Spine

Spine

We propose to each patient the most appropriate treatment for cervical or lumbar disc herniation, canal stenosis, as well as an integral approach for complex cervical spine pathology. We have special interest in the minimally invasive management of degenerative, traumatic and tumoral diseases of the lumbar and dorsal rachis.

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Cervical spine

The problems caused by the involvement of the cervical spine represent one of the most frequent reasons for consultation in neurosurgery. The cervical spine is subject to overloads originating in daily work activities, or traumatic, manifesting with painful or neurological symptoms.

At Neurovist we have extensive experience in the surgical treatment of complex cervical spine pathology. Consult us and we will advise you on the best treatment option for your cervical spine problem.

Pathologies

CERVICAL DISC HERNIATION

It consists in removing the affected intervertebral disc (discectomy), at the same time removing the osteophytes (“peaks” of bone formed by osteoarthritis), to decompress the cervical spinal cord.

After the discectomy, a DISC PROSTHESIS that replaces the function of the damaged disc is placed, or a box of biocompatible material filled with bone graft, which is fastened with a screwed titanium plate.

The approach is carried out by a small wound in the anterior part of the neck, which usually has a good cosmetic result. The surgery is performed with the help of the neurosurgical microscope, which allows a correct visualization of the structures of the surgical field, and lasts approximately 60 minutes.

CERVICAL MYELOPATHY

It is a procedure aimed at decompressing the affected nerve root, without removing the intervertebral disc, thus preserving the anatomy of the cervical spine.

CERVICAL CANAL STENOSIS

Sometimes the previous surgery is not enough to achieve a correct decompression of the canal, and it must be completed by an approach through the back of the neck, which also allows cervical fusion if necessary.

COMPLEMENTARY TESTING NECESSARY

The presurgical study of the patient is completed by complementary tests such as magnetic resonance and computed tomography of the cervical spine, as well as neurophysiological tests for the assessment of the damage produced in the nerves or spinal cord.

TREATMENT

The neurosurgical treatment is reserved for those cases with invalidating painful symptomatology, when a loss of force appears on the clinical examination, and when the neuroimaging shows a narrowing (stenosis) of the spinal canal with considerable involvement of the cord or cervical nerve roots in the neurophysiological tests.

Surgery of the cervical spine in general is very well tolerated by the patient; the majority of patients can be discharged from hospital within 24-36 hours. The medication required in the postoperative period consists of conventional analgesics or anti-inflammatories (paracetamol, metamizole, dexketoprofen, etc.).

The majority of patients do not require a cervical collar during the postoperative period.

If the patient’s symptoms improve significantly with the analgesic-anti-inflammatory medication, and the complementary tests indicate that there is no significant spinal or nervous compromise, initially a conservative management of the patient can be indicated, with follow-up in outpatient clinics to assess its clinical evolution.

TECHNIQUES

Microdiscectomy and arthroplasty or cervical arthrodesis

Consiste en retirar el disco intervertebral afectado (discectomía), extirpando al mismo tiempo los osteofitos (“picos” de hueso formados por la artrosis), para descomprimir la médula cervical.

Tras la discectomía se coloca una prótesis de disco que suple la función del disco dañado, o bien una caja de material biocompatible rellena de injerto de hueso, que se sujeta con una placa atornillada de titanio.

El abordaje se lleva a cabo por una pequeña herida en la parte anterior del cuello, que habitualmente tiene un buen resultado cosmético. La cirugía se practica con la ayuda del microscopio neuroquirúrgico, que permite una correcta visualización de las estructuras del campo quirúrgico, y dura aproximadamente 60 minutos.

Anterior or posterior cervical foraminotomy

Es un procedimiento dirigido a descomprimir la raíz nerviosa afectada, sin extirpar el disco intervertebral, por lo que preserva la anatomía de la columna cervical.

Decompression of canal and posterior cervical arthrodesis

En ocasiones la cirugía anterior no es suficiente para lograr una correcta descompresión del canal, y debe completarse realizando un abordaje por la parte posterior del cuello, que permite también la fusión cervical si es necesario.

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Lumbar spine

Back pain is one of the most frequent medical problems at present, which implies a significant decrease in the quality of life of the patients who suffer it, as well as a high economic cost in work casualties.

In Neurovist we defend that the neurosurgical treatment of the lumbar spine has a very satisfactory result if an adequate and personalized indication is made for each patient. Our philosophy is the mobilization and fast medical discharge for patients undergoing spinal surgery, which allows a quick reincorporation to their usual activities. Ask for a consultation and we will solve your doubts.

Pathologies

The intervertebral discs are located between the vertebrae and allow the mobilization of the spine with stability, since its function consists of the support and distribution of the loads during the movements of the spine.

The most frequent INDICATIONS of lumbar spinal surgery are DISC HERNIATION and CANAL STENOSIS, when they involve the lumbar nerve roots and cause painful symptoms and impairment of gait.

LUMBAR DISC HERNIATION

Lumbar disc herniation occurs when the degenerated intervertebral disc bulges into the spinal canal and compresses the nerve roots.

The symptomatology consists of a crippling pain that radiates from the lumbar region of the back to the legs, and that depends on the territory corresponding to the affected nerve. If nerve involvement is important, it can cause a loss of strength, which limits the patient’s progress.

The usual neurosurgical treatment in lumbar disc herniation is microdiscectomy, a procedure in which the spinal canal is accessed through a small wound in the lumbar area and the extruded disc fragment (disk hernia) is removed, so that the compression of the affected nerve root is eliminated, that is, the origin of the pain.

