Spinal disc herniation

An operation is usually unnecessary

More than 200,000 operations are normally carried out per year in Germany owing to spinal disc herniation (slipped disc). For the most part completely unnecessarily because conservative and minimally-invasive therapies are often more promising than surgery in the case of spinal disc herniation and back pain can also be quickly brought under control. Below you can find out all you need to know about the causes, symptoms and prevention of spinal disc herniation as well as treatment possibilities.

Our intervertebral discs enable us to twist and move our upper body sideways. They also act as a kind of “buffer”, absorbing shocks and vibrations in the spine. They have a layer of cartilage that is only a few millimetres thick and sits between the osseous vertebrae, ensuring that they do not rub directly against each other. The intervertebral discs themselves are made up of a soft core of aqueous gelatinous mass (80 per cent water) and a taut ring of fibrous cartilage (anulus fibrosis) surrounding it.

What happens in a spinal disc herniation?

Medizinische Grafik Hervorgetretene Bandscheibe

Medical graphics: Protruded intervertebral disc

From the age of around 20, the intervertebral discs start to wear out either more or less severely, depending on the strain placed on them. Over the years they also lose elasticity and solidity owing to a gradual reduction of the water content, among other things. Both processes can lead to tears in the outer fibrous ring and, depending on the strain incurred, to gelatinous mass leaking into the spinal canal.

This usually happens when the adopting a bending posture or movement: Thus the front side of the disc (pointing to the stomach) is compressed and the disc core is squeezed backwards. As a result, the disc core presses against the surrounding fibrous ring until the ring is no longer able to withstand the pressure, so it tears due to the pressure and the wear: The gelatinous content of the disc then leaks into the spinal canal (prolapse) and presses against the nerves located there, which can lead to severe pain.

What causes spinal disc herniation?

It is well known that you should not lift heavy objects by bending your back but by bending your knees with a straight upper body – few people stick to this rule, however. For some activities such as in nursing, “correct lifting” is not even possible. The discs between the five lumbar vertebrae, in particular, are put under enormous strain by lifting heavy loads when the upper body is bent meaning that they wear out much faster (lumbar spinal disc herniation) – the disc between the fourth and fifth lumbar vertebrae is the most affected. If the back is straight, the forces are distributed much more evenly over the discs and the muscles can support the spine better. That is why constant sitting and frequent lifting with a bent back enormously increases the risk of spinal disc herniation. The discs are also severely put under strain during pregnancy.

These days there are significantly more spinal disc herniations than in the past, but this is mainly due to an increasingly unhealthy lifestyle: Lack of exercise, poor posture during continually more office work and excess weight. Often it is then the sudden and severe stress placed on untrained backs with intervertebral discs worn down over many years that leads to prolapse, such as lifting a beverage crate.

What are the symptoms of spinal disc herniation?

Schmerzen Lendenwirbelsäule

Lumbar spine pain

Back pain does not necessarily mean that spinal disc herniation has occurred because this is only responsible for a small percentage of all back pain. Spinal disc herniation – above all in the elderly – often occurs without symptoms, needs no treatment and is not even noticed.

Typical symptoms for most herniated discs are localised, severe and stabbing back pain (lumbago). This can occur exclusively in the back or the arms and hands (brachialgia), or more frequently in the legs and feet (sciatica), depending on the region affected. More men than women are affected, particularly between the ages of 35 and 45.

The back pain usually increases when put under strain, the muscles of the spine become tense and harden in a reflex action and feel stiff. Every movement makes the symptoms worse, meaning that those afflicted resort to a relieving posture. Sneezing and coughing also make lower back pain worse.

Pressure on the nerves in the spinal canal can also cause abnormal sensations (paresthesia) such as numbness, tingling, a feeling of coldness, but also paralysis or other neurological dysfunctions in the bladder or rectum for example. This symptom distinguishes spinal disc herniation from lumbago.

How is spinal disc herniation treated?

Behandlungsbeispiel Akupunktur

Treatment example: Patient acupuncture

We aim to treat spinal disc herniation with conservative therapy as far as possible. Pain therapy takes a high priority here. Pain-relieving and anti-inflammatory medication helps to avoid the relieving postures that create additional tension in the back muscles and make the symptoms worse. And warmth can also bring improvement: Circulation is stimulated and the tense muscles are loosened. The options of conservative treatment also include acupuncture, osteopathy or massage.

