Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

Neurosurgery Spinal Column by liaoqinmei

VIEWS: 23 PAGES: 13

									            Neurosurgery / Spinal Column

            General Information
            With increasing age occur signs of wear and tear at intervertebral discs and spinal
            joints. Damages of the disc tissue are due to most different reasons as herniated
            discs are usually the result of accidents or other unforeseeable events. The interver-
            tebral disc consists of a hard fibrous ring and a softer inner part. The disc tissue is
            not supplied by blood vessels; supply is ensured only through diffusion, a complex
            system of suction- and pressure effect of the vessels surrounding the spinal column
            and the spinal canal.
            If the water content of the intervertebral disc declines, it loses its shock absorbing
            effect and shrinks what can clearly be seen in MRT. Its height is visibly reduced and
            the MRT signal shows lower water content. By increasing wear and tear the disc
            finally loses its elasticity and protrudes; and the fibrous ring is forcefully stretched
            – what causes heavy back pain. Of course, this situation may recede, but in most
            cases the increasing wearing down of the intervertebral disc and the pressure from
            within onto the fibrous ring result in small tears through which the gelatinous
            portion of the disc tissue is being squeezed out (sequestration). By squeezing onto
            nerves or the spinal cord within the spinal canal, this leaked disc tissue can cause
            heavy pain and even neurological deficits such as paralysis, changes in sensation or
            bladder-gastrointestinal disorders.
            A previously damaged disc cannot offer the same shock absorbing effect than a
            healthy one. All these degenerative changes result in the vertebral bodies being
            moved together and stressed excessively. Osteochondrosis as the result of this con-
            dition is also perfectly visible in MRT. Due to the chronic overload of the vertebral
            bodies with low spondylolisthesis further signs of degeneration occur (facet joint
            arthrosis). Bony and cartilaginous protrusions lead to narrowing of the nerve chan-
            nels (foraminal stenosis) and the spinal channel (spinal stenosis). Both degenerative
            narrowing conditions with chronic pressure lead to stress-dependent pain and after
            longer duration also to neurological deficits.




102   Rastatter Str. 17-19 • 75179 Pforzheim • Germany • Phone 07231- 60556- 0 • www.sportklinik.de • info@sportklinik.de
Neurosurgery / Spinal Column




                                                                                                                       Neurosurgery / Spinal Column
                                                                                                                              Ellenbogen
Cervical Spine (CS)
Die Halswirbelsäule (HWS) mit insgesamt 7 Wirbelkörpern ist der beweglichste
Wirbelsäulenabschnitt und stellt die mobile Verbindung zwischen dem Kopf und
der restlichen Wirbelsäule her. Aus dieser Bewegungsfunktion resultieren die
unterschiedlichen Probleme bei degenerativen (verschleißbedingten) und trauma-
tischen (verletzungsbedingten) Erkrankungen. In der Halswirbelsäule liegt direkt
hinter den Bandscheiben das Rückenmark, sodass aus dieser engen Lagebeziehung
viele Probleme entstehen. Degenerative Halswirbelsäulenerkrankungen kommen
gehäuft auch bei jüngeren Menschen vor. Klinisch-neurologisch muss man zwischen
radikulären (Kompression der Nervenwurzeln) und medullären (Kompression des
Rückenmarks) Symptomen und Defiziten unterscheiden. Ein Druck auf das Rücken-
mark muss nicht immer Schmerzen verursachen, ist jedoch ein langfristiges Problem,
da die Schädigung der Rückenmarksbahnen langsam fortschreitende Störungen mit
Gleichgewichtsstörungen, Gangunsicherheit und schleichender Querschnittsympto-
matik verursachen (cervikale Myelopathie).



