What is spinal neurosurgery? Spinal neurosurgery is a last resort

spinal surgery is a highly specialized medical discipline dealing with the surgical treatment of patients with complaints and diseases in the area of ​​the spine and spinal cord. Along with the surgical treatment of herniated discs and spinal stenosis, an integral part of spinal surgery is also the treatment of scoliosis, vertebral fracture, tumors of the spinal cord and spine, spinal anomalies and degenerative instability (eg spondylolisthesis).

Based on complaints, a thorough history, a thorough physical examination, imaging techniques (eg, computed tomography, magnetic resonance imaging, radiography), and an electrophysiological examination, the cause can be identified. back pain make a diagnosis and develop a treatment plan. Along with conservative treatment methods, surgery (spinal surgery) to stabilize the spine is an important component in the treatment of spinal diseases. Spinal surgery can be performed from the abdomen (ventrally) or from the back (dorsal). The standard methods today are endoscopic, minimally invasive surgery, especially “gentle” for the patient.

The structure and functions of the human spine

The human spine consists of 33 vertebrae and five sections: cervical, thoracic, lumbar, sacral and coccygeal. On both sides of the vertebrae, the transverse processes depart, and the arch of the vertebra is turned back and forms the spinal canal (spinal) canal. The spinal canal contains a very sensitive spinal cord, which is made up of nerve fibers that transmit impulses (signals) from the brain to, for example, the legs or arms. The spinal canal is surrounded on all sides by bone, thus protecting the spinal cord from injury. Between the vertebrae is the annulus fibrosus (intervertebral disc), a kind of cushion consisting of the nucleus pulposus and fibrous cartilage and serving as a shock absorber. Intervertebral discs also prevent excessive mobility of the vertebrae, which, in particular, can lead to spondylolisthesis (slipping of the vertebrae).

Due to the vertical position, the vertebrae, especially in the lumbar region, are subject to heavy loads, and since nerves depart from the spine, or rather from the spinal cord, in most cases, spinal diseases manifest themselves through pain and then through neurological disorders (for example, false sensations or paralysis). The S-shaped shape of the spine and intervertebral discs perform a shock-absorbing function in young years and soften the mechanical effects on the spine quite well, but with age, the spine becomes less mobile and the intervertebral discs lose their function. Elderly people are particularly susceptible to the development of various diseases of the spine, but there are diseases, often hereditary, that can occur at any age.

Diseases of the spine which are often treated with spinal surgery:

• Herniated disc
• Degenerative diseases of the spine, e.g. spinal stenosis, osteochondrosis, spondylosis, spondylarthrosis and lumbar scoliosis (lumbar scoliosis)
• Inflammatory diseases, e.g., infectious spondylodiscitis, rheumatoid arthritis (chronic polyarthritis), ankylosing spondylitis (Ankylosing spondylitis, Spondylitis ankylosans)
• Slipping of the vertebrae (spondylolisthesis)
• Intraspinal tumors
• Scoliosis
• Spinal injury (vertebral fracture)

Spinal surgery for a herniated disc

A herniated disc is characterized by a rupture of the annulus fibrosus or narrowing of the intervertebral spaces, resulting in protrusion of part of the nucleus pulposus into the spinal canal. Thus, the spinal cord and nerve root are compressed. Arise severe pain, often radiating to one of the limbs and leading to a characteristic loss of sensitivity, motor skills and reflexes in the area of ​​blood supply to the pinched nerve root, and in some cases to the occurrence paralysis phenomena. An accurate diagnosis of a herniated disc is made by magnetic resonance imaging (MRI) or alternatively by computed tomography (CT).

The need for surgery to remove a herniated disc does not always exist. If neurological prolapse is not observed, then the usual therapy is used conservative methods. These include anti-inflammatory and pain medications, injections, lumbar plexus analgesia, and periradicular therapy (infiltration of the intervertebral joints) under CT or X-ray guidance. When using periradicular therapy, cortisone is sprayed into the nerve root, which in most patients leads to the disappearance of pain.

