Our treatment focus in spine surgery includes conservative and surgical treatment of traumatic (e.g. vertebral body fractures), degenerative (e.g. spinal stenosis and herniated disc) and tumor-related (e.g. meningioma, schwannoma, metastasis) diseases.
Degenerative diseases are caused by age-related wear and tear. One of the most common degenerative diseases is spinal stenosis, a narrowing in the spinal canal. It can affect both the cervical spine (cervical spinal stenosis) and the lumbar spine (lumbar spinal stenosis). Due to the steadily growing proportion of older people in the population, the diagnosis of spinal stenosis is constantly increasing.
Another common degenerative spinal disease is herniated discs in the cervical and lumbar spine. Here, viscous material escapes from the disc nucleus (nucleus pulposus) and "squeezes" nerve structures in or outside the bony spinal canal.
Degenerative changes in the spine can eventually lead to instability and so-called spondylolisthesis.
Affected individuals often report long-standing, slowly or suddenly increasing back and/or leg pain caused by painful irritation (radiculopathy) or damage to nerve roots and degenerative changes at the vertebral joints (spondyloarthrosis), intervertebral disc spaces (discopathy) or vertebral bodies (osteochondrosis).
These pathological changes cause back or neck pain or radiate into the legs or arms at rest or under stress and are then described as painful radiculopathy. The pain, which primarily occurs during walking or movement, typically limits the ability of affected individuals to cover longer distances (50-500m) (neurogenic spinal claudication). As the disease progresses, neurological deficits such as sensory disturbances and paralysis (senso-motoric deficit syndrome), pain at rest, bladder and rectum disorders (incontinence) and sexual dysfunction (conus cauda syndrome) are possible.
The general desire for mobility, activity and a high quality of life in the long term has fortunately led to further development of conservative, but also surgical treatment methods. Therefore, after diagnosis, it makes sense to choose a treatment individually tailored to the patient together with other specialties.
A significant percentage (approx. 70-80%) of those affected with a herniated disc can be treated conservatively, i.e. without surgical intervention. Pain medication (local, oral, CT infiltration), targeted physiotherapy and/or other measures (chiropratics, osteopathy) often lead to a significant improvement in symptoms. Only if these measures do not show any success or even new complaints, such as paralysis and sensory disturbances, are added, is microsurgical decompression or an alternative surgical procedure advisable.
This low-risk and minimally invasive procedure uses "high-tech methods" such as a high-resolution surgical microscope, intraoperative imaging (real-time moving X-rays, intraoperative computed tomography, neuronavigation, endoscopy) and, if needed, intraoperative neurophysiological monitoring.
If the spine has also become unstable in the course of the disease, individual vertebrae can be stabilised by inserting screws, rods and "cages" (called spondylodesis or fusion). As a rule, mobility is not completely restricted by this - on the contrary: the reduction in symptoms usually leads to an improved quality of life and well-being for those affected.
A frequent consequence of vertebral body fractures after falls or minor trauma or spontaneously (osteopenia/osteoporosis) is considerable to immobilizing back pain. Occasionally also in connection with neurological deficiency symptoms (paralysis-feeling disorder, bladder-mast disturbances). A significant number of these fractures can be successfully treated conservatively for weeks to months. If this is unsuccessful, gentle surgical procedures such as vertebroplasty or kyphoplasty are available. In the case of complex fractures with malpositions and/or neurological deficits, the indication of a more complex surgical procedure (instrumentation/spondylodesis/vertebral body replacement) must be discussed.
In the treatment of severe (nerve) pain, the focus is on finding the actual origin of the pain in order to treat it specifically. By studying the medical history, physical examination, pain protocol and use of imaging techniques (CT/MRI or X-ray) and possibly electrophysiological examinations (SSEP,MEP), a specialist can diagnose the cause of the pain in most cases.
In a first step, an attempt is made to treat the pain conservatively - i.e. without intervention - with medications and physiotherapy, etc. If the effect remains insufficient, various measures of interventional pain therapy are applied, depending on the diagnosis: Nerve root infiltration, radiofrequency treatment, facet joint infiltration, thermocoagulation, cryotherapy, intrathecal pain pump, neurostimulator.
