2016-08-26

I have osteoporotic fractures in spinal column. What is this?

Osteoporotic fractures are defined as the sedimentation of vertebral bodies which occurs with minimum or not at all force (namely without a hit) due to severe osteoporosis. They result in pain and kyphosis, which means patient’s arching. The way of dealing includes the use of splint or the waxwork with vertebral restoration and cement injection.

2016-08-26

I have osteoporotic fractures in spinal column. What is this?

Osteoporotic fractures are defined as the sedimentation of vertebral bodies which occurs with minimum or not at all force (namely without a hit) due to severe osteoporosis. They result in pain and kyphosis, which means patient’s arching. The way of dealing includes the use of splint or the waxwork with vertebral restoration and cement injection.

2016-09-01

In what way is neck operated?

There are many ways. The best and most painless is the use of neck cage. This cage is placed between the vertebrae without the use of plates and screws and without the post-operative complications of dysphagia and difficulty swallowing. The approach is anterior from the neck and not posterior. Everything is performed with the use of high resolution and definition microscope.

 

How does pain in the neck usually appear?

Every anatomic element in neck is capable of causing pain. A usual cause of pain constitutes the chronic muscle and ligament strain, occurring due to bad posture. Disc degeneration (wear) may also cause pain. Pain in the neck may abruptly appear due to a sudden move or a car accident. Nevertheless, it may be also slowly established, remaining for weeks or months.

 

When shall I visit a doctor for pain in the neck?

  • When pain started abruptly after a fall or car accident
  • When pain reflects in arms, in legs or is combined with numbness
  • When pain is accompanied by limb weakness or difficulty in walking

 

What is cervical myelopathy?

Cervical myelopathy is the result of vertebral stenosis in the neck region. In spinal cord Magnetic Resonance Imaging usually –but not always- coexists a pathological sign. It causes severe symptoms of weakness, numbness, instability and stationarity both in the upper and lower limbs.

 

Does every person with intervertebral disc hernia need surgical operation?

The answer is no. Many people have intervertebral disc hernias in their neck or in their waist and are monitored for years by their orthopedic or neurosurgeon. The operation’s indications for intervertebral disc hernia are:

  1. When limb weakness or paralysis appears.
  1. When pain in the neck or in waist is not treated with the conservative treatment and is unbearable. In a few words when drugs are not enough and when there is neurogenic pain with reflection in the leg or in the arm for more than 2 months.
2016-09-01

In what way is neck operated?

There are many ways. The best and most painless is the use of neck cage. This cage is placed between the vertebrae without the use of plates and screws and without the post-operative complications of dysphagia and difficulty swallowing. The approach is anterior from the neck and not posterior. Everything is performed with the use of high resolution and definition microscope.

 

How does pain in the neck usually appear?

Every anatomic element in neck is capable of causing pain. A usual cause of pain constitutes the chronic muscle and ligament strain, occurring due to bad posture. Disc degeneration (wear) may also cause pain. Pain in the neck may abruptly appear due to a sudden move or a car accident. Nevertheless, it may be also slowly established, remaining for weeks or months.

 

When shall I visit a doctor for pain in the neck?

  • When pain started abruptly after a fall or car accident
  • When pain reflects in arms, in legs or is combined with numbness
  • When pain is accompanied by limb weakness or difficulty in walking

 

What is cervical myelopathy?

Cervical myelopathy is the result of vertebral stenosis in the neck region. In spinal cord Magnetic Resonance Imaging usually –but not always- coexists a pathological sign. It causes severe symptoms of weakness, numbness, instability and stationarity both in the upper and lower limbs.

 

Does every person with intervertebral disc hernia need surgical operation?

The answer is no. Many people have intervertebral disc hernias in their neck or in their waist and are monitored for years by their orthopedic or neurosurgeon. The operation’s indications for intervertebral disc hernia are:

  1. When limb weakness or paralysis appears.
  1. When pain in the neck or in waist is not treated with the conservative treatment and is unbearable. In a few words when drugs are not enough and when there is neurogenic pain with reflection in the leg or in the arm for more than 2 months.
2016-08-26

ENDOSCOPIC LUMBAR DISCECTOMY

The only discectomy surgical intervention in the world with parallel preservation of the anatomical structure.

If the intense pain or the neurological symptoms cannot be conservatively treated then surgical restoration is necessary. The purpose of discectomy is disc material removing and decompression or complete release of the nerve.