Herniated disc surgery: methods, risks and complications

Due to the fact that the risk of complications (e.g., scarring, re-herniation, infection, CSF leakage) after surgery to remove a herniated disc herniation is quite high, it should be performed only if conservative methods are ineffective or if there are unambiguous reasons to the operation. A symptom that requires urgent surgery, in particular, is the caudal syndrome, the so-called. compression of the cauda equina (compression of the nerve roots in the region of the ganglion known as the cauda equina) with signs of paralysis, paralysis of the bladder and rectum, and progressive or acute impairment of muscle function.

The standard operation to remove a herniated disc today is microsurgical discectomy, which almost completely replaced open discectomy. A herniated disc can also be removed using a minimally invasive technique.

Another treatment for a herniated disc is endoscopic discectomy. During the operation to remove a herniated disc, which is performed under local anesthesia, endoscopes and high-resolution video systems, as well as various micro-instruments are used. Surgical micro-instruments and an endoscope are inserted through small incisions in the skin and the protruding part of the nucleus pulposus is carefully removed, however, this method can not be applied to all types of herniated discs and not in all parts of the spine. This method, for example, cannot be used if the protruding part of the nucleus pulposus has come off and is in the spinal canal and if the hernia is located in the lumbar or sacral spine.

In the presence of a hernia with remaining intact outer layers of the annulus, minimally invasive techniques are also used. The most common of them, in particular, are: vertebroplasty, chemonucleolysis and laser hernia removal. When using all these methods, the nucleus pulposus is removed by heating, chemicals (chymopapain) or a laser.

If an intervertebral disc is removed during surgery, then in some cases it is necessary to intervertebral disc replacement on the implant.

Spinal surgery for spinal stenosis

Degenerative changes in the spine (wear phenomena) associated with aging or excessive exercise develop in most people at an older age, but they are not always clinically manifested. Bone growths on the spinal canal, degenerative changes, bulging of the intervertebral disc and arthrosis of the small facet joints can lead to spinal stenosis (spinal stenosis). As a result, due to the narrowness of the spinal canal, the spinal cord is irritated and the nerve roots do not receive sufficient blood supply. This causes complaints typical of spinal stenosis, namely: false sensations and pain radiating to the legs and, as a result, the inability of the patient to overcome long distances on foot. Along with such wear and tear, there are other causes of spinal stenosis: acquired (eg, spinal surgery) and congenital (anomalies in the development of the spine).

Asymptomatic spinal stenosis does not need to be treated. If it provokes complaints, then, based on their clinical picture, the degree of narrowing and suffering of the patient, it turns out whether therapy is possible and which one. Treatment for spinal stenosis may consist of conservative methods (eg, physical therapy), drug therapy (for pain), or surgery. However, only 2% of all patients need surgery.

Surgery for spinal stenosis

The absolute indication for surgery to eliminate spinal stenosis is Significant reduction in painless distance traveled, unbearable pain, acute, severe neurological deficits ( paralysis phenomena) or dysfunction of the bladder and rectum, as well as caudal syndrome. In the presence of therapeutically resistant pain with limited motor activity, the patient is also strongly recommended for surgical treatment.

During the operation to eliminate spinal stenosis, those parts that are responsible for the narrowing of the spinal canal are removed. This reduces the pressure on the nerves (decompression). The minimally invasive method is the standard today.

Spinal surgery offers the following treatments:

• Lumbar decompression combined with fusion is an expansion of the spinal canal and subsequent stabilization of the vertebrae through a system of screws and rods. The worn-out intervertebral disc is removed and a so-called titanium cage is implanted in its place.
• Ventral nucleotomy combined with fusion is a microsurgical removal of the intervertebral disc, the connection of damaged vertebrae and the introduction of implants to create space between the discs.
• Ventral uncoforaminotomy combined with fusion is the treatment of the vertebra with a spherical cutter, thereby increasing it, and the stabilization of the damaged vertebra in the spine.
• Intradiscal Electrothermal Therapy (VET) is the introduction of a needle into the intervertebral disc, which is then slowly heated. This leads to the strengthening of the collagen fibers of the intervertebral disc and the destruction of the nerve fibers located in them.
• When conducting decompression with implantation of an intervertebral disc prosthesis, the spinal canal is expanded and the intervertebral disc is replaced with an artificial one.
• Holding corporectomy with spinal fusion involves the removal of a vertebra and the connection of adjacent vertebrae. A titanium prosthesis is implanted in place of the removed vertebra to fill the resulting space.
• When conducting alignment fusion combined with fusion bonding of several vertebrae.

