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Patient cases — typical clinical journeys

The best guidance comes not from abstract explanations but from real clinical experience. The cases below illustrate characteristic clinical courses: non-surgical successes, planned and urgent surgical solutions, and complex tumour-surgery examples. The aim is to help you recognise your own situation among them.

Note on the cases: the cases presented here are composite — they combine the experience of several similar patients to illustrate a typical clinical course. They do not identify any individual.
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Non-surgical treatment

When the goal is reached without surgery

In the majority of spine complaints, surgery is not necessary. The 5 cases below show patient journeys where a combination of targeted injection therapy, medication and physiotherapy achieved lasting improvement — even when imaging showed significant findings.

01 Disc herniation · non-surgical

"The pain was already radiating into my leg" — a story of disc herniation

40-year-old office worker, sudden severe lower back pain radiating into the left leg

A 40-year-old office worker presented with lower back pain. He sat for long hours at work, and back pain was not new for him, but after a wrong movement, sudden severe pain appeared and within a few days radiated into the left leg. Sitting and bending became almost impossible; he occasionally felt numbness too.

He first tried rest and painkillers without improvement. Concerned that surgery might be necessary, he sought specialist advice. The MRI confirmed a disc herniation pressing on the nerve — explaining the radiating leg pain.

The first step was anti-inflammatory medication, but after several weeks there was no real improvement. Targeted, image-guided injection was then performed. Within days the pain decreased significantly and the radiation into the leg almost completely resolved. This was followed by a short repeat medication course and structured physiotherapy. The patient gradually built up strength, learnt how to move correctly, and within a few weeks returned to normal life. Today he remains symptom-free and continues the exercises he learnt.

Lesson

Targeted, stepwise non-surgical care is highly effective in many cases — and often makes surgery unnecessary.

02 Vertebral fracture · non-surgical

"After a wrong movement, a sudden sharp pain shot through my back" — vertebral fracture without surgery

72-year-old woman, sudden severe lower back pain without trauma

A 72-year-old woman presented with sudden lower back pain that appeared after a simple movement. The pain was severe enough to make walking and standing up difficult. There was no major fall or accident.

X-ray and MRI confirmed a compression fracture of the L1 vertebra. As a first step, we recommended non-surgical treatment: pain control and a thoracolumbar brace. The aim was to reduce pain and relieve load on the vertebra so that the fracture could heal stably. Over the following weeks the pain gradually decreased and the patient regained mobility. Follow-up CT confirmed good fracture healing — surgery was not needed.

Most fractures of this type heal well without surgery. Surgery (e.g. cement augmentation) is rarely needed and indicated only by the fracture pattern and pain. Importantly, osteoporosis often underlies these fractures, so investigation and targeted treatment of bone health are essential. In a fracture without trauma, other causes — such as a metastatic origin — must also be excluded.

Lesson

Sudden lower back pain in older patients can signal a vertebral fracture. With appropriate care, most cases heal well without surgery.

03 Bony microinjury · non-surgical

"My back hurt more and more after training" — bony microinjury in a young athlete

16-year-old competitive athlete, lower back pain triggered by load

A 16-year-old competitive athlete presented with recurrent post-training lower back pain. The pain was initially mild but progressively intensified, eventually affecting performance during loading. It improved with rest but returned after every more intense session.

MRI showed intact discs but an abnormal signal in the arch of one lumbar vertebra suggesting overload. CT showed no structural bone change. Based on symptoms and imaging, we made the diagnosis of an overuse-related bony microinjury.

As first-line treatment we recommended NSAID therapy and a 4-week pause from sport — the goal being bony regeneration. Follow-up MRI showed resolution of the lesion and the patient became symptom-free. A gradual, controlled return to sport was then permitted, with stepwise increases in loading.

Lesson

In young athletes, load-related lower back pain often hides an overuse bony injury. With early recognition and adequate rest, full recovery is achievable and more serious damage can be prevented.

04 Adult scoliosis · foraminal stenosis · non-surgical

"My leg hurt more and more when I was walking" — non-surgical care of adult-onset scoliosis

Woman in her 70s, gradual onset lower-limb pain and spinal curvature

A woman in her 70s presented with progressive lower-limb pain triggered by load. Examination and imaging revealed adult scoliosis with foraminal stenosis — narrowing of the nerve exit channels caused by the curved spine.

We applied a series of CT-guided nerve root blocks targeting the symptomatic levels, combined with targeted physiotherapy to strengthen the supporting trunk muscles. The pain resolved and the patient became symptom-free, returning to an active life.

Maintaining the symptom-free state requires regular physiotherapy.

Lesson

In adult-onset spinal curvature, pain often arises from narrowing at the nerve exit. With targeted injection therapy and appropriate physiotherapy, lasting improvement is often achievable without surgery.

05 Facet joint overload · non-surgical

"After a casual football game the back pain wouldn't go away" — facet joint overload

35-year-old IT specialist, left-sided lower back pain after occasional sport

A 35-year-old office-based IT specialist presented with sudden lower back pain after a casual football game. The pain was initially severe, decreased with anti-inflammatory medication, but returned shortly after. It localised persistently to the left side of the lower back, worsened with movement and load, and did not radiate into the leg.

