Neurosurgery

The following methods of treatment are used during the treatment of the nervous system (SPINE SURGERY):

1. Microsurgery which uses tubular retractors.

Tubular retractors are hollow cylinders of various lengths and diameters fixed on the operating table for convenient and low-trauma access to the surgical area. The use of such dilators reduces traumatization of soft tissues along the access path, as well as the blood loss, usually bringing it to a few milliliters, and has undeniable advantages in treatment of obese patients.

In our Clinic, a surgical microscope or a system for endovascular (full endoscopic) surgical procedures (endovascular surgical removal of disk herniation) is necessarily used.

The main indications for microsurgery using tubular retractors/  full endoscopic spine surgery:

• hernia of intervertebral disk with radicular, polyradicular, radicular ischemic syndromes,

• lateral spinal stenosis, 

• foraminal stenosis,

• implementation of TLIF (transforaminal lumbar interbody fusion), PLIF (posterial lumbar interbody fusion) methods,

• performance of decompression stage in case of spondylolisthesis, spinal stenosis in combination with stabilization systems.

The use of tubular retractors can significantly reduce tissue trauma during access, reduce blood loss, reduce the risk of infectious complications; and if this technique is fully mastered, it has practically no drawbacks compared to traction methods. 

2. Interbody fusion 

• Creation of a block in the operated segment to ensure support of the spine and preservation (reconstruction) of normal interaction between the elements of the spinal column

• For the cervical spine, the main type of spondylosyndesis is ACDF (anterior cervical discectomy and fusion) – removal of the disc, hernia of intervertebral disk followed by spondylosyndesis with various implants.

• For the lumbar spine, the main type of spondylosyndesis is TLIF (transforaminal lumbar interbody fusion), a spondylosyndesis performed using various implants through a facet joint previously removed from one side. The advantages of this method include low risk of damage to the contents of the spinal canal and nerve roots. Access is performed from one side using one implant. The TLIF technique provides for additional transpedicular fixation.

• PLIF (posterial lumbar interbody fusion) – a type of spondylosyndesis performed through expanded inter-arterial access. This technique involves spondylosyndesis from both sides. The advantages of this technique include a smaller extent of osseous structure resection. Some authors describe the possibility of performing PLIF without additional transpedicular fixation.

3. Transpedicular fixation

The stabilization method of the spinal segments by means of a rigid connection of screws held posteriorly through the roots of the arches into the vertebral bodies, using stems and, in some cases, cross connections.

It is possible to perform transcutaneous transpedicular fixation, in which, unlike the standard technique, procedures are performed not through one large incision, but through separate 1.5 cm incisions.