During a mobility-preserving operation (e.g. dynamic spinal stabilization), a dynamic implant is implanted in the patient, which stabilizes the vertebrae and at the same time maintains their mobility.

Spinal surgery for scoliosis

Scoliosis is a deformity of the spine in which the spine shifts to the side and the vertebrae twist (rotate), causing injury. In most cases, the causes of scoliosis are not known (idiopathic scoliosis). In only 10% of patients diagnosed with scoliosis, the cause may be congenital disorders (congenital scoliosis) or it may be the result of another disease (secondary scoliosis, eg after trauma or muscular dystrophy).

Mild scoliosis is quite common. It is either not accompanied by any symptoms or the stability of scoliosis is maintained with the help of physiotherapy. If scoliosis progresses, then it can be expressed through a rib hump, an inclined position of the head, or back pain.

Further development of scoliosis can lead to serious movement restrictions and degenerative changes in the vertebrae, up to a severe deformity of the chest.

Surgery for scoliosis

About 90% of all patients with scoliosis do not need surgical treatment; in such patients, scoliosis can be treated with the traditional method, with the help of physiotherapy, or with the help of a corset (supporting or corrective). However, if due to deformation of the chest, compression of the heart or lung occurs, then it will not be possible to do without surgery.

Principles of surgical treatment of scoliosis:

• Max straightening curvature
• Eliminate Rotation
• Fixation of the performed straightening by means of implants
• Spinal stabilization

Surgical treatment of scoliosis can be performed from the abdomen (ventrally), from the back (dorsal), or both sides (dorsoventrally or ventrodorsally). The following methods can be applied:

• With dorsal straightening of scoliosis, the lateral curvature of the spine is eliminated by means of screws and hooks fastened with a special rod. With this method of spinal stabilization, the overall mobility of the spinal apparatus is limited.
• In ventral derotation fusion, the spine is accessed through the chest or abdomen. The intervertebral disc in the damaged spine is removed and the vertebrae that require correction are fixed with screws. Next, the screws are fastened with a special rod. After the operation, it is not uncommon to wear a corset.
• Ventrodorsal surgery is performed to treat some complex forms of scoliosis (eg double curvature, ie combined scoliosis). Dorsal and ventral access to the spine can be performed in one or two operations.

Spinal surgery for vertebral fracture

A vertebral fracture can occur on the vertebral body, on the spinous process, and on the vertebral arch. Often, a vertebral fracture occurs as a result of an accident, a fall, or the use of physical force. Due to bone fragments or displacement of the vertebrae, fractures of the vertebrae often result in damage to the spinal canal, resulting in a risk of developing a syndrome of transverse spinal cord injury. In older people, a vertebral fracture can occur due to osteoporosis. A stable vertebral fracture may be asymptomatic.

However, the following symptoms may appear:

• Sudden onset back pain
• Unnatural reflexes
• Sensory disturbance
• Manifestation of paralysis
• Mobility restriction
• Paralysis in transverse spinal cord injury

Methods of surgery for vertebral fracture

Any intervention in spinal surgery should be carried out by a specialist. In the foreground is the stabilization of the spine through dynamic or static bonding of the vertebrae of the affected spine. With the help of spinal stabilization, it is possible to “unload” damaged or narrowed structures of the spine and prevent further damage to the spinal cord and nerves.

The following surgical methods are used for a vertebral fracture:

• Spinal fusion (blockage of the vertebral body): Ankylosis of two or more vertebral bodies. Spinal fusion is a common method of stabilizing the spine, which is carried out with the help of screws and rods. This method is also used for slipping of the vertebrae.
• Kyphoplasty: A minimally invasive technique that either inserts a balloon into the fractured vertebra and fills it with bone cement, or stabilizes the fractured vertebra with bone cement alone.

