Diseases

Each intervertebral disc consists of an inner, gel-like nucleus pulposus and an outer, stable ring of connective tissue and fibrocartilage that completely surrounds it. This ring is called the annulus fibrosus by medical professionals. Its function is to hold the softer nucleus pulposus inside the disc so that it acts like a shock absorber, cushioning the forces between the individual vertebrae. An annulus fibrosus tear occurs when this outer ring ruptures due to wear and tear, age-related degeneration, or excessive sudden stress. The gel-like nucleus pulposus can then protrude and compress the nerves of the spinal cord. This is also known as a herniated disc.

A bulging disc is the less severe form, or precursor, to a herniated disc. While it can also cause significant pain, this isn't always the case. Unlike a herniated disc, the fibrous ring of the disc remains intact in a bulging disc. It doesn't tear, but simply bulges outwards and can therefore press on sensitive nerve roots. This occurs because the fibrous ring loses its firmness due to wear and tear and aging. Sudden, acute stress or accidents can also cause a bulge. The advantage for patients is that a herniated disc doesn't require surgery or the removal of disc tissue. Bulges respond well to conservative treatments and usually resolve on their own.

Unlike a bulging disc, in a herniated disc, the inner, gel-like nucleus pulposus of the disc ruptures the outer fibrous ring surrounding it and penetrates the spinal canal. The fibrous ring tears completely. The resulting increased pressure on the sensitive nerves of the spinal cord causes sometimes severe pain. Depending on the location, this pain can radiate into the legs or arms, causing numbness and even paralysis.
Herniated discs most commonly occur in the lumbar spine (lower back), less frequently in the cervical spine (neck), and least frequently in the thoracic spine (upper back). The average age of onset is around 40.

Gait disturbances and other serious neurological dysfunctions occur when the herniated disc compresses the spinal cord (myelopathy). Depending on the symptoms and location of the herniated disc, various treatment options are available: microsurgical procedures, disc replacement surgery, and invasive pain management.

Special case: Herniated disc in the cervical spine

When herniated discs occur in the cervical spine, they can compress the nerve roots there and cause pain in the upper back, neck, and shoulder. This pain, in turn, can radiate into the arm and cause sensory disturbances or paralysis.

Symptoms of herniated discs in the lumbar, cervical and thoracic spine

The intervertebral disc connects the 24 vertebrae of our spine. In total, there are 23 intervertebral discs that allow our spine to move. Without them, we wouldn't be able to move.

In principle, intervertebral discs can be viewed as small buffers or shock absorbers. Age-related wear and tear, heavy strain, or accidents can cause both the discs and the surrounding outer fibrous ring to deteriorate. Because they lose elasticity and strength as a result, herniated discs can occur.

Depending on the location of the herniated disc, various symptoms can occur. These often cause severe pain and sensory disturbances. Mobility may be restricted.

The doctors at our spine center in Munich East can put together a perfectly suited, individually tailored therapy concept for you in the case of a herniated disc.

What can cause a herniated disc? Are there any risk factors?

A herniated disc can have various causes, which are not necessarily only related to age-related wear and tear. Even young people can suffer a herniated disc, or even multiple herniated discs. The causes are usually overuse or improper strain during certain tasks. Herniations often occur when the affected person bends or moves forward. This compresses the front part of the disc, the part facing the abdomen. The inner nucleus pulposus is then forced backward toward the spine, where the fibrous ring tears and the disc protrudes into the spinal canal.

Other reasons for a herniated disc can include:

– hereditary predisposition
– Muscle weakness
– incorrect gait or posture
– Being overweight or not getting enough exercise in everyday life.

What is the exact structure of the intervertebral discs?

Looking at the spine, the intervertebral discs lie between the individual vertebrae. They are flexible, yet firmly anchored in the vertebrae. An intervertebral disc consists of two parts: the inner, gel-like nucleus pulposus and the outer, surrounding fibrous ring.

The intervertebral discs can absorb moisture and various minerals and then gradually release them again to relieve the spine under stress.

What causes the pressure on the nerve root?