Endoscopy on the other side demands a very small incision (8 mm) from a far lateral position without being necessary to open the spinal canal. It constitutes hence an alternative solution of anatomical structure preservation in contrast to conventional “open” surgical operation. The risk of scars or complications appearance is very low since there is almost not at all tissue damage. In total the healing process is accelerated and the rehabilitation times become considerably smaller.

 

Why endoscopic discectomy is the most gentle and safe method?

Endoscopic discectomy allows us to treat disc hernia in a higher security framework parallely with more tissue preservation. The most important difference with a conventional endoscopic procedure is the lateral approach approximately 12 cm from the middle line through the foramen and the fact that local anesthesia is applied. We enter laterally and do not cut in the middle patient’s back. By this way nerves which lie in the spinal canal remain intact and nerves’ injuries, adhesions and other complications are avoided. Furthermore muscles, bone and intervertebral ligaments which stabilize intervertebral column remain intact.

Pain is significantly less and general anesthesia is not essential, advantages that are attributed to the fact that lateral access allows tissue preservation.

 

How is endoscopy performed?

An optical endoscope is inserted through a small skin incision under local anesthesia. It is equipped with small cannulas and pushed carefully in front of the side of disc prolapse. The extruded disc material can be under optical control removed. The protruding residues are removed with suitable forceps and a special nucleolyser laser. That contributes to nerve decompression and we have thus immediate relief of the patient.

The intervention lasts 30 to 45 minutes. The entry point is aseptically with a small piece covered and then the aperture is by a suture closed.

Patients are subsequently for 2 hours into a recovery room monitored, leaving hospital the same or the next day.

All endoscopic surgical interventions are not the same!

The fundamental difference from the other endoscopic operations –which also constitutes the major advantage-, is the entry point. Other techniques enter from the back in disc hernia. The lateral transforaminal access is much more conservative concerning the tissue in comparison with the posterior access since nerves and ligaments remain intact and local anesthesia can by applied.

 

The result depends largely in surgeon’s experience.

Most endoscopic discectomy techniques use the transforaminal access (lateral open for nerve exit). The primary target is, however, the disc himself. The remove of healthy disc material results in volume loss (blank). That will lead to recall of disc tissue prolapse back in the empty space and to decompression of the spinal nerve. This is in many cases successful. Procedures with similar philosophy are for example tissue shrinkage with laser, chomucleolysis, alcohol injections or disc tissue suction. The success rates of these techniques are rather low and are connected with risk of degeneration and increased instability.

The technique that Dr. Kapetanakis in Interbalkan Medical Center uses aims to the direct and safe removal of the hernia that compresses the nerve- independently from its localization or its size. Physical condition of the disc as well as the mobility and stability of the operated vertebral column part are fully maintained.

 

What is the postoperative care?

There will be a monitoring examination a day after the operation. Furthermore, a physiotherapist will explain you a particularly targeted rehabilitation program. During the first two weeks a specially equipped plastic corset must be placed. This corset will support your back, allowing you parallely soon to do your daily activities. It is recommended to start physiotherapies after a week. After 6 weeks you must begin strengthening exercises for your back and the abdominal muscles. You can simultaneously and gradually continue your sport activities.

 

When can I repeat my sport activities after my endoscopic discectomy?

After approximately three weeks you will be able to go for swimming or cycling. You can return in your usual sport activities after 6 weeks.

 

When can I return at work?

After from one to two weeks –and maybe earlier- you can continue simple office works and light physical work. You should not do any hard physical work during the first 6 weeks. You can subsequently increase it gradually.

 

What is the success rate of endoscopic discectomy?

Success rates depend largely on surgeon’s experience. In international scientific bibliography success rates are of 95%. Our statistical evaluation for endoscopic discectomy revealed a success rate of 97%.

All advantages of endoscopic discectomy at a glance:

  • Extremely high success rate >95%
  • Very low contamination rate <0.01%
  • The intervention is conducted under local anesthesia- general anesthesia is not required!
  • In the majority of cases patients feel no pain directly after the surgical operation!
  • Complications risk is significantly low since there is almost none tissue damage.
  • Instability is absent because the anatomical structures which stabilize vertebral column –ligaments and joints- remain intact. This is the basic difference in comparison with microscopic discectomy.
  • Less wound healing pain as well as more stability since back muscles are not cut.
  • Low contamination risk because access requires only a very small skin incision (8 mm)
  • Less scars in nerve roots region!
  • Patient is able to walk without pain already two hours after the operation.
  • Brief hospital stay: you can go back to home the day after the operation.
  • Already after some days you will be able to continue your usual daily activities.
  • Short rehabilitation times: you can go back to job after one or two weeks whereas you can continue your sport activities after 6 weeks.
  • Small scars.
2016-08-26

What is discoplasty with Discogel?

