Spine surgery

Spine medicine

Spine medicine services may be categorized into three main classes according to their nature:

  • Diagnostics
  • Surgical interventions
  • Conservative therapies

Traditional surgical techniques may be used for the entire spine, equally for the spinal surgical treatment of degenerative (problems caused by wear-out), traumatic (injuries caused by an accident) and inflammatory lesions.

Each branch of surgery seeks to provide the as much help as possible, with the least “harm” possible. The ever more common so-called minimally invasive (percutaneous, that is performed through the skin) techniques are significant because the risk associated with their use is the least possible on the surgical palette.

Percutaneous methodology may also serve as a diagnostic tool in addition to therapeutic application, therefore minimally invasive diagnostic methods are often used these days in addition to traditional imaging diagnostic scans. The essence of myelography (“spine dyeing”) and discography is to gain valuable supplementary information by injecting organic iodine into the body in cases when traditional diagnostic tools can’t be used and when it is necessary to localize the source of pain or to determine the degree of degeneration.

Depending on complex diagnostic results and physical examinations, specialists make a decision on the application of conservative therapy or surgical intervention. Open surgical techniques are used in case of advanced degeneration, such as severe intervertebral disc injury, while in the initial phases of degeneration, that is, relatively intact structure, the application of various percutaneous techniques may be considered.

There are several areas of the spine (nerve root block, small joint block, epidural block or sacral epidural adhesiolysis, (SEA)) where therapy and diagnostics may be performed in one session. In such a case, local anti-inflammatory injections contain local anesthetics and anti-inflammatory steroids.

The gist of percutaneous surgical procedures (traditional and laser disc decompression) is that penetration is performed through a very small incision, and target location as well as surgical manipulation takes place within the body in a “closed” setting. In addition to the least possible destruction of intact tissues, this procedure does not need general anesthesia, instead it is performed with local anesthesia or maybe intravenous narcosis. As in case of minimally invasive surgical interventions, its further advantages include decreased duration of hospital stay, more rapid rehabilitation and earlier returning to normal activity.

Other special treatment methods:

  • IDET (Intradiscal Electrothermal Annulopasty)
  • Vertebroplasty (in case of pain developing on the grounds of osteoporosis)
  • Balloon kyphoplasty (strengthening of the vertebral body)

The above surgical techniques are now supported by surgical navigation systems (Computer Assisted Surgery - CAS) which on the one hand allow increased accuracy during certain specific surgeries (such as tumor removal) and on the other hand, they help to decrease the use of mobile x-ray machines during surgery and therefore the amount of radiation burden of the patient during surgery can be decreased.