What are spinal interventions?
Spinal interventions are special minimally invasive procedures done on the outpatient basis under local anaesthesia.
They are done by our multidisciplinary team, which has many years of experience in both diagnosing and treating acute and chronic painful disorders of the cervical, thoracic, lumbar and sacral spine. Spinal interventions may therefore be diagnostic and therapeutic.
Diagnostic interventions are those which serve to establish the causes of pain, while therapeutic interventions aim to provide treatment for the painful conditions. Interventions are undertaken in a superbly equipped operating room for interventions with the use of Philips Veradius digital mobile X-ray unit with a flat detector, a higher resolution image and better contrast than in previous devices. The radiation dose in this device is two to three times smaller compared to other X-ray devices and it is the first device of its kind in the region. During the entire process, which encompasses all the necessary preparation, the intervention itself and the subsequent postoperative observation, which may last two to three hours, patients are placed in the day hospital under constant supervision of medical staff. Once discharged, patients are able to go home by themselves.

How to treat back pain in elderly patients?
The most common cause of cervical or low back pain in elderly people is spinal joint wearing. If long-term physical therapy and pain medication does not reduce spinal pain the recommended treatment option is a therapeutic intervention called radiofrequency (RF) neuroablation of the facet joints. The procedure is carried out with an RF generator that guarantees maximum safety and success of the procedure, together with a higher comfort level during intervention for both the surgeon and the patient. RF neuroablation of facet joints is a safe, suitable treatment for elderly patients, as it is undertaken under local anaesthesia, without skin incisions and with no surgical risks or complications. After completing the intervention and after a short observation period, patients are mobile and ready to go home accompanied by another person.

How to treat back pain in young patients?
Back pain is becoming a more and more common problem in young and active individuals. Sometimes the pain is temporary and transient, but if it persists more than 12 weeks it requires specific diagnostic and/or therapeutic interventions. If degenerative disease disc (DDD) is confirmed by diagnostic minimally invasive procedures, such patients can be treated with spinal minimally invasive interventions or minimally invasive surgery.

Biacuplasty involves neuroablation of sinuvertebral nerves in the painful disc, which effectively reduces chronic lower back pain. The procedure is performed under local anaesthesia, with mild patient sedation and with special needles that have a water-cooling feature (“cooled” RF). This approach greatly increases patient safety and efficacy of the procedure. After a biacuplasty and a short observation period, patient can go home accompanied by another person. Patients can return to office work two weeks after the procedure, and back to physical work and other demanding activities six weeks after the procedure. In the case of advanced disk degeneration, minimally invasive surgical treatment such as interspinous device implantation, dynamic stabilization or minimally invasive fusion can be offered to the patients.

When how to operate on a lumbar disc herniation?
Extrusions of lumbar intervertebral discs, lasting for a long period of time and causing neurological impairments (muscle paresis, loss of sensation), often require surgical treatment. The classical surgical approach, called wide laminectomy, causes unnecessary damage to the paravertebral muscles and creates large adhesions in the spinal canal. Interlaminectomy and microdiscectomy, by preserving segmental stability, reduce these side effects, enhance patient recovery and reduce the time of rehabilitation.

Does lumbar spinal canal stenosis always require surgery?
Evidence-based data shows that surgical treatment of spinal canal stenosis is more efficient than any other treatment option. The classic surgical approach, called decompressive laminectomy, utilizes long skin incision and extended rehabilitation. Spinal stenosis can be resolved in the following ways utilizing minimally invasive approaches: patients with soft tissue lumbar stenosis are successfully treated with the implantation of interspinous devices using the principle of indirect decompression. With the percutaneous implantation technique the surgeon achieves full effect of minimally invasive surgery because the patients can leave the hospital walking without aid the very next day. Microsurgical procedure called laminoforaminotomy is recommended for the patients with prevailing bone stenosis. In patients having stenosis with microinstability, an interspinous dynamic stabilizer can be offered after decompression. These patients, with the help of physio therapists, can rise out of the bed on the second postoperative day and can leave the hospital after two or three days.

What is spinal Instability?
Instability is the inability of the spine to change its physiological form under physiological loads. Chronic dysfunction of dynamic vertebral segment, spondylolisthesis and progressive degenerative deformity lead to instability and all of these conditions need to be treated with dynamic restabilization or fusion of unstable spine segments. Classical surgical fusion technique, with a long skin incision, significantly impairs the paravertebral muscles and prolongs rehabilitation period of the patients from three to four months. In lesser vertebral dysfunction with possible retrolisthesis, we propose dynamic stabilization with interspinous device. In overt instability with antelisthesis we recommend minimally invasive fusion techniques using percutaneous transpedicular fixation (MISS – minimally invasive spine surgery), anterior interbody fusion (ALIF) or transforaminal interbody fusion (TLIF). This treatment is carried out in specially equipped operating rooms, using the most modern implants of the world’s leading companies of high quality and guaranteed safety, and of course by specially trained spinal surgeons and medical staff. This approach significantly reduces the duration of postoperative pain and recovery. Rehabilitation is shortened from four to eight weeks.

What is osteoporotic fracture of the spine?
Vertebral fractures, caused by osteoporosis, often occur after physical loads such as lifting heavy objects or after falling down on the ground. Two-thirds of patients recognize the first signs of osteoporotic fractures after two to three weeks, and due to minimal changes in the classical roentgenograms these fractures are sometimes determined only by magnetic resonance imaging (MRI). Although most of these vertebral fractures heal naturally, some patients suffer constant pain with further clinical deterioration. The solution for these patients is a minimally invasive operation called vertebroplasty. Vertebroplasty is a procedure of filling a broken vertebral body with a high viscosity cement which serves to stabilize it. It is usually carried out under local or short general anesthesia which is especially important in elderly patients who make up the largest segment of the population with this problem. If the fractured vertebra has significantly reduced height, using the new technique of spinal stent (stent vertebral body, VBS), it is possible to restore vertebral height and then fill the vertebral body with cement. After these surgical procedures patients are mobile the very next day and capable of going home alone.

What is minimally invasive spine surgery?
The abbreviation MISS (minimally invasive spine surgery) includes all groups of minimally invasive spine surgeries. Particular progress has been made in the last decade in the field of minimally invasive decompression, minimally invasive dynamic stabilization and minimally invasive fusion. The highly educated professionals at St. Catherine Special Hospital has at its disposal the best equipment for conducting all minimally invasive spine surgeries.