Minimally invasive spine surgery

The treatment of spine conditions implies varied treatment from painkillers to kinetotherapy, to local anaesthetics, minimally invasive surgery or extensive surgery of the spine.

The most spread spine condition is disc herniation at different levels, in decreasing order of frequency: lumbar, cervical and thoracic. Besides disc herniation there are other degenerative conditions: spondylolisthesis, lumbar canal stenosis, scoliosis.

Minimally Invasive Spinal Surgery provides patients with an opportunity for effective treatment, allowing them an ultra-fast recovery and, last but not least, minimizing surgically induced lesions. Our team uses a wide range of minimally invasive techniques, including endoscopy with its variants (transnazal, transthoracic, transmuscular, etc.), the operative microscope, the tubular transcutaneous approaches and, last but not least, the infiltrations at all levels of the spine.

Tumours of the spine are well treated in our hospital: there are tumours of the bone (multiple myeloma and metastasis) or tumours of the nerves (schwannoma or neurinoma), tumours of the sheath of the spinal cord (meningioma) and tumours of the spinal cord (astrocytoma, hemangioblastoma, cavernoma etc). The treatment of these tumours involves special surgical and anaesthetic techniques, and include electrophysiological monitoring.

Spinal trauma can be a debilitating condition and is represented by fractures, luxation or contusion of the spine, part of which need surgery, but also by very painful syndromes (chronic, neuropathic pain) that can be treated in our hospital in the pain clinic.

Lumbar and cervical disc herniation

Disc herniation is a pathology of the spine characterized by a degeneration of the structure and form of the intervertebral disc, which, through a herniation of its central portion, compresses the nerves or the spinal cord within the vertebral canal.

Disc herniaton is a pathology of the spine that is characterized by a degeneration of the structure and shape of the intervertebral disc, which, through a herniation of its central portion, compresses the nerves or the spinal cord within the vertebral canal. Compression of the nerves leads to their inflammation which translates into pain, numbness and / or weakness of the upper limb or lower limb. Not always a herniated disc produces symptoms, and the vast majority of herniated discs do not require surgery. In our clinic, we will use all other treatment methods, if possible, until we propose surgery.

• Weight – Excessive body weight increases the risk of having a herniated disc
 
• Occupation – Patients with certain trades, such as drivers or masonry, are at greater risk of developing degenerative changes in the spine
 
• Genetics – there is a certain genetic predisposition for herniated disc in some patients. For a correct and complete diagnosis the patient requires a clinical, imaging and sometimes electromyographic assessment. Clinical evaluation will be done by the doctor who will test your reflexes, sensitivity and muscle strength. The imaging evaluation is done through an MRI of the region concerned. Sometimes, when clinical and imaging evaluation is not edifying, an electromyogram will complete the medical evaluation list.
• Weight – Excessive body weight increases the risk of having a herniated disc
 
• Occupation – Patients with certain trades, such as drivers or masonry, are at greater risk of developing degenerative changes in the spine
 
• Genetics – there is a certain genetic predisposition for herniated disc in some patients. For a correct and complete diagnosis the patient requires a clinical, imaging and sometimes electromyographic assessment. Clinical evaluation will be done by the doctor who will test your reflexes, sensitivity and muscle strength. The imaging evaluation is done through an MRI of the region concerned. Sometimes, when clinical and imaging evaluation is not edifying, an electromyogram will complete the medical evaluation list.

The treatment of herniated discs follows some steps, a treatment algorithm. Thus, with the exception of surgical emergencies, the treatment of disc herniations will initially use medication, corroborated with kinesiotherapy, then infiltrations and eventually, only if they fail, to reach to surgery. A very small number of patients require surgery. In our clinic, we will do our best not to operate. If surgical indication is required then we will propose this solution.

After surgery for a herniated disc, recovery is real easy, but of major importance. The sooner you mobilize and the faster you apply the post-surgical kinesiotherapy programs, the sooner you will return to life before the problem occurs. Thus, after surgery, you will spend 1-2 days with us in the hospital, after which you can continue with the kinesiotherapy program already started in the hospital. Neurosurgical control will be performed 6 weeks after surgical intervention. Until then, you will be completing the kinesiotherapy program, the scar of the intervention will already be cured and you can resume your life before surgery. Performing daily exercise to maintain your body’s tone will always be welcomed and we will encourage you to do it.