Discoplasty constitutes the most modern and bloodless discopathy treatment method, either in Cervical, or in Lumbar spine. It is a minimally invasive surgical technique.

This method includes the percutaneous infusion of a special gelatinous material (which consists of ethyl alcohol, cellulose and radiopaque substance- Discogel) within the intervertebral disc which has been undergone degeneration. General anesthesia is not required whereas the intervention is not bloody at all. Local anesthesia is applied in the entry points of the special fine needles.

The substance is injected in the destructed disc under fluoroscopic monitoring with special machines. That allows the surgeon to retain control throughout the operation.

 

How does Discogel act?

The injected in the disc centre drug exerts an osmotic effect, absorbing gradually hernia’s liquid material from the periphery to the centre of the nucleus. A new disc nucleus is by this way reconstructed, decompressing parallely the hernia and consequently the pressure that it exerts. Furthermore, Discogel seals any crack of disc integument (fibrous ring) occurring due to its degeneration. By this way the exit of inflammatory substances to nerve roots is inhibited. Because of this action, the correct medical term for this method is “ Nucleolysis” since in essence it destructs nucleus pulposus of the intervertebral disc.

 

In which cases can Discogel be applied?

The technique of discoplasty can be for the treatment of intervertebral disc hernia not only in the neck, but also in low back applied. One of its many comparative advantages is that it enables simultaneous treatment of not only one, but also two, three or more suffering discs. An extra advantage of this method is that it can be combined with anesthetic and cortisone infusion is vertebral joints, something that I usually do in my cases. Patient is thus in one session able to confront permanently a chronic problem which influences intensely negative his personal and professional daily routine.

 

Which are the success rates of operation with Discogel? 

When technique is applied in the framework of correct indications success rates are over 75%. The extremely important advantage of this method is that it constitutes a minimally invasive surgical technique, applied by local anesthesia, allowing the patient to return to his house the same day of operation.

 

Which are the advantages of this method?

The advantages of percutaneous discoplasty with Discogel for the treatment of problems concerning intervertebral disc hernia are many and obvious. It is indicatively referred:

  • The technique is percutaneous and does not concern surgery.
  • Patient is not required to receive anesthesia.
  • There are not surgical incisions, hemorrhage, inflammation risk or stitches that must be removed.
  • There is the ability to treat more than one disc.
  • Patient needs not to be hospitalized and can leave hospital after completion of the infusion.
  • According to recent studies up to 90% of the patients underwent Discoplasty avoided heavier and more painful surgical operations in the future (for example spinal fusion).

 

Which are the disadvantages of this method?

Disadvantages, if they can be considered disadvantages, contain the fact that the procedure is conducted under a little only local anesthesia, and, as a result, patient has perception of everything that occurs.

 

When do patients exit from the hospital?

The whole procedure does not last over 15 minutes and the patient leaves clinic after 3-4 hours. Heavy works must be avoided in the first week and he returns to normal life without pain. I just reexamine him in one month, in two months and in six months after the operation.

 

How much does the operation cost?

The operation cost is not forbidden, compared with the difficult economic conditions of our time. I would support that it in contrary is affordable for the majority of our fellowmen. When, on other side, this amount is with spinal fusion compared, one can understand that it approximately corresponds to 1/3 - 1/4 of spinal fusion price.

 

What is your opinion about the future use of Discogel?

Listen, this is a new method. It counts a follow-up of 5 years and the results are particularly encouraging. Having the opinion of its use in abroad but also in Greece, I believe that it constitutes the revolution in field of Spine Surgery. In fact and according to the physiology of material’s act it can deterrent a future surgical intervention.

 

Which is people’s percentage that can undergo this method?

According to studies a percentage of 70-80% of the people will present lumbago (low back pain) in one period of their lives. If this is due to the intervertebral disc then with minimum limitations (for example broken disc) the patient can undergo this method, provided that the symptoms insist for some time.

Do you recommend it as a bloodless and minimally invasive method?

