lumbal spine

Pain which has its origin in the lumbal spine can have many different reasons. Due to the fact that all structures which can cause the pain are closely related to each other it is very important to bring a lot of experience in the clinical diagnostics. Due to the character of the pain it is possible to differentiate in different categories.

Pain which has its origin only in the lumbal spine (Lumbago)

Most common reasons are:

A swelling of the vertebral disk which then depresses the ligamentum longitudinale posterior, a ligament which connects all vertebral bodies from the back and contains a lot of pain receptors.

An arthrosis of a vertebral joint. If the pain radiates down to the strip t is more likely that the origin of the pain is due to a degeneration of the bony structures.

Muscular malformations and problems can occur as a consequence of a slipped disk or an arthrosis. This can lead to pain as well.

Sliding vertebra

Pulling the pain in one leg (Lumboischialgia)

If the pain radiates into the leg it is very likely that a slipped disk depresses the nerval root. There is the possibility that nerval damage increases which could lead to paralysis. Please try to stand on your toes while standing on one foot. Other ways to check for a lumboischialgia is to walk on the heels or to check the ability to climb stairs.

Nerval damage

If the nerve itself gets damaged it can lead to paralysis, loss of sensation or bladder insufficiency. Depending on the degree of the damage it is necessary to diagnose the damage as soon as possible to increase the chance for a positive prognosis.

Walking limitation

If your walking abilities get limited due to pain or any other inability it is very likely that you suffer from a stenosis of the spinal canal which can squeeze the nerves and cause the pain. This clinical picture is also called Claudatio spinalis. Typically the discomfort which is caused by this stenosis gets less during bending down or sitting. The physician needs to make sure that he mix this clinical picture with the Claudatio intermittens which shows similar clinical symptoms but is caused by a stenosis of a blood vessel.

Differential diagnosis

Due to the fact that the areas at the skin can get supplied by either a nerve of the leg or a nerval root it is highly necessary to differentiated between this two to create the correct plan for a therapy. In most of the cases it is already possible to make a differentiation during the anamnesis but it is always helpful to take some other continuative examinations into account. In any case it is helpful to bring some experience. We are able to perform all the necessary examinations directly in our medical office.

Osteochondrose der LWS

Osteochondrose der LWS

Was beim Auto die Radlager, sind beim Menschen die Gelenke und Bandscheiben.

Like all other body parts which experience a permanent stress the lumbal spine gets perished with the time. The intervertebral disks which are situated between the single vertebral bodies have the function to absorb any shock or stress. They can be seen as some kind of a puffer for the spine. It seems like the human body can cope with nearly every movement and there are only some which can have a strong impact on the intervertebral disks. The lateral lifting of a heavy boy for example can cause a damage on the intervertebral disks which then can lead to a damage on the lumbal spine.

Recent twin studies showed a high genetic incidence on degenerative illnesses of the intervertebral disks. Current studies can be found on PubMed. Try to search for “disk degeneration genetics” to get a collection of current studies

With the help of physical examinations and the anamnesis it is possible to get a huge amount of information and signs for the discomfort. Due to this information we can then give advice pro or contra an operation and create a treatment plan. In many cases it is helpful to have current X-ray pictures or magnetic resonance imaging pictures. If the discomfort is caused by an osseous transformation it is better to have computer tomography scans.

Please take into consideration that most of the images are being made when you lie which means that the intervertebral disks are not exposed to the normal body weight.

If there is the suspicion that the discomfort got caused by a spondylolisthesis it can be helpful to create an x-ray image in motion. A Myelography can make sense if you want to see the motional effect on the nerves. If this raises suspicions on a disruption of the normal nerval function we can organize a electrophysiological examination.

The prognosis always relies on the differentiation between a nerval irritation or a nerval damage.

Nerval damage:

If it comes to a nerval damage it is necessary to start the treatment as fast as possible to prevent a further destruction of the nerve. As longer the damages stays untreated as lower is the chance that the discomfort gets reduced. Another negative effect of an untreated nerval damage is that it can result in long lasting pain which leads to a neuropathic pain syndrome. If the damage is more severe it could happen that the damage is already irreversible after some hours after the damaging event.


If the patient suffers from a pure pain syndrome which could appear due to a slipped disk it is possible to wait, see and treat conservatively. Based on our experience most of the pain can be completely removed if the treatment gets indicated properly. It is highly important that the pain gets treated as fast as possible to prevent the development of a pain memory. With the current medicine no one has to live with pain because nearly every pain is treatable. The current state of research shows that the pain memory starts to develop after six weeks which means that the pain which was originally caused by a slipped disk can last longer even if the physical cause has already been removed.

conservative therapy

The conservative therapy or the non- operative therapy contains the following:

medical information about the causes

medical information about the behaviour

if necessary: information about a chronic pain syndrome

drug treatment including a procedure to relax muscles

therapy including TENS



specific penetration

In most of the cases we will create a step-by-step therapy in the beginning of the treatment which has very little side effects.

We are very reserved and strict with the indication for an operation, that is why we only operate when no other option is possible. Previously we have an abundance of other conservative and operation- preventing possibilities to treat a patient.

Depending on the diagnosis and the severity of the disease the surgeon can choose from many different options for the operational therapy. With the time all these procedures got more and more gentle.

Percutaneous Laser Disk Decompression (Sclerotherapy)

Nadel mit Laserfaser

Nadel mit Laserfaser

With the help of an X-ray the surgeon inserts a thin needle into the intervertebral disk. Due to the administration of analgetics the entire intervention is nearly pain free. By the help of the needle the surgeon can then insert a glass fiber which carries a laser. The slipped disk can then be vaporized by a laser.

Laser Surgery (PLDD)

Percutaneous Laser Disk Decompression (Sclerotherapy)

Nadel mit Laserfaser

Nadel mit Laserfaser

With the help of an X-ray the surgeon inserts a thin needle into the intervertebral disk. Due to the administration of analgetics the entire intervention is nearly pain free. By the help of the needle the surgeon can then insert a glass fiber which carries a laser. The slipped disk can then be vaporized by a laser


Microsurgical operation:

The operation gets performed by the help of a special operation microscope. The surgeon prepares a minimal opening which has a diameter from 1-2 cm. Following this the surgeon can either dissect the slipped disk or dilate the spinal canal.

After a microsurgical operation the patient is allowed to stand up and walk again which is even helpful for the further healing process. In most of the cases the patient has to stay in the hospital for 1-4 nights.