Low back pain & disc disease
Chronic low back pain — Degenerative disc disease
SFCR Patient Sheet: Download the patient information leaflet (PDF)
What is low back pain?
Low back pain — commonly known as "lumbago" — refers to any pain located in the lower back, between the last ribs and the buttock crease. It is one of the most common reasons for medical consultation worldwide, and the leading cause of sick leave in adults under 45.
When this pain is linked to the wear of one or more intervertebral discs, it is called degenerative disc disease. The disc, which normally acts as a shock absorber between the vertebrae, becomes dehydrated, collapses and loses its ability to absorb impacts. This process is natural with age — it can be seen on the MRI of perfectly asymptomatic individuals — but it becomes painful when the disc loses its stability.
How it develops
Disc disease is a slow, progressive process influenced by several factors:
• Disc dehydration: from as early as 20–25, the disc begins to lose water and elasticity — this is a normal physiological process
• Segmental instability: as the disc collapses, the adjacent vertebrae "move" more, irritating the posterior facet joints
• Local inflammation: disc degradation releases inflammatory substances that stimulate nerve endings
• Contributing factors: sedentary lifestyle, excess weight, heavy lifting, vibrations (professional drivers), smoking
Symptoms & Clinical signs
Discogenic low back pain varies from patient to patient:
• Lumbar pain: a "bar-like" sensation in the lower back, worsened by prolonged sitting and at the end of the day
• Morning stiffness: the back feels "rusty" on waking and gradually loosens with movement
• Mechanical pain: increased by effort, bending forward and lifting; relieved by rest and changes of position
• Referred pain: the pain may "travel" into the buttocks or upper thighs without going past the knee (unlike true sciatica)
• Chronicity: low back pain is considered chronic when it persists beyond 3 months
Diagnosis
• Clinical examination: assessment of mobility, search for muscle spasms and associated neurological signs
• Lumbar MRI (key investigation): shows the "dark signal" of the dehydrated disc and changes in the vertebral endplates (Modic changes)
• Dynamic X-rays: in flexion-extension, they reveal any instability between the vertebrae
• Provocative discography: a specialised test that can reproduce the pain by injecting into the suspect disc (rarely necessary)
Treatment
The essential message: movement is the best treatment. Prolonged rest makes low back pain worse. The goal is to stay active while managing the pain:
Conservative treatment (in the vast majority of cases)
• Adapted physical activity: walking, swimming, yoga, lumbar "core" strengthening
• Active physiotherapy: stabilisation exercises, stretching, postural education
• Painkillers and anti-inflammatory drugs for acute flare-ups
• Injections: facet joint or epidural, depending on the dominant pain component
Surgical treatment (selected cases)
• Indications: only after prolonged failure of well-conducted medical treatment (at least 6 to 12 months) and significant functional impairment
• Lumbar fusion (arthrodesis): fusing two vertebrae to eliminate the painful disc movement
• Disc replacement: replacing the diseased disc with a mobile implant (in selected younger patients)
Key figures
80%
Of the population will experience low back pain at least once in their lifetime
90%
Of acute episodes resolve spontaneously within 6 weeks
35%
Of young adults (age 20) already show MRI signs of disc disease — without any pain
Recovery after surgery
When lumbar fusion is performed for disabling disc disease, patients are encouraged to stand the day after surgery. The hospital stay lasts 3 to 5 days. A soft lumbar brace may be prescribed for 4 to 6 weeks to support healing. Chronic low back pain, often present for months or even years, gradually improves during the first postoperative weeks.
Daily walking is encouraged from the time of discharge. Driving is generally possible from week 4. A rehabilitation programme begins around week 6, focusing on deep core strengthening and postural re-education. Return to work occurs between 2 and 4 months depending on the type of job. In the case of a disc replacement, recovery is often faster because segmental mobility is preserved, with a return to normal activities as early as 6 to 8 weeks.
Consultation with Dr Dimitriu
Dr Christian Dimitriu, a neurosurgeon specialising in spine surgery, manages chronic low back pain and degenerative disc disease that has not responded to medical treatment. During the consultation, he performs a thorough clinical examination (mobility assessment, discogenic provocation tests, neurological evaluation) and carefully reviews the lumbar MRI, paying particular attention to Modic changes and the degree of disc dehydration.
Dr Dimitriu emphasises the importance of conservative treatment first: active physiotherapy, core strengthening and targeted injections. Surgery is only proposed after failure of well-conducted medical treatment for at least 6 months, and only when functional impairment is significant. If an operation is indicated, he discusses the different options — fusion or disc replacement — based on the patient's age, the level involved and the clinical profile, ensuring a shared and informed decision.
Prevention and lifestyle
Preventing chronic low back pain relies on maintaining regular physical activity. Strengthening the deep trunk muscles (transversus abdominis, multifidus) creates natural support for the lumbar spine. Activities such as swimming, Pilates, yoga and Nordic walking are particularly beneficial. Workplace ergonomics are also essential: correct screen height, regular breaks from sitting, alternating between sitting and standing.
Maintaining a healthy weight significantly reduces the load on the lumbar discs. Stopping smoking is strongly recommended, as tobacco impairs disc microcirculation and accelerates degeneration. Proper lifting technique (bending the knees, keeping the load close to the body) should be applied consistently. Finally, managing stress and sleep plays an important role: psychosocial factors are recognised as key elements in the progression of low back pain to a chronic state.
Consultations in Île-de-France
Dr Dimitriu practises at 4 facilities in the Paris region (Île-de-France), easily accessible from central Paris: Clinique de l'Yvette (Longjumeau), Hôpital Privé d'Antony, Clinique du Mont-Louis (Les Lilas) and Hôpital Privé de l'Ouest Parisien (Saint-Cloud). See addresses and book an appointment.
Frequently asked questions
No, prolonged bed rest actually worsens low back pain. Current guidelines recommend staying as active as possible, adapting activities to the level of pain. Walking, gentle movement and gradual resumption of daily activities speed recovery and help prevent the pain from becoming chronic.
Surgery is only considered after well-conducted medical treatment lasting at least 6 to 12 months, when there is significant functional impairment. Options include spinal fusion (arthrodesis) or disc replacement in selected younger patients. Fewer than 5% of chronic low back pain patients require surgery.
Not at all. Around 35% of 20-year-olds already show MRI signs of disc disease without any pain. Disc degeneration is a natural ageing process. Only the correlation between imaging findings and clinical symptoms can determine whether the disc disease is actually responsible for the pain.
Swimming (especially backstroke), Nordic walking, cycling, yoga and Pilates are particularly recommended. Core abdominal and lumbar strengthening is essential. It is advisable to avoid high-impact sports (running on hard surfaces, heavy weightlifting) and repeated twisting movements without proper preparation.
Sources: WHO · HAS (Chronic low back pain, 2019) · SFCR · Brinjikji et al., AJNR 2015.