Degenerative Osteochondrosis
Cause
Is wear and tear or a gradual restructuring process with degeneration of the inter-
vertebral disc and protrusions or extensions of the vertebral bodies. This bone- and
connective tissue growth results in nerve- or spinal cord compression. Generally it
can be said that pain cannot be treated satisfactorily with conservative therapy.
Symptoms
Are often chronic pain in neck and back of the head or pain radiating to shoulder,
arm and fingers. Depending on the nerve affected and the dimension of this nerve
entrapment symptoms may also be lack of force, paralysis and changes in sensation.
Diagnosis
Is made by neurologic examinations as well as special examinations of the spinal
column; in individual cases also by electrophysiological measurements. X-ray ima-
ges of the cervical spine and sometimes so-called functional images are necessary.
Moreover, a CT and/or a MRT should be carried out. In rare cases even a cervical
myelography for further invasive diagnostics is necessary.
Therapy
In case that no neurologic deficits occur, primary aim should be conservative therapy
with intensive physiotherapy and pain medication. If no adequate improvement can
be achieved, indication for operative measures should be checked and discussed new.
Here, individual advice and definition of the optimally suitable surgery method are
of decisive importance.




Rastatter Str. 17-19 • 75179 Pforzheim • Germany • Phone 07231- 60556- 0 • www.sportklinik.de • info@sportklinik.de   103
            Neurosurgery / Spinal Column

            Operation Method
            Minimally-invasive technique (under local anesthesia):
            periradicular infiltration (PRI) – radiologically
            controlled facet infiltration
            When treating with periradicular infiltration (PRI) and the radiologically controlled
            facet infiltration a mixture of local anesthetic and a crystalloid corticoid preparation
            is used. After local anesthesia of the skin a thin cannula is inserted under radiological
            control directly to the point where the nerve exits the foramen and 1 – 2 ml of the
            medication injected. Under x-ray control, this medicine can also be applied into the
            small vertebral bodies near the cervical spine. Its local effectiveness requires only low
            dosages; the medication does only work directly at the site of action and degrades
            very slowly. However, in most cases there are several sessions necessary to achieve
            long-term freedom from pain.


            Microsurgical Operations:
            Ventral discectomy with placeholder
            Here, access is made via the front of the neck with complete removal of the da-
            maged disc. Decompression of nerve structures (nerve roots and spinal marrow) is
            made with the operating microscope. At the end a placeholder is inserted instead
            of the damage disc which has a re-erecting effect to the intervertebral disc space
            and relieves the neuroforamen; the development of osteophytes is prevented.
            Different materials such as polymer cement (PMMA) or synthetic cages (PEEK) are
            used. Only in rare and difficult cases with accompanying loosening of the mobile
            segment screwing together of the cervical spine and a titanium plate is necessary.


            Ventral Foraminotomy
            Here, access is also made via the front side of the neck to open up the nerve chan-
            nel. Compared to ventral discectomy however, preservation of the disc is possible.


            Dorsal microsurgical techniques:
            Foraminotomy, Laminectomy, Laminoplastics
            With dorsal foraminotomy, a bony entrapped nerve root can be decompressed by
            removing the osteophytes. A sole laminectomy with complete removal of the ver-
            tebral arch offers a good possibility to relieve the spinal cord. However there is the
            risk of instability afterwards and so it is used only rarely or in combination with a
            stabilizing procedure. Laminoplastics with dorsal extension and reconstruction of
            the spinal canal is another possibility to treat cervical myelopathy when suffering
            from cervical spinal canal stenosis. This method is especially promising when treating
            an ossification of the posterior longitudinal ligament.




104   Rastatter Str. 17-19 • 75179 Pforzheim • Germany • Phone 07231- 60556- 0 • www.sportklinik.de • info@sportklinik.de
Neurosurgery / Spinal Column




                                                                                                                       Neurosurgery / Spinal Column
                                                                                                                              Ellenbogen
Aftercare
Directly after surgery the patient starts with mobilizing exercises. After microsur-
gical operations at the cervical spine there are no noticeable limitations to sitting,
lying or walking, and even wearing of a neck collar is not necessary. The in-patient
stay at the hospital normally lasts 2-3 days. The following week start physiotherapy
and further conservative measures. As regards other activities after a cervical spine
surgery we would be pleased to give you individual advice.