A herniated disc in the thoracic, cervical, or lumbar spine can put significant pressure on the nerve roots. Typical symptoms of a herniated disc include:

– severe pain in arms or legs
– Tingling and numbness
– Symptoms of weakness or paralysis in the arms or legs

Herniated discs most commonly occur in the lumbar spine, accounting for approximately 90 percent of cases. The thoracic spine is rarely affected. If pressure is exerted on the nerve roots in the thoracic spine, this manifests as severe pain in the mid-back. In the cervical spine, the pain radiates into the arms and can also cause neurological deficits there.

What effect does the pressure have on the spinal cord?

The symptoms of a herniated disc pressing on the spinal cord are similar to the complaints mentioned above. However, there are also crucial differences, which become particularly noticeable in severe cases. These include numbness in the anal area, and the genital area can also be affected. Bladder and bowel function are severely impaired, and incontinence of urine or stool may occur. If these symptoms occur with a herniated disc, you must consult a doctor or our Spine Center Munich East immediately.

A herniated disc can also press on the lowest part of the spine, extending to the sacrum. If this occurs, you will usually lose all control over your bowels and bladder. Paralysis in the legs may also occur. In this case, you must seek immediate medical attention.

However, there are also symptoms that cannot initially be clearly attributed to the spine. They are nonspecific and different from typical back pain. Leg pain or numbness in the arms are not always symptoms of a herniated disc originating from the disc tissue. Sciatica, a pinched sciatic nerve, can also cause back pain. This makes a thorough diagnosis by an experienced specialist so important.

What is the diagnosis for a herniated disc?

Before a doctor begins treatment for a herniated disc, a comprehensive diagnosis is essential. In an initial consultation, you will describe your symptoms and provide information about any pre-existing conditions, accidents, or herniated discs in your family. This careful review of your medical history is important to rule out other conditions.

Following this, a neurological examination is performed, paying particular attention to sensory disturbances and nerve reflexes. Your muscle strength will also be tested, as a herniated disc often leads to muscle weakness. Other diagnostic procedures that may be performed before potential disc surgery include:

– CT (computed tomography) and MRI (magnetic resonance imaging): These imaging techniques can be used to visualize soft tissues, intervertebral discs, nerve structures and bones.

– Electroneurography (ENG): This involves examining the nerve roots so that the herniated disc can be precisely located and identified.

– Lumbar puncture: In rare cases, puncturing and extracting cerebrospinal fluid from the spine reveals whether an infection is behind the symptoms, for example, Lyme disease.

What might the therapy look like?

For a herniated disc, treatment options include conservative methods, minimally invasive catheter techniques, and surgical procedures. However, a herniated disc can usually be treated very effectively with conservative methods initially. The following options are available:

– Painkillers or cortisone injections

– Fango or red light therapy

– Physiotherapy

If conservative therapy proves ineffective, minimally invasive treatment or surgery can be considered. If even minimally invasive procedures fail, the herniated disc is surgically removed to relieve pressure on the nerve endings.

Facet syndrome occurs in the small vertebral joints located on the back of the spine, between the individual vertebrae. It is essentially a degenerative condition, also known as facet joint osteoarthritis. When facet syndrome occurs in the lumbar spine, it is called lumbar facet syndrome.

But what exactly is a facet joint?

Facet joints are the small vertebral joints that play a crucial role as connecting elements in the cervical and lumbar spine. They connect at the articular processes of two vertebrae. When intervertebral discs wear down, they lose height. This, in turn, reduces the space between the individual vertebral bodies and puts stress on the small joints. This leads to osteoarthritis, which attacks the cartilage surfaces of the joints. The wear and tear can also lead to increased production of synovial fluid, causing cysts to form on the facet joints.

Neck pain is more common than generally assumed. Sometimes it radiates to the shoulder or leads to headaches or dizziness. The pain can manifest in very different ways and sometimes even resembles muscle soreness. Many patients with neck pain also feel as if they have a stiff neck. Acute or chronic neck pain should always be examined by a doctor.

What could be the underlying causes of neck pain?

