Cervical disc herniation

Symptoms of cervical disc herniation are intense pain, frequently radiating into the arms, and often accompanied by a feeling of numbness in the area supplied by the trapped nerve root. If the herniated disc presses against the cervical spinal cord, can lead to paraplegia. Alarm signals are a change in gait pattern and increasing paralysis.
Conservative treatment is possible in many cases, with the exception of the above-mentioned signs of paraplegia.

Surgical treatment is performed in the case of:

• Unsuccessful conservative therapy
• Increasing muscle weakness ;
• Pain that cannot be controlled with medication
• Emergency: paraplegia

Established surgical methods are:

• Cervical decompression and fusion
• Disc replacement

Lumbar disc herniation

Symptoms of lumbar disc herniation are intense pain, frequently radiating into one or both legs (lumbar vertebrae), and often accompanied by a feeling of numbness in the area supplied by the trapped nerve root. Occasionally, signs of paralysis in the limbs may also be experienced. In extreme cases, paraplegia can occur. Alarm signals are faecal or urinary incontinence and saddle anaesthesia (numbness in the area of the genitals and the inner surfaces of the thighs). ; Conservative treatment is possible in many cases, with the exception of the above-mentioned signs of paraplegia.

Surgical treatment is performed in the case of:

• Unsuccessful conservative therapy
• Increasing muscle weakness
• Pain that cannot be controlled with medication
• Emergency: faecal or urinary incontinence and saddle anaesthesia

Established surgical methods are:

• Microsurgery
• Microscopically assisted percutaneous nucleotomy (MAPN)
• Fusion surgery

Surgical treatment is performed in the case of:

• Unsuccessful conservative therapy
• Increasing muscle weakness
• Pain that cannot be controlled with medication
• Emergency: faecal or urinary incontinence and saddle anaesthesia

Established surgical methods are:

• Microsurgical decompression
• Microscopically assisted percutaneous decompression (MAPD)
• Fusion surgery, if instability is also present

In a few isolated cases, the upper vertebra slides a long way forward. Beside back pain, overextension of the nerves can lead to pain in the legs ranging up to functional losses.
Conservative treatment is possible in the case of moderate instability symptoms.

Surgical treatment is performed in the case of:

• Unsuccessful conservative therapy
• Increasing muscle weakness
• Pain that cannot be controlled with medication

Established surgical methods are:

• Fusion surgery with decompression
• PLIF (posterior lumbar interbody fusion)
• TLIF (transforaminal lumbar interbody fusion)
• ALIF (anterior lumbar interbody fusion)

Pathological fracture (due to tumour spread/metastasis)

Spinal tumours are classified as primary and secondary:

Only around 5 percent of all primary tumours of the skeleton are localised in the spine. They can be benign or malignant. Tumour-like lesions or benign bone tumours such as haemangiomas, osteoid osteomas, osteoblastomas or aneurysmal cysts are rare. Primary malignant tumours are very rare and include giant-cell tumours, chordomas, chondro-, Ewing’s, fibro- or osteosarcomas.

Secondary spinal tumours (metastases) are caused by the spread of a tumour into distant tissue (e.g. the spine). Cancers of the breast, kidneys, prostate gland and lungs often metastasise into the spine. Spinal metastases are most commonly found in the thoracic spine (70%), followed by the lumbar spine (20%) and the cervical spine (10%).

Symptoms can include different levels of pain, caused by osteolysis (dissolution of bone) in the area of the affected vertebral body. This may be accompanied by pathological fractures and neurological dysfunctions over the further course, which become manifest in the form of sensory deficits, bladder/rectal disorders and ranging up to paraplegia.

In some cases, the finding is made by chance during routine diagnostic procedures. A sample biopsy from the vertebral body is often helpful to establish the diagnosis. The therapy must be adapted individually to the patient’s needs. Among other things, the type of primary tumour, the tumour stage and the general condition of the patient are taken into account. In some cases, the only option available is to provide sufficient pain therapy.

Established surgical methods are:

• Vertebroplasty
• Balloon kyphoplasty
• Minimally invasive stabilisation
• Decompression
• Vertebral body replacement

In rare cases, it occurs as a result of injections close to the spine. The predisposing factors are: diabetes, obesity, alcohol dependency, immunosuppression. Sepsis can lead to the dissolution of a disc, abscess formation in the muscles or in the spinal canal (epidural abscess), ranging up to a “melting away” of the adjacent vertebral body.

The symptoms are usually unspecific and range from a general feeling of fatigue, bouts of fever, and back pain, all the way up to signs of paraplegia. In uncomplicated courses, conservative treatment can be given in the form of rest and administration of an antibiotic.

An operation is necessary in the case of:

• Lack of response to conservative therapy
• Abscess formation
• Neurological deficits
• Bone destruction posing a risk to stability

Established surgical methods are:

• Sample biopsy to determine pathogens
• Microsurgical decompression and lavage
• Minimally invasive stabilisation
• ALIF – abscess removal
• Minimally invasive surgery

In these patients, treatment is based on physiotherapy according to Schroth. Additional treatment forms that come into question are a corset and correctional surgery. However, most patients get by without an operation.

We offer you the whole spectrum of scoliosis therapy. Beside the experience of the medical staff in the Spine Department and Paediatric Orthopaedics, the qualified physiotherapy team and our hospital’s own orthopaedic technology unit are an enormous advantage for the treatment of our scoliosis patients.

We are also able to treat special forms of scoliosis that occur at a very early age. Among other things, so-called growth-friendly implants that grow with the child are used here.

We also treat the increasingly frequently occurring form of wear-related, so-called “de-novo” scoliosis. As a general rule, patients with such curvature of the spine undergo staged diagnostics, before being allocated to individually adapted treatment. All aspects of conservative therapy (infiltration, denervation, multimodal therapeutic approaches) are applied, as well as surgical forms of therapy if nonsurgical measures fail.

Hyperkyphosis can occur during growth, e.g. in the case of Scheuermann’s disease, as well as in advanced age, e.g. due to osteoporosis, wear, fractures, or Bekhterev’s disease. ;