Disc Herniation
Cause
Due to degeneration of the intervertebral disc there sometimes occur tears in the
fibrous ring through which the inner gelatinous portion of the disc is squeezed
out. The possible resulting pressure onto nerves or the spinal cord causes pain and
neurologic deficits.
Symptoms
Acute neck pain and heavily radiating pain to arms and fingers with the feeling of
weakness and numbness or other abnormal sensations. With severe neurological
deficits such as paralysis, changes in sensation or bladder-gastrointestinal disorders,
immediate operation may be necessary in individual cases.
Diagnosis
Diagnosis is made with neurologic examinations and special examinations of the
spinal column; if necessary also electrophysiological measurements. Moreover, X-
ray images of the cervical spine with functional images as well as a current MRT
are needed.
Therapy
Without obvious neurological deficits, conservative therapy should be the first
choice. Treatment comprises pain medication and if necessary immobilization with
neck brace. After the acute phase starts intensive physiotherapy. In case that conser-
vative therapy does not bring the required result, indication for operative measures
should be checked and discussed new. Here, individual advice and definition of the
optimal time of operation as well as the optimally suitable operation method is of
decisive importance.


Operation Method
Ventral microsurgical discectomy with placeholder
Here, access is made via the front of the neck with complete removal of the damaged
disc. Decompression of nerve structures (nerve roots and spinal marrow) is made
with the operating microscope. At the end a placeholder is inserted instead of the
damage disc which has a re-erecting effect to the intervertebral disc space and re-
lieves the neuroforamen; the development of osteophytes is prevented. Different
materials such as polymer cement (PMMA) or synthetic cages (PEEK) are used.




Rastatter Str. 17-19 • 75179 Pforzheim • Germany • Phone 07231- 60556- 0 • www.sportklinik.de • info@sportklinik.de   105
            Neurosurgery / Spinal Column

            Ventral microsurgical discectomy with artificial intervertebral disc
            With younger patients with a mobile and only slightly damaged disc, preservation
            of the mobile segment can be achieved by implanting a disc prosthesis after micro-
            surgical removal of the real disc.


            Dorsal microsurgical foraminotomy
            With dorsal foraminotomy small and outwards situated soft herniated discs can be
            removed and the entrapped nerve root decompressed.
            Aftercare
            Directly after microsurgical operation mobilization is recommended. Drainages are
            only inserted in exceptional cases and the patient normally does not have to wear
            a neck brace. The in-patient stay lasts normally 2-3 days. In the week following the
            surgery physiotherapy and further conservative measures are started.




            Cervical Myelopathy
            Cause
            Cervical myelopathy is a gradual wearing process with degeneration of the disc.
            Developing bony protrusions (osteophytes) narrow the spinal canal at the cervical
            spine and thus lead to compression of the spinal cord.
            Symptoms
            In many cases occurs chronic pain in neck and back of the head, but often this does
            only pose little discomfort. However, even if not very strong - the permanent pres-
            sure onto the spinal cord results in the medium term in irreversible damages to the
            spinal cord and therefore poses respective risks.
            Diagnosis
            Is made by neurologic examinations as well as special examinations of the spinal
            column; in individual cases also by electrophysiological measurements. X-ray images
            of the cervical spine and sometimes so-called functional images are necessary. Mo-
            reover, a CT and/or a MRT should be carried out whereby assessment of the MRT as
            regards possible signs in the spinal cord for myelopathy is of particular importance.
            Therapy
            With a manifest cervical myelopathy, conservative treatment is relatively promising.


            Operation Method
            Microsurgical ventral discectomy with placeholder
            Here, access is made via the front of the neck with complete removal of the da-
            maged disc. Decompression of nerve structures (nerve roots and spinal marrow) is
            made with the operating microscope. At the end a placeholder is inserted instead
            of the damage disc which has a re-erecting effect to the intervertebral disc space
            and with this prevents the development of new osteophytes. Different materials
            such as polymer cement (PMMA) or synthetic cages (PEEK) are used.


106   Rastatter Str. 17-19 • 75179 Pforzheim • Germany • Phone 07231- 60556- 0 • www.sportklinik.de • info@sportklinik.de
Neurosurgery / Spinal Column




                                                                                                                       Neurosurgery / Spinal Column
                                                                                                                              Ellenbogen
Microsurgical ventral decompression with removal of vertebral bodies
and plate osteosynthesis
Access is made via the front of the neck. By means of an operation microscope the
vertebral body (or bodies) and the adjacent discs are removed what creates a long
relieving effect to the spinal cord. In order to re-stabilize the spinal column after-
wards, implantation of a tricortical iliac crest bone grafting or a metal vertebral
body replacement is necessary. Additionally a ventral plate osteosynthesis has to be
carried out in order to ensure sufficient stability. However, this relatively complex
operation method is rather rare.