The causes of neck pain can vary widely. Most often, tense muscles are the culprit, resulting from prolonged sitting or poor posture. Neck pain can also indicate problems in the cervical spine. A herniated disc doesn't necessarily occur in the lower back. In cervical spine syndrome, the herniated disc can occur in the upper cervical vertebrae. Other causes of neck pain can include:

– Inflammation in the area of the vertebral bodies (spondylitis)
– rheumatic diseases
– previous injuries, such as whiplash
– Diseases of the shoulder joint
– Spinal canal narrowing (spinal stenosis)
– Osteoarthritis of the small vertebral joints in the cervical spine

If neck pain persists for more than three months, it has likely become chronic. Poor posture over an extended period, such as when working from home, can also trigger neck pain. In particular, neck pain can occur when the cervical spine is severely curved due to poor posture.

Chronic damage caused by excessive pressure on nerve pathways in the arms or legs is also known as "peripheral nerve compression syndromes." These conditions occupy a special position within our treatment spectrum. A thorough neurological examination is essential to rule out spinal problems.

The most common condition by far is carpal tunnel syndrome, which occurs in the wrists. It is easily recognizable due to its distinctive symptoms: typically, the first three or four fingers go numb at night. These symptoms often also occur while cycling or during other activities that involve bending the wrist. In later stages, it can lead to numbness or tingling in the fingertips or entire fingers, as well as impaired fine motor skills and even paralysis. If conservative therapies are ineffective, surgery is necessary to relieve pressure on the compressed nerve. Otherwise, muscle atrophy could occur.

Diseases affecting the arms (upper extremities)

– Carpal tunnel syndrome (compression of the median nerve in the wrist)

– Narrowing of the nerve canal on the inside of the elbow, also known as the "funny bone". When the arm is under stress, patients experience an electric shock sensation on the inside of the elbow (cubital tunnel syndrome).

– Damage to the ulnar nerve in the wrist (Guyon's canal syndrome). This manifests as tingling sensations, sometimes progressing to paralysis in the little or ring finger. It can occur, for example, after straining the hands during long bike rides.

– Compression damage to the radial nerve above the wrist in the forearm (Wartenberg syndrome). Pain usually occurs in the thumb or index finger, sometimes also in the ring finger, e.g. when wearing a heavy bracelet or wristwatch.

– Nerve compression in the forearm below the elbow (supinator syndrome). The pain in the elbow and on the outside of the forearm when lifting, carrying, or holding objects feels similar to tennis elbow.

– Compression of the median nerve on the front of the forearm (pronator teres syndrome). Pain and tingling occur in the middle fingers when rotating the forearm.

– Due to nerve compression in the shoulder, rotational movements of the arm lead to deep-seated shoulder and back pain (incisura scapulae syndrome).

Nerve tumors in the arm are usually benign. They cause swelling, pain, and abnormal sensations.

Diseases affecting the legs (lower extremities)

– Compression of a cutaneous nerve that runs along the outer front of the thigh (meralgia paresthetica). This causes pain and sensory disturbances on the outside of the hip joint.

– Compression of the peroneal nerve (peroneal nerve compression syndrome). This causes pain or irritation on the top of the foot or on the outside of the lower leg.

– Compression of the cutaneous nerves in the lower thigh (infrapatellar compression syndrome). This causes pain on the inner thigh as well as burning or electric shock-like sensations that can radiate into the knee and also into the lower leg. The pain worsens when standing or walking. Most of these symptoms resolve on their own after a longer period of time.

– Compression of the tibial nerve at the ankle (posterior tarsal tunnel syndrome) can lead to numbness in the sole of the foot, tingling, and painful burning in the heel. Causes include overuse or injury.

– Compression of the peroneal nerve at the ankle or on the top of the foot (anterior tarsal tunnel syndrome) leads to pain on the top of the foot and to sensory disturbances of the skin between the first and second toes.

– Compression of the metatarsal nerves between the metatarsal bones on the sole of the foot can lead to irritation or the formation of nerve ganglia that are very painful when walking (Morton's neuroma). These usually develop between the third and fourth toes, sometimes between the second and third. The sometimes sharp, shooting pains on the sole under the midfoot are exacerbated by wearing high or tight shoes. Typically, the pain subsides quickly when shoes are removed and one walks barefoot or in socks.

