The Spinal stenosis is a usually age-related narrowing of the spinal canal, frequently in the lumbar region. Typical is claudicatio spinalis: after a short walking distance, the legs ache and become fatigued, but this eases when sitting or leaning forward.
Not every narrowing visible on an MRI causes symptoms — clinical examination is the deciding factor.
From our patient consultations and the medical reports submitted.
Almost always in this order.
Movement therapy, epidural injection, decompression surgery — the clinical escalation path. Here is a brief, unvarnished summary of what the current studies show.
Flexion-based exercises expand the spinal canal geometrically: in stenosis, extension reduces the cross-sectional area of the canal by 67%, while flexion enlarges it. On this basis, structured programmes combine flexion-based strength training, stretching, and endurance training, usually with physiotherapist support over six to twelve weeks. The updated Cochrane analysis and other systematic reviews show a functional improvement of about 20% and a pain reduction of about 16% compared to standard care. Manual therapy combined with individualised exercise (MTE) improves walking distance and symptoms in the short term more effectively than group gymnastics or purely medical supervision. Effects are not immediate; radiological severity does not correlate with response.
Ammendolia C et al. Cochrane / Update. — Comer C et al. Clin Rehabil 2024;38(3):361–374. PMID 37715644. — Temporiti F et al. Eur Spine J 2022;31:1370–1390.
NSAIDs and low-dose cortisone mitigate pain and local inflammation but do not change the bony narrowing; evidence for a specific benefit in spinal canal stenosis is weak. Epidural cortisone injections are intended to dampen perineural inflammation and are administered under image guidance. Systematic reviews and the Cochrane update show at best a small, short-term benefit for radicular pain; in the large LESS-RCT (n=400), the additional effect of cortisone to local anaesthetic was small at six weeks and no longer detectable after twelve months. There is no significant difference in function and pain between steroid-plus-local anaesthetic and local anaesthetic alone at 3, 6, and 12 months. Repeated injections increase cortisone-typical systemic burdens without proven additional benefit.
Oliveira CB et al. Cochrane Database Syst Rev 2020;4:CD013577. — Friedly JL et al. LESS-RCT. N Engl J Med 2014;371:11–21. — Liu K et al. Meta-analysis (n=1010). Drug Des Devel Ther 2015.
Decompression (laminotomy, minimally invasive or classical) creates space in the bony spinal canal and directly relieves the nerve roots. In prospective cohorts, around 68% of patients are satisfied with the outcome five and ten years post-operation, with clear improvements in pain, ODI, and walking distance compared to baseline. About 25% of operated patients undergo surgery again within ten years, usually due to recurrent stenosis, adjacent-segment degeneration, or instability. Outcomes of conservative and operative treatment converge in the medium term: in one meta-analysis, surgery showed a small ODI advantage after two years (MD 3.85; 95% CI 0.48–7.22), while no significant difference was detectable at six and twelve months. Surgery is appropriate in cases of pronounced neurological deficits and after documented conservative failure; in multisegmental stenosis, precise correlation with the symptomatic level is crucial.
Held U et al. 10-year follow-up (n=72). Eur Spine J 2020;29:2231–2242. — Ulrich NH et al. Swiss cohort, 3 years. Spine 2017;42:E1077–86. — Zhang Y et al. Meta-analysis movement vs. surgery (n=897). PMC6115590.
Epidural injections often relieve leg pain for only a few weeks, and decompression surgery is a major procedure that many patients wish to avoid if possible.
In spinal canal stenosis, thickened tissue constricts the nerve roots in the spinal canal; under load, venous congestion and nerve root hyperexcitability occur there, triggering the typical leg pain dependent on walking distance. At the foramen, where the nerve roots exit, this area is accessible from the outside.
Axomera targets this nerve root region: computer-controlled electrical signals in the dimension of cellular electrical fields are placed with millimetre precision at the foramen and along the course of the nerve in the leg. The goal is to reduce hyperexcitability and improve blood flow to the nerve root — the bony narrowing itself is not expanded by this.
How inflammation and pain are connected →Inflammation has an electrical dimension. Axomera starts exactly there.
Axomera is an internationally patented bioelectrical procedure.
How Axomera therapy works →Every therapy needs its own examination — before the Axomera therapy is the precise Axomera diagnostics.
Axomera bioelectrically modulates the body's own signals that control inflammation and regeneration — here, point-by-point along the affected segment and nerve region.
MRI: severe age-related spinal canal narrowing. Two years of low-dose cortisone, NSAIDs, and physiotherapy brought no sufficient improvement — surgery was considered. The patient decided on Axomera therapy. After the second treatment, 500 m walking distance; after the third, 1000 m. Checks every three months; in the event of changes, re-treatment to continue avoiding surgery if possible.
Patient, 78 — documented individual case from the practice.
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.
Medical assessment via video.
Examination, Axomera diagnostics, plan, costs.
Are you traveling from further away? Start with 01 or 02. Only when it is clear that Axomera is suitable for you do we plan the journey — condensed into a few days. Available internationally as a concierge service upon request.
Prefer personal contact? Call: +49 211 866880
Our practice treats exclusively by prior appointment.
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.
