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All Posts Tagged: Spine

Disc hernia: new data in its treatment

In recent years, spinal surgery has made tremendous progressUntil recently, or even at the present time, when a patient learned that they needed back surgery, they experienced great fear and uncertainty. Everyone has a friend, acquaintance or neighbor who, after a back surgery for a herniated disc, suffered for a long time, did not solve their problem, or was in even worse pain. Most of course got better, but not for some time after the operation.

Percutaneous Lumbar Decompression

Today this belief is beginning to change and this is only the beginning. Because the most modern technique of waist restoration has come to Greece: Η Percutaneous Lumbar Decompression. The method has all the advantages of surgical treatment, i.e. anatomical and functional restoration of the problem. However, is not accompanied by the discomfort, post-operative pain and bed rest, like the well-known normal surgery.

More specifically: any patient who suffers from symptoms of spinal stenosis, almost 10% of the population over 50 years of age, or from lumbar herniated disc, which causes severe symptoms of back pain and sciatica (persistent back and leg pain, often in young people), until now had 2 options: The first option was to take a lot of medication, do physiotherapy and miss days of work and activities whenever he had a pain attack, usually 1-3 times a year. The second option was to go into surgery, often with fear and uncertainty about the final outcome.

But now with Percutaneous Lumbar Decompression, the patient has almost complete recovery, without the risks of open surgery, or the discomfort of constant recurrence and medication.

Not a day in bed

With a few hourshospitalization in the hospital, an incision of a few millimeters is made, which is then seen as a scratch on the skin. The patient does not lose blood and the musculoskeletal system is not injured. From this small opening, everything needed to fully decompress the spinal canal and the nerves that are under pressure is done.

In just a few days, the patient returns to full activity. He doesn’t have to stay in bed for a day. The relief of his symptoms is immediate and noticeable. As patients say, “the leg stretches out, becomes stronger and walking becomes more confident”. Post-operative medication is practically non-existent (small dose of paracetamol).

The problem ceases to exist and all patients resume their daily activities without pain. Younger people go back to work quickly. Older people can walk again as much as they want, so they can take care of their work or visit their friends, without thinking that they cannot walk more than 100-200 metres without being stopped by pain.

The most modern surgical method is not out of reach for anyone. Thanks to it, anyone who does manual work or leads a sedentary life and needs to work for a living can work again. without pain. But even if he is older, he doesn’t isolate himself at home, pining away because he can’t bear to walk down the street. The solution now exists, for everyone!

Ν. Marathi
Director of the Neurosurgery Clinic
Athens Euroclinic

Published in boro.gr

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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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Postoperative chronic pain

 

 

This category includes a number of conditions such as the so-called failed back / failed neck pain syndrome. Many of these patients continue to suffer from pain, although clinical and imaging tests (X-rays, MRI scans, etc.) do not identify any cause of their pain.

Implantation of spinal cord stimulators in the spine

Postoperative chronic painIn selected cases , implantation of spinal cord stimulators in the spine may help.The correct diagnosis of the syndrome made by specialized doctors (anesthesiologists, neurologists, or neurosurgeons) and the correct choice of patients who may benefit from it is a prerequisite. The stimulator is implanted in the patient’s body, usually in the abdomen. After a short period of training it can be used by the patients themselves through a simple remote control, depending on the intensity and location of their symptoms. It significantly improves symptoms by controlling pain in the exact area where it occurs. The implant operation is relatively simple. The surgery lasts 30-45 minutes, under general anesthesia, and the duration of postoperative treatment is 2-3 days. The use of the system can start during the hospitalization of the patient and its beneficial effects are immediately felt. About 2 in 3 patients in this category are relieved of their symptoms and no longer need to take chronic medication with all its possible side effects.

 

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