Disc degeneration starts in young adults and then slowly progresses, particularly in the lower parts of the cervical and lumbar spine, sometimes leading to neck- or lower back pain. Protrusion, or frank herniation, of a degenerated disc may compress adjacent nerve roots, leading to loss of sensation, or even paralysis of the muscles supplied by this particular nerve. This is sometimes accompanied by pain radiating into the respective arm or leg.
While many cases of disc disease can be successfully treated conservatively by exercise, pain medication, or periradicular steroid injections, advanced cases with neurological deficits require minimally invasive surgery to prevent permanent loss of function.
With advancing age, the spinal canal tends to become narrower, especially in the lower back. This is caused by bony exophytes developing at the rims of the vertebral bodies, or at the facet joints. Resulting nerve compression can lead to load-dependent diffuse back pain, forcing patients to stop walking sometimes even after short distances. When detected early, this problem can be managed conservatively with exercise, supportive soft braces, pain medication, or epidural steroid injections. More severe stenosis may require decompressive surgery. The latter procedure is also used in advanced stenosis of the foramina through which the nerve roots must pass when leaving the spinal canal.
With advancing age, bones may become brittle, particularly in women, a condition termed osteoporosis. To prevent the devastating consequences of vertebral fractures in the elderly, routine screening for osteoporosis is recommended in women from age 50 on, and in men aged 60 or over.
We offer state of the art DXA bone mineral density assessment on premises. Detected early, osteoporosis can successfully be treated by oral medication and physical activity, thus preventing a substantial proportion of possible fractures later in life.
In scoliosis, the spine is not straight, but develops one or more curves in the frontal plane, usually during the pubertal growth spurt. Progression of the curve comes to a halt upon growth arrest. Systematic screening for scoliosis should be performed at age 12, especially in young women, who are more prone to develop this growth disorder than men.
Mild cases are managed with an exercise program, additional bracing is used for more severe forms. Corrective surgery may be considered in extreme cases with curves exceeding 45°.
Vertebral fractures can occur as a consequence of high velocity trauma, as in vehicle accidents, but also after minor falls in elderly patients suffering from osteoporosis.
Stable compression fractures can usually be managed conservatively by rest and bracing, if applicable. Unstable fractures, however, especially those causing neurological deficits, require immediate decompression and internal fixation.
The term spondylolisthesis describes an instability between two vertebral bodies, most often found in the lower part of the lumbar spine. Two major forms are distinguished, one of which goes back to childhood, while the other one develops later in life.
Patients typically suffer from lower back pain when standing for prolonged periods of time, or when carrying heavy loads. This condition requires regular exercises to strengthen the muscles of the trunk. A minority of patients not responding to conservative treatment require internal fixation to regain stability of the spine.