With appropriate patient selection, I would say that I strongly recommend it to patients coming to my infirmary in Thessaloniki and in general to patients from N. Greece who I treat.

2016-08-26

What is lumbago and what sciatica? What is their etiology?

Using the term “lumbago” we mean back pain, whereas “sciatica” means pain in the lower limb, due to pressure to sciatic nerve. Intervertebral disc hernia constitutes the most frequent cause of lumbago and sciatica in young and middle-aged people.

 

What does vertebral instability mean?

Vertebral instability is the lack of stability and the abnormal movement between two vertebrae. It constitutes a frequent cause of chronic lumbago, leading to gradual destruction of intervertebral joints.

 

What is spondyloarthritis?

Spondyloarthritis is the destruction of joints of two adjacent vertebrae. It is frequent in older patients, constituting a frequent cause of chronic lumbago and as well as of vertebral stenosis.

 

What is vertebral stenosis?

Vertebral stenosis is the stenosis of spinal canal. This canal is formed by the vertebrae, serving the passing of the nerves that provide sensation and motion to our arms and legs. Stenosis may be found in the neck, thorax or in our waist, leading to numbness and weakness to our upper or/and lower limbs, depending on its localization.

 

I have osteoporotic fractures in spinal column. What is this?

Osteoporotic fractures are defined as the sedimentation of vertebral bodies which occurs with minimum or not at all force (namely without a hit) due to severe osteoporosis. They result in pain and kyphosis, which means patient’s arching. The way of dealing includes the use of splint or the waxwork with vertebral restoration and cement injection.

 

I suffer from acute lumbago-sciatica. Am I in danger to become paralyzed?

In extreme cases, which are not nevertheless unlikely, the sciatica due to a large intervertebral disc hernia may can combined with severe nerve pressure, leading to temporary or, if it is not treated on time, to permanent paralysis of specific muscles. Such muscles are, except for leg muscles, the muscles which control the anus or the urinary bladder. The result is urinary and faecal incontinence. Elements that must worry us are the intense numbness or decreased strength of one muscle and numbness in genitals and anus.

 

What is cauda equina sundrome?

The appearance of urine disorders or the urine or faecal incontinence is called cauda equina syndrome and constitutes a bell for emergency treatment.

 

I suffer from acute lumbago-sciatica. Is there drug therapy?

The administered drug therapy aims to soothe nerve irritation which causes the pain. However, it cannot treat the problem etiology, which usually is intervertebral disc hernia. You may overcome but not treat the substantial nerve pressure. This is the reason why the same clinical picture often returns in another time.

 

When is surgically intervertebral disc hernia treated?

An intervertebral disc hernia is surgically treated if the pain remains for a long period of time despite the drug therapy or if it presses the nerves, leading to decreased neural function.

 

What is the difference between endoscopic discectomy and microscopic discectomy?

Despite the limited incision and accuracy that microscope provides, microscopic discectomy remains still an open intervention. It demands general anesthesia, injuring parallely back muscles and bones. Endoscopic method is in contrast conducted under local anesthesia, causing almost not at all tissue injuring so that it does not require hospitalization. It is characterized by much shorter hospital stay and direct mobilization. We substantially enter from a far lateral skin incision of 8 mm. Patient is in the same time mobilized since it is conducted under local anesthesia, being able to leave hospital the same day.

 

What is kyphoplasty?

Except for spinal fusion, there are also other types of surgery which can be conducted with fine tubes, such as kyphoplasty. It constitutes a modern method of vertebral osteoporotic fractures treatment. The operation is conducted with two small incisions of one cm for every vertebra. A special balloon is through the tubes in vertebra inserted, correcting while swelling the shape of the broken vertebra. The created after balloon deflation space is filled with acrylic cement and the vertebral body is thus strengthened and stabilized. Patient usually remains in the hospital for one day. The return in daily activities is direct and pain relief is spectacular.

2016-08-26

What is facet joint block injection?

It is the injection of local anesthetic and cortisone, conducted with a fine needle and fluoroscopic guidance, fluoroscopy (c-arm). This is performed for the treatment of vertebral small joints chronic pain.

 

What is the epidural injection?

It is the injection of local anesthetic and cortisone in epidural space of vertebral column. It aims to inflammation repress and pain relief for the patient.

 

Can I avoid a spine surgery by an injection?

Yes, depending of course on the nature of the problem. If it is about a big problem, no.

2016-08-26

What is percutaneous spinal fusion?