Neurosurgery is one of the most complex areas of modern medicine, requiring maximum professionalism from specialists and the most modern equipment of medical centers.

National Medical and Surgical Center. N.I. Pirogov is the largest multidisciplinary surgical institution in Moscow.

Currently, the National Medical and Surgical Center. N.I. Pirogov includes two neurosurgical departments. The departments are equipped with all the necessary modern equipment for high-tech surgical treatment of patients with diseases of the brain and spinal cord, spine, and peripheral nervous system.

At the NMHC them. N.I. Pirogov performs the entire range of neurosurgical operations at the level of world standards.

When performing surgical interventions, neuronavigation, neurophysiological monitoring and mapping of the cerebral cortex are used. Endoscopic and minimally invasive technologies are widely used. The use of these techniques makes it possible to perform the full scope of surgical intervention at the modern level with minimal trauma to the tissues of the brain and spinal cord.

The wide possibilities of the multidisciplinary Center allow for a comprehensive examination of patients in order to determine all the features of the course of the disease and identify comorbidities, which makes it possible to develop an individual treatment plan for each patient.

Modern anesthetic management of operations and developed methods of postoperative management of patients allow early activation of patients and significantly reduce the risk of postoperative complications.

The main activities of the Department of Neurosurgery:

• spinal cord tumors;
• lesions of peripheral nerves (tunnel syndromes of any localization, tumors of peripheral nerves, herniated discs);
• arterial aneurysms of cerebral vessels of various localization;
• hydrocephalus;
• arteriovenous malformations, arteriovenous fistulas, angiomas;
• intracranial hematomas (epidural, subdural, intracerebral);
• brain tumors (gliomas, meningiomas, teratomas, epindimomas, craniopharyngeomas, etc.);
• pituitary adenomas;
• neurofibromatosis;
• strokes - hemorrhagic and ischemic;
• defects of the bones of the skull;
• epilepsy and parkinsonism, latent (resistant) to conservative therapy;
• anomaly Arnold-Chiari;
• syringomyelia;
• soft tissue tumors of the head;
• post-traumatic neuropathies;
• consultations on vascular diseases of the brain and spinal cord (aneurysms, arteriovenous malformations, hemorrhagic and ischemic strokes).

The leading neurosurgeon of the Pirogov Center is a candidate of medical sciences Zuev Andrey Alexandrovich.

About the specialist:

Zuev Andrey Alexandrovich - neurosurgeon. Over 15 years experience in neurosurgery. Currently, he is the head of the 2nd Department of Neurosurgery of the National Medical and Surgical Center. N.I. Pirogov.

Education:

Diploma with honors from the Moscow Medical Academy. THEM. Sechenov, clinical residency in neurosurgery at the Research Institute of Emergency Medicine N.V. Sklifosovsky on neurotrauma, vascular neurosurgery, neurooncology.

One of the priorities of the neurosurgical department is the provision of high-tech care to patients with diseases and injuries of the spine and spinal cord.

Modern operating room equipment (neuronavigation, endoscopy, microscopes and microsurgical equipment, high-speed drills, ultrasonic bone knife, devices for intraoperative blood collection and reinfusion, etc.) allows you to perform any type of surgical intervention in the least traumatic way, which significantly reduces the cost of further rehabilitation treatment .

In the conditions of the neurosurgical department, such operations as endoscopic interventions on all parts of the spine, removal of tumors of the spine and spinal cord of hard-to-reach localization, reconstructive operations for diseases and injuries of the craniovertebral junction, restoration of the spinal canal in severe degenerative lesions of the spine are performed. Minimally invasive methods of installing modern implants are actively used to minimize surgical trauma and accelerate the social and labor adaptation of patients.

The department performed more than 4,000 decompressive and stabilizing interventions for patients with diseases and injuries of the spine and spinal cord, more than 500 spinal surgeries are performed annually.

Modern methods are used to diagnose injuries of the spine and spinal cord.

Rice. 1. CT scan of the cervical spine. 3D reconstruction of the upper cervical spine. An unstable fracture of the C2 vertebral arches is determined on both sides (“the hangman's fracture”).