Dorsal microsurgical decompression and laminoplastics
A microsurgical decompression is carried out in several stages. Here, the ligamenta
flava and possible osteophytes are removed. Reconstruction of the spinal canal by
laminoplastics is a preferred surgery method when treating very long cervical ste-
noses especially with elderly patients.
Aftercare
Directly after surgery the patient starts with mobilizing exercises. After microsurgical
operations at the cervical spine there are no noticeable limitations to sitting, lying
or walking, and even wearing of a neck collar is not necessary. The in-patient stay
at the hospital normally lasts 3-4 days. Only in rare cases and with previous neuro-
logic deficits rehabilitation treatment is necessary. As regards other activities after
a cervical spine surgery we would be pleased to give you individual advice.




Fractures
Cause
Acute or recent physical violence to the cervical spine with rupture of the ligament
structures and fractures of the vertebral bodies, vertebral arches and vertebral
joints. But fractures may also be the result of tumors, inflammations of the spinal
column or osteoporosis.
Symptoms
Neck pain, headache and other discomfort near the whole spinal column. Further-
more movement restrictions of the spinal column and various degrees of neurolo-
gical deficits.
Diagnosis
Is made with a neurological examination and a special examination of the spinal
column. Furthermore, X-ray images of the cervical spine as well as so-called func-
tional images are necessary, and a CT and a MRT should be carried out. In rare cases
nuclear medicine examinations are needed for further diagnostics.
Therapy
FIn case that no obvious instability or neurological deficits can be detected, treatment
can be done conservatively. This includes stabilization by means of a neck brace and
pain medication. After the acute phase controlled physiotherapy can be started.
When treating fractures of the cervical spine offering individual advice regarding

Rastatter Str. 17-19 • 75179 Pforzheim • Germany • Phone 07231- 60556- 0 • www.sportklinik.de • info@sportklinik.de   107
            Neurosurgery / Spinal Column

            indication to operation as well as choosing the most appropriate operation method
            is of decisive importance.


            Operation Method
            Microsurgical ventral discectomy with removal of vertebral bodies and
            plate osteosynthesis
            Access is made via the front of the neck. By means of an operation microscope
            the damaged parts of the disc and the broken vertebral body are removed what
            enables decompression of the nerves and the spinal cord. Afterwards the cervical
            spine is re-stabilized by implanting a tricortical iliac crest bone or a metal vertebral
            body replacement. Additionally a ventral plate osteosynthesis is needed to ensure
            sufficient stability.


            Dorsal microsurgical decompression with stabilization
            A microsurgical decompression is carried out in several stages by removing ligaments
            and compressed parts of the bone. Stabilization of the cervical spine is carried out
            by dorsal fixation with a screw-rod system. In rare cases and only with severe rup-
            tures with massive instability, ventral and dorsal stabilization techniques need to
            be applied both at the same time.


            Aftercare
            Mobilization should follow surgery as soon as possible. After complex stabilization
            operations, the patient should furthermore wear a neck crest during the initial phase.
            Especially with previous neurologic deficits, rehabilitation treatment is necessary.




108   Rastatter Str. 17-19 • 75179 Pforzheim • Germany • Phone 07231- 60556- 0 • www.sportklinik.de • info@sportklinik.de
Neurosurgery / Spinal Column




                                                                                                                       Neurosurgery / Spinal Column
                                                                                                                              Ellenbogen
Lumbar Spine (LS)
The lumbar spine (LS) is the lower part of the spinal column with a total of 5 verteb-
ral bodies. It connects legs and pelvis with the rest of the spinal column. By walking
upright, this part of the spinal column is exposed to heavy stress, what often causes
painful irritations summarized under the generic term “back pain”. Important is here
differentiation in this wide range of disease patterns which range from simple pain
symptoms to complex disc herniations with neurological deficits. Degenerative lumbar
spine disorders are very common symptoms and may also affect younger patients.



