Spine Surgery

Spine Surgery

Overview

The Spine Surgery Department is dedicated to providing our patients with the most advanced and least invasive neurosurgical and spine medical treatments.

Our expert surgeons use the latest available treatments with the aim of providing the best possible medical outcome opting for minimally invasive surgical techniques that minimize complications and allow for quicker and easier recovery time for our patients, such as:

  • Discectomies
  • Spinal fusions
  • Vertebroplasty / kyphoplasty
  • Stereotactic radiosurgery for spine tumors
  • Cervical laminectomy, laminotomy, laminoplasty and fusion
  • Transoral decompression of the craniovertebral junction using a microscope
  • Endoscopic decompression of the craniovertebral junction
  • Endoscopic intranasal decompression of the craniovertebral junction
  • Cervicothoracic fusion

We treat a wide range of neurological conditions of the spine, including:

  • Cervical myelopathy
  • Chordomas
  • Extramedullary tumors
  • Intramedullary spinal cord tumors
  • Stenosis

Cervical Myelopathy

Cervical myelopathy refers to a set of symptoms from different conditions, such as:

  • Spinal cord tumors
  • Extramedullary tumors that press the spinal cord
  • Vascular malformations
  • Neurological conditions such as transverse myelitis
  • Compression of the spinal cord

Treatment of cervical myelopathy

Cervical myelopathy due to spondylosis, degenerative arthritis and rheumatoid arthritis requires individual surgical treatment.

Our surgeons apply various surgical techniques for spinal cord decompression, as well as spinal fusion techniques in order to achieve the repair and stabilization of the spine, regardless of the cause of the cervical myelopathy.

Intensive physiotherapy and rehabilitation after surgery help maximize the outcome for the patient.

Chordoma

Chordoma is a rare type of bone cancer that forms from the remains of the notochord. Usually it appears at the base of the skull but it can grow at any part of the spine.

Chordomas are locally aggressive tumors, although histologically they give a picture of benign tumors. They are often inactive for a period of time, but then they become very aggressive and large in size.

Early and aggressive treatment of the chordoma is required, as they can give metastases to other parts of the body.

Treatment of chordomas

Our surgeons have great expertise in the surgical treatment of chordomas of the craniovertebral junction.

Patients are preoperatively examined using CT and MRI. By applying endoscopic and open surgical techniques and using intraoperative neuronavigation computer assisted technologies, total tumor removal is achieved, allowing for increased survival.

During the same surgery, the patient may also be subjected, to cervical spinal fusion in order to restore the stability of the craniovertebral junction.

Postoperatively radiotherapy – radiosurgery may be required in consultation with the oncology department.

Extramedullary Tumors

Extramedullary tumors grow not within the spinal cord, but within the spine exerting pressure on the spinal cord.

There are several types of extramedullary tumors, such as:

  • Meningiomas
  • Swannomas
  • Neurinomas
  • Filum terminale ependymomas

Treatment of extramedullary tumors

Most extramedullary tumors can be completely removed as they are accessible and with clear boundaries in relation to the spinal cord. In the case of large filum terminale ependymomas total removal of the tumor may be impossible, because  they adhere to many spinal nerves. Postoperative radiation therapy may be required in consultation with the oncology department.

A detailed neurophysiological examination is performed during the surgery and a microsurgical technique is applied in order to safely and completely removes the tumor while keeping the patient’s functions intact.

Also, intraoperative ultrasound is used to accurately locate the extramedullary tumor.

Postoperatively, patients follow a physiotherapy program to maximize the beneficial outcome of the surgery.

Intramedullary Spinal Cord Tumors

Spinal cord parenchyma can be infected by various types of tumors, benign or highly malignant.

The most common types of intramedullary tumors are:

  • Ependymomas and subtypes
  • Gangliomas
  • Astrocytomas
  • Hemangioblastomas
  • Paragangliomas

Diagnosis of spinal cord tumors

The diagnosis of intramedullary spinal cord tumors involves neurological examination and imaging testing such as CT scan and, occasionally, angiography.

Treatment of spinal cord tumors

Surgery to treat spinal cord tumor is extremely delicate and difficult. The aim of the surgery is to:

  • Completely remove the tumor, in cases of tumors with low malignancy with distinct boundaries, such as ependymomas, hemangioblastomas and paragangliomas
  • Removal of as much as possible of the tumor, in the cases of invasive tumors, such as astrocytomas

Neurophysiological testing and the use of intraoperative ultrasound to accurately identify the tumor is required to minimize the risk of inducing neurological damage by the removal of intramedullary tumors.

Depending on the histological profile and extent of tumor removal, radiotherapy and / or chemotherapy may be required in consultation with the oncology department.

Stenosis

Stenosis occurs when the spinal canal narrows, reducing the available space for the spinal cord and the nerves.

Stenosis of the spinal cord may be congenital, that is, from the birth of the patient, acquired or a combination of both.

Treatment of stenosis

When conservative treatment does not bear the desired results, surgery is recommended with the aim of decompressing the spine and widening of the spinal canal. Laminectomy, laminotomy and foraminotomy are the most common methods of surgical treatment for stenosis, sometimes combined with fusion.

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