Modern Spine Surgery: Effective Solutions for Back Pain—An Expert Interview with PD Dr. Christopher Becker

 Priv.-Doz. Dr. Christopher Becker is an experienced specialist in orthopedics and trauma surgery with a particular focus on spinal and pelvic pain. Since August 2024, he has been running his own practice, spectrum MED, in the heart of Munich, while also serving as Chief Physician for Spinal Surgery at Artemed Klinikum München Süd. PD Dr. Becker has earned an excellent reputation, particularly for his expertise in minimally invasive pelvic ring and spinal surgery. His comprehensive understanding of the complex anatomy and function of the pelvis enables him to provide precise and individualized treatment for a wide variety of pain syndromes, including postpartum symphysis pain, sacroiliac joint pain, and coccyx pain.

In addition to his clinical work in a modern, interdisciplinary setting, PD Dr. Becker places great emphasis on patient-centered care. His treatment plans combine innovative minimally invasive techniques with a holistic approach that encompasses surgical, conservative, and rehabilitative measures. Restoring his patients’ quality of life is always his top priority. Through his involvement in numerous professional societies and expert groups, PD Dr. Becker stays up to date on the latest scientific developments and continuously integrates current findings into his work. In this way, he combines medical excellence with an empathetic approach, thereby creating the best conditions for the successful treatment of spinal and pelvic pain. In an interview with PD Dr. Becker, the editorial team of the Leading Medicine Guide learned more about modern spinal surgery, particularly for patients with back pain.

Back pain is one of the most common complaints worldwide and can significantly impair quality of life. Modern spinal surgery now offers a wide range of minimally invasive treatment options designed to specifically alleviate pain and restore the spine’s functionality. Thanks to minimally invasive techniques and innovative procedures, many patients can recover more quickly and return to their daily lives sooner. The focus is on individualized treatment that addresses both the causes of the symptoms and the needs of the patients.

Diagnosing back pain is a complex task, as its causes can be very diverse—ranging from muscle tension and intervertebral disc disorders to degenerative or inflammatory changes in the vertebrae, joints, or nerve structures.

“Most patients initially come to us because of back pain—some also experience leg pain. In such cases, a thorough medical history is crucial, as many clues can be gleaned from the patient’s history alone. For example, whether there have already been blockages in the sacroiliac joint or the facet joints. The subsequent clinical examination then usually reveals quite quickly the nature of the symptoms. If the symptoms have been present for some time, I generally order an MRI of the lumbar spine—that’s standard practice for me. This also allows us to assess the soft tissue structures: facet joints, ligaments, sacroiliac joint—all of these can be clearly visualized with this imaging. In the vast majority of cases, this already provides a clear indication of the cause of the symptoms. Based on this, I then discuss with the patients which treatment options are feasible—particularly in the area of interventional procedures, in which we specialize. And, of course, surgical options as well, although a great deal can be achieved today, especially in the field of minimally invasive spinal surgery,” explains PD Dr. Becker.

Before surgical treatment is considered, conservative treatment is always the first line of defense. This includes physical therapy exercises to strengthen the core muscles, posture training, exercise programs, and manual therapy. In addition, physical therapies such as heat or cold applications, electrotherapy, shockwave therapy, or ultrasound may be used. Pain medications—ranging from NSAIDs to muscle relaxants and centrally acting substances—are tailored to the individual, although early interdisciplinary pain management often yields more lasting results, particularly in cases of chronic pain. Psychotherapeutic elements are also incorporated into rehabilitation plans or as part of multimodal programs to provide holistic support for patients. Surgical treatment is considered only if these conservative approaches fail to produce sufficient improvement after weeks or months, or in cases of acute, severe symptoms such as paralysis, unsteady gait, or bladder and rectal dysfunction. The goal is always to select the treatment option best suited to the individual—one that is as minimally invasive and tissue-sparing as possible, with the aim of quickly restoring mobility and quality of life.