Disc Herniation
Cause
The degeneration process of a disc results in loss of liquid, reduction of height and
finally in laceration of the fibrous ring. The leaked disc tissue exerts pressure on the
nerves what causes pain and also may lead to neurological deficits.
Symptoms
Acute and chronic, stress-dependent back pain which radiates to the leg. Movement
restrictions of the spinal column, weakness and loss of power of legs and feet. The
sensation of tingling, warmth and cold in the legs. Gait disorder with the feeling of
insecurity when walking. Impairment of the rolling movements of the foot when
walking. Bladder- and bowel voiding dysfunctions.
Diagnosis
Is made with a neurological examination and a special examination of the spinal
column. Furthermore, X-ray images and functional images of the lumbar spine are
needed and a MRT should be carried out as it offers optimal view on the herniated
disc.
Therapy
Cases without obvious neurological deficits should be treated conservatively first.
This comprises intensive physiotherapy and pain medication; in some cases also local
infiltrations. However, if these measures do not bring adequate improvement, in-
dication for operative treatment should be assessed and discussed. Here, individual
advice and definition of the best strategy and the optimal operation method are
of decisive importance. Herniated discs which cause acute high levels of paralysis or
bladder-colon disturbances need to be treated in an emergency operation.


Operation Method
Minimally-invasive percutaneous nucleotomy
DThis procedure is carried out under local anesthesia. Under radiologic control a
cannula is inserted sideways into the disc space to inject contrast medium. Then the
respective disc tissue is removed by means of a pneumatically operated suction- and
cutter mechanism. This technique is especially suitable for patients with subligamen-
tal disc herniation. Patients with relevant bony narrowing of the nerve exit canals
(foraminal stenosis), in an advanced stage of degeneration with resulting reduction
of disc height (osteochondrosis), or a definitely sequestered disc do not benefit from
this operation method in the long term.


Rastatter Str. 17-19 • 75179 Pforzheim • Germany • Phone 07231- 60556- 0 • www.sportklinik.de • info@sportklinik.de   109
            Neurosurgery / Spinal Column

            Transforaminal endoscopic discectomy
            This operation method can be carried out under local- or general anesthesia. Access
            is made via an 8-10 cm long incision from the side next to the spinal column. Through
            this incision the endoscope is inserted to the nerve exit canal (foramen) to remove
            the sequestered disc under endoscopic control. This minimally-invasive technique is
            especially suitable for patients with extremely outside-lying disc herniation (lateral
            sequester).


            Microsurgical sequestrectomy
            This microsurgical operation is carried out under local anesthesia. Access is made
            through a 2 – 3 cm long incision, whereby a special speculum is used to retract the
            back muscles to the side. The spinal canal and the nerves lying inside are reached via
            the natural bone window. After preparation by means of the operation microscope
            the leaked disc material can be removed with a special miniature forceps. The disc
            itself is preserved and only degeneratively changed material is removed; this helps
            to maintain the function of the disc. Entrapped nerves are immediately relieved and
            the radicular radiating pain eases. Disturbances in sensation and paralysis however
            need some time for complete regression.


            Aftercare
            With microsurgical operations, mobilization is started immediately after surgery.
            Getting up and walking is already possible the day of surgery. Also wearing a girdle
            is not necessary as statics and biomechanics of the lumbar spine are not impaired
            by this gentle microscopic treatment. The in-patient stay normally lasts 2 – 3 days,
            physiotherapy and other conservative therapies are started the week after surgery.
            Although patients feel recovered after a very short time, carrying heavy load or un-
            dertaking strenuous sporting activities should be avoided during the first 3 – 4 weeks.
            Duration of disability varies individually and depends on many different factors.




            Facet Syndrome
            Cause
            Excessive strain on the spinal column not only causes damages to the discs but also
            leads to mechanical wear and tear on the vertebral joints, or more precisely on the
            inner surfaces – the so-called facets. Thus the term facet syndrome stands for wear
            and tear (arthrosis) of the small vertebral joints. Due to signs of wear or degenera-
            tive spondylolisthesis occurs excessive strain on the joints and with this continuous
            wear and damage of the joint cartilage. Exuberant bone formation and extension
            of joint facets are the result.
            Symptoms
            Back pain after periods of long standing, sitting or lying and when getting up. Most
            common complaints are back pain radiating to the buttock and the groin to the
            thigh. Rotating movements of the spinal column are painful, especially getting up
            in the morning can be very difficult.



