WELCOME TO MY HOMEPAGE
Dr. Helmut Hiertz
Medical Specialist for Neurosurgery
I have been concentrating on spinal surgery and conservative treatment of spinal disorders for over 20 years.
Precise investigation and evaluation of the radiological images are always vital to the successful treatment in order to launch a personalized treatment plan. Its goal is a significant improvement in pain situations as well as regaining health-related quality of life.
By cooperating with the back pain center, I can manage to offer short-dated appointments for initial examination and subsequently perform radiological investigation and the initiation of targeted therapy at very short notice. The follow-up physical therapy can also be induced rapidly through the cooperation with the Physikarium Bad Schallerbach.
Surgical treatment is carried out individually – from minimally invasive to the deformity correction by osteotomy – in the Medical Center Bad Vigaun. The in-patient conservative treatment consisting of pain management, infiltration and punctures as well as physical therapy are accomplished in Bad Vigaun, too. (www.badvigaun.com)
Activities in international and national societies
• IGASS (International Group for Advancement in Spinal Science) – Member of the Scientific Board
• European Spine Society
• AO – International
• Austrian Spine Society – Advisory Board
• Neurosurgical Society – Spine Surgery Research Group Leader 2009-2011
• Medical Studies from 1979 to 1986 at the University of Vienna
• Promotion 1986 Vienna
• Neurosurgical training at Wagner Jauregg Hospital Linz
• During the training already intensive studies of spinal surgery; several internships with Prof. Benini and Prof. Grob at the Schulthess Clinic, Zurich, as well as with Prof. Harms in Germany.
• Medical Specialist in Neurosurgery since 1 Jan 1993
• Establishment of spinal surgery in Wels since 1 Sep 1999
• I managed to build up a nationally and internationally recognized spine surgery center in Wels.
• As part of the hospital reform in 2011 the department of independent spine surgery was suspended by the hospital (Klinikum Wels) which eventually led to a mutual termination of my employment with the hospital by 31 Dec 2011.
Since January I am to my patients´ disposal in the new ordination Wels St. Stephan´s West, Salzburger Straße 65 and at the Medical Center Vigaun, Karl-Rödhammer-Weg 91. (www.badvigaun.com)
Interdisciplinary Ordination Center Wels – St. Stephan´s West
Partner of Backpain Center Wels
Consultation by telephone arrangement
Address: Salzburger Straße 65
Tel: 0043 (0)664 563 64 04 (Monday – Friday 1pm – 5pm)
Email: email@example.com – for subject please indicate ordination request
Directions: See location
Motorway exit Wels West to city center, Salzburger Straße about 2km towards the center, then St. Stephen´s West on the right, entrance at the ambulance service drive-in. Take first drive (sign on the left) and go to the parking lot at the back of the house.
Medical Center Bad Vigaun,
A-5424 Bad Vigaun (www.badvigaun.com)
Tel: 06245 8999-622 Mrs. Mohr (office hours 8am – 4pm)
Directions: See location
Car: Motorway A1 to motorway A10 – continuing to Hallein – then good system of road signs and signals to Bad Vigaun and to the Medical Center (Wels – Bad Vigaun 139 km, 1h 20 min, www.viamichelin.at).
Rail: Wels to station Bad Vigaun (2h30min – www.fahrplan.oebb.at). Transfer from the station to the Medical Center Vigaun can be arranged on request.
Bus: Public-transit bus from Salzburg or Hallein. The bus stop is right in front of the private clinic.
Airplane: The airport Salzburg can be reached by car in 20 minutes. Transfer can be arranged on request.
Dr. Helmut Hiertz
In the ordination case history, neurosurgical examination, statement discussion and consultation on the reasonable potential therapies are carried out.
The conservative inpatient and surgical services are performed in the Medical Center Vigaun. For private patients no or low additional charge arises (consult with your private insurance). For self-paying patients a quote will be drawn up (Mrs. Mohr Tel.: 06245/8999-622).
Services in the ordination:
• Differential diagnosis, precise treatment planning and detailed counseling
Surgical therapy in the Medical Center Bad Vigaun:
Cervical spine – surgical therapy
• degenerative diseases: disc herniation and stenosis
• inflammatory diseases often in the context of polyarthritis of first and second cervical vertebrae
Thoracic spine – surgical therapy
• degenerative diseases
• post-traumatic deformities
• cement stabilization for osteoporotic fractures
Lumbar spine – surgical therapy
• degenerative diseases – disc herniation and stenosis
• degenerative deformities
• cement stabilization for osteoporotic fractures
• post-traumatic deformities
• inflammatory diseases
In-patient conservative therapies in the Medical Center Bad Vigaun:
Pain therapy with infusions, medicamentous and physical therapy
Targeted infiltration treatment under X-ray
Medicamentous therapy directly in the spinal canal
Differential diagnosis with myelography (radiographic contrast examination of the spinal canal for the evaluation of spinal canal narrowings and variances in motion and strain)
Rapid differential diagnosis of pain conditions, evaluation of the neurological status and specific therapy in order to avoid formation of chronic pain is essential.
The therapy will always be first performed conservatively in regular neurological situations;
unless improvement occurs after a few weeks of therapy or a neurological deficit arises
(paralysis), surgical treatment should be proceeded.
