Symptoms

Committed experts from Munich APEX SPINE Center will help you to get well again!

There are many causes for back pain – they may be of degenerative, inflammatory or functional nature and affect different parts of the spine. Diseases of the backbone are common among all age groups, in the older patients, however, it is mostly degenerative changes of the spine, that cause pain, movement restrictions and sometimes neurological symptoms.

You will find detailed information on the most common spine diseases on our website. To facilitate your access to the condition that may interest you, we put a short “pain profile” in front of each clinical picture. The more of the listed symptoms apply to you, the more probable it is, that you are affected.

You might 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 disk. Hence, not all listed symptoms may prevail simultaneously.

What is a herniated disk?

Intervertebral disks are elastic cartilaginous joints of about 5 mm thickness between adjacent vertebrae. Their main function is to dampen impacts of daily life activities – they work just as a shock absorber. In their centre is the nucleus pulposus – a jelly-like tissue which is surrounded by a firm fibrous ring (the anulus fibrosus).

A disk herniation is a relatively common condition. There are four main causes:

1. an inherent weakness of the disk tissue

2. a sudden twisting movement of the body

3. heavy lifting or pushing

4. lack of physical activity

Due to lack of physical activity and constant sitting, the rear part of the invertebral disk can be virtually „starved". This causes a weakness in the disk tissue and fissures or protrusions of the disk may occur.

Poor musculature can additionally increase the risk of a disk herniation. When a disk herniates, parts of the nucleus pulposus protrude into the spinal canal through fissures of the anulus fibrosus. It may then happen that the prolapsed tissue compresses the spinal cord or the efferent spinal nerves. In such cases the acute back pain comes along with neurological symptoms in the dermatome of the affected nerve root.

Main cause is mostly a long-term undue stress from poor posture or inactivity which comes along with normal aging processes (degenerative disk disease). At times the actual disk herniation is preceded by bulging of the jelly nucleus into the fibrous ring (disc protrusion).

What causes a lumbar disk herniation?

On the base of a pre-existing damage of the intervertebral disk its actual bulging out is triggered mostly by a sudden twisting movement or heavy lifting. There are cases, however, where a disk herniation occurs without apparent cause.

Which section of the spine is affected most often?

In more than 90% of the cases a disk herniation occurs in the lumbar spine – mainly between the vertebrae L4 and L5 or L5 and S1. Less frequently also the cervical or thoracic spine are affected (refer also to disk herniation of the cervical spine)

How is the disk herniation treated?

Conservative Treatment

In the best of cases it will do to give the back two weeks of physical rest and to treat pain with analgesic drugs. For strengthening of the muscles of the back and the abdominals a targeted physiotherapy is recommended. Concomitant thermal or electrotherapy and manual therapy may provide additional symptom relieve.

In persistent cases injections of local anaesthetics and corticosteroids directly at the compressed nerve root (periradicular infiltration) or at the spinal cord (peridural infiltration) may help in the short-term. Severe neurological symptoms may render a hospitalisation necessary where analgesic and anti-inflammatory infusions are given.

Surgical treatment

One main focus of the APEX SPINE Center are endoscopic spine surgeries. As opposed to other endoscopic techniques our special surgical procedure allows to remove all slipped disks regardless of their size and location. This is especially important for prolapses at L5/S1 and in the thoracic spine - they can be reached endoscopically only by transforaminal surgery. This means, the access to the herniated material is possible via the osseous opening of the vertebrae where the spinal nerves exit. Hence we don't have to use the traditional posterior point of entrance which is associated which a much greater risk of injury. Dr Schubert constantly develops this technique further. He is internationally one of the leading spine surgeons who – additionally to all conventional spine surgeries – carries out routinely those endoscopic interventions at the cervical, thoracic and lumbar spine. Some of the techniques are worldwide unique in our spine clinic. Up to now more than 4000 patients have been successfully treated with this special endoscopic technique by Dr Schubert.

Dr Schubert regularly presents his experiences and results on national and international conferences and publishes his work in scientific journals. Hence the APEX SPINE Center has grown to an internationally acknowledged training center. On a regular base physicians from all over the world join us to stay informed or improve their skills with our surgical procedures. Additionally continuous education courses for spine specialists are offered where with live-surgeries and workshops all knowledge about the new techniques is passed on to interested colleagues.