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All Posts Tagged: Sciatica

Percutaneous spine surgeries

 

 

In modern surgery, with the help of technology and the accumulation of experience, new methods have been developed, which help surgeons perform operations that in the past were particularly traumatic, with minimal risk of surgical trauma. A typical example is spine surgeries, such as spinal fusion.

 

Percutaneous spine surgeries significantly reduce patients’ discomfort, pain, risks and hospitalization time. Thus, even the largest spinal fusion does not mean that the patient is required to stay in bed. Patients with spondylolisthesis, spinal stenosis, lumbar spondylosis, and vertebral fractures after injury can move without pain within a few days and are discharged from the hospital in 2-3 days. This is because neither the back muscles nor the bones and ligaments are injured, so the pain is comparatively minimal. The need for blood transfusions during spinal fusion surgeries is practically zero.

All open spinal fusions can be replaced by percutaneous ones, with the mere exception of surgeries to repair scoliosis. The time of full functional recovery is dramatically reduced by reducing the cost of health expenditures at individual and national level.

Microdiscectomyis a case of day care, while the incision in the skin is less than 2 cm. The patients do not even have to spend the night in the hospital. Thus,recovery is accelated and they are able to return to their activities.

Percutaneous kyphoplasty , for the repair of vertebral fractures (eg from osteoporosis), is also performed with daily hospitalization and immediate mobilization and relief of the patient.

These methods utilize technologies such as robotic navigation, neuronavigation, surgical microscope and endoscope, as well as a number of advanced surgical tools and equipment , such as the ultrasonic osteotomy. Surgeons who know these techniques, can offer patients the surgical care of the 21st century in Greece , with the exact same quality characteristics as in the most advanced medical countries in the world.

Open spine surgery  

 

Percutaneous surgery. See how small the skin opening and the overall surgical injury are

Open spine surgery. Percutaneous surgery

See how small the skin opening and the overall surgical injury are

Kyphoplasty surgery to repair a vertebral fracture

Kyphoplasty surgery to repair a vertebral fracture

Patient with spondylolisthesis between 4th and 5th lumbar vertebrae Rehabilitation with percutaneous spinal fusion and implant in the disc. The spondylolisthesis has been redone.
Patient with spondylolisthesis between 4th and 5th lumbar vertebrae Rehabilitation with percutaneous spinal fusion and implant in the disc. The spondylolisthesis has been redone.
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Pain Treatment with Radiofrequency Electrode Application

 

 

Radiofrequency therapy is indicated for the treatment of  neuropathic pain, neuralgia, but also persistent musculoskeletal pain such as sciatica, low back pain and neck pain, which is continuous, has an anatomically clear distribution and is resistant to conservative treatment (medicines, patches, etc.).

Neuropathic pain can be treated with the use of radiofrequency. Examples of such diseases are postherpetic neuralgia and trigeminal neuralgia.

An example of non-neuropathic pain that can be treated with radiofrequency is back pain due to degeneration of the vertebral joints, as well as selected cases of neck pain.
The use of radiofrequency is not indicated when the pain is of central etiology, i.e. the nervous system damage is located in the brain or the spinal cord.
The radiofrequencies are applied via an electrode to the active tip of a special needle, using a continuous electric field, which causes the controlled production of heat through the friction of ions. When this heat (60-90 ° C, depending on the indications) acts on a target nerve, it provokes its selective destruction and modification, with the aim of stopping the transmission of painful signals to the spinal cord and brain, thus pain relief.

The electric radio frequency field is generated by a special radio frequency generator and is applied to the target through a special needle with an active non-insulated tip. An electrode connected to the generator enters into this special needle. The generator has an indication screen and provides detailed information regarding the various parameters of the operation.

 

DESCRIPTION OF THE SURGERY (MAINLY CONCERNING THE SPINE)

The operation is performed under local anesthesia and twilight anesthesia, with X-ray guidance (C-arm). The patient does not need to spend the night in the hospital and can go home just a few hours after the end of the operation (day care).

After all the antiseptic measures have been taken, a special needle is directed with absolute precision towards the target. We use radiographic guides, taking multiple profile, face and oblique shots, so that the needle and the electrode can navigate between the sensitive structures and away from blood vessels, the spinal cord, the dura mater and the internal organs (eg the lungs, in medial nerve access).

When the final correct position is confirmed radiographically through various shots, a contrast agent is administered to erase the contour of the nerve and its extension into the spinal canal (in case the surgery is performed inside the spine). The special electrode is then connected to the radio frequency generator.
An aesthetic test with nerve stimulation follows, using specific intensities (μA), voltages (mV) and frequencies (Hz), in order for the active tip of the needle to be placed as close to the target as possible (ie to the sensory area of the nerve). Once this is achieved and the measurements of the above parameters and tissue resistance (Ω) are satisfactory, a motor testing follows and the patient’s response to this type of stimulation is observed to ensure that the active needle tip is at a safe distance from the motor nerve that is not a target. This is a particularly delicate process if we consider that the tip of the electrode is usually 1.4 mm in diameter, while the diameter of the nerve can range from 2-5 mm. The target nerve is obviously in close proximity to the motor branch and its artery and vein, so absolute certainty is required before the treatment application, in order to avoid complications.
The electrode is then heated in a controlled selected temperature, for a few minutes (1 to 2.5 minutes, depending on the therapeutic protocol) exerting its therapeutic effect. The rise in temperature is not painful for the patient because during thermocoagulation the anesthesiologist administers twilight anesthesia and systemic central analgesia. In most cases, applying heat to a sensory nerve would be particularly painful, without continuous anesthesia. A typical operation takes 30-90 minutes, as thermocoagulation of more than one sensory branch may be required. Access may also be difficult due to anatomical abnormalities in the area (eg significant osteophytes, or anatomical variants).