Endoscopic spine fusion is recently used. It is conducted under local anesthesia and controlled sedation. Patient gets up the same day, walking in 1 hour, leaving hospital the other day and losing hardly any blood.

 

What is the hospitalization time of percutaneous spine fusion or endoscopic spinal fusion?

On average one to two days.

 

When does a patient who has undergone an endoscopic spinal fusion in job return?

In this case times are by ¼ in comparison with the open-conventional spinal fusion reduced and patient returns namely after fifteen (15) days, depending of course on the work [for heavy physical work in month and a half (1.5 months)].

 

In how much centers is endoscopic spinal fusion performed?

In only 3 centers. In America, Austria and in Interbalkan Medical Center of Thessaloniki by Dr. Kapetanakis.

2016-08-26

What is percutaneous spinal fusion?

Percutaneous spinal fusion is performed through a small incision of 2 cm to 4 cm and is almost bloodless without muscle destruction. It is substantially about the use of screws by lateral approach and not in the middle line, conducted absolutely bloodless. Endoscopic spinal fusion is recently used. Patient gets in this case up the same day with the intervention. It is performed under local anesthesia and controlled sedation and, as a result, patient walks in 1 hour and leaves the hospital the other day losing almost no blood at all.

 

What is the hospitalization time of the patient who has undergone open-conventional spinal fusion?

Hospitalization time is on average five days.

 

What is the hospitalization time of percutaneous spinal fusion or endoscopic spinal fusion?

On average one to two days.

 

When does a patient who has undergone open-conventional spinal fusion in his daily activities return?

After two months.

 

When does a patient who has undergone percutaneous spinal fusion in his daily activities return?

In three days.

 

When does a patient who has undergone open-conventional spinal fusion at work return?

After two months, depending of course on the type of his job.

 

When does a patient who has undergone endoscopic spinal fusion at work return?

In this case times are by ¼ in comparison with the open-conventional spinal fusion reduced and patient returns namely after fifteen (15) days, depending of course on type of work [for heavy physical work in month and a half (1.5 months)].

 

In how much centers is endoscopic spinal fusion performed?

In only 3 centers. In America, Austria and in Interbalkan Medical Center of Thessaloniki by Dr. Kapetanakis.

 

How much blood is required for patient transfusion in open-conventional spinal fusion?

On average two bottles.

 

How much blood is required for patient transfusion in microinvasive spinal fusion?

No bottle.

 

What is the eXtreme Lateral Interbody Fusion (XLIF)?

It is a spinal fusion performed from an incision 2 cm from a side of the body without coming in contact to the spinal nerves.

 

In which vertebral levels can eXtreme Lateral Interbody Fusion (XLIF) be conducted? 

In entire lumbar and in thoracic spine.

 

When can I walk after percutaneous spinal fusion?

In two hours after the surgery.

 

What is spinal fusion and which are its applications?

Spinal fusion is the method by which motion between two vertebrae is abolished. It can be performed in anterior or posterior vertebral portion or both, using screws, rods and other special implants. Bone implants are also used. Spinal fusion is applied in deformation correction such as scoliosis but also vertebral stenosis, in instability and in spondyloarthritis.

 

Can intervertebral disc replacement parallely with screws positioning be performed?

No, these are two totally opposed things. When we perform intervertebral disc replacement we must have mobility in vertebral column. Mobility is in contrast with screws and rods positioning abolished.

Contact Form






What is the sum of 8 and 2?

CONTACT

Dr. Stylianos N. Kapetanakis

Orthopedic and Spine Surgeon MD, FRCS, PhD
Priv. Consultant Spine Surgeon
Ass. Professor at Medical School of Democritus University of Thrace

THESSALONIKI:
Pavlou Mela 16 and Tsimiski
Phone: +0030 2311289109 & +0030 6983455456
Monday - Friday


European Interbalkan Medical Center
Asklipiou 10, 57001 Pilaia
Phone: +0030 2310400464, +0030 2310400463 & +0030 6983455456
Monday - Friday

CHANIA:
Tzanakaki 13 
Phone: +0030 2821055549 & +0030 6983455456
Monday - Friday

RETHYMNO:
Tandalidou 2 and Dimitrakaki
Phone: +0030 2831035650 & +0030 6983455456
Monday - Friday

HERAKLION:
Machis Kritis 10, Chandax
Phone: +0030 2810528007, +0030 6983455456
Monday - Friday

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