MRI showed moderate wear of one lumbar disc. Increased fluid was visible in the left posterior facet joint, indicating overload and inflammation. We diagnosed facet joint pain and performed a targeted CT-guided facet joint block. The pain decreased significantly, and structured core-strengthening physiotherapy followed.

Wear of the disc reduces the spine's "shock absorber" function, transferring more load onto the posterior facet joints. This leads to overload and inflammation. The aim of physiotherapy is to strengthen the trunk muscles, which can partly take over this stabilising role.

Lesson

Even with mild disc wear, pain can develop under overload. With appropriate treatment and muscle strengthening, symptoms can be lastingly resolved and recurrence prevented.

Surgical solution

When surgery is the right path

In some cases, non-surgical treatment is not sufficient or the clinical picture demands immediate intervention. The 5 cases below show patient journeys where a surgical solution — planned or urgent — produced lasting improvement. Where possible, I chose minimally invasive techniques.

06 Disc herniation · surgical

"I could barely walk anymore" — when surgery brought the solution

45-year-old active man, persistent disc herniation unresponsive to non-surgical care

A 45-year-old active man presented with lower back pain that progressively worsened over several weeks. The pain soon radiated into the right leg; sitting and standing both became difficult, and even short walks required frequent stops. Numbness in the leg appeared intermittently.

MRI confirmed a disc herniation compressing the nerve. We started with anti-inflammatory medication, followed by CT-guided injection therapy and physiotherapy. Despite these measures, the pain only briefly eased and returned, persistently affecting daily activity, work and sleep.

In this situation surgery became the appropriate option. We removed the herniated disc fragment, decompressing the nerve. The patient experienced significant improvement within the first days: the radiating leg pain resolved and movement gradually became easier. After short rehabilitation and targeted physiotherapy he returned to daily activity within weeks and to his prior life style soon after.

Surgical indication for disc herniation: paralysis (motor weakness in the leg), suspicion of cauda equina syndrome (sudden urinary or bowel difficulty, lower-limb numbness or weakness), or persistent pain unresponsive to non-surgical care.

Lesson

When non-surgical treatment fails to bring lasting relief, well-timed surgery can restore function and quality of life.

07 Spinal stenosis · surgical

"I could walk less and less" — spinal canal stenosis

68-year-old previously active man, neurogenic claudication

A 68-year-old previously active man presented with progressive walking difficulty. After short distances, leg pain, numbness and weakness developed; he had to stop or lean forward to relieve the symptoms — characteristic neurogenic claudication.

MRI showed significant narrowing of the lumbar spinal canal at multiple levels. Targeted injection therapy and physiotherapy were tried first but produced only short-lived improvement. As walking distance progressively shortened, the indication for decompression surgery became clear.

Through a small midline incision we opened a bony window (laminotomy) on the back of the spine and decompressed the nerve roots and dural sac — "recalibrating" the canal. After surgery the patient regained substantial walking distance, and within weeks returned to active daily life.

Lesson

When non-surgical treatment of spinal stenosis is no longer sufficient, decompression surgery can restore the ability to walk.

08 Spondylolisthesis · athlete · surgical

"During training my back kept hurting more often" — vertebral slippage in a young athlete

22-year-old regular sports practitioner, recurring load-related lower back pain over months

A 22-year-old regularly active man presented with months of progressive load-related lower back pain. The pain affected sport and gradually intruded on everyday activity. Imaging revealed spondylolisthesis — slippage of one vertebra over the next — with associated nerve compression.

Non-surgical treatment did not produce lasting improvement, and the morphology — instability with nerve compression in a young, active patient — pointed to surgery. We performed a minimally invasive stabilization (MI-TLIF), preserving the surrounding muscles.

After surgery the pain resolved, mobility was restored, and the patient gradually returned to sport. Bony fusion was confirmed on follow-up CT.

Lesson

In a young, active patient with vertebral slippage, well-timed minimally invasive stabilization can restore function and enable a full return to sport.

09 Disc wear · stabilization

"My back kept locking up more often" — disc wear in a manual worker

48-year-old manual worker, increasingly frequent "locked-back" episodes over years

A 48-year-old manual worker had experienced increasingly frequent painful episodes over the years. Imaging showed significant wear of one lumbar disc combined with instability — abnormal hypermobility between two vertebrae. Non-surgical treatment provided only temporary relief and the episodes returned with increasing frequency.

The MI-TLIF technique (minimally invasive transforaminal lumbar interbody fusion) offered the right solution: through small skin incisions, percutaneous titanium screws were placed and the worn disc was replaced with a cage filled with bone-graft substitute, achieving stable fixation. The minimally invasive approach preserved the surrounding muscles, which is particularly advantageous for active patients.

After gradual mobilization and targeted physiotherapy, the patient returned to manual work within months. Follow-up CT confirmed bony fusion.