– Compression of the sciatic nerve in the buttocks can lead to severe pain in the gluteal region (piriformis syndrome). If a doctor can rule out spinal causes for the sciatic pain and also excludes arthritis-related sacroiliac joint pain, piriformis syndrome is likely. However, an experienced back specialist should be consulted. We offer this specialized diagnostic service at the Munich East Spine Center.

Nerve tumors in the leg are also usually benign. They too lead to swelling, pain, and abnormal sensations.

In all these cases, conservative therapy is attempted first. If surgery for these nerve compressions is nevertheless necessary, most procedures can be performed on an outpatient basis under local anesthesia. Hospitalization and general anesthesia are only required in exceptional cases.

The term post-discectomy syndrome describes problems or complaints that can occur after a previous disc surgery.

In such cases, pain following an operation primarily aimed at relieving pressure on the sciatic nerve may initially disappear from the leg and then reappear after a period of time.

The causes of this pain are varied. Wear and tear on the intervertebral discs appears to play a crucial role.

An intervertebral disc consists of the inner, soft core (nucleus pulposus) and an outer fibrous ring (annulus fibrosus). The optimal combination of the soft core and outer ring ensures that the disc acts like a shock absorber, cushioning all forces acting on the vertebrae. Over the course of a lifetime, however, the core loses water and shrinks (a grape becomes a raisin). In an MRI scan, this disc then appears black, known as a "black disc." Causes of this process include hereditary predisposition, metabolic changes, and external stress. This also explains why some people experience symptoms very early on, others later, and still others remain completely pain-free.

The medical term scoliosis refers to a fixed lateral curvature of the spine, which can vary in severity. This usually results from asymmetrical spinal growth. This asymmetrical growth also leads to a rotation of the vertebrae. Consequently, the spine can no longer perform its normal functions.

Normally, and in a healthy state, our spine functions, among other things, as a kind of shock absorber for the body. During normal walking, vibrations are transmitted to our body, which the spine must absorb. With scoliosis, this is no longer possible.

Scoliosis very often begins in childhood and adolescence, during important growth periods. The vertebrae and intervertebral discs shift or twist. This leads to deformations of the vertebral bodies, which eventually result in a pronounced curvature and later in stiffening of the affected areas.

What are some possible causes of scoliosis?

The causes of scoliosis can be varied and also depend on the specific type of scoliosis. Very common are so-called idiopathic scoliosis, the causes of which cannot be determined. Other forms of scoliosis usually occur as a secondary symptom of other diseases, for example, dysfunctions or diseases of the nerves or muscles (neuromyopathic scoliosis). Certain connective tissue disorders can also trigger scoliosis.

In idiopathic scoliosis, genetic factors are suspected, but this has not yet been fully proven. Distinctions are also made regarding the affected regions. Among others, the following types of scoliosis exist:

– in the area of the thoracic spine (thoracic scoliosis)
– in the area of the lumbar spine (lumbar scoliosis)
– in the area between the lumbar and thoracic spine (thoracolumbar scoliosis)

Scoliosis affecting both the lumbar and thoracic spine is also possible. This form is referred to as thoracic and lumbar scoliosis.

What are the symptoms of scoliosis?

Especially in its early stages, scoliosis can progress unnoticed without causing any symptoms. However, lung function may be impaired in the early stages of scoliosis. This is determined through a lung function test. Scoliosis can also be visually apparent, namely through a deformity of the spine.

Pain or restricted mobility usually only occur in an advanced stage of scoliosis. Over the years, a protective posture is often adopted, which can lead to muscle strain and eventually to chronic back pain. Other symptoms that can occur alongside scoliosis include:

– reduced chest cavity
– Shortness of breath
– Heart problems

What does the diagnostic process for scoliosis look like?

The first and most important step in diagnosing scoliosis is a physical examination. This involves a thorough examination of various points that may indicate scoliosis:

– Position of shoulders and pelvis
– Symmetry of the spine

For example, if a lumbar protrusion is present, this can be an initial indication of scoliosis.

