The strength of the conservative treatment of the spine lies in the multimodality, i.e. different forms of treatment are combined with only minor side effects. A targeted rehabilitation program and our own exercise therapy not only help the injured professional but also the recreational athlete.
Our spine consists – very simplified – of a movable and an immovable part. The cervical, thoracic and lumbar spine form the movable part, while the sacrum and coccyx remain rigid in their position. The spine is made up of 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae and finally the sacrum and coccyx, which connect to the pelvis.
The spine can also be divided into the anterior and posterior spine. The anterior column consists of the vertebral bodies and the intervertebral discs and is subjected to pressure. The posterior column is formed by the vertebral arches, vertebral processes and ligaments.
A total of 32 to 33 vertebrae are connected by intervertebral discs that act as elastic shock absorbers. In addition, muscles and ligaments bind the vertebrae to each other and thus lend the spine its mobility.
In detail, the spine, which is curved in a double S-shape from the side, consists of seven cervical vertebrae, twelve thoracic vertebrae, five lumbar vertebrae, five sacral vertebrae and the coccyx, which is formed by three to four coccyx vertebrae.
The two upper vertebrae of the 7 cervical vertebrae differ from the remaining vertebrae by their shape. The first vertebra (atlas) consists – to put it simply – only of a bony ring and carries the head.
The second cervical vertebra (axis), which has a so-called tooth (Latin Dens), forms a joint together with the atlas. The tooth is a bone protrusion at the front of the second cervical vertebra, which fits into the inside of the first cervical vertebra. When the head is turned, the atlas ring moves around the axis tooth. A band on the inside of the first vertebra holds the tooth on the inside. The seven cervical vertebrae allow the head maximum mobility.
Each of the twelve thoracic vertebrae, which form the centre of the spinal column, is connected by a pair of ribs. These vertebrae are less mobile and are therefore able to protect the organs in the chest well. All pairs of ribs, with the exception of the two lower ribs (free ribs), are connected to the breastbone by two joint surfaces at the front.
The lumbar vertebrae are located below the thoracic vertebrae and above the sacrum vertebrae. Without our 5 lumbar vertebrae we could not bend, bend or rotate our body in any direction. They are the vertebrae that carry the heaviest weight when walking: The lumbar vertebrae are stressed by the weight of the trunk, arms and head, a total of 25 to 30 kilos. That is why they are also the largest and strongest. The high mechanical stress on the lumbar spine results in the lower intervertebral discs and vertebral bodies wearing out more than other vertebrae over time.
sacrum and coccyx
Five Sacrum vertebrae ensure that the upper body has a firm foundation and does not sink down without support. Situated between the lumbar vertebrae and the coccyx, they are connected to the pelvis both by each other and by the sacroiliac joint – a connective tissue-like, fixed, slightly mobile joint – and thus guarantee the stability of the trunk. The coccyx is probably a relic of our most distant ancestors who still had a tail. In humans, these three to four fused vertebral remains are functionless.
The intervertebral discs, also known as intervertebral vertebrae, are bodies made of cartilaginous tissue that serve as links between the vertebrae. They each consist of a fibrous ring and a gelatinous core. While the fibrous ring supports the spine, the soft gelatinous core acts like a shock absorber, distributing shocks evenly over the adjacent parts of the vertebral body. In a healthy disc, the neutral position is the center.
The discs adapt to all movements through an optimal interaction of fiber ring and gelatinous core. Due to these permanent stresses, the gelatinous core loses fluid and the intervertebral discs become narrower in the course of a day. That is why people are about 2 centimetres smaller in the evening than in the morning. However, the lying position during sleep regulates the fluid balance of the gelatinous core of the intervertebral disc again and you are as large the next morning as you were the morning before.
The invasive treatment
The invasive treatment should always be seen as an additional treatment option that contradicts the risk of complications and the risk of failure.
Injection treatments: In most cases, a local anaesthetic is used, which is mixed with one or more homoeopathic or cortisone preparations.
Neural therapy: the injection takes place superficially into the tissue (hives) or is injected deep into the tissue.
Facet joint injection: Injection into the intervertebral joint.
Periradicular injection therapy: Injection directly to the nerve root.
Peridural infiltration: directly into the peridural space between spine and spinal cord. The needle position can be precisely positioned under ultrasound, X-ray or CT control.
Denervation procedures: The pain-conducting nerve fibres from the affected intervertebral joints are switched off by targeted electrical impulses. The difficulty lies in the precise identification of the affected intervertebral joints.
Kyphoplasty is a procedure in the treatment of vertebral body fractures in which the fractured vertebra is stretched back to its original height with a balloon in order to be able to be filled precisely with cement in a second treatment step (vertebroplasty).
Relief surgeries: By removing parts of vertebral arches, bone attachments caused by wear (spondylophytes) and intervertebral disc tissue (sequester), a narrowed nerve or the spinal canal can be relieved without significantly reducing the stability of the spinal column.
Stiffening operations are performed to correct spinal column curvatures (scoliosis or massive hunchback formation) and to stabilize unstable segments. In general, it should be noted that chronic and persistent back pain alone is not a reason for surgery.