Vertebral canal stenosis

Vertebral canal stenosis is a degenerative condition of the spine characterized by the narrowing of the spinal canal through which the nerves and the spinal cord pass. This condition compresses the spinal nerves and the spinal cord into the cervical and thoracic area and only the spinal nerves in the lumbar region, thus specific signs and symptoms are to be found at the clinical examination of the patient.

Spinal stenosis is a degenerative condition of the vertebral column characterized by narrowing of the spinal canal through which the spinal cord and spinal nerves pass. Narrowing of the canal compresses the spinal nerves and spinal cord in the cervical and thoracic area and only the spinal nerves in the lumbar region since the spinal cord normally ends at the L1 vertebra. Canal stenosis can be observed most commonly in lumbar and cervical areas. Spinal stenosis is caused by degenerative, wear-related changes. In severe cases of stenosis, surgery may be recommended.

Many patients may have signs of canal stenosis without symptoms. When the symptoms appear, they start gradually and get worse over time. They vary depending on the location of the stenosis.

– Cervical stenosis – can cause numbness, paraesthesia or weakness in the upper and lower limbs. Paresthesia in the hands is the most common, but many patients report problems with walking and balance.

– Lumbar stenosis – can cause pain or cramps in the legs when prolonged or walking. Discomfort disappears when sitting or bending forward.

Although some people are born with a narrow spinal canal, in most people, the appearance of narrowing occurs throughout life due to some causes:

• bone growth
• osteoarthritis
• wear injuries may lead to osteophytes that can grow in the canal
• disk herniation – the rupture of the outer portion of the disc allows the soft material to escape from it and compress the spinal cord or nerves.
• thickening of ligaments that keep the spine in position
• the appearance of tumors – portions of the tumor may grow in or towards the vertebral canal
• spinal trauma in the case of road accidents or other major accidents can cause sprains, fractures or dislocations.

Rarely, untreated patients with severe spinal stenosis can progress to permanent deficits:

• numbness
• weakness
• balance disorders
• incontinence
• paralysis

Your doctor will ask you during the consultation about the onset of your problem, if it gets worse, if you have other medical problems, if there are any medications or positions that will improve your problems, if you have pain and where it is located, if you have problems with the bladder, etc. You will also be examined clinically to make sure there are no other problems.

Symptoms present in canal stenosis can also occur in other conditions caused by age-related degeneration, so imaging is very important.

Radiographs and CT scann – show the bone structure of the spine and eventual osteophytes

MRI – the most eloquent imaging assessment. On very fine sections and in 3 anatomical planes, the stenosis area will be clearly seen, whether it is important or not, if there are other associated problems of the spine.

Lumbar canal stenosis treatment ranges from simple drugs such as Paracetamol to stenosis decompression surgery. Physical therapy is recommended at any stage of treatment. The role of the physical therapist is very important. Generally, patients with spinal canal stenosis decrease daily activity to reduce pain. Muscle weakness leads to even more pain. The physical therapist will teach you exercises that will increase your muscular strength and the flexibility and stability of the spine and will increase your balance.

Infiltrations are a valuable resource in the treatment of canal stenosis. Nerve roots can be irritated and swollen when they are compressed. Injecting steroidal anti-inflammatory drugs around the root will help reduce inflammation and will partially lower the compression of the nerve root. However, infiltrations do not work for everyone. Repeated infiltrations can weaken nearby bones and tissues, so only a few infiltrations are indicated per year.

Surgery is a last resort. If all the other non-surgical methods were correctly indicated and used and did not work, then surgery will decompress the spinal cord and / or spinal nerves by enlarging the vertebral canal.

