ENIf back pain has been shooting down your leg for months, the MRI report says “disc herniation”, and one doctor at home recommends surgery while another advises against it, a spine centre at a German hospital can give you an opinion that helps you decide. Its surgeons review the images themselves, not just the report, and tell you whether there is a reason to operate.
Spine surgery in Germany starts with the question of whether an operation is needed at all. Below: when surgery cannot be avoided, which conditions it treats, how operations are done and where, how to choose a centre and how to organise the trip. This is the entry page of the section: individual conditions such as disc herniation, stenosis and scoliosis have pages of their own.
When the spine needs an operation
The spine needs an operation less often than many people think: most back pain, even when a herniation shows up on the scans, settles without surgery. Treatment starts with physiotherapy, exercise and pain relief and, if the pain radiates into the leg, targeted injections near the nerve root: under X-ray guidance, an anti-inflammatory drug is injected next to the compressed nerve, often with a local anaesthetic. The current guideline of the German Spine Society recommends offering such injections for nerve-root pain caused by a lumbar disc herniation. Non-surgical care is covered on the back pain treatment page.
See a doctor at once if warning signs appear: increasing weakness in the leg or foot, numbness in the saddle area between the legs, or loss of bladder or bowel control. These signs point to severe nerve compression, and an urgent operation may be needed. The most serious form is cauda equina syndrome, named after the bundle of nerve roots in the lower spinal canal that serve the legs, bladder and bowel.
A planned operation is considered for severe nerve pain that persists despite adequate treatment, spinal stenosis that keeps shortening the distance a person can walk, instability (vertebrae shifting against each other during movement), marked deformities, fractures and tumours. The surgeon decides together with the patient, comparing the images with the symptoms and the examination: an MRI picture alone is not enough.
Spinal conditions treated with surgery
Surgery treats disc herniation, spinal stenosis, scoliosis and other deformities, and spinal fractures and tumours. An intervertebral disc is an elastic cushion between two vertebrae; in a herniation, its soft core pushes out through a tear in the outer ring and presses on a nerve root. The surgeon removes the prolapsed part under an operating microscope or endoscopically through a small incision. An artificial disc suits only a limited group of patients; see the disc replacement page.
Spinal stenosis is a narrowing of the canal that carries the nerves. Typically the legs hurt and feel heavy when walking and ease on sitting down or bending forward. It is treated with decompression: the surgeon removes the bone or thickened ligament that presses on the nerves. If vertebrae are unstable or one has slipped out of line, spinal fusion follows: two or more vertebrae are joined with screws and rods so that they grow together.
Scoliosis and other curvatures of the spine are treated in both children and adults. While a child is still growing, a brace can often hold back the curve; when the deformity is severe or progressing quickly, the spine is straightened and fixed surgically. How doctors choose between the two is explained on the scoliosis treatment page.
Vertebral fractures follow injuries or osteoporosis, when bone becomes brittle. Kyphoplasty can stabilise a broken vertebra: bone cement is injected into it through a hollow needle and hardens inside; complex fractures are fixed with screws. Tumours of the spine and spinal cord are treated by neurosurgeons and spine surgeons together with oncologists, who plan drug treatment and radiotherapy.
How spinal operations are performed in German hospitals
In German hospitals, spinal operations are performed by two specialties: orthopaedic and trauma surgeons, and neurosurgeons. In large centres they work as one team with pain specialists and radiologists. A surgeon’s own experience is documented by the German Spine Society’s personal certificates: basic, master and, at the top level, the certificate of excellence.
Many operations are done through small incisions, with an operating microscope that magnifies the field many times over or an endoscope, a thin tube carrying a camera and instruments. When screws are placed, navigation helps: a system that shows the surgeon on the images, in real time, where the instrument sits in the vertebra. During complex procedures, intraoperative neuromonitoring continuously measures how the nerves and spinal cord conduct signals and warns the surgeon if they are at risk.
After surgery, patients are mobilised early, getting up and walking with a physiotherapist within the first days; rehabilitation follows, in a rehabilitation clinic or as an outpatient. The operating surgeon decides how long the patient stays in hospital and when it is safe to fly. The centres themselves are assessed by the German Spine Society (Deutsche Wirbelsäulengesellschaft): under its spine centre certification system, a hospital can be certified as a maximum-care spine centre, a specialist spine centre or a spine unit.
