If symptoms occur, a suspected diagnosis or even a well-founded diagnosis should first be determined by means of an initial examination. 

The complaints can have different reasons:

A) Complaints caused by muscular tension.

B) Discomfort from trauma.

C) Complaints from herniated discs, bulging, spinal constriction, signs of wear.

D) Complaints after an operation

E) Other (infections, osteoporosis, tumors, etc.)

F) Nerve related pain

Ⅰ – The conservative conventional measures and therapies:

a) bed rest, corset, orthoses, neck tie

b) manual therapy, heat applications

c) Physical therapy

d) Physiotherapy, manual therapy (chirotherapy)

e) TENS procedure

f) drug-based pain therapy in stages according to WHO

g) Syringes, injections, infusions

h) wheals/neural therapy

Ⅱ – The minimally invasive therapy and procedures. 

a) Infiltration with preparations containing cortisone and local anesthetic, infiltration with PRP or BET (blood-specific therapy – plasma), hiatus blockade (caudal flooding)

b) CT, imaging-guided interventional pain therapy (PRT)

c) CT (X-ray, C-arm, fluoroscopy, ultrasound) controlled facet denervation (therapy) using

1) Laser/ radio frequency

2) Cryotherapy

3) Alcohol preparation (diluted)

4) heat

5) Endoscopic (endoscopic facet and SI joint denervation)

d) CT (X-ray, C-arc, fluoroscopy, ultrasound) controlled epidural catheter therapy (Ratz, EP catheter modified according to Arous, Salim etc.)

 EP catheter is a minimally invasive procedure for the treatment of chronic back pain of various causes and genesis:

Bulging discs, herniated discs, adhesion formation (scar-related pain and discomfort), therapy-resident pain syndrome, postnucleotomy syndrome (functional limitations, disorders and postoperative pain caused by a microsurgical operation). in some forms of spinal stenosis (spinal canal narrowing). The operation is performed using imaging methods (computed tomography, C-arm, etc.)

The operation can be performed under local anesthetic or general anesthesia.

e) CT (X-ray, C-arm, fluoroscopy) guided laser nucleotomy (lasing and disc attenuation) PLDD

Percutaneous laser disc decompression (PLDD) is a minimally invasive, effective therapeutic method in the treatment of herniated discs, bulging discs, chronic discogenic (disc-related) pain. The PLDD achieves a volume reduction of the intervertebral disc.

The operation is carried out using imaging methods (computed tomography, C-arm, etc.)

The operation can be performed under local anesthesia or general anesthesia.

f) Nucleoplasty (percutaneous coblation of the intervertebral disc)

 Nucleoplasty is a minimally invasive procedure for the treatment of herniated discs, bulging discs and disc-related back pain (e.g. lumbar syndrome). The nucleoplasty is performed using imaging methods (computed tomography, C-arm, etc.).

The operation can be performed under local anesthetic or general anesthesia.

g) PASHA® catheter: therapy for chronic back pain

The PASHA catheter (inventor Dr. Omar Pascha) or EPIDURAL-RF-STIMULATION-Treatment EPRFT) is a minimally invasive pain therapy intervention/operation. The effect of the method occurs through the effect of the multifunctional electrical electrode on nerve function. A permanent change in pain conduction over several months to two years occurs after high-frequency current treatment over four to seven minutes.

The EPRFT therapy is carried out using a small electrode placed directly on the painful area. This electrode is attached to a flexible tube (catheter).

The operation is carried out using imaging methods (computer tomography, C-arm, etc.) The operation can be carried out under local or general anesthesia.

h) Disc FX operation of the intervertebral disc

Disc FX procedure is a minimally invasive therapy for disc-related back pain.

The therapy method mentioned above is a combination of mechanical removal of intervertebral disc tissue using micro forceps and electrothermal therapy with local heat generation (evaporation).

The operation is carried out using imaging methods (computer tomography, C-arm, etc.) The operation can be carried out under local or general anesthesia.