Rice. 2. MRI of the cervical spine in the sagittal projection in T1 mode. A traumatic hernia of the C6-C7 disc is determined, the focus of myeloischemia at the level of C6-C7 is a contusion of the spinal cord.

Rice. 3. Vertebral angiography, direct projection - the absence of filling of the left vertebral artery due to its traumatic occlusion.

Rice. 4. Intraoperative microscope.

1. Trauma of the spine and spinal cord.

One of the key concepts for determining the tactics of treating patients is the concept of spinal injury stability. To define this concept, F. Denis (1983) created a classification based on the concept of three mechanical pillars. The anterior support column includes the anterior longitudinal ligament; anterior 2/3 of the vertebral body, annulus fibrosus and disc. The middle supporting column consists of the posterior third of the vertebral body, annulus fibrosus, disc, and posterior longitudinal ligament. The posterior supporting column consists of legs, arches, articular and transverse processes, spinous process, supra-, interspinous, yellow ligaments and capsules of intervertebral joints. Taking into account the classifications of F. Magerl and F. Denis, as well as taking into account the degree of angular deformation of the spinal column , the degree of narrowing of the spinal canal and the degree of displacement of the vertebrae R. Mauegs et al. (1996) determined the algorithm of surgical tactics for vertebral fractures and spinal cord injury.

Algorithm of surgical tactics for spinal fractures.

If there is not a single parameter of the 3rd rank, but there is at least one of the 2nd rank, stabilization is required and, in some cases, decompression of the spinal cord.

If there are neither 2 nor 3 ranks, treatment is usually conservative.

Classification of spinal cord injury.

By terms: the most acute period (the first 8 hours); acute period (from 8 hours to 3 days); early period (from 3 days to 4 weeks); intermediate period (from 1 to 3 months); late period (more than 3 months).

Type of spinal injury: contusion of the vertebrae; vertebral fractures; dislocations of the vertebrae; self-adjusted dislocation of the vertebra; fracture-dislocation of the vertebrae; partial or complete rupture of the capsular-ligamentous apparatus; vertebral motor segment; rupture of the intervertebral disc.

By type of damage to the neural formations of the spinal canal: uncomplicated spinal cord injury (without damage to the spinal cord and spinal nerves); complicated vertebral-spinal injury (with damage to the spinal cord and / or spinal nerves).

By type of damage to neural structures: concussion of the spinal cord; contusion of the spinal cord and / or roots of the spinal nerves; compression of the spinal cord and / or roots of the spinal nerves; partial rupture of the spinal cord and / or spinal nerves; complete anatomical rupture of the spinal cord and/or spinal nerves.

By the nature of the compressing substrate: subdural hematoma; epidural hematoma; intracerebral hematoma; bones or bone fragments; traumatic disc herniation; foreign body.

According to the mechanism of education: compression (type A), distraction (type B), rotational (type C).

Rice. 5. Classification of spinal injuries according to the mechanism of formation (according to F. Magerl, 1994).

Rice. Fig. 6. Control 3D-CT after reconstructive surgery for a combined fracture of the C2 vertebra (transarticular fixation of C1-C2 according to F. Magerl, translaminar fixation of C1-C3 with a hook system, anterior cervical fusion of C2-C3 with a titanium plate).

Rice. Fig. 7. Control radiography of the cervical spine after anterior transdental fixation of a fracture of the odontoid process of the C2 vertebra.

Rice. 8. Control CT scan of the cervical spine. Axial cut. C1 fixation in unstable fracture.

1. percutaneous methods of fixation and/or stabilization of broken vertebrae;
2. minimally invasive approaches;
3. endoscopic technologies.

a) b) c) G)

Rice. 9. CT scan of the thoracic and lumbar spine. Sagittal reformation, anterior (a) and lateral (b) projections. Comminuted fracture of the L1 vertebral body, fracture-dislocation of the Th12 vertebra. Control CT of the thoracic and lumbar spine after the first stage of decompression and stabilization surgery: transpedicular fixation Th10-Th11-L2-L3. 3D reformation (c, d).

