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diagnosis
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Neurosurgery Diseases

We focus on the treatment of spinal diseases and offer the entire spectrum of surgical and non-surgical therapy procedures.

We offer the following treatments among others (listed in the order of diseases):

Disc prolapse


Conversation/Medical history
The most important part of the examination is the conversation with you. We discuss with you when the symptoms started, whether a sensory disturbance or weakness is present, etc. To determine the extent of nerve damage due to disc prolapse, we perform a comprehensive neurological examination. We check your reflexes and sensitivity, and the gross strength of nerves in the vicinity of the prolapsed disc.

Diagnosis
The investigation methods used to examine disc prolapse also include so-called imaging procedures like Computed tomography and Magnetic resonance imaging. They enable us to obtain a direct view of the spinal canal and nerves. The purpose here is to establish whether the clinical condition has been caused by anatomical changes. This is because any treatment is meaningful only when the symptoms, clinical findings, and imaging reports concur with each other. If this is not the case, we will initiate further diagnostic measures.

Conservative treatment
Protection, heat therapy, and drug-based pain therapy for a period of four to six weeks alleviate the symptoms effectively in the majority of cases. Ninety percent of patients with a disc prolapse can be treated successfully by these conservative measures and without surgery!

Injection treatment
When conservative measures alone do not alleviate the symptoms, drugs may be injected at the affected nerve root. We usually perform such so-called PRT (periradicular therapy) under X-ray guidance on computed tomography or even fluoroscopy.

Surgical treatment
Despite the critical viewpoint that operations are performed too frequently, one should not forget that there are very clearly defined indications for surgery. If there is nerve damage - which you will perceive as a weakness or palsy of muscles - surgery is unavoidable. A further indication for surgery is lack of symptomatic improvement after conservative therapy. Whether a surgical intervention is meaningful or desirable in these cases depends on the limitation of your quality of life. We will discuss this subject with you. In such interventions, it is now common practice to use so-called microsurgical procedures with a small surgical access.

Follow-up treatment
In every case, after conservative or surgical treatment of disc prolapse, active follow-up treatment is a must. You undergo targeted exercises for your abdominal and spinal muscles, and receive physiotherapy.
  • Prevention
  • Strengthening the muscles of the trunk
  • Improving strains in daily life (back pain prevention)
  • Reducing overweight
  • Giving up smoking
You thus improve the nourishment and care of your intervertebral disc and, by the way, your entire body as well. Your body will be grateful to you for these measures.

Lumbar spinal stenosis


Pain treatment
To alleviate acute pain we use so-called analgesic agents - so-called non-steroidal anti-inflammatory drugs (NSAID), such as ibuprofen, diclofenac or paracetamol. However, these drugs should only be used for a short period of time; they are no permanent solution for the disease.

In cases of very severe pain we can perform a so-called epidural infiltration. We inject a local anesthetic - in some cases combined with cortisone - directly into the spinal canal. This is usually performed under X-ray control. Pain can be alleviated temporarily by this procedure.

Physiotherapy
The muscles of the trunk can be specifically strengthened by suitable exercises. Your symptoms can thus be reduced to an appreciable extent.

Surgery
To reduce pressure on nerve fibers and thus alleviate symptoms in the long term, we use a variety of surgical interventions. A number of surgical procedures, in keeping with the state of the art in science and technology, are available to achieve this end, which is also known as decompression.
We no longer perform complete resection of the vertebral arch or so-called laminectomy. Instead, we use a microsurgical technique under microscopic control with a high-speed milling device, and only remove the bony portion that causes narrowing of the canal.
If the narrowing of the spinal canal is due to the instability of a so-called listhesis (slippage), we use the procedures described in the section entitled Spondylolisthesis.

Spondylolisthesis


Diagnosis
If your medical history, symptoms, and your preliminary examination reports show signs of a slipped disc, we establish your disease by performing X-ray investigations in upright position, as well as so-called functional images in forward and backward bending position. Functional images of the lumbar spine in forward and backward bending position may depict the slipped disc when the malalignment is not fixed. With the aid of magnetic resonance imaging we can then evaluate the spatial impairment of the spinal canal. The extent of displacement of the vertebral body according to Meyerding’s classification (grades 1-4) can be determined on X-ray investigation. X-rays in two planes are obtained for this purpose.

Pain treatment
We use analgesic agents to achieve pain relief, so-called non-steroidal anti-inflammatory drugs (NSAID), such as ibuprofen, diclofenac or paracetamol, and muscle relaxants. However, these drugs should only be used on a temporary basis - they are no permanent solution for the disease. In case of very severe pain it may be meaningful to consider measures such as infiltration at the site of pain. Bed rest may also be helpful.

Physiotherapy
Once the acute phase has abated, active physiotherapy is a crucial measure. Treatment with a corset is only meaningful when used in conjunction with active strengthening of abdominal and spinal muscles.
In this context we also discuss your professional activity and leisure sports, and advise you in case it would be necessary for you to reduce weight. Your complaints can be perceptibly reduced by these measures.

