
The slippage of individual vertebra against each other (“spondylolysis/spondylolisthesis”) can occur in young people, for example due to a break in the vertebral arch, or in older people as a process of slippage due to the compression of the intervertebral discs (pseudospondylolisthesis or pseudolisthesis). If the articulated segment concerned is displaying instability, then it may be necessary to carry out a reinforcement (spinal fusion or spondylodesis). The spinal column is laid bare from the back, the nerves are released from the constricted space and titanium screws are screwed into the vertebra from the back. These are connected using rods that are aligned to the bones, so that the articulated segment is stabilised until the bones coalesce. In cases of significant instability and pain, including in connection to an intervertebral disc, this disc is removed and replaced with an artificial one made out of titanium (or synthetic material) (so-called 360° fusion).
In case of a painful slackening of an articulated segment due to the degeneration of an intervertebral disc and to compression, decompression can be combined with dynamic neutralisation, using a rod-screw system (Dynesis, Balanc Sys,) which acts as a buffer and allows for movement, so that the pain is relieved. If the slackening is limited, then an interspinous buffer (DIAM) may be sufficient. If several segments are affected, then the reinforcement of one segment may be combined with a buffer for the other (DTO Dynamic Transition Option).
In rare cases, the intervertebral disc is the sole cause of pain. In such cases an intervertebral disc prosthesis may be inserted, as long as the existing strict indication guidelines are fulfilled. This operation is carried out from the front through the abdomen.
The section of the spinal column that is most frequently affected after the lumbar vertebral column is the cervical spine. A similar range of treatments is available for this section. It ranges from conservative treatment, minimally invasive operations, through to reinforcements and intervertebral disc prostheses.
Growing older also increases the risk of osteoporosis, a decalcification of the bones. Simple daily movements can break a vertebra, which is often very painful and cannot be adequately treated using painkillers alone.
Kyphoplasty, or the introduction of a balloon into the vertebral body, and its straightening and filling using bone cement, can quickly relieve the pain, and restore mobility. If the break is particularly bad or is causing instability, then it is possible to carry out a minimally invasive fixation through small incisions and using screws embedded in bone cement.
This department also works closely with the Oncological Department in Brig. In case of need, interventions aimed at stabilising and relieving pain in the spinal column are carried out on patients.
Modern techniques allow for most back problems to be treated through individually-tailored therapy.