Hydrogel – Filling (augmentation) of the disc with cartilaginous gel

What is a hydrogel:

is a polymer that has a high water content and is not water-soluble at the same time.

As a result of signs of wear and tear (degeneration of the intervertebral disc), the volume of the intervertebral disc will reduce over time, resulting in a reduction in the height of the intervertebral disc.

The load on the vertebral bodies and vertebral joints increases, leading to pain and discomfort.

The minimally invasive intervention technique using hydrogel restores the volume as well as the height and thus the physiological function of the intervertebral disc.

The operation is performed using imaging methods (computed tomography, C-arm, etc.)

The operation can be performed under local anesthesia or general anesthesia.

i )     Percutaneous nucleotomy (decompressor)

Percutaneous nucleotomy using a decompressor is a minimally invasive method for treating disc-related back pain. This method is intended to relieve pressure on the nerve root and reduce volume within the intervertebral disc. Pressure relief of the nerve root as well as volume reduction within the intervertebral disc.

With this method, an individual decision is made in advance as to whether the patient has the prerequisites based on his or her diagnosed findings. The operation is carried out using imaging methods (computed tomography, C-arm, etc.). The operation can be performed under local anesthesia or general anesthesia.

U)- Percutaneous endoscopic surgery, epiduroflexendoscopy for intervertebral disc lesions and stenoses (narrowing of the root hole)

Percutaneous endoscopic surgery is a minimally invasive percutaneous surgical technique for the therapy and diagnosis of patients with herniated discs and foramen stenosis.

j) Kyphoplasty/vertebroplasty for vertebral body fractures: Minimally invasive surgical procedures

Procedures for osteoporosis-related or tumor-related (also in some traumatic) fractures of the lumbar and thoracic vertebrae.

The operation is carried out by the implementation of bone cement in the fragile sections of the spine under imaging procedures (computed tomography, C-arm, etc.)

The operation can be performed under local anesthesia or general anesthesia.

Ⅲ-macro-microsurgical operations. (Open operations using a microscope)

a) Intervertebral disc surgery for herniated discs.

Decompression surgery (exposing and relieving pressure on nerve roots, meninges and spinal cord) for narrowing of the spinal canal (stenosis) and bone wear. 

Reversal surgery for recurrent herniated discs and adhesion formation (scar formation)

X-Stop, Diam, Coflex procedure (surgery). –

are minimally invasive beautifying operations as an alternative to conventional open operations for spinal stenosis (spinal canal narrowing), facet lesions, post-nucleotomy syndrome.

Dynamic stabilization (stiffening) with CoflexDynamic stabilization with DSS

Spinal fusion or stabilization (stiffening) with Coflex F and Coflex F-Plus, Disk-Teck etc.

Stabilization (stiffening) using internal fixators (screws and rods) with and without cage (placeholder)

PLIF Technique (Posterior Lumbar Interbody Fusion) Access and incision from the back of the spine.

TLIF technique (Transforaminal Lumbar Interbody Fusion) Access via the intervertebral foramina

PLF (Posterolateral Fusion) access from the side and behind.

Open anterior surgery on the lumbar spine with insertion of an artificial disc using a Pro-Disk implant

Stiffening operation on the cervical spine with placeholder (made of titanium or plastic) and additional metal plate – access from the front.

Stiffening operation on the cervical spine with cage placeholder access from the front.

Surgical removal of a disc and implantation of a disc prosthesis. 

Surgery on cervical spine with hybrid technology (cage / prosthesis)

Corporectomy of the cervical spine (complete removal of a vertebral body) – supply

Vertebral body replacement made of titanium or plastic

b) Peripheral nervous system surgery for:

A) Carpal Tunnel Syndrome.

B) Sulcusulnaris syndrome (ulna gut syndrome)

C) Tarsal Tunnel Syndrome

D) Plexus lesion

E) Pernaeus and femoral lesions (damage)

F) Pain therapy interventions:

1) implantation of drug pumps (morphine, baclofen)

2) SCS (Spinal Cord Stimulation) implantation

3) Blockages and denervation of the trigeminal nerve)