110   Rastatter Str. 17-19 • 75179 Pforzheim • Germany • Phone 07231- 60556- 0 • www.sportklinik.de • info@sportklinik.de
Neurosurgery / Spinal Column




                                                                                                                       Neurosurgery / Spinal Column
                                                                                                                              Ellenbogen
Diagnosis
Is made with a neurologic examination and a special examination of the spinal co-
lumn. Moreover, X-ray images of the lumbar spine with functional images as well
as images of CT and MRI help proving the diagnosis. Also helpful may be testinfil-
trations of the vertebral joints.
Therapy
Conservative measures and pain medication can be successful when treating the fa-
cet syndrome. With many patients, sling table therapy is very successful in the short
term. All in all however, success of conservative therapies when treating advanced
stages of facet degeneration.


Operation Method
Radiologically controlled facet infiltration (diagnostic and
therapeutic)
Radiologically controlled facet infiltrations are carried out under local anesthesia.
After local anesthesia of the skin a thin cannula is inserted directly into the facet joint
at the lumbar spine and a small amount of local anesthetic (approx. 2 ml) injected
under radiologic control. For diagnosis it initially is helpful to perform injections
from both sides of the mobile segment. When therapeutically treating a facet block
which can also be combined with a periradicular infiltration (PRI), a mixture of a local
anesthetic and a crystalloid corticoid compound is injected. Here, too, a thin cannula
is inserted into the skin after local anesthesia and a small amount of the mixture
(2 – 3 ml) injected directly into the small vertebral joints. This medicine can also be
injected directly into the tissue surrounding the nerve exit at the foramen. The local
effectiveness needs only small dosages and the mixture has a long-lasting effect.
Nevertheless several sessions are necessary to achieve long term freeness of pain.


Interspinous Retractor
This low invasive operation can be carried out optionally under local anesthesia or
short-acting anesthesia. Under x-ray control the retractor is inserted through an ap-
prox. 4 cm long incision at the back and then positioned between the bony spinous
processes to relieve the vertebral joints. The operation is normally carried out on
in-patient basis but patients can already walk the day after surgery. This in-patient
stay lasts about 1 – 2 days.


Aftercare
There is no special aftercase necessary after radiologically controlled facet infiltration
or the PRI. The therapy can lead to comprehensive reduction or even complete eli-
mination of discomfort. After implantation of an interspinous retractor, progression
is controlled via x-ray and clinical check-ups. Complementary conservative therapy
measures are in most cases very helpful.




Rastatter Str. 17-19 • 75179 Pforzheim • Germany • Phone 07231- 60556- 0 • www.sportklinik.de • info@sportklinik.de   111
            Neurosurgery / Spinal Column

            Spinal Canal Stenosis
            Cause
            Narrowing of the verterbral canal occurs mostly with elderly patients due to chronic
            wear as well as exuberant bone formation, vertebral joint arthrosis, disc protrusions,
            ligament thickenings and vertebral body dislocations. The spinal canal with the
            nerves inside becomes increasingly narrow and the continuous pressure results in
            pain and neurological deficits.
            Symptoms
            In most cases stress-dependent back pain which radiates to the legs. Other symptoms
            are weakness or loss of muscle power in legs and feet or the sensation of tingling,
            warmth and cold in the legs. Furthermore gait disorder with the feeling of insecurity
            when walking. Characteristic are also the symptoms of spinal intermittent claudication
            (claudicatio spinalis). Here, walking distances have to be more and more reduced.
            Diagnosis
            Is made by neurologic examinations as well as special examinations of the spinal
            column. X-ray images of the lumbar spine and so-called functional images are neces-
            sary. Moreover, a CT and/or a MRT should be carried out. In rare cases even a lumbar
            function myelography for further invasive diagnostics is necessary.
            Therapy
            With a severe spinal canal stenosis, conservative treatment has little prospect of suc-
            cess as it is nearly impossible to have influence on the bony narrowing of the lumbar
            spinal canal i.e. the mechanical compression of the nerves. In the case of massive
            instability of the lumbar spine, even microsurgical decompression is not sufficient.
            In these individual cases, stabilization has to be considered. Here, individual advice
            and choice of the optimal surgery method are of essential importance.