• Common medication that reduce pain and inflammation can be helpful
• Cold or hot compresses can be placed at the inflammatory site to reduce pain
• Diet and proper nutrition can lead to weight loss, lowering the axial load of the spine
• Orthopedic walking sticks or frames can lower pain by allowing you to bend forward

Vertebroplasty

Vertebroplasty is a minimally invasive surgical procedure that treats certain vertebral compression fractures. This type of fracture is very common in people with osteoporosis.

Vertebroplasty is a minimally invasive surgical procedure that treats certain vertebral fractures resulting from compression of one or more vertebral bodies. This type of fracture is very common in people with osteoporosis. In our clinic, patient treatment is multidisciplinary: neurosurgeon, orthopedist, radiologist and endocrinologist. This treats both the effect and the cause of the fracture, with the best chances of healing, as well as avoiding other fractures in the future. Treatment of compression fractures of osteoporosis can be treated with antalgic drugs, bed rest, external brace, or rehabilitation medicine. In patients with very severe pain, vertebroplasty can relieve pain, increasing patient mobility and decreasing drug intake.

• severe pain that does not disappear under medical treatment
• Mobilization is minimal or impossible
• Rehabilitation medicine is impossible due to pain
• Imaging tests show exactly what vertebra is causing the pain.

Most patients can be treated as one day hospitalisation, the patient being slightly sedated during the procedure. Fractured vertebra discovery is performed by radiographic examination.

• quick return to normal activity. Fracture stabilization allows rapid mobilization of the patient by relieving pain.
• Significant decrease of the pain medication until it is eliminated.

Kyphoplasty is similar to vertebroplasty, but uses special balloons to create space inside the vertebral body, spaces that will be filled with cement, reducing the risk of embolism of the injected cement. Kyphoplasty can correct spinal deformities and restore vertebral height.

Spinal fusion

Spinal fusion is the surgical connection of two or more vertebrae, eliminating the movement between them. Spinal fusion involves surgical techniques that mimic natural healing processes of fractured bones. During the spinal fusion, the surgeon will implant osteosynthesis material (screws, rods and cages) in the space between the vertebrae to be connected.

Spinal fusion is the surgical connection of two or more vertebrae, eliminating the movement between them. Spinal fusion involves surgical techniques that mimic natural healing processes of fractured bones. During the spinal fusion, the surgeon will mount osteosynthesis material in the space between the vertebrae to be connected. Titanium screws and rods can be used to maintain mounting position, favoring the best healing. Spinal fusion blocks one or more vertebral levels, modifying how the spine moves, increasing mechanical stress in adjacent levels. Spinal fusion permanently connects two or more spine vertebrae to improve stability, to correct a deformity or reduce pain.

Spinal fusion is recommended to treat the following medical conditions:

• vertebral fractures create a spine instability, requiring spinal fusion to stabilize the spine.

• spinal deformities – scoliosis and important kyphosis require surgical corrections in some cases

• spondylolisthesis – In this case a vertebra slips over the inferior vertebra. If the pain generated is very important, or neurological deficits such as muscle weakness or important numbness appear, spinal fusion may be indicated

• disc herniation – very rarely, after a disc herniation surgery, a second spine stabilization intervention is required.

Spinal fusion is generally a safe procedure. But as with any surgery, spinal fusion is at risk of complications:

• infection
• deficient healing of the scar
• bleeding
• hematoma
• lesions of the vessels or nerves around the spine
• pain

In addition to the immediate risks of the procedure, spinal fusion changes the way the spine moves, changing the distribution of the movement in the segments adjacent to the operating level, thus adding an increased level of wear in them, leading to their degeneration and possibly chronic pain.

After surgery, you will spend a few days into the hospital. Depending on the extent of surgery, you may experience pain and discomfort in the postoperative period, but these symptoms are usually well controlled with medication. It takes a few months for bone healing to be complete. Kinetotherapy is very important during the postoperative period, learning how to move, how to sit, how to walk in a way that will keep your spine correctly aligned.

Not always the changes seen on MRI or radiographs are the source of pain, so the correct diagnosis is essential. In our clinic, the multidisciplinary approach by discussing these cases with several clinic specialists greatly increases the specificity of the diagnosis, offering the best treatment for the patient.