Following the physical examination, further diagnostic measures can be taken at our Munich-East Spine Center: 4D spinal measurement and, if necessary, special X-ray examinations (bending X-rays), MRI and CT scans.

Scoliosis – what does the therapy look like?

Our doctors can treat scoliosis using either conservative or surgical methods. The type of therapy depends on the form and severity of the scoliosis. If scoliosis is diagnosed during childhood or adolescence, conservative therapy is usually sufficient.

This includes a special type of physiotherapy designed to strengthen the back muscles. Simultaneously, breathing exercises are performed to expand the rib cage and normalize breathing. Additionally, corset therapy is used. Modern corsets come in various ready-made fits that can be precisely tailored to each individual case. This restores stability to the spine and allows the back muscles to gradually rebuild their strength.

If conservative therapy is no longer an option, surgery becomes necessary. Dynamic stabilization, for example, can be used for spinal degeneration. The goal is to restore the spine's range of motion. At our Munich-East Spine Center, we use various systems for this purpose, which we would be happy to explain to you in more detail before any scoliosis surgery.

Is it possible to prevent scoliosis?

Scoliosis cannot usually be prevented, as its causes are unknown. It is crucial that scoliosis is diagnosed as early as possible to ensure the success of subsequent treatment. Special attention should be paid to posture, especially in children. Any incorrect or compensatory postures should be pointed out to a doctor as soon as possible.

Spinal stenosis, also known as vertebral canal stenosis, refers to a narrowing of the spinal canal. Not every case of spinal stenosis necessarily causes symptoms. Especially in the early stages, there are often no symptoms or only barely noticeable ones. Only over time does the increasing narrowing of the spinal canal lead to significant impairments.

This common spinal condition compresses the nerve roots, leading to mild to severe back pain. The pain usually occurs during movement, such as walking. Other activities, like cycling or sitting in general, tend to alleviate the pain. Bending the upper body forward widens the spinal canal, giving the nerves sufficient space and significantly reducing the pain.

In spinal stenosis, we distinguish between two variants: lumbar and cervical spinal stenosis. Lumbar spinal stenosis occurs in the lumbar spine, while the cervical variant affects the cervical spine.

Causes of spinal stenosis – what's behind it?

Spinal stenosis primarily occurs with increasing age, due to natural wear and tear. The intervertebral discs deteriorate and can no longer fully perform their function as natural shock absorbers. However, it can also be a congenital narrowing of the spinal canal. In this case, the bony structures (pedicles) that connect the vertebral bodies to the vertebral joints are shortened and thickened.

Acquired spinal stenosis is usually caused by a herniated disc or facet joint osteoarthritis. This also applies to cervical spinal stenosis. Other causes of spinal stenosis include:

– Injuries to the vertebral bodies
– Scarring after spinal cord surgery
– certain bone diseases

Spondylolisthesis, also known as vertebral slippage, can also be a trigger. This involves instability in certain areas of the spine, leading to a slippage of the vertebrae. If left untreated, spondylolisthesis can lead to spinal stenosis.

What are the typical symptoms of spinal stenosis?

As with many other conditions, spinal stenosis can manifest in various ways. Back pain can also be caused by a herniated disc and not by spinal stenosis. The back pain often radiates into both legs, sometimes only on one side. In the early stages, the pain is felt only in the thigh, but soon affects the entire leg. Other signs that may indicate spinal stenosis include:

– Restrictions in movement (lumbar spine)
– Tension in the lower back
– Weakening or deterioration of the leg muscles

If spinal stenosis is already advanced, the bladder and bowel can also be affected. Incontinence and loss of bowel control can result. Sexual function may also be impaired in some cases.

How can a doctor diagnose spinal stenosis?

At our Munich East Spine Center, we place great emphasis on a comprehensive and thorough diagnosis. A detailed medical history is essential to gain an overview of existing illnesses, pre-existing conditions, and family medical history. Should spinal stenosis be suspected, further diagnostic measures can be implemented.

– MRI (Magnetic Resonance Therapy, Nuclear Spin)

– CT (computed tomography)

– X-ray or CT scan of the spinal canal with contrast medium (functional and stress myelography)

With this myelography, the doctor can precisely locate the narrowing of the spinal canal.