A) b) c) d) e)

Rice. 10. Comminuted fracture of the L1 vertebra. CT scan of the lumbar spine, sagittal reconstruction (a). MRI of the lumbar spine, T2 WI (b). Control radiography of the lumbar spine in AP and lateral views after combined fusion with a vertebral body prosthesis and a titanium plate (c, d). Control CT scan of the lumbar spine, frontal reconstruction (e).

In degenerative diseases of the spine, depending on the stage of the disease, various options for surgical treatment are used; priority belongs to minimally invasive surgical interventions. In the advanced stages of the disease, it is possible to use various types of extended discectomy with hemi- or laminectomy, with or without fixation.

The degenerative process of the spine goes through several stages:

Stage I - the stage of dysfunction. At this stage, pain first appears in the projection of the spine during movement. An MRI of the corresponding section of the spine reveals the initial signs of disc degeneration (I and II degrees according to Kee-Yong). At the same time, there is no pathological displacement of the vertebrae relative to each other on functional radiographs.

Stage II - the stage of instability. The pain becomes constant, there are symptoms of irritation of the roots of the spinal cord. On MRI, changes in the height of the disc are determined, its degeneration appears (III and IV degrees according to Kee-Yong), prolapses of the discs (herniated discs) occur, the nature of the signal from the endplates changes (Modic 1 and 2). On functional radiographs of the lumbar spine, instability or hypermobility is revealed, retro-or antelestheses occur.

a) a) a)

Rice. Fig. 11. MRI of the lumbar spine in the axial (a), frontal (b) and sagittal (c) planes, which shows a large sequestered L5-S1 disc herniation with compression and edema of the left S1 root.

Classification of degenerative processes in the intervertebral disc according to MRI (T2 VI).

“There is an opinion that spinal surgery is extremely dangerous. However, this judgment is erroneous. Today, neurosurgery has reached the highest level of development, new methods of surgical intervention have appeared. We offer our patients the most effective and safe minimally invasive methods of treating injuries and diseases of the spine using modern equipment. This will avoid complications and return to the usual rhythm of life as quickly as possible.”

The Department of Neurosurgery of the Clinical Hospital on Yauza performs diagnostics and treatment of pathologies of the nervous system. Our specialists successfully perform operations for degenerative diseases, injuries, spinal tumors in adults and children. We treat intervertebral hernias, spinal stenoses, deformities, tumors, spinal injuries and other diseases.

A differentiated approach, the use of the most informative diagnostic methods (X-ray, CT, MRI), innovative equipment make it possible to conduct a comprehensive assessment of the condition of the spine and prescribe the optimal treatment for each patient. We give preference to sparing methods of surgical treatment of diseases of the spine, which makes it possible to carry out interventions of any volume at a high modern level, as well as to shorten the rehabilitation period.

Our doctors have extensive experience in successfully performing spinal surgeries and master the full range of techniques for their implementation.

Areas of work

Doctors of the Department of Neurosurgery of the Yauza Clinical Hospital diagnose and treat all major diseases of the spine. We specialize in the following operations:

• operations for degenerative diseases of the spine;
• operations for spinal injuries;
• operations for spinal deformities;
• operations for metastatic lesions of the vertebral bodies and osteoporosis (vertebroplasty);
• operations after the syndrome of unsuccessfully operated spine.

Innovative technologies

In diagnostics and surgical intervention, we use the methods that are used in the best clinics in the world, we perform research using the latest technologies:

• Operations for degenerative diseases of the spine(disc herniation, spondylolisthesis, stenosis): decompression of the spinal cord, stabilization of the vertebrae, preparation for prosthetics and prosthetics of the intervertebral discs. Endoscopic removal of spinal hernia using minimally invasive instruments.
• Operations for spinal injuries: restoration of the vertebral body, decompression of the spinal cord, removal of the vertebral body and the use of modern technologies for prosthetics of the vertebral bodies using sliding cages, as well as cementing substances, etc.
• Spinal deformities in adults and children: surgical restoration of the sagittal balance - correction of the curvature of the spine in the frontal and sagittal plane, with redistribution of the load on the spine and lower limbs.
• Spinal tumors (metastases), osteoporosis: vertebroplasty - restoration and anesthesia of a damaged vertebra with a stent, a balloon with cementing substances (kyphoplasty, stentoplasty).
• Surgery after Failed Spine Syndrome (FBSS).
• Radiography spine - detection of foci of destruction in the bones, pathological fractures, tumors. We perform x-rays of the entire spine, its sections or individual vertebrae. The study is carried out on a digital radiographic system that creates the highest quality image at the lowest radiation exposure;
• Computed tomography of the spine- the doctor assesses the condition of the vertebrae: their integrity, the presence or absence of displacements, violations of bone density. Obtaining slices of the spine allows you to see the places of narrowing of the spinal canal, as well as to establish the causes of the narrowing: tumor, metastases, damage to the intervertebral discs, tissue proliferation. It is carried out on the latest generation tomograph, which provides high quality images with minimal radiation exposure.
• Magnetic resonance imaging- the gold standard for diagnosing degenerative-dystrophic diseases of the spine. The doctor gets the opportunity to assess the condition of the intervertebral discs, ligaments, muscles, vessels that feed the spine. The images show tumors, metastases, inflammation in the vertebrae and surrounding soft tissues. MRI is performed on a digital system with high quality visualization of even the smallest details and pathological changes at the initial stage.

Spinal surgery is the treatment of various degenerative-dystrophic disorders, spinal injuries, diseases of the spinal cord through surgical intervention. Surgical manipulations on the spinal column in order to free the patient from serious pathologies and related suffering is a very responsible process that requires great professionalism and utmost precision. Currently, Israel is considered the mecca of surgical treatment of the spinal column, and Germany is in second place. But what is there in Israel that is not, for example, in Austria, Poland or Slovenia? Actually nothing. Surgical techniques in all developed countries are used alone. If a doctor has performed a thousand successful operations, then what difference does it make in which country he operates? Modern medical equipment is available to almost all major clinics in any of the European countries. The only difference is in which doctor and clinic they invested in to enter the world market, and in whom they did not. Orthopedics has long been an area that has not developed as actively as, for example, genetic engineering or oncology. The reason for this is the anatomical feature of the human body - all parts of the musculoskeletal system are under constant mechanical action from the force of gravity. All sources contain information that the most unique minimally invasive technologies are used in advanced Israeli clinics when performing operations on the spinal column. The most interesting thing is that in the medical community of Europe, no one considers these technologies unique. It's just that the Russian reality has developed - there was and is not effective medicine in Russia and there was and is effective medicine in Israel, moreover, there is a visa-free regime between countries. We have been proving to our patients for a long time that
that similar treatment can be obtained for significantly less money in other European countries.

Indications for spinal surgery

People with complaints of periodic or constant discomfort, stiffness in any area of ​​the musculoskeletal system should definitely come to a good specialized institution for examination. A timely diagnosis will make it possible to urgently take appropriate measures to eliminate the destructive focus, to minimize the likelihood of irreversible consequences. Few people think why the first persons of states and just wealthy people are much less likely to suffer from fatal diseases than others. Of course, the best medicine is available to such people, but the main reason is the regular diagnosis of the body, even before the onset of pain. Thus, it is possible to suppress diseases at the stage of their inception. Therefore, timely diagnosis is the most important rule for maintaining health.

For radical intervention on the spinal column can serve:

• traumatic lesions of the spine;
• osteoarthritis, kyphosis;
• intervertebral hernia, osteochondrosis;
• vascular malformations;
• spondylolisthesis with severe instability;
• osteoporosis with a complication in the form of a compression fracture;
• stenosis of the spinal canal;
• congenital malformations of the locomotor apparatus;
• hemangioma, oncological formations, etc.

Painful symptoms poison a normal existence: not only negatively affects the physical and psychological state, but is also fraught with a dangerous outcome. A person is in a vicious circle - in order to live, physical activity is needed, but it is not there, because it brings terrible pain. Chronic pathogenesis can lead to partial or absolute paralysis, atrophy and paresis of the muscles of the limbs, severe diseases of the pelvic organs. In particular situations, the risk of death cannot be ruled out. Therefore, if a specialist insists on the importance of the operation, then it is really extremely necessary, and you can’t hesitate!