For particularly stubborn complaints we use infiltrations near the spine for diagnosis and treatment such as:

  • Discography: X-ray and contrast-enhanced procedure for displaying the disc
  • Epidural injections: by using image intensifier control technology, local pain-relieving and anti-inflammatory preparations are injected into the spinal canal of the affected lumbar vertebral segment
  • Periradicular therapy (PRT): Treatment for spinal disc herniation by injecting pain-relieving and anti-inflammatory substances directly into the area of the affected nerve root

Spinal catheter technique according to Dr Schneiderhan

Beweglicher Katheter - Kathetermethode nach Dr. Schneiderhan

Spinal cord endoscopy (elastic catheter)

Dr Schneiderhan further developed the spinal catheter technique according to Prof. Dr Racz. With this special stretchy catheter, we are able to treat precisely the affected nerve root, alleviating pain rapidly and in a targeted way. As pioneers in Germany of this minimally-invasive treatment method, which is now recognised worldwide, we offer our patients the highest level of expertise, as we have been performing most operations of this type in Europe for many years.

Physiotherapy

Alongside pain therapy, physiotherapy plays a central role in the treatment of spinal disc herniation. For example, isometric strengthening therapy helps to stabilise and activate individual muscle groups by actively tensing certain muscles and muscle groups. If the exercises are performed regularly, the spine is relieved and patients rapidly feel better.

When must spinal disc herniation be treated surgically?

When is surgical treatment of spinal disc herniation necessary?

  • When the pain is ongoing over a long period and has not improved with conservative therapy
  • When the pain radiates into the arms and legs and if dysesthesia (disturbance of sensitivity) or paralysis is present
  • If bladder or bowel function is disturbed
Physiotherapie am Patienten

Example of treatment: Physiotherapy on the patient

The possibilities of conservative treatment should always be exhausted before an operation is considered because the majority of intervertebral disc operations are unnecessary. Minimally-invasive spinal surgery is sufficient to eliminate the symptoms in many cases. Here we use micro laser treatment which does not require a cut to be made. Thanks to this method, pain caused by spinal disc herniation can be treated in a targeted and effective way. Micro laser therapy according to Dr Schneiderhan also allows treatment in particularly narrow and difficult-to-access areas of the intervertebral discs of the cervical and lumbar spine.

Mikrolaser

Dr. Schneiderhan shows microlasers

If an operation to treat an intervertebral disc is recommended, we micro-surgically remove the part of the gelatinous core that has prolapsed so that the nerve roots can be alleviated. From the removed intervertebral disc tissue, cells can, in turn, be taken which, thanks to autologous disc cell transplantation (ADCT), can be reinserted into the affected disc after a cultivation period of about three months to form new disc tissue there.

Your advantage with us: customised treatment concept

We have been making life without back pain possible for patients since 1993. We particularly specialise in treating spinal disc herniation. With us, you are directly at the source of state-of-the-art medical techniques as well as the highest level of expertise in successfully treating ailments of the spine. Alongside tried & trusted treatment methods we also offer you innovative therapy concepts for your back health. These include our interdisciplinary pain consultations in which our specialist doctors develop a tailored and interdisciplinary treatment concept for you.

Expert advice:

<<In Germany there are too many operations for spinal conditions. This often occurs if a patient goes directly to a doctor who performs operations himself or if he refers the patient to a surgeon. In interdisciplinary centres, however, doctors of different specialist fields discuss the best treatment together. Colleagues of different specialist fields consider whether an intervention is actually necessary. We know that acute back pain often gets better spontaneously, or can be successfully treated with conservative or at the very least minimally-invasive treatment methods. >>  –  Dr. med. Reinhard Schneiderhan

 

All necessary examination methods for making a comprehensive diagnosis are available to you in our practice. You do not need to arrange follow-up appointments because further examinations of the intervertebral disc such as X-ray or magnetic resonance imaging can usually be carried out by us on the same day. You save time, thanks to our interdisciplinary practice concept and receive a well-founded diagnosis and an individually tailored treatment concept based upon it within one visit.

Kernspintomografie eines Bandscheibenvorfalles

Magnetic resonance tomography of a slipped disc

How to prevent spinal disc herniation

The best way to prevent spinal disc herniation is to develop strong back muscles. In doing so there are five important prevention measures:

  1. Lift loads in a back-friendly way: Do not lift heavy objects with a bent back, but by bending the knees with a straight upper body
  2. Exercise: Strong back muscles relieve the spine. Cycling or swimming are particularly back-friendly sports
  3. The right mattress: A good and individually selected mattress helps you to stabilise the spine at night
  4. Ergonomic workplace: Those who need to sit for long periods in their job should make sure that their workplace is as back-friendly and adaptable as possible. This includes an ergonomic desk chair and standing up frequently
  5. Avoid excess weight: A healthy body weight relieves the spine

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