What treatment options are available?

In the early stages of spinal stenosis, conservative treatment can be very effective. There are several good options available in the field of conservative treatment methods, such as physiotherapy. Muscle-relaxing treatments or specific exercises can further relieve pressure on the spine. Other examples of conservative therapies include:

– Support corset to relieve and support the spine
– Taking specific pain-relieving medications
– Back school

Spinemed: This computer-monitored spinal stretching system allows for targeted relief of pressure on the vertebrae. Essentially, it relieves pressure within the spinal canal.

Several minimally invasive treatment methods are also suitable for this condition. Radiofrequency thermotherapy can selectively deactivate pain-conducting nerves using heat. The same effect can be achieved with cold, specifically through a procedure called cryodenervation (nerve deactivation using a cold probe). The following therapies also fall into the minimally invasive category:

Facet joint therapy: Vertebral joints are also known as facet joints, which explains the name of this therapy. Facet joint therapy is a CT-guided form of pain therapy. The goal is to treat the affected nerve root directly at the facet joint.

– Injection therapy of the vertebral joints: Under image intensifier X-ray control, injections can be placed precisely and with millimeter accuracy in the region of the affected joint.

– Nerve root treatment: Catheter therapy is also performed under fluoroscopic X-ray guidance. The injection catheter is placed precisely at the nerve root.

If spinal stenosis cannot be treated with conservative or minimally invasive methods, surgery is unavoidable. This can be performed in various ways, for example, by inserting special implants in the spinal column.

Can spinal stenosis be prevented?

While this isn't strictly possible, there are certain behavioral patterns that can help keep your spine healthy in the long run. Sufficient exercise is important, and cycling is particularly good for keeping your spine moving. Avoid poor posture, which can lead to back problems. Other preventative measures include:

– Avoiding obesity
– Strengthening of the back muscles through specific exercises

Spondylodiscitis is an inflammatory disease of one or more intervertebral discs involving the adjacent vertebral bodies.

Inflammation can partially destroy the vertebral bodies, which, together with the simultaneous damage to the intervertebral discs, can result in massive deformities.

Spondylolisthesis (vertebral slippage) is a very common type of vertebral instability. There are various causes of spondylolisthesis. In older age, it develops when wear and tear weakens the vertebral joints. This leads to loosening, which causes the vertebrae to slip out of place.

The body attempts to compensate for the loss of stability through bone resorption, similar to a leaning tower that is kept from toppling over by buttresses and cement. This leads to a thickening of the vertebral joints, a condition known as spondylarthrosis.

What are the underlying causes of spondylolisthesis?

As mentioned previously, various triggers or causes can underlie spondylolisthesis. For example, if the flexible connection between the joints is defective, the vertebrae can slip out of place. However, age-related wear and tear is a much more common cause of spondylolisthesis.

The intervertebral discs consist of a soft inner core surrounded by an outer fibrous ring. With increasing age, the inner core loses fluid, leading to dehydration of the disc. This results in impaired function of the muscles and ligaments surrounding the discs, making it easier for vertebrae to slip out of their normal position.

Certain sports are associated with an increased risk of spondylolisthesis (vertebral slippage). This is related to specific movement patterns that can promote this condition. In particular, regularly hyperextending the back, as occurs in weightlifting or javelin throwing, can trigger spondylolisthesis. Other causes of spondylolisthesis can include spinal injuries or specific diseases. These include, for example, the (rare) osteogenesis imperfecta (brittle bone disease).

What symptoms can indicate spondylolisthesis?

The symptoms of spondylolisthesis can vary widely, depending on the severity. It's also possible for spondylolisthesis to be completely asymptomatic or painless in its early stages. However, back pain is more common and often worsens with exertion or movement. If the spondylolisthesis is already very advanced, the following symptoms or accompanying conditions may also occur:

– Loss of reflexes
– Loss of sensation, muscle strength and mobility, often also in the legs

The symptoms mentioned do not necessarily indicate spondylolisthesis; they can also occur with other back problems. Therefore, a comprehensive and thorough diagnosis at our Munich-East Spine Center is important if spondylolisthesis is suspected.

