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Waldkliniken Eisenberg

German Centre for Orthopaedics

Spine Department

If you are suffering from a spinal disorder, the first thing we do is to perform comprehensive diagnostic measures. We then offer you optimal therapy that is designed to meet your individual needs.

Beside all forms of conservative treatment and therapy, in the case of chronic pain and under specific circumstances, we offer the option of multimodal pain therapy. In this holistically orientated method, pain therapists, spinal specialists, psychologists and physio- and ergotherapists work hand in hand.

In addition, the department has comprehensive expertise in all modern surgical methods, from the treatment of spinal disc herniations and the implantation of disc replacements to spinal fusion. Apart from this, our doctors and therapists are specialised in the field of scoliosis (lateral curvature of the spine).

Our team of doctors

No doctors found

PD Dr. Patrick Strube

Senior physician
Spine
036691-81439 (Terminvergabe: 036691-81602)

Head of the Spine Department

Specialist for orthopaedics/trauma surgery; Specialist for orthopaedic surgery; Master’s certificate of the German Spine Society

Dr. Alexander Hölzl

Senior physician
Spine

Specialist for orthopaedics & trauma surgery; special trauma surgery, emergency medicine; Master’s certificate of the German Spine Society

Dr. Timo Zippelius

Senior physician
Spine

Specialist for orthopaedics & trauma surgery; special orthopedic surgery

Dr. Sophia Vogt

Specialist
Spine

Fachärztin für Orthopädie und Unfallchirurgie

Dr. Christian Fisahn

Specialist
Spine

Dr. Christian Lindemann

Assistant physician
Spine

Dr. Sabrina Böhle

Assistant physician
Spine

Kristian Heinz

Assistant physician
Spine

Spinal disc herniation

Spinal disc herniation

In the case of spinal disc herniation (also called a slipped disc or prolapsed disc), gelatinous parts of the disc extend into the spinal canal. In the case of disc protrusion, parts of the fibrocartilaginous ring of the intervertebral disc bulge into the spinal canal. The protruding disc tissue can exert pressure on the contents of the spinal canal (spinal cord and nerve roots).

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

Spinal canal stenosis

Spinal canal stenosis

The term spinal canal stenosis is used to describe a circumscribed narrowing of the spinal canal. This can lead to a compression of the spinal cord, nerve roots or nerves. It is commonly caused by wear phenomena, in rare cases by acute injuries or tumours.

 

Cervical spinal canal stenosis (cervical spine)

The occurrence of symptoms is dependent upon the localisation and extent of the stenosis. Under weight-bearing, increasing pain, sensory disturbances and impairments of urination and defaecation may occur, as well as muscle paralysis ranging up to paraplegia.
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

 

Lumbar spinal canal stenosis (lumbar spine)

The occurrence of symptoms is dependent upon the localisation and extent of the stenosis. Under weight-bearing, increasing pain, sensory disturbances and impairments of urination and defaecation may occur, as well as muscle paralysis ranging up to paraplegia.
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:

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

Spondylolisthesis

Spondylolisthesis

Spondylolisthesis (vertebral slippage) is a sign of spinal instability. It occurs when degeneration leads to a weakening of the connections between the vertebrae. Above all loosening in the area of the joints and ligaments leads to a slippage of the vertebrae. This instability manifests itself in back pain, which is more intense under weight-bearing.

Nocturnal pain, for example when turning over in bed, is a sign of greater instability. The body tries to compensate the loss of stability by new bone formation (spondylosis), joint enlargement (spondylarthritis) and thickening of ligament structures (ligamentum flavum hypertrophy), which additionally leads to narrowing of the spinal canal (so-called "spinal canal stenosis"), with pressure on nerve structures. In younger patients, the cause may be a congenital weakness or loosening of the so-called isthmus (spondylolysis).

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)

Vertebral body fractures

Vertebral body fractures

Depending on the cause, vertebral body fractures are differentiated into three categories:

  1. Traumatic fracture (accident-related)
  2. Osteoporotic fracture (due to bone depletion)
  3. Pathological fracture (due to tumour spread/metastasis)

Traumatic vertebral body fractures (accident-related)

Spinal injuries are relatively rare in comparison with other injuries of the locomotor apparatus and occur with an incidence of approximately one percent of all injuries. The consequences for the injured person may mean dramatic impairments of their quality of life. Most frequently affected is the transition from the thoracic spine to the lumbar spine (thoracolumbar transition), the second cervical vertebra and the transition from the cervical spine to the thoracic spine.

Over the further course after injury, curvature of the spine (posttraumatic kyphosis) can occur, so that neurological problems may become apparent even years afterwards.

The objective of treatment is rapid pain reduction as well as mobilisation of the patient. Neurological disturbances should be avoided, reduced or alleviated. Surgical fusion of sections of the spine is often unavoidable. We try to solve the patient’s problems with the least possible surgical effort.

 

Osteoporotic fracture (due to bone depletion)

“Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk.” (WHO definition of 1993)

This means that too little normal bone tissue is available and more bone is broken down than is newly formed. If the body has lost 40 percent of its bone mass, there is an acute risk of fracture of the spine, the neck of the femur and of the radius, even in injuries involving minimal energy.

The risk of suffering an osteoporosis-related vertebral fracture over the course of later life is 40 percent in women over the age of 50 years. In other words, four out of ten women who are 50 years old today will go on to suffer from a vertebral fracture, from a statistical point of view. The risk of suffering a second vertebral fracture is 8-10-fold higher after the first fracture.

Conservative treatment is possible in the case of moderate symptoms, insofar as no threat of further deformation or damage to nerve structures. The important thing in all forms of treatment is the diagnosis and therapy of osteoporosis.

Established surgical methods are:

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

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

Inflammations

Inflammations

Infections of the spine are rare. If the intervertebral disc is affected one refers to a spondylodiscitis, if the vertebral body is affected one refers to a spondylitis. Infection is commonly caused by bacteria spreading from another infection focus (e.g. pneumonia, a urinary tract infection, or open wounds).

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

Fatigue fracture of the sacrum

Fatigue fracture of the sacrum

A fatigue fracture of the sacrum occurs as a result of reduced bone quality, e.g. due to osteoporosis (age-related, cortisone therapy, etc.) or tumour diseases. It occurs spontaneously or as a result of minor trauma. In over 70 percent of the cases, the fracture occurs on both sides.

The diagnosis is mostly rendered at a late stage, often after a long period of suffering, or not at all. In the Spine Department, we deal with this subject very intensively. We have our own therapy algorithm and a surgical method for treating fatigue fractures of the sacrum.

A fatigue fracture of the sacrum becomes apparent through deep-seated pain that increases upon weight-bearing. The pain often radiates into the groin and/or into the thighs. The symptoms may begin gradually or suddenly. Sometimes, the patients can no longer walk. Fatigue fractures are diagnosed by clinical examination, supported by x-rays, CT and MRI.

We always start treatment with an initial conservative therapeutic approach. Under adequate pain therapy, the patient is mobilised with the aid of our physiotherapists and, if necessary, an orthosis is fitted. If mobilisation is not possible with a minimum of pain, we recommend surgical treatment.

We carry out a newly developed minimally invasive stabilisation of the sacrum, which enables immediate mobilisation after the operation. A hospital stay of around five days is required if surgical treatment is required.

Scoliosis, (hyper-)kyphosis

Scoliosis, (hyper-)kyphosis

The most common forms of scoliosis occur during the growth phase of children and especially adolescents. Girls are affected more often than boys. Treatment mainly depends on the degree of curvature and the remaining growth to be expected.

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. ;

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