For cases with chronic back-pain that do not respond to conservative treatment and intensive strengthening-therapy (for example MedX), an accurate diagnosis and source-detection is necessary. In the majority of this cases the source turns out to be a mechanically induced nerve-irritation caused by disc-bulging or bone-hypertrophy (abnormal bone growth). In order to determine the pain-source, a thorough examination, considering the following diagnostic options, should be conducted:
- Blood-tests (aimed particularly at rheumatism, gout and further inflammatory processes)
- X-ray, including flexion- and extension-images
- MRI (Magnetic Resonance Images)
An endoscopic hernia-removal could bring a durable pain-relief, should the above mentioned examinations not emphasise a mentionable degeneration of the discs or spine.
A post-operative rehabilitation-program, in connection with the operative treatment, is one of the keys to a lasting pain-freedom and a good sense of being.
Should the pre-examinations not result in an explicit diagnosis, a discography of the presumed as well as the adjacent levels should be conducted. This examination can determine, whether there exists a tear of the annulus (outer ring of the disc), that causes the chronic back-pain. Under certain conditions, the discography is combined with a computer-tomography. Has a tear of the annulus been confirmed, a percutaneous nucleotomy can be performed.
In cases with an obvious disc-degeneration - constricted to one or two levels - the outcome of the discography helps to determine whether a discoplasty, a disc-prosthesis or a spondylodesis would bring the best possible outcome.
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Chronic Backpain