 

RESULTS

Radiofrequency therapy is a safe and effective method of treating several chronic painful syndromes. If the pain is significantly reduced with the first application of radiofrequency then the treatment can be repeated more times. There is strong clinical evidence that radiofrequency therapy is effective in treating trigeminal neuralgia, radicular nerve pain, and spinal pain (Lord 2002). In a large study, 92.5% of patients with trigeminal neuralgia reported excellent or good relief after treatment of the trigeminal ganglion with traditional radiofrequency (Chen 2001).
The denervation of the facet joints in the lumbar and cervical spine, with the application of radiofrequency in the medial nerve branch is documented by large studies (RCT studies). A recent  review for the invasive treatment of chronic spinal pain by the American Society of Interventional Pain Physicians (ASIPP)  concludes that denervation of the lumbar and cervical joints of the spine is highly effective in a short period of time (3-6 months) and moderately documented for a long period of time (>>1 year).

After treatment, patients are usually relieved of the need for continuous analgesic treatment and all the possible side effects and ineffectiveness it may bring, while fully returning to their activities without any restrictions.

Especially in the case of denervation of the facet joints in the lumbar and cervical spine, the absence or reduction of pain (i.e. backache or neck pain), allows other therapeutic actions to be performed (i.e. physical therapy for muscle strengthening) which have a continuous and long-lasting effect as far as the reduction of pain episodes is concerned.

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New treatment for back pain, sciatica and cervical syndrome

In modern medicine  a new trend is developing in the treatment of diseases. These are new treatments for the most common health problems, such as back pain, sciatica and cervical syndrome . These treatments  do not require hospitalization , they cost little and are just as effective as  surgical procedures.

Long-term medication in many patients is not effective, while surgery can be costly, painful and often the  patient is afraid to enter the operating room.

This created the need for medical intervention that will not lag behind in effectiveness, will be clearly more economical, and will restore  good health to patients of all ages.

Spinal diseases are becoming more and more common. As far as young people are concerned, those diseases are caused due to a sedentary lifestyle, weight gain,  lack of exercise and extended working hours. In the elderly, it is the increase in life expectancy, and working despite their old age due to  financial need. The result is that we see more and more patients with back and neck pain who take medication for a long time, but  continue to suffer. They consume large amounts of drugs, increasing their medical expenses, or undergoing open surgeries, at great  cost.

Some of them will not get well if they do not have surgery, but they do not make that decision, for all the reasons mentioned above. However, a percentage  of over 80% of the chronic pain that does not go away with drugs can now be treated without surgery , simply in the office of a specialized Spine Surgeon!

But how did we get to this development? The method of nerve infiltration of the nerve roots of the lumbar and cervical  spine has been known for years. All of these methods are examples of minimally invasive treatments of the spine. We perform these  operations in the operating room using radiological guidance and under local anesthesia. They last 30 minutes and then the patient is able to move in just a few  hours’ time. After the operation, daily hospitalization is required. They are performed using special equipment and by specialized surgeons.

Ultrasound-guided filtration

What is new, however, is that now these same surgeries have evolved even moreand can now be performed using ultrasound, without surgery, in a simple and safe way. The specially trained surgeon applies the method of nerve infiltration with ultrasound guidance . Sounds complicated, but it only lasts 5 minutes and can be relieve   pain for months or even years! It offers everything that nerve infiltration surgeries do, but it does not need to be done in a hospital, the patient is not  exposed to radiation and is mobilized in 20 minutes. So simple!

This new method is gaining ground in the United States and Western Europe. It has been enthusiastically received by both  patients and insurers, as it drastically reduces treatment costs and recovery time. Now it is done in Greece too!

With this technique, injuries to muscles, blood vessels and nerves are avoided. The advantage is that the ultrasound is painless, bloodless and provides a continuous image of the internal organs, without any side effects or radiation. All that is  required is a modern ultrasound and a doctor with the specialized knowledge.

Of course, we must be very careful in choosing the right patients. There are patients who need a normal surgical discectomy  (even in a minimally invasive way). These patients should not  undergo such treatment, because it will not prove to be beneficial and they will not avoid  discectomy in the end. Choosing the correct method and patients is the responsibility of the specialist surgeon. Therefore, if minimally invasive methods are  not used properly, they can harm the patient, delaying proper treatment.

Proper information of patients contributes significantly to the selection of appropriate treatment. Surgeons who know these techniques are  able to provide patients with modern surgical care in Greece, with the exact same quality characteristics as in the most  advanced medical countries in the world. Thus, everybody’s health is improved, reducing the material and ethical costs of invasive treatment.

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