Not everyone needs spine surgery. Here are the methods used before or instead of an operation — with an honest assessment of what each of them offers.

1. Exercise therapy

The foundation of treatment for most back pain and disc herniation. Core strengthening, mobility work and a gradual return to activity reduce pain and the risk of recurrence. Many herniations shrink on their own over time, and radicular pain resolves within 6–12 weeks in most people.

2. Medication and epidural injections

A short course of NSAIDs and neuropathic pain medication ease the acute phase. An epidural corticosteroid injection for radicular pain often reduces it for several weeks or months and helps get through the acute phase without surgery, but it does not remove the cause. Usually no more than 3–4 injections a year are given.

3. Radiofrequency denervation

Used for facet joint pain confirmed by a diagnostic block. Relief may last 6–12 months, after which the procedure is sometimes repeated. In the large MINT trial, denervation showed no clear advantage over an exercise programme, so patient selection matters.

4. PRP and cell-based methods

PRP injections into the facet joints, sacroiliac joint or disc, as well as cell products, are being studied; in small studies some patients reported less pain. There is no evidence that they restore the disc or reliably replace surgery. They can be discussed with the physician when standard treatment has not helped.

5. When surgery is really needed

Urgently — with cauda equina syndrome (numbness in the groin area, bladder problems) and increasing leg weakness. Electively — if radicular pain is severe and does not settle after 6–12 weeks of treatment, or with marked stenosis limiting walking. In such cases surgery relieves pain faster than conservative treatment.

How to choose the method?

The choice depends on the source of pain, neurological symptoms, how long the problem has lasted and previous treatment — not just on the size of the herniation on MRI. We send your images and description of symptoms to several partner clinics; clinic physicians propose a plan and cost, and you compare the options. More on the herniated disc page.

Who it is not suitable for and possible risks

Contraindications

  • Active infection — at the injection site or systemic, with fever.
  • Active cancer or ongoing chemotherapy.
  • Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
  • Pregnancy and breastfeeding — the procedure is usually postponed.
  • A corticosteroid injection into the same area in recent weeks.
  • Urgent surgery, not injections, is needed if there is progressive leg weakness, numbness in the groin area or bladder dysfunction.

Possible risks

  • Pain and swelling at the injection site for 1–3 days.
  • Bruising where blood or fat tissue is taken.
  • Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
  • The effect may be absent or smaller than expected.
  • Injections into the intervertebral disc carry a rare risk of disc inflammation (discitis).

If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.

Scientific evidence

Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:

  1. Lurie JD et al. Surgical versus nonoperative treatment for lumbar disc herniation: eight-year results for the spine patient outcomes research trial. Spine (Phila Pa 1976), 2014.
  2. Bailey CS et al. Surgery versus Conservative Care for Persistent Sciatica Lasting 4 to 12 Months. N Engl J Med, 2020.

Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised

Clinic and method matching — free of charge

Describe your case and attach your MRI report. We will identify clinics that use the relevant methods and forward your request to them. No obligation; we reply within 24 hours.

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Frequently asked questions

What can replace spine surgery?

For most herniated discs and back pain, treatment starts with exercise therapy, pain relief and injections (PRT, facet blocks), sometimes radiofrequency denervation. About two thirds of herniations shrink over time.

When can spine surgery not be avoided?

With cauda equina syndrome (saddle numbness, bladder problems), increasing leg weakness, spinal instability, fractures or tumours — surgery is not postponed then.

How long should non-surgical treatment be tried?

Usually 6–12 weeks if there are no warning signs. If leg pain persists and limits daily life, the surgeon discusses an operation — it relieves pain faster, although results after a year are often similar.

How does RegenPAS help organise treatment?

RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.

How much does treatment cost and how long do I need to stay in Munich?

The cost depends on the method, the diagnostics needed and the clinic itself: prices differ between clinics. We request offers from several clinics and send you their conditions and quotes so you can compare. Price guidance is on the treatment cost page. For an outpatient procedure, 2–3 days in Munich are usually enough: examination, procedure and follow-up visit.