Surgery
Spondylolisthesis can usually be treated effectively only by an extensive surgical intervention. Therefore, symptomatic treatment should be used as long as possible. This is especially true in view of the fact that the process of herniation may come to a standstill at any stage. Depending on age, surgical procedures are used only in cases of very advanced slippage of the vertebral body, therapy-resistant symptoms, or neurological deficits.
In surgical treatment we aim to achieve stabilization of the loose segment. This is usually required in younger patients. The intervention is generally performed with a screw-rod system and so-called cages in the disc space.
Dynamic stabilization with a movable rod system may be used in selected cases. However, this requires very careful diagnostic investigation.

Permanent therapy
For symptomatic treatment of spondylolisthesis, in the long term you will have to focus on active stabilization of muscles. Therefore, regular exercise is indispensable. This is also true when the affected motor segment has been stabilized surgically.

Facet joint syndrome


Diagnosis
Attrition of intervertebral joints is seen on X-ray investigations in nearly all persons beyond a certain age. Therefore, X-ray investigations are frequently not useful to establish the diagnosis. The patient’s medical history, the exclusion of other diseases of the spine, and if necessary a test injection into the intervertebral joint will confirm the diagnosis. For a so-called facet injection we anesthetize the presumably affected intervertebral joint in a targeted manner. This is performed under image-guided control, such as computed tomography or X-ray fluoroscopy. After checking the position of the needle on the imaging procedure, a local anesthetic is administered. When the pain experienced during the injection is very similar to the pain experienced previously by the patient, and when it improves during the anesthetic procedure, it may be concluded that the patient has a facet joint syndrome.

Pain treatment
We use analgesic medications to achieve pain relief, so-called non-steroidal anti-inflammatory drugs (NSAID), such as ibuprofen, diclofenac or paracetamol, and muscle relaxants. However, these drugs should only be used on a temporary basis - they are no permanent solution for the disease.

Physiotherapy
Symptom-oriented physiotherapy is very helpful to alleviate symptoms. We focus on building up the muscles of the abdomen and the spine, and thus deloading and stabilizing the entire spine. In addition to physiotherapy you should do regular sports. You should select those types of sports that do mobilize the intervertebral joints, but do not impose a strain on them. These include biking, walking, or backstroke swimming.

Facet blockade
We may perform so-called facet blockade when all other treatment methods have been ineffective. We inject a local anesthetic combined with cortisone into the diseased intervertebral joints. This alleviates pain and inhibits inflammatory processes in the affected joints. However, quite often the injections alleviate the symptoms just for a limited period of time.
When facet blockade is no longer successful, we may perform sclerotherapy in the region. The small nerve that conducts pain to the facet joint is selectively heated. This treatment frequently alleviates the symptoms, but based on experience we know that the effect is sustained for just a few years.

Facet joint sclerotherapy
We are one of the few clinics that offer sclerotherapy of facet joints as an endoscopic procedure. The endoscopic access to facet joints is a truly minimally invasive method. The endoscope provides images of the actual site of origin of pain. We are then able to immediately draw conclusions about the causes and perform treatment in the same session. As the camera of the endoscope provides very clear images, the radiation burden associated with other frequently used imaging procedures such as X-ray or computed tomography can be reduced. By this method of microtherapy, only those nerve fibers responsible for transmitting pain signals to the brain are blocked. Usually the patient experiences marked symptomatic relief immediately after the intervention, or is entirely free of pain. As the nerve fibers can grow again, it may be necessary to repeat the treatment after a few months or years. However, the endoscopic procedure is so gentle that it can be repeated without difficulty.

Vertebral body fracture


Kyphoplasty
Balloon kyphoplasty is a minimally invasive procedure to remedy vertebral body fractures. Fracture treatment with balloon kyphoplasty takes about one hour (per segment). Depending on the individual patient, the procedure usually requires an in-hospital stay of a few days.
Balloon kyphoplasty can alleviate or eliminate back pain due to a vertebral body fracture, and restore the height of the vertebral body. Under X-ray guidance, two small incisions are performed. A balloon is then introduced into the vertebral body and inflated. The height of the vertebra is restored by this procedure. Bone cement is then applied to stabilize the cavity thus created.

Neuromodulation for pain syndromes


What we offer
We offer a neuromodulative procedure for these patients. So-called spinal cord stimulation (SCS) is a minimally invasive treatment for chronic pain. The posterior funiculus of the spinal cord is stimulated through an electrode introduced into the epidural space, using mild electric currents. The duration of the impulse, its frequency, and its amperage can be set and adjusted through an external programming device. The painful area must be covered with the tingling paresthesia triggered by stimulation. Owing to the anatomy of the spinal cord and its nerve supply, pain in the extremities can be treated particularly well by such stimulation. Regulation and power supply are achieved by an impulse generator usually implanted below the abdominal wall; the generator is similar to a cardiac pacemaker.
The intervention can be performed on an inpatient or outpatient basis. A number of approved indications are accepted by the health insurance companies. These include therapy-refractory (i.e. not responding to common treatment) sciatic pain (pain in the legs), peripheral arterial obstructive disease (PAOD), and the complex regional pain syndrome I and II (CRPS/Sudeck’s atrophy).