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Treatment Methods

Endoscopic
spine surgery

Full-endoscopic spinal surgery is a modern and safe alternative to conventional spinal surgery. The most popular endoscopic procedures involve removing bulging, herniated or sequestrated disc material from the spinal canal in treating sciatic and femoral neuralgia or lower limb paresis. The second most common procedure is performed for constrictions of the spinal canal (stenosis), which cause weakness and pain in the lower limbs, lumbar pains, neurogenic claudication (weakness in lower limbs after walking a short distance), numbness and reduced sensation in the feet or the entire limbs.

 

Procedures in full-endoscopic spinal surgery are performed through a 5-mm endoscope working channel under saline irrigation. Using saline pressure and tools which eliminate bleeding in radio frequencies significantly reduces scarring and increases visibility. With endoscopes we can reach spinal pathologies even at very deep levels and make them fully visible thanks to xenon lighting, high-powered magnification and wide field of vision with optical instruments positioned at an angle of 25 degrees.

 

Endoscopic surgery has a number of unique advantages over other techniques. Here are some of them:

 

The endoscope is small in diameter and placing it under X-ray control directly into the involved level of the spine significantly reduces trauma that is associated with every surgery. Reducing injury to the minimum means fewer changes in the immune system, lower influence on immunity and less adverse effect on the cardiovascular system and the whole body. This results in quicker recovery and return to active life.

 

Thanks to endoscopy we can reach the spine within minutes even in very obese patients. The duration of the surgery and general anaesthesia is much shorter due to the use of a working channel, placed under X-ray control. This improves patient experience.

 

The pressure of saline solution used in the procedure and a new system for bleeding control lowers blood loss to absolute minimum even in very extensive endoscopic spinal surgeries.

 

Good visibility of nerves lowers the risk of their injury and reduces the number of potential complications caused by damage to the dura mater, bleeding or infections.

 

The narrow working channel causes much less injury to the lumbar area muscles, speeding up the recovery process and significantly reducing postoperative pain. The post-operative pain caused by endoscopic surgery is usually controlled with small doses of paracetamol.

 

Using a high-speed drill to obtain bone access reduces postoperative pain.

 

The above technological advantages of the full endoscopic access in spine surgery bring the following benefits to the patient:

 

• shorter hospital stay – up to 12 hours when optimal conditions are met,
• reduced risk of developing complications,
• significantly less pain related to the surgery itself,
• the patient gets up immediately after awakening from anaesthesia which reduces complications due to prolonged lying in bed – this is especially important for elderly patients,
• the procedure can be performed on elderly patients suffering from other diseases that would disqualify them from conventional treatment,
• shorter recovery and quicker return to work.

Microscopic
spine surgery

Microsurgeries performed with operating microscopes are now the ‘gold standard’ in minimally invasive spine surgery around the world. In St Wojciech’s Hospital in Poznań we use microscopic procedures for those procedures which cannot or should not be performed via endoscopic access. We use a state-of-the-art microscope Leica F50 M525 intended for spinal surgery and the least invasive spreading systems  – Picollino and Cervicolino by Medicon, which significantly reduce surgery-related injuries. We use Aesculap high-speed drill for minimally invasive bone access, which significantly reduces postoperative pain.

Microsurgery is usually performed in very extensive multi-level procedures or procedures involving implants. Compared with traditional spine surgery it has the following benefits:

 

• less invasive treatment, less injury, less damage to muscles in the accessed areas;
• better visibility of nerves due to magnification and illumination guaranteed by Leica F50 microscope;
• the possibility to insert implants in all areas of the spine using minimally invasive techniques;
• the possibility to perform minimally invasive treatments for spinal tumours

Conventional
spine surgery

Surgery without the use of microscope or endoscope requires much wider access to the spine to provide sufficient visibility and illuminate the operated structures. This requires a larger incision, even over 10 cm in length in some cases, leading to a much larger wound. With the use of endoscopic techniques the same procedure would only require a 5 mm incision.

 

Classic discectomy involves:

• extensive incision,
• marked decrease in immunity,
• significant infection risk, including neuroinfections,
• significant risk associated with poor wound healing,
• liquorrhoea, which requires long rest,
• significant blood loss,
• damage and scarring of spinal muscles causing chronic lumbar pain,
• intra-articular fractures caused by traditional bone forceps, another cause of postoperative pain,
• delay in assuming an upright posture,
• increased risk of damage to neural structures due to lack of magnification and proper lighting, which may lead to paresis and dysaesthesia.

 

Conventional discectomy means:

• long treatment,
• increased health risk,
• severe pain caused by the surgery.

 

We do not operate this way.

Compare methods of surgery
- make an informed decision

Discover the differences between modern and traditional methods of spinal surgery.

