Spinal surgery
INFLAMMATION OF THE SPINE – ON INTERVERTEBRAL DISCS, VERTEBRAE, SPINAL CORD OR NERVES
Back pain that gets worse after exertion can be an indication of inflammation of the spine. Inflammatory spinal diseases are triggered by bacterial pathogens or a rheumatic process. Depending on the findings and degree of inflammation, conservative treatment methods can be successful and heal the inflammation. However, early surgery can also alleviate these inflammatory complaints in the spine.
Your intervertebral discs, vertebrae, spinal cord and nerves can be destroyed by these inflammatory processes. Therefore, do not hesitate to contact our spinal surgery specialists if you are suffering from spinal pain. At the ETHIANUM in Heidelberg, Prof. Dr Jürgen Harms and Priv.-Doz. Dr Berk Orakcioglu are at your disposal as renowned experts for inflammation of the spine. The specialists will examine you comprehensively and treat you individually depending on the diagnosis and progress of the inflammation. Please remember: the earlier the cause of the inflammation of the spine is identified, the faster effective treatment can be provided and further damage to the spine averted.
We have compiled information on the three most common inflammatory diseases of the spine for you here. We have also briefly outlined the symptoms and surgical treatment options for diagnosing spinal inflammation.
Infectious spondylodiscitis – primarily treated with bed rest and antibiotics
Infectious spondylodiscitis usually occurs in the lower thoracic and lumbar spine. Bacteria, viruses, fungi or parasites can infect the spine via the blood or lymph channels. Sites with inflammatory vertebral disease can include vertebral plates, intervertebral discs and vertebral bodies.
If conservative treatment with immobilisation and antibiotics is unsuccessful, infectious spondylodiscitis can attack and deform vertebral segments. Neurological deficits such as paralysis can be the result of a diagnosis of spondylodiscitis.
The symptoms of infectious spondylodiscitis:
- Fever
- Purulent abscesses
- Pulsating, throbbing back pain after exertion
- Feeling of compression and pressure on the spine
- Tissue destruction (necrosis) of vertebrae and intervertebral discs
- Neurological disorders through to bladder and rectal dysfunction
- Instability of the spine
Diagnosis of infectious spondylodiscitis
Histological and microbiological examinations can identify the pathogen causing the inflammatory vertebral disease (infectious spondylodiscitis). This is the basis for successful treatment. X-rays reveal the extent of the deformities and destruction of the vertebrae and intervertebral discs. Computed tomography and magnetic resonance imaging with and without contrast agents are useful for a more differentiated assessment of the inflammatory processes. Skeletal scintigraphy is used to precisely localise the inflammatory foci.
Conventional treatment and surgical procedures for infectious spinal inflammation
Bed rest for several weeks and the administration of antibiotic, pathogen-specific medication is mandatory in the treatment of inflammatory vertebral disease (infectious spondylodiscitis). This treatment can be followed by immobilization of the spine with a corset.
But what happens if these therapies do not work? If there are already neurological problems or serious deformities or even a loss of position of the spine, surgery may be advisable.
In a surgical procedure, inflammatory defects in the spine can be reconstructed using the body’s own bone material from the iliac crest, fibula chip or rib chip. Stiffening the affected vertebral segment can also stabilize the spine. Decompression of the spinal canal and spinal cord frees the spinal column.
RHEUMATOID ARTHRITIS – CHRONIC POLYARTHRITIS
Rheumatoid arthritis is an autoimmune disease that occurs in episodes. It affects joints, tendons, tendon sheaths, bursae and also the cervical spine. The immune system turns against its own body and attacks it. Rheumatoid spine inflammation (rheumatoid arthritis) is considered incurable.
The symptoms of the cervical spine in rheumatoid arthritis
Rheumatoid arthritis can manifest itself in the cervical spine. The inflammatory rheumatic process affects and destroys the bones and ligaments of the upper and lower head joint. The following symptoms can be indications of rheumatoid arthritis:
- Feeling of instability in the cervical spine (neck)
- Neck pain, headaches
- Painful crunching and cracking
- Locking or cracking of the vertebrae
- Neurological deficits in arms and legs
- Dizziness, nausea, rapid eye movements
- Drop attacks: sudden falling over, gait disturbances
- Lhermitte’s sign: electrical tingling along the spine
- Shortness of breath, dysphagia, voice disorders
- Bladder and rectal disorders
- Respiratory paralysis
Diagnosis of chronic polyarthritis
Early diagnosis and timely treatment of the rheumatic spine with regard to surgery are helpful in chronic polyarthritis. The damaged spine can be visualised using X-rays, computer tomography and magnetic resonance imaging. Neurophysiological examinations precisely differentiate the damage to the nerves and spinal cord. In the event of instability and neurological damage, stabilisation measures stem the progression. This prevents further complications.
Surgical treatment of the rheumatic spine
- Dorsal fusion of C1 and C2 using the Harms technique
- Transoral dense resection with dorsal fusion
- Ventral corpectomy with anterior and posterior instrumentation
- Dorsal decompression with dorsal instrumentation and fusion
INFLAMMATORY RHEUMATIC DISEASE OF THE SPINE – ANKYLOSING SPONDYLITIS
Ankylosing spondylitis usually begins at the sacroiliac joint. As a result of ascending inflammation, it destroys vertebral joints and entire vertebral segments. At the same time, calcification of the ligamentous apparatus in rheumatoid arthritis causes stiffening of the spine. Ankylosing spondylitis is characterised by a bent posture towards the floor. This is due to the increasingly stiffened spine.
Ankylosing spondylitis – the diagnosis
Many symptoms of ankylosing spondylitis are similar to those of other diseases. This makes early diagnosis and treatment of spondylitis difficult. The same applies to the different courses and clinical pictures of ankylosing spondylitis. A clinical history, X-rays, computerised tomography and magnetic resonance imaging confirm the diagnosis.
The possible symptoms of ankylosing spondylitis:
- Deep back pain
- Deformation and stiffening of the spine
- Hunchback formation of the thoracic spine
- Osteoporosis (bone loss) due to immobility
- Vertebral fractures due to non-elasticity of the spine
- Difficult chest breathing due to stiffening of the spine
- Fusion surgery (fusion of two or more vertebrae)
- Stabilisation of vertebral fractures
- Osteotomy
- Resection
Surgical procedures for ankylosing spondylitis
Unfortunately, ankylosing spondylitis (ankylosing spondylitis) cannot be cured. However, the client’s quality of life can be significantly improved. Conservative measures such as physiotherapy, anti-inflammatory drugs, muscle relaxants and painkillers provide support.
The following surgical options for spondylitis treatment provide relief if the posture is increasingly bent:
- Fusion surgery (fusion of two or more vertebrae)
- Stabilisation of vertebral fractures
- osteotomy
- resection
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OUR SPECIALIST FOR SPINAL SURGERY
Get to know the experienced and dedicated neurosurgeon and spinal surgeon Priv.-Doz. Dr Berk Orakcioglu.
BERK ORAKCIOGLU
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Specialist in spinal surgery
Priv.-Doz. Dr Berk Orakcioglu is a specialist in spinal surgery. The neurosurgeon performs highly demanding operations with a high degree of safety and precision. His interpersonal understanding in particular characterises his dealings with his clients.
