You suffer from...

• Severe lower back pain radiating into the buttocks, legs or feet and which may be aggravated by sneezing or coughing.
• A feeling of numbness or even paresis in your leg
• Eventually also from numbness of the inner thighs, the anal or genital region, bladder and/or bowel dysfunction
• The clinical picture depends on to what extent adjacent nerves are compressed by the herniated disc. Hence, not all listed symptoms may prevail simultaneously.

For more detailed information please refer to:

• Herniated lumbar disk
• Spinal stenosis
• spondylolisthesis
• quick online advice and diagnosis
• second opinion

Actually a variety of possible causes have to be considered if your back is aching – for example degenerative changes of the vertebral bones or joints, which may then lead to irritations or narrowing of parts of the spinal cord or the nerves that exit from the spinal cord. Rheumatic diseases or traumatic injuries and – quite seldom- also tumours may lead to back pain. An appropriate diagnosis and analysis of the contributing factors are hence often complicated and require the long-term experience of the specialised physician.

!! It is important to distinguish !!

• local back pain – that is solely in the back

from

• pain that originates in the back but radiates also into other regions of the body – for example into the legs.

Mostly back pain manifests in the lumber spine (lower back pain, lumbagos). Quite rarely pain originates in the thoracic spine. If pain is located in the neck (neck pain), their origin is usually in the cervical spine.·

Acute back pain

A common cause for acute (radiating) back pain are degenerative changes of the invertebral discs. It might be a fissure in the fibrous ring or positively a protrusion of the disc or actually a veritable disc prolapse.

Chronic back pain

If back pain lasts more than 6 weeks it is considered chronic. Every chronification of pain is a challenge for the treating physician. If conservative treatment options – like physiotherapy, electro- or thermal therapy, and analgesic pain management - do not relieve symptoms within 6 to 8 weeks, a differentiated analysis of the underlying causes of pain is necessary. Usually a blood analysis as well as imaging methods like x-ray, computed tomography (CT) or magnetic resonance tomography (MRI) will apply.

If with these techniques there is still no sufficiently precise diagnosis possible, a discography of the affected spinal disks might be indicated. With these methods, fissures in the outer fibrous ring (anulus fibrosus) of the disk may be detected. In some cases it might be required to combine discography and computed tomography. If a rupture of the spinal disk is diagnosed, a percutaneous nucleotomy might be an appropriate therapeutic option. In cases of significant degeneration of not more than one or two spinal disks, helpful interventions might be discoplasty (endoscopic decompression and refreshing of the disk), an artificial disk replacement or a spondylodesis. Which of these options applies has to be considered carefully.

No successful therapy without precise diagnosis

!! The success of a surgical intervention greatly depends on how well it really targets the structures that are responsible for your pain !!

Eventually back pain cannot be relieved with a surgical intervention. This may be the case if an underlying disease or other factors render a successful surgery questionable. In order to decide in individual patients if and what surgical intervention is really promising, vast experience of a spine specialist is indispensable. If the clinical picture suggests that no significant relieve of pain can be expected from spine surgery it is important that patients be offered a highly individualised therapeutic strategy. For an efficient relieve of symptoms this generally comprises much more than the conventional injections, analgesics and physiotherapy.