Lesson

For instability caused by disc wear, MI-TLIF stabilization can provide lasting relief — particularly suited to active patients thanks to muscle preservation and faster recovery.

10 Cervical disc herniation · urgent surgery

"One morning I couldn't use my hand properly" — cervical disc herniation requiring urgent surgery

42-year-old dentist, sudden hand weakness and arm pain

A 42-year-old dentist woke one morning unable to use his right hand properly. Fine motor control had deteriorated, accompanied by radiating pain into the arm and numbness in the fingers. For a hand-based profession, this was an immediate threat to his livelihood.

MRI showed a large cervical disc herniation compressing the nerve root with marked muscle weakness — an indication for urgent surgery. Within 24 hours we performed an ACDF (Anterior Cervical Discectomy and Fusion): through a small incision in the front of the neck the disc was removed, the nerve was decompressed, and a cage with bone-graft substitute was placed.

The arm pain resolved immediately, and hand function progressively returned. Within 3 months the patient had recovered completely and returned to dental practice.

Lesson

When cervical disc herniation produces established muscle weakness, time matters: urgent surgery can preserve full functional recovery.

Spine tumours — complex surgical care

Spine tumour surgery is one of the most complex fields, always carried out within an institutional setting and with a multidisciplinary team. The 4 cases below illustrate slices of this spectrum.

More on spine tumour surgery
Tumour cases

Selected tumour-surgery cases

Each case below was managed within an institutional setting and with the involvement of a multidisciplinary team.

11 Osteoid osteoma

"My back kept hurting, especially in the evenings" — osteoid osteoma in a young patient

13-year-old boy, recurrent night-time back pain

A 13-year-old boy presented with recurrent night-time back pain — the most characteristic symptom of osteoid osteoma. The pain typically responded to NSAIDs, but the location of the lesion was crucial: in this case the tumour sat too close to a nerve root, making radiofrequency ablation (the usual minimally invasive treatment) unsafe.

We performed open surgical removal — precise, focused, and through a small incision. The pain resolved immediately after the operation, and follow-up confirmed complete tumour removal. The patient has remained symptom-free since.

Lesson

For osteoid osteoma, choice of technique depends on tumour location: when ablation is unsafe, open surgical removal provides equally definitive results.

12 Ewing sarcoma · chondrosarcoma

"It started as simple back pain" — malignant vertebral tumours, different management

Two young male patients, both with mass lesions in the L4 vertebra

Two young male patients presented with mass lesions in the L4 vertebra. Same location, fundamentally different histology — and therefore very different treatment strategies.

The first patient was diagnosed with Ewing sarcoma. The treatment plan: combination chemotherapy first (the disease responds well to systemic treatment), followed by surgery and radiotherapy. Excellent long-term outcome with multidisciplinary collaboration.

The second patient had chondrosarcoma — a tumour that does not respond to chemotherapy or radiotherapy. Here only en bloc resection — removal of the tumour-bearing vertebra in a single piece with intact margins — provided a curative option. We performed a complex multi-stage operation with abdominal and plastic surgical involvement, followed by reconstruction.

Lesson

Two tumours with the same anatomical location can require entirely different treatment strategies. Histological diagnosis is decisive.

13 Metastatic spine involvement

"My back pain suddenly became unbearable" — metastatic spine involvement and urgent nerve decompression

48-year-old man, history of renal cancer, acute pain and lower-limb weakness

A 48-year-old man with a history of renal cancer presented with acute back pain and rapidly progressive lower-limb weakness. Imaging revealed a metastatic vertebral lesion compressing the spinal cord — an immediate threat to walking ability and an indication for urgent surgery.

Within hours we performed nerve decompression and stabilization. Postoperatively the weakness resolved and walking returned. Subsequent multidisciplinary care followed: oncology, radiotherapy and continued spine surgical follow-up.

Today, more than 7 years after the surgery, the patient is in stable oncological condition with good quality of life.

Lesson

In metastatic spine involvement, well-timed surgery is not only a means of pain control but a key element in preserving function and quality of life. Multidisciplinary care provides the foundation for long-term survival.

14 Sacral chordoma

"It started with bowel and bladder problems" — sacral chordoma

65-year-old man, complex multi-stage surgical treatment

A 65-year-old man presented with bowel and bladder symptoms — typical early symptoms of a sacral chordoma. Imaging confirmed a large mass in the sacrum compressing the adjacent neural structures.

Chordoma is a slow-growing but locally aggressive tumour that does not respond to chemotherapy or radiotherapy. The only effective treatment is en bloc resection — complete removal of the affected sacral region with intact surgical margins. This requires multi-stage surgery and the collaboration of multiple specialties: spine surgery, abdominal surgery, plastic surgery and urology.

The procedure was carried out in stages and was followed by complex reconstruction. The patient has reached stable oncological status with preserved quality of life.

Lesson

Sacral chordoma can be cured only by complete surgical removal — the procedure is one of the most complex fields of spine tumour surgery, achievable only with multidisciplinary teamwork.

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If your situation resembles one of these cases, the first step is a personal consultation — for an accurate diagnosis and a personalised treatment plan.

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