WHAT ARE SPINAL INTERVENTIONS?
They are special minimally invasive surgical procedures in local anesthesia which our multidisciplinary team (surgeon vertebrologist, neurosurgeon, orthopedic surgeon, on the basis of long-term experience in treating acute and chronic spine pain disorders, discovers the causes and treats pain in the cervical, thoracic and lumbar spine and radicular pain of all regions. The procedures for discovering these disorders are called diagnostic interventions and the procedures of treatment therapeutic interventions. The procedures are done in an excellently equipped operation room with the use of the digital Philips Veradius mobile X-ray machine with a flat detector and higher quality image and contrast than machines prior to it. The radiation dose is reduced to to three times and that is the first machine of its kind in the region. During the whole process of preparation, doing the intervention and observation which lasts 2-3 hours, the patient is located in the daily hospital under constant supervision from the medical personnel. After the procedure is done the patient can go home.
HOW TO TREAT BACK PAIN IN OLDER PEOPLE?
The most common cause of neck pain and back pain in older people are the joints of the spine. If long-term physical therapy does not reduce the pain or patients take drugs against pain for a longer time, the advisable treatment is then -RF neuroablation of the facet joints of the spine. Seizure is done with the machine for radiofrequency neuroablation which enables maximal safety and success of the procedure, as well as comfort for the surgeon and patient during the procedure. Neuroablation of the facet joints of the spine is an especially safe and adequate method of treatment for older people because it is done in local anesthesia without skin incisions and there are no surgical risks and complications. After the procedure and short observation, the patients are mobile and go home accompanied by another person.
HOW TO TREAT BACK PAIN AND YOUNGER PEOPLE?
Back pain is becoming more common in younger active people. Sometimes the pain is occasional and passable, but i fit lasts more than 12 weeks specific diagnostics and therapy are needed. If the generative disc disease is confirmed, it can be treated with therapeutic interventions and minimally invasive surgeries.
THERAPEUTIC INTERVENTION – BIACUPLASTY
Therapeutic intervention – biacuplasty is a procedure of neuroablation of sinuvertebral nerves of the painful disc which uses chronic low back pain. The procedure is done in the local anesthesia with mild sedation to the patient with special needles that have guided cooling with which the patient's safety and procedure efficacy is at a maximum level. So, afther the procedure and short observation, the patients can go home accompanied by another person. Returning to an office job is allowed after two weeks and physical activity after 6 weeks. If the disc changes are advanced it is possible to do a minimally invasive surgery, dynamic stabilization or minimally invasive fusion.
CAN A HERNIATED DISC BE TREATED WITHOUT SURGERY?
Herniated discs and spinal stenosis by mechanical or inflammatory processes can cause radicular pain. Patients heal naturally, but 15% have pain longer than six weeks. With these patients it is necessary to confirm the place of the nerve irritation with magnetic resonance after which the pain can be reduced by a therapeutic intervention – epidural steroid intervention. Injections are applied through an interlaminar or transforaminal approach on the level of a verified hernia or stenosis. The procedure is done in a modern operation room. Localization of the injections is determined by the digital mobile X-ray machine Philips Veradius. After the procedure is done, it is possible to go home accompanied by another person, and maximal therapeutic efficacy is expected in a few days. The reduction of pain is expected with 90% of patients with a herniated disc who get the injection in the period of 12 weeks from the start of symptoms and in 50% that have chronic stenosis.
WHEN AND HOW TO HAVE HERNIATED DISC SURGERY?
Disc protrusion (type of herniated disc) is effectively treated with therapeutic interventions. However, disc extrusions usually require surgical procedures if pain does not go away or possible neurological damage (muscle paresis, loss of sensation). Classical surgical procedure with wide laminectomy causes unnecessary damage to the paravertebral musculature and creation of postoperative adhesions. Microsurgical approach with interlaminectomy and discectomy with preservation of stability of the segments reduce the mentioned adverse effects of the procedure and speed up patient recovery, as well as shorten the time of rehabilitation.
DOES STENOSIS OF THE LUMBAR SPINAL CANAL NEED SURGERY?
Medical scientific evidence show that surgical treatment of spinal canal stenosis is more effective than any other procedure. The classic surgical procedure is a method called long incision and decompressive laminectomy with longer rehabilitation. Minimally invasive approach to solving the problem of spinal stenosis is the following: implanting an interspinous implant with microsurgical laminectomy and foraminotomy. Some of the patients with mostly soft tissue lumbar stenosis are treated successfully by implanting an interspinous implant on the principle of indirect decompression. With percutaneous technique of inserting an implant, a minimally invasive effect of the operation is achieved, because the patient walks along the next day. This is why the microsurgical laminectomy is the method of choice. With microinstability confirmed preoperatively, an interspinous dynamic stabilizer can be implanted. Patients can get up on their feet the second day with help of physiotherapist and can leave the hospital after 2-3 days.
WHAT IS SPINAL INSTABILITY?
The inability of the spine to not change its shape under physiological loads. Chronic disfunction of the vertebral disfunction of the dynamic segment, spondylolisthesis and progressive degenerative deformity can lead to instability which needs to be treated surgically.
In these patients, it is necessary to do dynamic restabilization or fusion of the instable segments of the spine. Classical surgical technique of fusion with long incision significantly damages the paravertebral musculature and prolongs rehabilitation of patients to 3 to 4 months. With indicated stabilization of one or two spine segments, we implant interspinous inserts, minimally invasive fusion using sophisticated technique of percutaneous transpedicular fixation (MISS - minimally invasive spine surgery), anterior intercorporal fusion (ALIF) or trans foraminal intercorporal fusion (TLIF). This type of surgery is done in specially equipped operation rooms using implants from leading World companies (Synthes, Johnson&Johnson) of high quality and guaranteed safety with specially educated spinal surgeons and medical personnel. With these principles the duration of post-operative pain is significantly reduced, as well as the postoperative rehabilitation to 4 to 8 weeks.
WHAT IS AN OSTEOPOROTIC FRACTURE OF THE SPINE?
Spine fracture caused by osteoporosis most commonly occurs after excessive loads in everyday life or a fall at the same level. 2/3 of patients note is the first symptoms after two to three weeks and because of minimal changes on the classic x-ray, these patients are sometimes diagnosed too late. Most spine fractures caused by osteoporosis heals naturally, but a part of the patients suffers constant pain with worsening. Answer to these problems is modern minimally invasive surgery called vertebroplasty with high viscosity cement (Vertecem, Confidenc). Vertebroplasty is a procedure of filling the fractured vertebra with cement which becomes stable and pain disappears. It is done in local or short general anesthesia which is especially important for patients of older age which make up most of the patients with this problem. If the fractured vertebra is significantly lowered in height it is possible to implant a „vertebral body stent“ (VBS) to regain height of the vertebra and then fill it up with cement. Regardless of the procedure, the patients are mobile and ready to go home the next day.
MISS – MINIMALLY INVASIVE SPINE SURGERY?
MISS (minimally invasive spine surgery) includes all groups of minimally invasive spine surgeries. Special progress has been made in the area of minimally invasive decompressions, minimally invasive dynamic stabilizations and minimally invasive fusions. St. Catherine Specialty Hospital is a quality institution for doing all minimally invasive spine surgeries.