Patient factors such as age, pre-existing conditions, or lifestyle play a central role in the decision for or against surgical treatment in the field of spinal surgery. The patient’s individual physical condition and functional reserve significantly influence the risk assessment as well as the selection of the surgical procedure.

A patient’s biological age—not just their chronological age—is often decisive: While a fit 75-year-old with good cardiovascular function and an active lifestyle may well be a candidate for minimally invasive surgery, a significantly younger but severely multimorbid patient with impaired organ function may face a much higher risk of complications. Common comorbidities such as diabetes mellitus, cardiovascular disease, osteoporosis, or chronic lung disease not only affect a patient’s suitability for surgery and anesthesia but also influence the healing process and susceptibility to infection following the procedure. Lifestyle also plays a role that should not be underestimated: Severe obesity can both complicate the technical execution of the surgery and delay postoperative recovery, while a high level of physical activity and good muscle condition support rehabilitation.

“For certain patients with back pain in particular, minimally invasive procedures should be specifically considered—that is, procedures that are particularly gentle, require only short operating times, and result in a brief hospital stay. Lifestyle is a key factor influencing healing. In particular, prolonged sitting—such as from office work—has a negative impact on the prognosis, especially after surgeries like those for a herniated disc. If patients resume sitting for long periods every day immediately afterward, this can significantly impair the healing process. Smoking also plays a role—especially with major procedures such as spinal fusion surgery. We now know that smoking can interfere with bone healing because it negatively affects blood flow and microcirculation. In procedures where, for example, an implant in the intervertebral disc space is intended to ossify, smoking can significantly reduce the chances of successful healing. For this reason, many doctors—depending on the procedure—advise their patients to quit smoking. “In some countries, such as the U.S., this is even a prerequisite for certain surgeries,” explains PD Dr. Becker.

In addition to medical factors, personal expectations, professional and social demands, and the motivation to actively participate in follow-up care also play a role. For example, a patient who wants to return to physically demanding work as quickly as possible or who is very active in sports has different requirements regarding the stability and load-bearing capacity of their spine than someone with a predominantly sedentary lifestyle. The decision to undergo surgery is therefore not based solely on imaging findings or standardized algorithms, but always on a careful, individually tailored risk-benefit assessment. An interdisciplinary approach that also incorporates internal medicine, rehabilitation, and psychosocial aspects is essential for finding the optimal form of therapy for each patient.

PD Dr. Becker notes, “Before spinal surgery is even considered, the question arises as to when a procedure is not possible at all. From a surgical perspective, there are only a few exclusion criteria. Significant limitations usually arise from the patient’s general condition—for example, in cases of severe cardiovascular disease or severely impaired lung function. In such cases, anesthesiologists often determine that surgery would be too risky. From a purely surgical standpoint, most procedures—including minimally invasive ones—would often still be feasible. Only in cases of severe deformities might surgery be discouraged from a surgical perspective as well.”

In modern spinal surgery, minimally invasive techniques are increasingly being used, which differ from conventional open surgical procedures in several key ways. The goal of these procedures is to make the surgery as gentle as possible for the patient—while maintaining the same or even improving therapeutic effectiveness.

Instead of large skin incisions and extensive muscle dissection, minimally invasive procedures are performed through tiny skin incisions using specialized instruments and imaging. Often, a so-called tube (a small tube) is used through which microsurgical instruments and a camera are inserted.

“Nowadays, many spinal procedures can be performed using minimally invasive techniques—this also applies to more complex surgeries such as spinal fusion. However, not every patient is automatically a suitable candidate for this approach. Overall, the proportion of minimally invasive procedures is increasing significantly, primarily due to advances in the relevant instruments. In about 70 to 80 percent of cases, this gentle technique is already being used today. The advantage for patients is that the hospital stay is often short—usually two nights, or about four for spinal fusion. The physical strain is also significantly less than in the past. Many patients today are more relaxed about spinal surgery. Nevertheless, it remains important to speak openly about potential risks—even though serious complications such as paralysis are now very rare. “Thanks to modern, standardized techniques and continuous advancements, spinal surgery is now considered a very safe specialty,” states PD Dr. Becker.