How is the diagnosis made?

When spondylolisthesis is suspected, we pay attention to certain factors during diagnosis, such as similar conditions in the family history or acute spinal injuries. As part of the physical examination, we assess the course of the spine. Movement patterns and any existing misalignments can also indicate spondylolisthesis. Further diagnostic measures that can be used when spondylolisthesis is suspected include:

– Functional test of the spine
– X-ray examination
– Computed tomography (CT)
– Magnetic resonance imaging (MRI)

How can a doctor treat spondylolisthesis?

Spondylolisthesis, like many other spinal conditions, can be treated both conservatively and surgically. Pain management, physical therapy, and regular exercise are among the conservative therapies that can help with spondylolisthesis.

Another conservative treatment option involves modern corsets, which can minimize spinal instability. Gait and posture can also be improved by wearing special corsets. Once stability has returned, the corset can be gradually discontinued, allowing for greater freedom of movement.

If conservative therapy is unsuccessful, surgery may be performed. At our Munich-East Spine Center, we most often perform dynamic spinal stabilization. This procedure restores the spine's natural range of motion and provides stability. Depending on the extent of the degeneration, various systems can be used for dynamic stabilization.

In very rare cases, when no other surgical method is possible, spinal fusion may be considered. At our Munich-East Spine Center, we utilize all modern minimally invasive procedures (including dynamic techniques), such as specialized minimally invasive forms of spinal fusion. The fusion can be performed directly through the skin, requiring only several small incisions. Screws are then inserted through these incisions to fuse the vertebrae together.

Is there a way to prevent spondylolisthesis?

As with many other spinal conditions, strong back and abdominal muscles are essential for preventing spondylolisthesis. Good back muscles provide sufficient stability for your spine. However, if you participate in a regular exercise program, it's important to choose activities that are gentle on the spine. These include, for example, cycling, swimming, or Nordic walking.

It's important to incorporate a certain amount of movement into your daily routine. Prolonged periods of sitting are bad for your spine and can lead to permanent damage. It's better to get up and move around regularly. Strong back muscles are the best way to prevent spondylolisthesis from developing in the first place. We'd be happy to provide you with more information about the treatment and prevention of spondylolisthesis.

Vertebral fractures can have various causes. In younger adults, the most common causes are road traffic accidents or sports injuries.

However, falls, household and workplace accidents, and physical violence also play a role. Other causes are possible in older people. Neurological injuries occur in 40 percent of cervical spine injuries and in 20 percent of thoracic and lumbar spine injuries.

In spinal instability, the normally firm structure between the vertebrae loosens. This loosening usually occurs with increasing age, when wear and tear have weakened the vertebral connections.

In this context, wear and tear means that the intervertebral discs, vertebrae, joints, ligaments, and muscles can no longer withstand the stresses caused by increasing age and constant strain. This leads to complex changes in spinal balance and a shift in the center of gravity.

However, the body attempts to restore balance. This can then lead to spinal deformities such as degenerative scoliosis (lateral curvature), kyphosis (forward curvature with hump formation), and spondylolisthesis.

There are numerous sports that put greater strain on the spine and can even lead to injuries, especially in untrained muscles. These are mainly contact sports and sports that compress the spine or strain it through dynamic twisting movements. These include, among others:

– Tennis
– Squash
– alpine skiing
- Football
– Athletics jumping events
– Athletics throwing events
– Boxing
– Golf

golfer's back

One in two golfers suffers from back problems. This is because the sport puts more strain on the spine than many realize. Besides insufficiently trained abdominal and back muscles and an inflexible thoracic spine, the main reasons are faulty swing technique.

During the golf swing, the upper body rotates around the spine, exerting enormous forces on it. The lumbar spine, in particular, is not designed for these rotational movements. In extreme cases, this can even lead to a herniated disc. However, the significant stresses involved in swinging the golf club alone weaken and increasingly wear down the intervertebral discs.

In typical golfer's back, in addition to pain in the lower back, sudden neck pain or muscle tension also occur.

