Spine: non-surgical treatment and when surgery is needed

Spine Conditions

M51.1

Herniated Disc

Herniation of an intervertebral disc with nerve compression. Pain, numbness, weakness in the extremities.

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M48.0

Spinal Stenosis

Narrowing of the spinal canal with compression of the spinal cord and nerves. Pain when walking, numbness in the legs.

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M42

Osteochondrosis

Degenerative changes in the intervertebral discs. Chronic back pain, stiffness, reduced mobility.

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M43.1

Spondylolisthesis

Displacement of a vertebra relative to another. Instability, pain in the lower back, nerve compression.

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M54.3

Sciatica

Inflammation or compression of the sciatic nerve. Shooting pain from the lower back through the buttock to the leg.

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M47.8

Facet Syndrome

Arthrosis of the facet joints. Chronic pain worsening with extension and rotation. Often misdiagnosed.

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M96.1

Failed Back Surgery Syndrome

Persistent pain after spinal surgery. Scar tissue, adjacent segment disease, nerve damage.

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M45

Ankylosing Spondylitis

Ankylosing spondylitis: symptoms, diagnosis, role of regenerative methods in peripheral joint involvement. Does not replace base therapy.

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Other conditions

In addition to the conditions listed above, a regenerative method is effective for the following spine pathologies:

Disc protrusion
Foraminal stenosis
Scheuermann disease
Ankylosing spondylitis
Coccygodynia
Sacroiliac joint dysfunction

Every case is individual. Send your MRI images for a free assessment of treatment possibilities using a regenerative method.

Spine: treatment options and what is known about them

The treatment plan is made by the clinic doctor after an examination and a review of your images. The table shows the options usually discussed for this diagnosis and how well they have been studied.

Option	What to expect	How well studied
Exercise therapy and physiotherapy	Reduces pain, strengthens muscles, improves function; the basis of treatment	Well studied, recommended
Painkillers and NSAIDs	Ease pain during flare-ups; long-term use is limited by side effects	Moderate evidence
Epidural or perineural injection	Reduces radicular pain for weeks or months, helps get through a flare-up	Moderate evidence
Radiofrequency denervation	Switches off the small pain nerves of the joint; in some patients the effect lasts 6–12 months	Limited or conflicting evidence
PRP / CGF	Concentrate from your own blood; may reduce pain, growth of new tissue has not been shown	Little data
BMAC / MFAT	Cell preparations from bone marrow or fat; more expensive, no proven advantage over PRP	Little data
Surgery — the type depends on the diagnosis	If conservative treatment does not help or there is an indication	When indicated — the doctor decides

We send your request to several partner clinics. Some will suggest conservative treatment or injections, others surgery; each clinic quotes its own conditions and price. We help you compare the options.

Regenerative methods: realistic expectations

Most back pain comes from muscles, joints and discs and settles within a few weeks. Staying active and regular exercise help most; painkillers are for short courses. For facet pain confirmed by a diagnostic block, radiofrequency denervation can help. There is little data on PRP for back pain; age-related changes on an MRI do not need injections in themselves.

When surgery is discussed. Surgery for back pain without nerve compression rarely helps. It is discussed for vertebral instability, fractures or nerve root compression.

If an injection helps, the effect usually builds up over 6–12 weeks, and the result is assessed after 2–3 months. No clinic can guarantee a result.

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:

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.
Brinjikji W et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol, 2015.

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

Frequently Asked Questions About Spine Treatment

Spine: can surgery be avoided?

Almost always: treatment is based on exercise, physiotherapy and painkillers, with nerve blocks or denervation if needed. Surgery is rarely necessary.

Spine: do PRP and cell-based methods help?

There is little data. For chronic pain exercise comes first, and for confirmed facet pain, denervation. PRP injections may be discussed on an individual basis.

When can I expect a result after an injection?

If an injection helps, relief usually builds up over 6–12 weeks. The result is assessed after 2–3 months; not everyone needs a repeat procedure. No clinic can guarantee a result.

Spine: when is surgery needed?

Surgery for back pain without nerve compression rarely helps. It is discussed for vertebral instability, fractures or nerve root compression. The decision is made by the clinic doctor.

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.

What is needed for a preliminary assessment?

Your MRI (or CT, X-ray) report and the images if you have them, plus a short description of your symptoms and previous treatment. Send them via the form on the website — the assessment is free and without obligation: the coordinator replies within 24 hours, and the clinic physician’s preliminary opinion follows in 1–3 business days.

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.