Neurosurgery abroad: information about methods

Modern spinal surgery is, first of all, measures performed using high-tech optical devices. Microsurgery makes it possible to carry out complex manipulations in the musculoskeletal region with extreme precision. Its advantages include relative painlessness, a low percentage of complications, a quick recovery period, and the absence of scars. Consider the most used principles of surgical treatment of the spine today.

This is the removal of a separate piece of tissue above the nerve or the protruding part of the intervertebral disc under the surrounding nerve plexuses in order to relieve pinching. Microdiscectomy does not last long, is not accompanied by profuse blood loss or excruciating pain, and this is its advantage. It is prescribed for intervertebral hernias. Resection is done through an endoscope through a small incision (about 3 cm). An anesthetic injection acts locally, without depression of consciousness.

Laminectomy

This is an open neurosurgical procedure used for stenosis in order to relieve the nerve roots from severe compression. During the session, a local excision of a part of the corresponding arch of the bone element and / or compacted tissue, which caused narrowing and compression of the nerves, is carried out. It is performed under general anesthesia.

kyphoplasty

It is intended for complete or fragmentary regeneration of a destroyed vertebra, correction of its position in case of compression fractures. Kyphoplasty is based on the introduction of bone cement into the previously prepared and corrected body of the damaged link. The preparatory stage involves the use of a special air cylinder.

This is a puncture (without cuts) reconstruction of the structure, shape, and supporting functions of the vertebrae in fractures caused by back injuries, osteoporosis, neoplasms, metastases. Vertebroplasty uses a fast-setting astringent mixture that is injected under local anesthesia along with a contrast agent and an antibiotic into the diseased area. As a result, the body, filled with a specific material, is rapidly regenerated, strengthened, stabilized, and the support functions are actively restored.

Nucleoplasty is aimed at combating hernia and the result of its harmful effects. The destroyed nucleus pulposus is removed by evaporation with cold plasma. So, it is reduced in volume, ceases to protrude through the fibrous ring, due to which the terminal endings of nerve fibers and bone and cartilage structures are unloaded, get rid of the pressure factor. The whole process takes no more than 1 hour. General anesthesia is not needed. The postoperative period is characterized by rapid positive dynamics.

This method is recommended for deformations, destabilization of the axial segment. It is often performed for scoliosis, structure, spondylolisthesis, violations of the integrity of the bone. The goal is to fix and immobilize two adjacent vertebral bodies through their fusion. Depending on the nature and genesis of the disease, an anterior or posterior incision is made to open access to the problem area, after which the disc is removed, followed by the introduction of a bone implant and metal fixators.

Important! The decision on the need for surgery is made exclusively by a neurosurgeon and an orthopedic surgeon of the highest category based on a thorough examination. Doctors, in addition to the main problem, always take into account all the associated health problems, the individual characteristics of the patient's body. The effectiveness of the operation, the speed of recovery, and the absence of the appearance of postoperative pathological conditions directly depend on the correctly chosen tactics. Therefore, it is important to receive this kind of care in specialized centers with high standards of medical care.

Where is the best place to get treatment?

As a highly developed state in the field of medicine, the Czech Republic specializes in the restoration of the musculoskeletal system. This is one of the few countries in Europe famous for safe and high-quality surgical therapy, an innovative accurate diagnostic system, and a well-planned rehabilitation program.

Surgical intervention is prescribed by a panel of specialists on the basis of clear indication criteria, when the conclusion clearly indicates the impossibility of saving the patient from pathology by conservative methods. Multidisciplinary staff, including qualified neurosurgeons, orthopedists, traumatologists, oncologists, neurologists, physiotherapists, is not inferior in competence to German or Israeli doctors.

The only difference is that services of a similar level in the Czech Republic will cost much less. Here, surgeons no less professionally perform open and closed operations. The clinics are equipped with unique robotics, cutting-edge endoscopic, laser, microsurgical, and tomographic equipment, which makes it possible to solve tasks of unimaginable complexity, which would have been impossible to implement for several years.