There are a wide range of spinal disorders: People of all ages suffer from them. They are often caused by degeneration of the intervertebral discs or the small joints of the spine (facet joints). However, inflammation, injuries or deformities can also cause pain. Dr Oetke’s special expertise lies in the conservative and surgical treatment of all spinal disorders and injuries:
Neck and back pain
We must first find the cause of the pain in order to select the right course of treatment. MRI or X-ray images are therefore sometimes used alongside the clinical examination.
Conservative measures such as injections, physiotherapy or medication are often sufficient to relieve the symptoms. This allows the ‘girdle’ of muscles to regain its stability in order to keep the bony musculoskeletal system in shape.
Most disc hernations affect the lumbar spine. However, the cervical and thoracic spine can also be affected. The background to this ailment is usually years of degeneration of the intervertebral disc, which is mostly due to overloading and improper stress on the disc.
Pain and anti-inflammatory medication, physical rest and physiotherapy provide relief. Injections near to irritated nerve structures also have great potential for providing relief in case of severe complaints. In special cases, the minimal invasve laser treatment of the intervertebral disc (PLDD) can be used as a complementary and useful treatment measure. If the symptoms still have not disappeared after several weeks or if there are neurological complaints, surgery is the right choice.
Osteoarthritis of facet joints
Degeneration of the small facet joints most commonly affects the cervical and lumbar spine. It is often older patients who suffer from this problem: Standing up, bending or straightening up is painful. Conservative procedures such as physiotherapy or targeted injections at the facet joint, including with hyaluronic acid, provide relief. In case of repeated complaints, radiofrequency therapy or thermal denervation is also available as a promising and useful supplementary form of therapy.
Vertebral body fractures
For most patients, a vertebral body fracture is caused by a serious traffic accident or a severe sports injury. For older patients, vertebral fractures are often spontaneous and caused by reduced bone density (osteoporosis). This results in back pain with reduced mobility. There are sometimes neurological symptoms, too. The doctor assesses the injury using an MRI or CT exam: If the vertebral fracture is stable, a conservative treatment with medication, physiotherapy and a well adapted corset is often sufficient. Otherwise, surgical stabilisation will be required.
Spinal stenosis describes a constricted narrowing of the spinal canal. Depending on the part of the spine in which the nerves are compressed, the pain radiates to the arms (upper or cervical spine) or legs (lower or lumbar spine). There can also be neurological symptoms such as tingling, numbness or weakness. The multimodal treatment concept includes anti-inflammatory medication, physiotherapy and corsets. Targeted injections around the affected nerve structures can also be very effective. If these methods are not successful, minimally invasive surgery is the next step to take. This will widen the spinal canal with fine instruments and relieve the nerves, so that the patient’s load-bearing capacity and mobility are restored.
Spondylolisthesis is a slippage between two neighbouring vertebrae. This most commonly affects the lumbar spine and spondylolisthesis is often associated with spinal stenosis. This results in back pain, which sometimes radiates into the lower extremities, and can be associated with neurological deficits. If there are no neurological symptoms short-time rest, anti-inflammatory medication, physiotherapy and corset provide further relief. Once again, targeted injections into the vertebral joints and around the affected nerve structures can be particularly effective. If the desired effect is still not achieved then surgery must be considered. This will involve the affected vertebrae which will be moved back into the correct position and connected to each other stably. Doing this kind of correcting stabilization will also relieve pain caused by affected nerve structures.
When the intervertebral discs and their adjacent vertebral bodies are affected by an infection, this is called spondylodiscitis. This causes patients to suffer from back pain. Secondary symptoms include night sweats, fever and weight loss. If the patient does not receive suitable treatment, the infection can spread throughout the entire body and, in the worst-case scenario, can be life-threatening. To avoid this danger, the patient urgently requires a course of antibiotics in addition to physical rest. If the infection of the intevertebral disc and vertebral bodies cannot be combated effectively by antibiotics, physical rest and corset or if the inflammation is too far advanced, only a surgery can permanently heal the disease.
Rheumatoid arthritis causes the mucous membranes of small and large joints to become inflamed. This can also affect the spine and lead to rheumatic instability. If the affected bone and ligament structures are destroyed in this way, it can lead to vertebral structure displacement (spondylolisthesis). There is also a risk of neurological symptoms. The consequences of rheumatic instability are pain and decreased levels of mobility in the affected area of the spinal column, as well as sensory disturbances, which at worst can include paralysis of the arms or legs. It is important to be diagnosed early and to undergo consistent treatment. If the symptoms cannot be effectively treated with anti-inflammatory medication, a surgery with stabilization of the affected area of the spine will be recommended. This will result in a significant reduction of the pain, increased mobility and restoration of quality of life.
Abnormalities and deformities
There are two types of spinal deformations:
In cases of kyphosis, the side view reveals a too strong concave curvature of the affected section of the spine. This type of malformation usually affects the thoracic spine. In case of a severe concave deformity, a hunchback or hump may result.
Scoliosis relates to a three-dimensional deformity of the spine. It can be seen not just from the side but also the front, as individual vertebral bodies are also twisted.
Physiotherapy is enough to balance out deficits in mild cases. More severe curvatures are treated with a special individually adapted corset. Otherwise, a surgery can correct the deformity and fix the affected section of the spine.