DAMAGE TO PATIENT CAUSED BY THE OPERATIVE PROCEDURE

POSSIBLE SURGERY-RELATED COMPLICATIONS

SURGERY TIME

RECOVERY TIME

VISIBILITY OF NERVES DURING SURGERY

DEGREE OF PATIENT ACCEPTANCE

PERIOPERATIVE PAIN

DAMAGE TO SPINAL MUSCLES

Endoscopic methods Full-endoscopic operations

Minimal

Minimal

30 minutes

6 weeks

Very good

Very high

Low, usually does not require medication or only paracetamol

Minimal

Microscopic methods or endoscopy-assisted microdiscectomy

Small

Minor

1 hour

12 weeks

Good

High

Mild, requiring standard pain-relievers

Minor

Traditional discectomy

Major

High risk of complications

1.5 hour

6 months

Poor

Poor

Often requires strong opioid pain medications, delays re-assuming an upright posture and returning to activity.

Significant

COMPARE POST-OPERATIVE SCARS

THREE LUMBAR DISC HERNIATION PROCEDURES PERFORMED WITH VARIOUS METHODS

ENDOSCOPIC METHOD

MICROSCOPIC METHOD

CONVENTIONAL METHOD

OUR EQUIPMENT

Wolf microdiscectomy endoscope for posterior and lateral approach

An endoscope for lumbar disc herniation surgery with access through the yellow ligament or intervertebral foramen. It is long and thin, allowing every surgical approach and minimising injury. It is used for removing fragments of intervertebral disc herniated into the spinal canal, which press on nerve roots.

Wolf-stenosis endoscope for decompression of lumbar spinal canal stenosis

An endoscope for the most advanced spinal procedures. It offers the possibility of advanced bone resection and joint abrading with the use of a high-speed drill. The set includes tools for removing overgrown ligaments. The working channel of this endoscope is slightly wider (7mm) which allows to use a larger number of tools.

Leica F50- M525 surgical microscope

Leica F50- M525 is a modern surgical microscope used in spine and head surgery. Xenon light provides excellent illumination, even with very deep structures. A system of electromagnetic brakes facilitates movement and positioning of the microscope which makes the operation much quicker. The microscope is also provided with a recording system making it possible to document every operation.

Aesculap high-speed drill

Bone access in microsopic surgery is performed with a high-speed drill. This helps to avoid intra-articular fractures which might occur when traditional tools (bone forceps) are used. As a result the patient feels less lumbar pain after the surgery and recovers more quickly.

WE OFFER LESS INVASIVE TREATMENT

Minimally invasive treatment methods is not only about small scar size. Minimal invasiveness means less operation-induced damage to the body, less blood loss, smaller decrease in immunity and less pain before and after the operation.  Modern treatment is based on the principle of solving the patient’s problems with a minimal surgical intervention. Spinal endoscopy fits perfectly into this philosophy.

 

Dr Piotr Winkler

WE USE
CUTTING-EDGE SOLUTIONS

 

Cutting-edge endoscopic surgery is performed under continuous saline solution irrigation, which reduces haemorrhage, minimises trauma and allows for better visualisation of the operated area with minimal access portal. The working channel of modern endoscopes is not wider than a medium-sized pen. Currently, the most state-of the art endoscope used for the most complicated operations is the Wolf model I use. It allows safe operating on patients, even those who suffer from the most severe spine conditions.

GET UP ON YOUR FEET AN HOUR AFTER THE SURGERY

It is easier for a patient to choose full-endoscopic treatment over any other surgical procedure. As in other surgical specialties, endoscopy in spine surgery increases the safety of the procedure and reduces the number of potential complications, such as bleeding, infections, cerebrospinal fluid leaks or nerve root damage. And when treatment is safer, patients find it easier to decide on surgery to eliminate pain. Fully-endoscopic surgeries are shorter, involve taking fewer medications and are less burdensome for patients who often suffer from other diseases. With reduced trauma to the spine and surrounding muscles in full-endoscopic access, it takes very little time for the patient to get up from bed.

Already an hour after surgery patients are able to walk, accompanied by a doctor or a nurse. They can go to the toilet by themselves without feeling the pain that accompanied every spine surgery not so long ago. Patients may return home even the following morning after a session with a physiotherapist who will teach basic isometric exercises. The recovery period after the surgery is also shorter and less painful since the spinal muscles and their attachments are not damaged. Patients who choose endoscopic methods return to full activity sooner. After only 6 weeks we can say: we operate, you live as you like.

PATIENTS REVIEWS

Piotr Winkler - ZnanyLekarz.pl
Piotr Winkler - ZnanyLekarz.pl

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