            Operation Method
            Microsurgical Decompression
            This microsurgical operation is performed under general anesthesia. Access is made
            through a 2 – 3 cm long incision, whereby a special speculum is used to retract the
            back muscles to the side. The spinal canal and the nerves lying inside are reached
            via the natural bone window. Under microscopic control the enlarged facet joint
            segments are undermined by means of diamond micro milling cutters and small
            punches what extends the nerve exit canal and the spinal canal. Thanks to an ope-
            ration method newly developed some years ago (Spetzger, et al) the spinal canal
            can be decompressed from both sides through only one access. This method has by
            now already become one of the standard procedures for microsurgical treatment of
            spinal canal stenoses (Spetzger, et al). The disc itself is preserved if no obvious disc
            herniation can be detected. In many cases, the facet joint is heated up with special
            forceps and treated with bipolar coagulation. This has a positive effect on local pain.
            Trapped nerves are relieved and the radiating pain eases quickly. With following
            conservative therapy extending the walking distance is achieved very soon.




112   Rastatter Str. 17-19 • 75179 Pforzheim • Germany • Phone 07231- 60556- 0 • www.sportklinik.de • info@sportklinik.de
Neurosurgery / Spinal Column




                                                                                                                       Neurosurgery / Spinal Column
                                                                                                                              Ellenbogen
Aftercare
With microsurgical operations, mobilization is started immediately after surgery.
Getting up and walking is already possible the day of surgery. Also wearing a girdle
is not necessary as statics and biomechanics of the lumbar spine are not impaired
by this gentle microscopic treatment. The in-patient stay normally lasts 3 - 4 days,
physiotherapy and other conservative therapies are started the week after surgery.



Fractures
Cause
Fractures are often caused by acute violence on the thoracic- or lumbar spine or
are the result of an accident in the past with rupture of ligament structures and
fractures of vertebral bodies, vertebral arches and vertebral joints. But fractures
can also occur in connection with tumors, inflammations of the spinal column or as
sign of osteoporosis.
Symptoms
Severe diffuse back pain and discomfort throughout the whole spinal column with
movement restrictions up to neurologic deficits. Especially with elderly patients or
as a result of certain diseases, fractures may occur as a result of minor falls.
Diagnosis
Is made with a neurologic examination as well as a special examination of the spinal
column. Furthermore, X-ray images with functional images as well as a CT and a
MRI are necessary; in some cases even nuclear medicine examinations are needed
for more precise diagnostics. Important is here differentiation and consideration
of the actual cause.
Therapy
If there is neither obvious instability nor any neurological deficit detectable, treat-
ment can be done conservatively. Adjustment of an individual girdle as well as
stabilization by means of special physiotherapeutic measures together with pain
medication bring often complete healing. When treating fractures of the thora-
cic- and lumbar spine, individual advice as well as discussion of the indication and
most appropriate operation technique is of decisive importance. With osteoporotic
fractures or vertebral body metastases, minimally-invasive techniques with injection
of PMMA-cement show very good results.


Operation Method
Vertebroplasty and Kyphoplasty
Minimally-invasive surgery can be performed optionally under local- or general
anesthesia. In prone position and under permanent x-ray control, one or two can-
nulae are inserted through the pedicle of the affected vertebrae. Then the verteb-
ral body is re-erected by inflating a balloon (kyphoplasty). In case that this special
positioning has already caused this re-erection, polymer cement (PMMA) is directly
injected into the vertebral body (vertebroplasty). This pasty cement fills the broken
vertebrae from the inside and hardens within several minutes so that immediate
stabilization is achieved.



Rastatter Str. 17-19 • 75179 Pforzheim • Germany • Phone 07231- 60556- 0 • www.sportklinik.de • info@sportklinik.de   113
            Neurosurgery / Spinal Column


            Aftercare
            Mobilization is possible directly after surgery what enables the patient to get up
            and walk already the day of operation. Girdles are only necessary in individual cases.
            The in-patient stay normally lasts 1 – 2 days and in the week following the surgery
            physiotherapy and other conservative treatments can be started.




114   Rastatter Str. 17-19 • 75179 Pforzheim • Germany • Phone 07231- 60556- 0 • www.sportklinik.de • info@sportklinik.de

								
To top