Interdisciplinary collaboration between surgeons, pain specialists, and physical therapists plays a central role in the success of treatment for spinal conditions. Back pain and spinal disorders are complex conditions that can rarely be fully treated with a single therapeutic measure.

“Interdisciplinary collaboration is very well established here. In our practice, we work closely with pain specialists and maintain regular communication with specialists in physical medicine—a network that dates back to our time at the university hospital. We also maintain close ties with the departments of visceral and vascular surgery, particularly when it comes to differential diagnosis—for example, to determine whether symptoms originate in the groin, are caused by circulatory disorders in the legs, or stem from a disc problem. “Such interdisciplinary assessments are routine for us,” emphasizes PD Dr. Becker.

The surgeon assesses the structural cause of the problem and selects the surgical procedure; pain management specialists provide individually tailored pain treatment before and after the procedure; and physical therapists support early mobilization as well as long-term functional rehabilitation. Together, this creates a holistic treatment plan tailored to the patient. This coordinated teamwork not only improves clinical outcomes but also increases patient satisfaction. Ultimately, it is this interdisciplinary approach that distinguishes modern spinal medicine—with the goal not merely of performing surgery, but of restoring quality of life in a sustainable way.

Postoperative care following spinal surgery is a crucial component of treatment success and begins immediately after the procedure. The goal is to promote healing, prevent complications, and provide the best possible support for a return to daily life.

PD Dr. Becker explains: “Our follow-up care is structured and well-organized. It is important to us that patients return even after the procedure, because we want to closely monitor the healing process and assess the surgical outcome ourselves. To this end, we have standardized procedures: We contact patients two weeks after surgery—in person for patients from the region, and often by phone for those who have traveled from farther away. Our follow-up care plan also includes scheduled appointments: at two weeks, six weeks, and three months. Further treatment—particularly when to begin physical therapy and which exercises are appropriate—is tailored individually based on the patient’s current findings and condition. For more extensive procedures, such as spinal fusion, it takes an average of about two to three months before patients can once again bear full weight and manage their daily lives—including a normal workload—without difficulty.”

Many back problems cannot be attributed solely to medical conditions—in some cases, genetic factors also play a role. For example, there are congenital malformations or predispositions, such as weak connective tissue, that can increase the risk of herniated discs.

“One example is Bertolotti syndrome, an often-overlooked transitional anomaly in the lower spine that is congenital and can cause back pain. Overall, however, such congenital causes are relatively rare and are usually not the focus of spinal surgery—more severe malformations, such as those seen in young patients with cerebral palsy, are treated at specialized centers. Much more commonly, however, back pain is the result of lifestyle factors. Lack of exercise, prolonged sitting—such as during a typical office day—and weak back muscles are widespread causes. People with predominantly sedentary jobs almost inevitably develop symptoms over the years. Yet simple measures such as getting up regularly, doing stretching exercises, using ergonomic workstations, or targeted muscle-building exercises could help prevent wear and tear or at least slow it down. “Targeted strengthening of the back and abdominal muscles in particular is often neglected—yet a strong muscular support system plays a crucial role in spinal health,” advises PD Dr. Becker.

At the spectrum MED Munich practice, everything is under one roof!

“We offer pain management, work closely with physical therapists, and cover the entire spectrum: from simply prescribing physical therapy to injections and interventional procedures. One example is laser treatment of the intervertebral disc—a method that falls between an injection and surgery. We try to perform as much as possible right here in our practice before even considering surgery. Should it come to that, we collaborate with specialized partner clinics. When it comes to surgery, you should ideally turn to experienced specialists—doctors who perform such procedures regularly. That makes a big difference. We repeatedly see cases where patients have undergone procedures that clearly lacked the necessary expertise. That’s why the growing number of specialized centers makes perfect sense—and that’s exactly where you should seek treatment,” recommends PD Dr. Becker, and with that, we conclude our conversation.

Thank you very much, Dr. Becker, for this valuable information!