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FAQ

Frequently Asked Questions

Some questions come repeatedly up during office hours. We want to give you a small selection of common questions and answers that may already help you in advance.

Of course, there will still remain many individual questions unanswered. To answer these, please use our online office hours or make an appointment in our practice.

 

Please click on the different headlines

Please click on the different headlines

When is surgery necessary for a herniated disc?

When is surgery necessary for a herniated disc?

The need for surgery depends on the complaints.
If neurological deficits are in the foreground, with paralysis or disturbances of urination and / or stool, then it may be either, the so called conus or cauda equina syndrome, and there is an urgent indication for surgery, because these disorders are signs of a strong pressure on nerves, that, if the duration is prolonged, will damage the nerve irreversibly.
Pain syndromes can first be treated conservatively, i.e. with pain medication, physical therapy and local injection. These treatment measures should be tried for about 6 to 12 weeks max. If within that time, no significant improvement, then a surgical removal of the incident should also be considered. This will immediately relieve the nerve and the symptoms disappear.

How is a herniated disc being operated?

How is a herniated disc being operated?

The best method is endoscopic surgery. This is a very gentle process. An endoscope has a diameter of 8 mm, and the scar is not even bigger. This allows the muscles and surrounding tissues to be perfectly spared. Even in the depths the dreaded scar formation is significantly lower or non-existent. A surgeon should possibly leave no "traces" behind. This goal cannot be reached to 100% nowadays. But it is possible to make those "tracks" very small, i.e. to make them barely visible. Endoscopy is the way to achieve this goal.

Do I need an artificial intervertebral disc?

Do I need an artificial intervertebral disc?

This can only be resolved through a thorough investigation. This applies in principle to a visible disk damage (e.g. "black disc" on MRI) and to appropriate clinical findings (e.g. permanent back pain, which does not respond to a treatment with physiotherapy and medication). In the functional X-ray images mobility in the damaged segment should be present, with a minimum disc height. Often, to clarify the cause of pain, a discography will be carried out. Under pressure the contrast agent is injected into the intervertebral disc. The increase in pressure causes pain, the so-called memory-Pain. As a cross check t a facet infiltration can follow as it is sometimes difficult to distinguish between the two pain generators (disc and facets). If the facet infiltration resulted in no significant improvement of the pain, but the memory-pain was clear then the removal of the old worn-out disc and replacement with an artificial is reasonable.

Is the implantation of an artificial intervertebral disc a complex operation?

Is the implantation of an artificial intervertebral disc a complex operation?

There are no simple operations, in general. But in the hands of experienced spinal surgeons, the risk is limited. Nevertheless, surgery should be performed only when the conservative treatment measures have failed. It is often achieved through targeted training of the back and the abdominal muscles to stabilize the because of the damaged intervertebral disc weakened segment. Indeed the disc cannot regenerate, i.e. it will not be able to assume its former function of the damping, but harden and lose altitude. Nevertheless, if the segment will regain stability, a significant reduction of pain can be achieved and the wear process stopped.

How big is the scar after the implantation of an artificial intervertebral disc?

How big is the scar after the implantation of an artificial intervertebral disc?

The operation is performed in a minimally invasive technique. The scar length and localization is dependent on the implant height. In average, the scar is 5-8 cm long. If only the so-called L5/S1-Segment is affected, then a bikini-cut can be made, i.e. the scar is diagonally and below the bikini pants and therefore not visible at the beach. If the L4/5 segment is concerned, it is necessary to make a longitudinal section below the navel. The wound is then sutured to the skin in order to achieve the best cosmetic effect.

Can I do sports with an artificial disc?

Can I do sports with an artificial disc?

The meaning of an implantation of the artificial disc is to restore its full mobility, i.e. after a period of rest, in which the artificial intervertebral disc heals (3 months) you are back to normal resilience. Of course, extreme sports are associated with an increased risk for the artificial disc, since it is the weak point in the case of an accident. Normal leisure sport is safe.

If the spine is stiff, I can still move?

If the spine is stiff, I can still move?

The stabilization or colloquially stiffening of the spine, results in no significant limitation of movement, especially since usually only one segment is affected. Often, before surgery, due to the pain and reflex muscle tension, the motion in the lumbar spine is already limited. By eliminating the pain and through the relaxation and harmonization of the muscles, the mobility can even be improved after surgery.

If a section of the spine stiffens, what happens with the disc above and below?

If a section of the spine stiffens, what happens with the disc above and below?

It is true that due to the stabilization of a segment, the pressure on the neighboring segments increases. It is therefore important to maintain a back-friendly life after surgery, i.e. optimum weight, training of the back and abdominal muscles, reduced stress, ergonomic furniture, possibly standing desk, adjustable desk, etc.

When should a stabilization be carried out?

When should a stabilization be carried out?

A stabilization operation is useful when there is an instability of the spine. It is important to restore the geometry of the spine and relieve the nerves. Whether there is an instability of the spine, can often already be found on X-rays. These motion pictures are done in a horizontal position, since then the muscles are relaxed and relaxations show up more clearly. In special cases, motion pictures on the so-called Upright MRI can also be performed. Instabilities can vary. In milder forms a dynamic stabilization with motion preservation may also be sufficient. If a spondylolisthesis is present, the balance of the spine must be reconstructed and the segment stiffened so that it does not lead to a further slide.

Instability of the spine with signs of post-back-sliding of the 4th lumbar while bending backwards. This leads to a narrowing of nerve in the nerve canal (red arrow, top).

Can I do sports after a stiffening?

Can I do sports after a stiffening?

The meaning of a stabilization operation is to improve the quality of life, i.e. after a period of rest, which the implanted material needs to grow in (about 3-6 months), the capacity is restored and normal leisure sport is possible. Certain rules should however be followed, so that future back pain is prevented. This should be discussed with the physiotherapist and doctor.

When does the spinal canal have to be widened?

When does the spinal canal have to be widened?

A narrowing of the spinal canal leads to a narrowing of the spinal cord and nerves. This can cause pain, numbness and paralysis. These disorders can be temporarily but also permanently. Unfortunately, the recreational potential of a nerve is limited, meaning that lost function is often not recurring. Therefore, the spinal canal has to be widened even at first appearance of symptoms, coupled with appropriate imaging and electrophysiological diagnosis. Then the procedure can be performed often minimally invasive. In later stages, larger operations are required often with stiffening and the prospects are worse.

How is the follow-up after a spinal operation?

How is the follow-up after a spinal operation?

Already in the hospital will the follow up start, with the aim to restore mobility and strength as quickly as possible.
A corset is often prescribed after surgery. This improves the stability and sense of body position and prevents the so-called "wrong" movements, primarily twists of the spine and bends forward. The corset is usually also for the gradual mobilization. The patient is allowed to be up on the first day. Together with the physiotherapist the first walking exercises take place. Overall, within the first three weeks, the pressure should be kept low. It is called the discharge or relief stage, which means a lot of lying, little sitting and walking moderately.
After being discharged from the hospital, early presentation in practice will be done. There is first prescribed lymphatic drainage, to relax muscles and reduce swelling. Strong activation in this early stage is not necessary. This is followed by the 4th to the 6th weeks at the healing stage. As physical therapy is also prescribed to activate the muscles and it is made an application for an inpatient or outpatient rehabilitation treatment in order to intensify the training and to expedite the re-integration into employment. The beginning of the rehabilitation is usually from the 7th week on in the so-called structural and pressure stage. After completion of the rehabilitation, work consists mostly of activity and work can gradually be started, e.g. done according to the Hamburg model. Physiotherapy will continue and rehab sports can begin.