Case Evaluations

We are a multilingual team. You can write to us in English, German, French, Spanish, Italian, Russian, Ukrainian, Polish, Japanese, Chinese and Czech.

Preparation for Evaluation

Please note: Medical evaluations and surgical plans given by Prof. Dr. Bertagnoli are intended for the use of Prof. Dr. Bertagnoli's potential patients only. These evaluations and surgical plans assume his level of skill and experience. Spine surgeries are complex and should not be seen as universally applied with the same skill, research knowledge and experience across all surgeons.

Accurately assessing the source a patient's pain is paramount in a patient's evaluation. Back pain can have many sources such as myogenic (muscular) neurogenic (nerves), psychic (brain and psychological sources) discogenic (from the spinal disc themselves) and most common, nerve root compression by spinal structures. This is why a thorough investigation must be done.

Imaging and Tests

Imaging is only part of the evaluation and patients are encouraged to contact us, even if they do not have the initial imaging. Patients' histories and their pain profiles can be gathered and their imaging can be added at a later time. Imaging is only a part of the process.

If you do not have any metal in your back, in most cases an MRI with upright X-rays of the affected area are requested for an evaluation, along with your medical background and history of complaints. The upright X-rays should include an AP (front back), Lateral (neutral side view), Lateral flexion (neck/lower back bent forward) and Lateral extension (neck/back bent backward) views. Many people assume X-rays are not needed, because MRIs are a superior technique, but this is not true. Upright X-rays tell the doctors about boney structures and compression of the spine under load, which is important for a complete evaluation. Upright MRIs and CTs are preferred, but are not available in most locations. These images can be done in Germany or in your image center. We ask that they not be more than six months old. CTs may be requested of people with pacemakers as an alternative to MRIs. Patients with metal in their spine may also receive this request, because metal can obscure an MRI (these distortions are called artifacts in medical parlance). A CT may also be requested of patients after the initial evaluation to judge the condition of their facet joints. Also an ElectoMyeloGraph (EMG) and Nerve Conduction Study (NCS) maybe required in a few cases.

While not necessary for the initial evaluation, a bone density of all lumbar patients to check for osteoporosis or osteopena is required for all patients seeking artificial disc replacement (ADR) surgery. Some spine doctors do not require this and some only require it of post menopausal women. However, our findings show that men and patients, younger than expected, are testing positive for osteoporosis. Osteoporosis is not a disqualification for artificial disc replacement (ADR) surgery, as Prof. Dr. Bertagnoli has co-developed AMP Vertebroplasty (insertion of a ceramic material into the bone) as a method of hardening soft bones . If you feel that orthopedic spine surgery is in your near future, you should have this easy and very affordable test.

A pain diagram will be sent to patients to assist in the evaluation. This is not and should not be a dermatome map, which biases the patient's response. It is unfortunate that some doctors send a dermatome map to patients, as a diagnostic tool.

Notice: A comprehensive medical answer to an inquiry needs time and efforts from doctors and staff. We ask for your kind understanding in that the doctors and Prof. Dr. Bertagnoli cannot give you instant answers and note neither does your local doctor. Patient evaluations are now free to those who use our new online evaluation system.

Evaluation Steps:

1. Patient contacts Prof. Dr. Bertagnoli's staff by email or phone
2. Staff sends email with evaluation instructions
3. Patient completes the evaluation process and notifies staff that it is completed
4. Staff checks patient files and forwards the patient's case to Prof. Dr. Bertagnoli for an evaluation
5. Patient receives email with evaluation, intervention plan if needed
6. Staff sends patient a cost estimate for any planned intervention
7. Patient notifies staff or doctors, if they wish to be scheduled
8. Scheduling dates are discussed and agreed upon

*Note: These steps are only a general outline. Indeed there are often exceptions. The doctors may often request additional or newer tests or imaging, or the patient may have difficulty with uploading their images. There may also be conference calls between the patient and doctors.

After surgery date is selected.

1. Patient coordinators will send patient a schedule of events, forms to complete and tests to take prior to surgery.
2. Patient will complete forms, choose hotel accommodations, complete pre-operative tests and notify staff of their test results, travel arrangements and if they need an airport pickup.
3. Normally patients stay in a hotel the night before hospital admission, which is between 8:00 AM and 8:30 AM the next day.
4. Hospital admission/check-in is quite easy. A stop at the main desk at the entrance and then a walk down the hall to the ward nursing station. 5. Depending on schedules, the head ward nurse is usually the first to interview the patient, then one of Prof. Dr. Bertagnoli's staff doctors, usually Dr. Nickl, interviews the patient and draws blood for blood typing. No worries, of the thousands of patient treated by Prof. Dr. Bertagnoli only one patient has ever needed a blood transfusion. This interview is primarily focused on checking all medical information about the patient once again.
6. Next and very importantly the patient will be visited by the anesthesiologist. It is the anesthesiologist who is chiefly responsible for the patient care after the surgery.
7. Visits by the physical therapist (although little physical therapy is used in back surgeries) and the dietician will follow.
8. Finally comes the visit by Prof. Dr. Bertagnoli to review the patient's case and planned intervention one more time. This can last between 15 -90 minutes depending on the complexity of the case and the number of patient questions. Note: That on some rare occasions, when the professor is called away, this interview may not take place on this day.
9. Surgery is the next day. Usually the most complicated cases go first.
10. Prof. Dr. Bertagnoli does 1 - 4 surgeries per day depending on the complexity of the cases.
11. X-ray, MRI and CT machines are available for emergency imaging at the hospital, which also has a emergency trauma center and a helipad and is a German ADAC facility.
12. After the OR, all cases go to the Post-op room and then to their rooms or the ICU, depending on the complexity of the case. ICU charges are not added to a patient's bill. This is the German medical system. ICU charges are usually $10,000 per day in the US.
13. After hospital discharge the patient is asked to stay in Germany for another 7 - 10 as an extra safety margin, should anything arise.