In the case of a herniated disc disc tissue presses on a nerve root; this triggers nerve root inflammation with radiating pain into the leg (sciatica) or into the arm, often associated with tingling and numbness.
Most herniations improve conservatively over weeks — if pain persists, the question arises about further options.
From our patient consultations and the medical reports submitted.
Almost always in this order.
About 80–90% of lumbar herniated discs regress spontaneously within six to twelve weeks; even sequestered herniations can shrink significantly radiologically. The basis of conservative care is active movement, targeted physiotherapy, and NSAIDs when required — bed rest is obsolete and worsens the outcome. Systematic reviews show a small to moderate short-term effect for NSAIDs in sciatica compared to placebo; for opioids, there is no superior benefit alongside relevant side effects. Despite regression on MRI, functional limitations, tingling, or residual pain remain in some patients; a clearly time-limited conservative trial (generally 6–12 weeks without red flags) is evidence-based standard. With increasing neurological deficits, bladder or bowel dysfunction, the conservative strategy must be abandoned immediately.
Chiu CC et al. Rate of spontaneous regression, meta-analysis. Clin Rehabil 2015. PMID 25009200. — Rasmussen-Barr E et al. NSAIDs for sciatica. Cochrane Database Syst Rev 2016;10:CD012382. — Hahne AJ et al. Non-surgical treatment for LDH: systematic review. Spine 2010;35(11):E488–504.
Periradicular and epidural cortisone infiltrations (PRT, transforaminal, interlaminar, caudal) are intended to dampen perineural inflammation at the compressed nerve root. The Cochrane Review (Oliveira 2020) and other meta-analyses show a small, short-term effect on leg pain and function—predominantly up to four weeks; the effects are mostly not clinically relevant and cannot be robustly demonstrated beyond six months. Additional effects of cortisone compared to local anaesthetic alone are minor; an influence on the subsequent decision for surgery is not consistently proven. Rare but serious complications (especially transforaminal, particulate cortisone: neurological events) are documented, which is why image-guided technique and non-particulate cortisone are recommended. Useful as a bridge during severe radicular pain—no substitute for a long-term strategy.
Oliveira CB et al. Epidural corticosteroid injections for lumbosacral radicular pain. Cochrane Database Syst Rev 2020;4:CD013577. — Pinto RZ et al. ESI for sciatica: SR/MA. Ann Intern Med 2012;157(12):865–877. — Bicket MC et al. Epidural steroid safety review. Reg Anesth Pain Med 2015.
Disc surgery—usually performed as microsurgical discectomy or minimally invasive endoscopic technique—is indicated in cases of paralysis, cauda equina syndrome, or persistent unbearable pain for more than three months. Short-term results are good: 78–95 % of patients report a significant improvement in symptoms 1–2 years after the procedure. Long-term data refine this picture: in large cohorts with 10-year follow-up, the overall reoperation rate is between 16.5 % and 22.1 %; a recurrence of the herniated disc in the same segment is the most common cause (approx. 10 %). About 30–70 % of those operated on report residual symptoms of varying severity in long-term studies—an aspect that is often overlooked in preoperative counselling. Surgery is an established and in many cases useful procedure when clearly indicated; given the recurrence and long-term rates, it should—except in absolute indications—only be considered after a sufficiently long conservative trial.
Aihara T et al. 10-year follow-up. J Clin Neurosci 2022. PMID 34929635. — Kim CH et al. Nationwide sample cohort, 10 years. Spine 2019. PMID 30973508. — Rushton A et al. BMC Musculoskelet Disord 2018. PMC6134506.
MRI longitudinal studies show: the larger and more displaced the disc fragment, the stronger the pain, but also the more likely the spontaneous regression under conservative therapy.
The process takes weeks to months and is mediated by inflammation and remodelling processes in the epidural space, leading to the resorption of the disc tissue. This is a strong argument for initially treating acute disc herniations conservatively—provided there are no absolute indications for surgery such as paralysis or cauda equina syndrome—and giving the body time for its own healing capacity.
Rashed S et al. Predictive factors for spontaneous regression, SR/MA. J Neurosurg Spine 2023;39(4):471–479. PMID 37486886. — Chiu CC et al. Probability of spontaneous regression, SR. Clin Rehabil 2015;29(2):184–195.
Periradicular injections often only work for a few weeks, and disc surgery—absent signs of paralysis—is usually only considered after a longer conservative trial.
The herniated disc fragment compresses the nerve root; a perineural acidosis—local acidification—develops around the affected root, which additionally sensitises the pain fibres and makes the nerve root hyperexcitable. At the foramen, where the nerve root exits the spinal canal, this region is near enough to the surface to be targeted specifically.
Axomera focuses on this nerve root region: computer-controlled electrical signals in the dimension of cellular electrical fields are placed millimetre-precisely at the foramen and along the course of the nerve in the leg. The goal is to buffer the acidosis, relieve the nerve root, and reduce its hyperexcitability—it does not remove the disc herniation itself.
This neurophysiological hypothesis is empirically supported by many patient histories (real-world data), not by controlled studies; as with other indications, around 20–30 % of those treated do not respond. In the case of increasing paralysis, sensory disturbances, or bladder and bowel dysfunction, an immediate surgical assessment is necessary — Axomera is not a substitute in such cases.
How inflammation and pain are connected →We treat one level deeper — where the body regulates inflammation and healing itself.
Axomera is an internationally patented bioelectrical procedure.
How Axomera therapy works →Every therapy requires its own examination—with us, this is the Axomera diagnostics as the basis for the precise Axomera therapy.
Axomera modulates cellular signals to control inflammation and regeneration. The aim is to interrupt chronic inflammation and initiate higher-quality regeneration.
For three years I had lumbar pain radiating down into my lower leg. I could no longer play table tennis. Injections, nerve root blocks, acupuncture, painkillers, physiotherapy—hardly any improvement. My doctor then used three Axomera treatments—with significant improvement one day after the first treatment. Very good procedure. I wish I had used it much earlier.
Patient, 77—distinct individual case history.
Documented individual cases, with patient consent. Individual outcomes differ.
Developer of Axomera therapy · Medical Director
As the developer of Axomera therapy, he oversees the indication and is involved in your treatment personally upon request. His experience in conservative pain medicine informs the planning of your treatment series.
Doctor, orthopaedics & trauma surgery (in specialist training)
Performs your Axomera treatment and accompanies you throughout the entire treatment series. He reviews your findings and assesses whether the procedure is suitable for you. He also participates in the technical development.
Doctor, Specialist in Orthopaedics and Trauma Surgery
Organises your previous findings, performs Axomera diagnostics, and accompanies you throughout the entire treatment series. He reviews your findings and, based on his experience, assesses whether the procedure is suitable for you.
Three ways to reach us, around the clock, directly here on the site. For each, you can upload doctor's letters, findings, and MRI images at the same time — encrypted into your file, reviewed by a doctor before we speak.
Ten minutes with a doctor. Free of charge.
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The telephone initial assessment is not a treatment and does not replace an examination. Whether Axomera is suitable for you will be decided after a medical examination.
