Dr Ferdinand Krappel is a specialist in spinal surgery at the Upper Valais Hospital Center in Brig – and has made the Valais Spinal Center renowned far beyond the canton’s borders. The Upper Valais Hospital Center itself is an integral part of the Valais Hospital. Thanks to the excellent high-performance medical care provided by the experienced orthopedic surgeon Dr Krappel and his team, the Valais Spine Center was recertified for a further four years at the start of 2021 – by the German Spine Society and Euro Spine, the European Spine Society.
As a specialist and researcher, Dr Krappel has been fascinated by the spine for decades. He believes there is still so much new to discover and research in this field. In an interview with the Leading Medicine Guide, Dr Krappel discusses modern treatment options for the spine and explains the regenerative PRP procedure.
Leading Medicine Guide: Dr Krappel, you have been working in the field of spinal medicine for three decades. Isn’t that monotonous?
Dr Ferdinand Krappel: No, not at all. The back isn’t just a joint like the hip or the shoulder. It consists of many individual joints, large and small, intervertebral discs, muscles and ligaments. The structure of the spine is unique – stable and resilient, yet at the same time flexible and elastic. We doctors and scientists are still discovering new things about the spine: how does this chain of joints work, how do they interact, or how does one block the other? The back is – in my view, of course – the most important part of the body.
Leading Medicine Guide: Most people associate the word ‘back’ with pain. Back problems are the second most common reason for sick leave.
Dr Ferdinand Krappel: Exactly, back pain is terrible and anyone who has it needs to see a doctor immediately – not in a week’s time. I place the utmost importance on this in my clinic. Apart from that, we are also still in the process of learning about pain and understanding it from a scientific perspective. Pain has many dimensions: physical, psychological and chronic. So, with every patient, I first take plenty of time to analyze their pain with them: how did it start, where does it occur, when does it appear, and how intense is it?
Leading Medicine Guide: And what about pain that has more psychological causes?
Dr Ferdinand Krappel: We always experience everything as a whole person; body and mind are interconnected, and cannot be separated. And we doctors cannot always completely eliminate the pain. But we can help the patient learn to cope with the pain. It is important to define the goals during the consultation: What does my patient want to achieve? What is medically feasible? How can we enable a life with reduced pain? When I first started working in Switzerland, I went to see the head of the psychiatric clinic and told him that we would now be working closely together. Pain is a complex phenomenon. That is why I also began studying psychology alongside my medical work.
Leading Medicine Guide: So surgery isn’t the first choice for back pain?
Dr Ferdinand Krappel: Absolutely not. The first thing we do is talk our patients out of surgery. After the pain analysis comes the ‘technical examination’, so to speak. You have to picture it like this: the spine has a mechanical structure, consisting of vertebrae and ligaments, muscles and intervertebral discs. And then there’s the ‘electronics’ – the nerves and blood vessels that supply everything. So we look to see where the pain might be coming from and try to eliminate it with targeted pain-relieving injections. With the help of the patient’s feedback, we then proceed slowly and carefully. Looking closely – that’s my motto.
Leading Medicine Guide: Do you mainly see older people with signs of wear and tear in their backs?
Dr Ferdinand Krappel: No, on the contrary. We are seeing more and more younger people with degenerative conditions. And these aren’t just people with a predominantly sedentary lifestyle, but also many athletes.
Leading Medicine Guide: Don’t we all think sport is healthy?
Dr Ferdinand Krappel: Of course, exercise is essential, and fitness is beneficial. But in moderation. A young spine that is still growing should be exercised with care. Think of it this way: if you sow a lawn and then walk straight over it, everything gets ruined again. Unfortunately, we are seeing more and more damage to the intervertebral discs in young people. Especially among those aged between twenty and thirty. The gym certainly plays a role here. Weight training should only take place according to a proper training plan and under professional supervision. But genetic predispositions, lifestyle and diet also affect the intervertebral discs. In conclusion, I can say that doing a lot of sport isn’t necessarily good for the body. And now here’s something that will surely please those who aren’t keen on exercise: a one-hour walk every day – you can’t go wrong with that, and it does a world of good for your health.
Leading Medicine Guide: What do you do with young patients who come to your clinic with disc problems?
Dr Ferdinand Krappel: First of all, we’ve had a rethink. In the past, we used to implant a dynamic system to stabilize the spine in young people with disc damage. But with such a procedure, we simultaneously alter the entire system – that is the downside. We have now discovered new methods for treating younger people: regenerative procedures. Regenerative, or restorative, medicine is about stimulating the regrowth of diseased, injured or damaged tissue. We motivate the body, so to speak, to heal itself. Orthopedics in particular offers a wide field for the application of regenerative methods. A great deal of research and investigation is currently taking place here; there are experimental and clinical studies, but some things are still a long way from widespread medical application.
Leading Medicine Guide: What is already possible in the treatment of disc damage?
Dr Ferdinand Krappel: For certain types of disc damage, we can use the ‘Platelet-Rich Plasma’ (PRP) procedure. This is a relatively new therapy, but one that is becoming increasingly established in orthopedics. With PRP, blood is taken from the patient and then processed in a specific way. The patient is therefore, in a sense, treated with a product derived from their own blood. This is possible because platelets play a key role in all the body’s repair processes. They contain growth factors, stimulate the cells and improve blood circulation. This is what the therapy makes use of. Using specific centrifugation techniques, platelet-rich plasma is extracted from the patient’s own blood, which is then specially processed and injected into the damaged intervertebral discs.
Leading Medicine Guide: What patients are naturally most interested in is: does the procedure have any side effects – and how does PRP work?
Dr Ferdinand Krappel: Because we use the body’s own product in the therapy, there are no side effects. PRP stops inflammatory processes and triggers repair mechanisms. So far, every clinic has developed its own specific preparation methods, but efforts are being made to develop a standardized production process for PRP. Exactly how the enriched plasma works and where it takes effect has not yet been scientifically clarified. But it helps the intervertebral disc to regenerate itself. I conducted a study in which all patients remained symptom-free and relapse-free three years after treatment. Often one injection is sufficient, though some patients require up to three sessions. The results depend somewhat on the condition of the patient’s own blood. The treatment can be carried out on an outpatient basis; a session lasts perhaps fifteen minutes. PRP works significantly better than cortisone; you will need to check with your health insurance provider on a case-by-case basis to see if they will cover the treatment.
Spitalzentrum Oberwallis, Brig (source), photos by Dr Krappel: image rights held by Richard Kuonen