It is carried out with microsurgical technique and minimally invasive, with hospital discharge at 24 hours.

LUMBAR DISCOPATHY AND INSTABILITY

The advanced disc degeneration (discopathy) can cause an instability of one or more vertebral segments, because the affected disc or discs can not assume correctly the usual functions of suppression and shock absorption of the loads.

Clinically, it translates into chronic low back pain that is very disabling on occasion, which may or may not be accompanied by pain radiating to the lower limbs.

The indicated treatment in cases in which conservative management is insufficient to calm the pain is the fixation of the affected segments with screws and bars (arthrodesis), associated with a canal decompression if necessary.

In certain determined patients another type of neurosurgical treatment can be offered by means of a dynamic stabilization, whose foundation is to limit the range of movement of the vertebrae in which the pain takes place, and which does not completely restrict the mobility of the vertebrae.

LUMBAR SPINAL STENOSIS

One of the most frequent pathologies that we value in the consultation of neurosurgery of the spine is the stenosis of the lumbar canal, which consists of a narrowing of the channel that surrounds and protects the nerve roots that are directed to the lower limbs, with the consequent entrapment from the same. This phenomenon causes a clinical pain radiated by both legs and a claudication of the gait.

The neurosurgical treatment indicated in these cases is SPINAL CANAL DECOMPRESSION, which is performed minimally invasive, with hospital discharge at 24 hours, obtaining very satisfactory results in most cases.

This procedure consists of opening the bony case that surrounds and compresses the nerve roots, in such a way that we release the affected nerves.

A more selective technique is the FORAMINOTOMY, which is applied when it is only necessary to decompress one of the intervertebral foramen through which the nerve roots of the spinal column emerge.

These selective decompression techniques are performed with micro-surgery technique through a small wound in the lumbar area, and do not alter the support structure of the spine.

COMPLEMENTARY TESTING NECESSARY

In the pre-surgical study of the patient, complementary tests are requested such as spinal radiographs in movement (dynamic), magnetic resonance and in some cases a computed tomography of the lumbar spine.

Neurophysiological tests such as electromyography (EMG) provide information on the damage produced in the nerve roots and help to monitor their evolution after the intervention.

How is the surgery?

In the case that complementary tests indicate that there is no significant nervous compromise, initially a conservative management of the patient can be indicated, with follow-up in outpatient clinics to assess their clinical evolution. Depending on the evolution of the patient’s symptoms during this follow-up, some type of neurosurgical treatments mentioned above will be considered.

In the immediate postoperative period, we mobilized the patient early 12 hours after surgery, progressively wandering to objectify and assess the surgical result. Usually, we do not prescribe lumbar corsets in cases of disc hernia surgery and lumbar canal decompression.

In these patients it is not necessary to perform rehabilitation treatment unless they have suffered a neurological deterioration that makes it advisable to facilitate the recovery of damaged nerves.

The majority of patients undergoing lumbar spine surgery are discharged from hospital within 24-36 hours.

The medication prescribed in the postoperative period consists of conventional analgesics or anti-inflammatories (paracetamol, metamizole, dexketoprofen, etc.), since surgery is usually well tolerated by the patient.

3D render of a medical image showing a male with neck pain

Spinal Tumors

The spine can be affected by benign and malignant tumor lesions, which can affect the structure of the vertebra or the spinal canal. In general, the most frequent are metastatic tumors, which invade the spine from lesions located in other regions of the body.

The most frequent benign tumors involved in the neurosurgeon are the schwannomas and neurofibromas, originating from the nerves housed in the vertebral canal. They are lesions of slow growth and that are manifested when generating a space commitment in the spinal canal, compressing the nerves housed in it.

In Neurovist we have a wide experience in the management of this type of tumors, which we approach in a minimally invasive way without affecting the support structures of the spine. In the intervention we counted on the collaboration of Neurophysiology, indispensable to guarantee the safety of the patient and to avoid sequels. They can usually be completely resected, and the patient’s subsequent evolution is favorable.

Vertebroplasty and kyphoplasty

A very frequent problem in Neurosurgery is vertebral fractures by wedging or crushing, which occur in patients suffering from osteoporosis. The loss of bone tissue in the vertebral bodies predisposes them to suffer these fractures in which the vertebrae are crushed by mild or moderate trauma.

The symptomatology they generate consists of pain in the area of the back where the fractured vertebra is located. It can become very intense and disabling for patients. These patients should be evaluated by the neurosurgeon as soon as possible in order to perform a vertebroplasty or kyphoplasty, percutaneous techniques (through the skin), by means of which attempts are made to recover the normal height of the vertebra with a ball that is inserted in the vertebral body through a cannula. Subsequently cement is injected into the balloon to stabilize the vertebra.

It is extremely important to perform an early diagnosis and treatment to be able to perform these techniques, usually before three months, since after this time the treatment becomes the arthrodesis (fixation with screws and bars).

Cervical Disc Prosthesis

In many patients with cervical disc hernias, the placement of a disc prosthesis may be indicated in their treatment. The difference with conventional treatment is that the prosthesis behaves like a “normal” disc, allowing a natural range of movement of the cervical spine.

At Neurovist we work with the latest generation of cervical disc prostheses, specifically the M6-C from Spinal Kinetics, the most advanced prosthesis at the moment.

Once intervened, the patient maintains the same cervical mobility as before, being able to develop their daily activities with absolute normality. It is a treatment especially indicated in young patients with an intense vital activity.