Spine hospitals in Germany
Spinal surgery in Germany is done in specialised centres at university hospitals and specialist private hospitals; here are examples among AlenMed’s partners. Werner Wicker Klinik in Bad Wildungen has a centre for spinal disorders and the German Scoliosis Centre. Both are headed by chief physician Dr Luis Ferraris, an orthopaedic specialist who leads the hospital’s spine surgery and treats scoliosis. The hospital also has a centre for people paralysed after damage to the spinal cord and a neurosurgery department headed by chief physician Jamil Makki.
At ISAR Klinikum in Munich, the spine surgery department has been led since 2013 by neurosurgeon PD Dr Ralf Rothörl. Earlier he spent eleven years in neurosurgery at Regensburg University Hospital and then worked as a senior consultant at the neurosurgical clinic of the Technical University of Munich at Klinikum rechts der Isar. Spine surgery is now his main field, and he operates using microsurgical techniques. At Leipzig University Hospital, Prof. Christoph-Eckhard Heyde heads spine surgery and the children’s spine centre. He treats diseases and injuries of the spine in children and adults and holds the German Spine Society’s certificate of excellence.
Other partner hospitals have spine departments too. Asklepios Orthopaedic Hospital Bad Abbach runs a centre for spine and scoliosis therapy that treats children as well as adults. Schön Clinic Bad Aibling Harthausen has a spine surgery centre that, alongside operations, puts particular emphasis on conservative treatment and pain therapy. ATOS Clinic Heidelberg also has a spine surgery centre. For children there is Altona Children’s Hospital in Hamburg, where paediatric orthopaedic surgeons and paediatric neurosurgeons work together in a children’s spine centre.
How to choose a spine centre
Choose a spine centre by criteria you can check, because there is no official ranking of the “best” hospitals in Germany. The first is certification by the German Spine Society and its level: the higher the level, the wider the range of conditions the centre handles. The second is experience with your particular operation: ask how many such procedures the centre performs. The third is whether orthopaedic surgeons and neurosurgeons work together, and who exactly will operate. The fourth is whether the centre offers conservative treatment first where it is appropriate: a hospital that recommends surgery without asking how you have been treated so far is a warning sign.
A second opinion before a major operation, such as an extensive fusion over several vertebrae, is normal practice in Germany: people with statutory health insurance there have a legal right to one before certain planned spinal operations. What the treatment costs depends on the type of operation, the length of stay and the implants; how the bill is made up is explained on the cost of spine treatment page.
Frequently asked questions
Who operates on the spine in Germany: an orthopaedic surgeon or a neurosurgeon?
Both: orthopaedic and trauma surgeons and neurosurgeons are trained in spinal surgery. The division of work depends on the hospital: some centres are run mainly by orthopaedic surgeons, others by neurosurgeons, and large centres combine both. Disc herniations and stenosis are operated on by either. More important than the specialty is the experience of the surgeon and the centre with your operation.
Can a German surgeon review my case before I travel?
Yes, as a preliminary assessment based on your documents. A surgeon at the spine centre studies the MRI and CT images, discharge letters and previous treatment, then says whether surgery is indicated, which operation he or she would suggest and what it would cost by the hospital’s estimate. The final decision comes only after an in-person examination; sometimes new images are needed.
How risky is spine surgery?
Like any operation, it carries risks: wound infection, bleeding, nerve damage, a recurrent herniation and, after a fusion, extra strain on the neighbouring vertebrae. How high they are depends on the procedure and the patient’s health. Under German patients’ rights law, the doctor must explain risks and alternatives in person and in good time, so that consent is a considered decision.
How long will I need to stay in Germany after the operation?
It depends on the operation and on recovery, so the operating surgeon sets the length of stay. After removal of a herniated disc it is usually shorter; after a fusion or scoliosis correction, longer. Before you leave, the surgeon checks the wound and your condition and decides when it is safe to fly. Rehabilitation can follow in Germany or at home, based on a written plan.
How AlenMed arranges spine treatment in Germany
AlenMed starts with your documents: MRI and CT discs (the images themselves, not just the reports), discharge letters and a list of previous treatment. AlenMed translates them and sends them to the spine centres of partner hospitals across Germany, where surgeons give a preliminary assessment: whether surgery is needed, which operation and what it would cost according to the hospital’s estimate. The more complete the documents, the more precise this first answer.
Then comes the trip: a visa invitation, an interpreter at appointments, accommodation near the hospital, arranging rehabilitation after surgery and a written follow-up plan for your doctor at home. AlenMed’s office is in Munich; its partner hospitals are all over Germany.
This material is for information only and is not an offer. The treatment approach is decided by the doctor at an in-person consultation.