Tumors in the spinal canal, such as meningiomas or neurinomas (schwannomas), are overwhelmingly benign and grow slowly, so that symptoms usually develop gradually and the diagnosis is often made only late. Tumor-related compression of the nerves or spinal cord can cause pain, impairments of sensation and coordination, disturbances of bladder and bowel emptying, paralysis, and, for example in the case of a location in the upper cervical spine, ultimately even life-threatening conditions. The optimal treatment for most tumors in the spinal canal is microsurgical removal; complete resection represents, in the clear majority of cases, a permanent cure. By far most tumor removals are performed with the patient in a prone position via a posterior surgical approach. During the operation, the functions of the spinal cord and nerves are monitored using intraoperative electrophysiological neuromonitoring (IONM), in order to immediately detect stress on or functional impairment of nerves during the operation, so that the surgical approach can be adjusted. The goal is always to achieve the most complete tumor removal possible while maximally protecting the nerves. The frequency of surgery-related neurological deficits is very low, and more than 90% of operated patients experience a clear improvement or regression of symptoms after surgery.
The incidence of infections of the spine (spondylodiscitis) is increasing worldwide. Reasons include, among others, a rising average age, illnesses associated with impairment of the immune defense (for example diabetes, immunosuppressive treatments such as chemotherapy or cortisone therapy, obesity), and previous invasive treatments or surgeries. Detection of the causative pathogen and determination of its antibiotic sensitivity are the prerequisites for targeted antibiotic therapy, which represents one of the cornerstones of the treatment of spondylodiscitis. A conservative approach is indicated when there are no neurological deficits, the infection is not spreading through the body, and there is no instability in the affected section of the spine. Indications for surgery, with removal of as much of the inflamed tissue as possible and, if necessary, stabilization of the affected section of the spine, include neurological deficits, destruction of the vertebral body with resulting instability, sepsis, or pain that cannot be managed conservatively. Both after conservative and after surgical treatment of spondylodiscitis, residual symptoms frequently remain, which can be attributed to vertebral destruction, misalignment, or chronic irritation of the affected nerves (neuropathy).