Status: 15.01.2024, 13:44 PM
By: Andreas Beez
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Thorough diagnostics: Spine specialist Dr. Reinhard Schneiderhan examines his patient Sabine Bertsch. © MVZ
Many patients suffer from back pain, often due to spinal stenosis. A spine specialist explains how to get rid of back pain without surgery.
Herniated disc, lumbago or pinched sciatic nerve – most people have heard of these back problems. But very few people know what to do with the term spinal stenosis. The narrowing of the spinal canal is a widespread disease, especially in older people. According to expert estimates, about one in five people over the age of 60 struggles with the problem.
In the case of persistent back pain, doctors often advise fusion surgery
In addition to back pain, symptoms usually include pain, tingling and numbness in the legs. Patients are finding it increasingly difficult to stand and walk. Often they have – in the truest sense of the word – a long ordeal and a marathon of doctors behind them. Neurosurgeons in particular often advise fusion surgery in the case of such medical histories. Unstable parts of the spine are stabilized with a system of rods and screws.
Fusion surgery on the spine also has disadvantages
But this major intervention also has disadvantages. As a result, the spine loses mobility, and everyday stresses are shifted to the adjacent areas of the spine. What many patients don't know: "In the case of spinal stenosis, fusion surgery can be avoided in many cases. Treatment methods are available to help those affected more gently but very effectively," says Dr. Reinhard Schneiderhan. Here, the Munich-based spine specialist explains the alternatives. And two patients report how they have benefited from it.
One thing is clear: If you have severe back pain, you have to go to the doctor for help. In the case of less dramatic, but still severe complaints, however, there are a few things you can do yourself in everyday life to get some relief. Here, Dr. Reinhard Schneiderhan gives four tips:
► Step positioning: Lie flat on your back on a firm surface. Place the legs on one or more pillows so that the knees form a right angle. This position relaxes and relieves the back.
► Get moving – now more than ever: Exercise allows for faster recovery. Therefore, try to maintain your usual activities as much as possible.
► Drinking is important – also for your back: intervertebral discs consist of a quarter of fluid. When they are loaded, they release water, and when they are unloaded, they reabsorb new, nutrient-enriched water.
► Clever lifting: To reduce the strain on your spine, you should not lift heavy objects with a rounded back. Instead, bend your knees and lift the load with your back straight by the strength of your leg muscles. Always divide your groceries between two bags and carry one in each hand. This keeps the spine straight.
Two patients report how they managed to get their back pain under control without major surgery
Two women, the same problems: the pain literally ate away at their quality of life and suitability for everyday life. "I could hardly walk 50 meters anymore, getting up from the sofa became a feat of strength, I had to roll down somehow," says Monika Hosseini-Hausberger. Four herniated discs and adhesions had narrowed her spinal canal more and more. As a result, she ended up under the knife with a neurosurgeon four times. Four times without success. "On the contrary, my symptoms got worse and worse." Many visits to the doctor, no solution – the trained painter and varnisher was at the end of her tether.
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Sabine Bertsch had a similar experience. For more than 20 years, the 64-year-old businesswoman had been struggling with her spinal stenosis, dragging herself to her beauty salon every day despite severe pain. "If you're self-employed, you can't afford many sick days – and you can't afford the long downtime after a major operation." This was one of the reasons why she decided against a fusion operation on her spine, which had been recommended to her by doctors.
Patient with severe back pain says: "I even swallowed pills containing opiates"
At the same time, however, her desperation grew, as her complaints increased more and more in recent years. Twice she came to the clinic with the Sanka in an emergency. "In order to somehow endure the pain, I even swallowed pills containing opiates. I knew that this couldn't be a long-term solution." That's why Sabine Bertsch from Schwäbisch-Hall traveled to the spine center in Taufkirchen in the south of Munich after a tip from an acquaintance. Patients from all over Germany come to Dr. Reinhard Schneiderhan's practice to get a second opinion on how to treat their persistent back problems.
Pain therapist Dr. Reinhard Schneiderhan recommends treatment with the spinal catheter
The experienced pain therapist advised Sabine Bertsch to treat her with the so-called spinal catheter – a procedure that he has been using and has developed for decades. "It is particularly suitable for patients with so-called combined spinal stenosis. This is the name given to narrowing of the spinal canal due to intervertebral disc tissue and bony wear. It is also suitable for patients who have already undergone spinal surgery and are struggling with pain from scar tissue."
Spinal catheter: Cocktail of medication is directed directly to the pain sites
The basic principle: A thin tube is inserted into the spinal canal via a natural opening on the sacrum on the lower back, while the patient sleeps under twilight sleep anesthesia. The two advantages of this method: "On the one hand, we can gently detach intervertebral disc, soft tissue and scar tissue that presses on the nerve root. On the other hand, we pass a cocktail of medication through the catheter tube exactly where the pain arises. The solution consists of painkillers and a ten-percent salt-enzyme mixture. The most important effect is that fluid is removed from the disturbing tissue through a kind of transport process called osmosis. As a result, it shrinks, the pressure on the nerve root disappears permanently."
Long-term study by Kiel University underpins benefits of spinal catheter therapy
The benefits of the catheter are underpinned by a long-term study by Kiel University. "It became clear that catheter therapy has the greatest chances of success in chronic back pain with nerve root involvement – ahead of all other treatments such as conservative therapies or open surgery," emphasizes Dr. Schneiderhan.
For this minimally invasive treatment, the patient usually spends two and a half days in the hospital. Sabine Bertsch was in the Helios Clinic in Perlach. "I got better very quickly. When the pain subsided, I started with back exercises and now go to the osteopath regularly. Even if not every day is the same: Overall, I'm getting along very well today. It is particularly important to me that I no longer need opiate painkillers."
Neurosurgeon Dr. Zainalabdin Hadi explains to his patient Monika Hosseini-Hausberger how the procedure on her spine is performed. © MVZ
Intraspine: High-tech buffer for the back helped patient get back on her feet
Unlike Sabine Bertsch, Monika Hosseini-Hausberger could not avoid surgery, but no complex stiffening was necessary. As a first step, the 44-year-old underwent a so-called epiduroscopy. This is an endoscopy of the spinal canal. In the process, Dr. Zainalabdin Hadi removed scar tissue. The second procedure was minimally invasive – that is, with small accesses and filigree instruments. The neurosurgeon at the Taufkirchen Spine Center inserted a so-called intraspine spacer. This is a kind of high-tech buffer for the back. "Instead of conventional metal implants, we use an implant made of silicone and plastic," explains Dr. Hadi.
Silicone implant: The Intraspine works like a kind of high-tech buffer for the back. © MVZ
Neurosurgeon Dr. Hadi explains: Intraspine acts like a shock absorber for the back
The procedure only takes about half an hour. Essentially, this involves stretching the affected segment of two vertebral bodies and the intervertebral disc with a special instrument (spreader) and placing an implant made of silicone in it. Neurosurgeon Hadi: "It is not rigid, but yields slightly when loaded, so that it fulfils a shock absorber function. This relieves the strain on the vertebral joints and the intervertebral discs, and the spinal canal remains open." However, Hadi continues, the intraspine spacer is not suitable for all patients with spinal stenosis: "This method is not suitable for large instability in the spine or fractures. In such cases, the silicone implant would not guarantee sufficient stability. In this case, a classic fusion operation would make sense."
Patient says: "I can walk again. I really enjoy that!"
Monika Hosseini-Hausberger was relieved by the minimally invasive surgery: "The first few months after the procedure were tough, I needed patience, but it got better and better. Finally things are looking up again. Today I can walk again and take longer walks. Once a month I go hiking. I really enjoy that."