Treatment strategy of lumbar disc herniation
A herniated disc in the lumbar spine is a very common disease, with many patients being asymptomatic and therefore do not require special treatment. It is only important to develop a good muscular system and to avoid damaging behavior.
The situation of patients with relevant symptoms is quite different. In a pain situation X-ray and MRI investigation of the lumbar spine should be performed at an early stage in order to obtain an accurate diagnosis. Above all the case should be observed whether a deformity of the spine (listhesis, scoliosis) exists and in what way the width of the spinal canal is displayed. At a spinal stenosis and/or a protrusion deformity of the disc, the clinically relevant pathology then of course is not caused by the herniated disc but by the stenosis and/or deformity.
The first two pictures show the normal situation of the disc and the spinal canal
The third and fourth picture show the situation of stenosis with bulging of the spinal disc, spondylarthritis and foraminal stenosis
Through pressure on the spinal nerve, a radicular problem (pain in the leg according to the affected root, sensory, motor disorder) arises; pressure on the central cauda fibres may cause the cauda syndrome with paralysis and autonomic disorders (bladder/intestinal paralysis).
Strong degeneration of the facette joints may also itself or combined with the radicular problem cause severe back pains with locking or pseudoradicular leg pains.
The careful examination of the patient is always essential, on the one hand to determine the exact location of pain, on the other hand to detect the neurological situation.
Therapy of radicular problems
In regular neurological condition immediate pain treatment with NSAIDs as far as morphine preparations, periradicular or epidural cortisone infiltrations and physiotherapy are indicated.
In a neurological deficit or non-recovery despite conservative treatment after a few weeks the sole microsurgical discectomy is indicated.
If additional severe back pain exists, which is usually regarded as a leading symptom, a spare fixation is indicated. It can be carried out either dynamically, provided good segment height, or in strong degeneration as fusion.
Prolapsed L 3/4 – discectomy and dynamic fixation
Stenosis with deformity of L 3-5, decompression and fusion.
Treatment strategy for lumbar stenosis
The bony narrowing of the spinal canal causes pressure on the spinal nerves in the spinal canal and also on the extravasating nerves.
Normal spinal canal
Narrowed spinal canal
This pressure effect causes pain with radiation into the leg and a spinal claudication symptom, i.e. through the pain, the walking distance is shortened differently. The affected patients have to make a break after individually different walking distances, they have to sit down or relieve the spinal canal by bending their back. Depending on the stability of the spine considerable backache may arise.
In the investigation with X-ray and MRI of the lumbar spine, an opinion of the vortex position is formed – for example a scoliosis (vertebral displacement to the side) or a listhesis (vertebrae shift forward or back) should be visible. Next, the curvature of the spine is assessed. The forward bow (lordosis) depends on the angle between the femoral head and the sacrum and is equal from birth for every human being.
Normal lumbar scoliosis listhesis
If the stenosis demonstrated by imaging causes considerable back pain and/or leg pain or neurogenic claudication symptoms individualized therapies should be carried out.
Therapy begins with medication in pill form or by infusions with additional physical therapy and therapeutic exercise.
If these remedies do not suffice, a cortisone therapy by puncturing the spinal canal should follow; in the case of considerable back pain infiltration treatment of vertebral joints is indicated. The cortisone treatment in the spinal canal can also be complemented by a contrast study of the spinal canal (myelography), which has the advantage that the narrowness of the channel and possibly vertebral displacements during exercise while standing and moving can be detected. (Sometimes stenosis of the lumbar spine is not seen in the MRI).
The MRI shows narrowing in L 2/3, myelography in L 2/3 and L 3/4, bending prevents pressure action.
Through this puncture and infiltration significant improvement may occur for a longer time. If the duration of improving is very short, surgical procedure should be considered.
Before the operation the stability situation has to be clarified. If the spine is stable, the spinal canal can be extended microsurgically (“undercutting”) without disturbing the architecture of the spine. Previously, the entire spinous process and the vertebral arches were removed (laminectomy) – this often led to vortex relaxation and contributed to further narrowing (this surgical technique should be considered as historical).
Laminectomy – the posterior elements are lacking, 2nd picture: undercutting and relief of the canal
If the stability of the spine is disturbed, then the operation has to be combined with the relief of the spinal canal (undercutting – microsurgery) and stabilization.
Stenosis with deformity L 3-5 – decompression and stabilization
The Medical Center Bad Vigaun in Salzburg Tennengau offers everything for your health and well-being. On a particularly charming and equally conveniently located site you will find a well-equipped private clinic, a modern spa and rehabilitation center, a health hotel with four-star comfort and healing thermal baths with soothing thermal spa water and modern sauna and wellness area.
State-of-the-art medicine in a nice atmosphere.
Personal support, individual medical care, effective therapies and caring support are entirely important in the private clinic Bad Vigaun. From the first meeting till treatment and surgery up to rehabilitation, patients are accompanied by the same medical and nursing team. Through our comprehensive range of medical and therapeutic services, we can specifically address our patients and support the healing process in holistic therapy.
Most modern operating and treatment rooms and a private laboratory ensure the seamless transition from hospitalization to rehabilitation as well as rapid recovery and regeneration.