Therefore, it is important to warm up and stretch before each round of golf. Furthermore, you should have your swing and stroke technique regularly checked and corrected by an experienced golf coach. The unfortunately often observed bending of the spine towards the pelvis should be strictly avoided.

Another particular danger lurks at the end of the golf swing. After striking the ball, the player comes to a stop with their spine bent backward, facing the target, and watching the ball. Golfers refer to this final position as the "finish." However, this puts considerable strain on the small vertebral joints.

Healthy sports

In contrast, it is possible to exercise without risking back damage. This is important because sufficient exercise strengthens the muscles and even supports the spine. The following sports are therefore particularly recommended:

– Jogging on soft ground

– Nordic Walking
– Backstroke and front crawl
- Ride a bike
– Inline skating and ice skating
- Dance
– Yoga

Many women and men with herniated discs and back pain, and especially patients after spinal surgery, often ask themselves: When and how often is sex allowed, which positions are recommended, what should you pay attention to?

As a general rule: Avoid anything that tenses the muscles and puts excessive strain on the body. Fast, short, and uncontrolled movements are detrimental; slow movements are advisable. Avoid anything that could compress the spine and avoid rapid back-and-forth movements. Furthermore, the surface you are working on should be neither too hard nor too soft.

In contrast, gentle, rhythmic and relaxed movements of the pelvis can even act like preventative exercises against back pain and promote relaxation.

It is also crucial whether the man or the woman is suffering from back pain. Anyone experiencing pain should always assume a passive position.

For men with back problems, these positions, for example, could be considered:

1. The woman sits or lies on an elevated surface, such as a worktop or table. The man can stand in front of her. He should keep his upper body upright.

2. The man lies on his back and the woman sits on his pelvis. The movements originate from her.

3. The missionary position with the upper body only slightly raised and legs as straight as possible.

Women with back problems, on the other hand, might prefer these positions:

1. The woman lies on her back with her legs only slightly bent or straight. The man lies on top of her and takes the active role.

2. The woman lies on her back. The man lies on his side in front of her pelvis. Her legs are positioned over his pelvis. She lies passively, and he is sensitive in his thrusting movements.

3. The woman lies on her stomach on a large blanket or pillow, or stands with her upper body lowered onto a sufficiently high surface. He stands behind her and again monitors the intensity of the thrusts.

These positions also allow for back-friendly lovemaking:

Spoon position
An effortless and comfortable position; the spine, hip joints and knee joints can be moved easily, and the back is subjected to only minimal pressure.

In the profile
This position is beneficial if both partners suffer from back pain. One partner lies on their back with bent knees, while the other lies on their side with their hips and knees bent as if sitting. Their legs should then be positioned over their partner's waist and between their thighs.

face to face
With both partners facing each other, she wraps her thighs around his hips as if she were sitting on his lap. His hips and knees are slightly bent, so that her buttocks rest on his thigh. Both should be able to move easily and without back pain.

prone position
This position is comfortable for the woman lying on the bottom in a neutral position. However, if the man also suffers from lower back pain, he will not prefer this position. The man's elbows provide weight relief. A flat pillow under the abdomen offers additional support for the woman's lower back.

Woman astride
The stable neutral position of the man with lower back pain allows for pain-free pleasure. The woman controls the angle and depth of penetration; leaning back and supporting herself on his thighs reduces the pressure of his weight.

Reverse missionary position
This position also protects men with lower back pain and offers them the best opportunity to delay their orgasm. It is also suitable for couples where the woman is short and the man is tall.

Seated position
Depending on the type of back problem, a seated position can also be practical. The partner with back pain supports their back against the stable seat back, and a small footrest prevents painful lumbar lordosis.

Kneeling position
This position should also be gentle on the back if both partners suffer from lower back pain. Kneeling allows both partners to extend their lumbar spine, and the woman can also easily vary her position. Pillows under the knees provide comfort.

Sex after back surgery

If one partner has recently undergone spinal surgery, the couple should wait until the fourth postoperative week before engaging in sexual activities that could strain the back. Even after that, it is advisable to resume the positions described above very cautiously and gently.