Orthopaedics

The Orthopaedics Departments in the hospitals of Athens Medical Group are available on a 24-hour basis and boast a highly qualified and experienced staff.

More than 22,000 cases, covering the whole range of Orthopaedics, are treated annually in the Group’s International Centers of Excellence and Reference by top orthopaedic surgery experts, with international experience in Europe and the USA.

At Athens Medical Group your team of orthopaedic surgery experts uses the most up-to-date and innovative techniques and technology, for the diagnosis and treatment of all orthopaedic conditions with the best functional and cosmetic results.

The Orthopaedics Department is supported by all medical specialties, to ensure that your problem is thoroughly evaluated and that all treatment options are considered.

The foot and ankle is an area of the body that is prone to problems and injuries. Virtually everyone faces a foot and ankle problem during their lifetime, either inherited or as a result of chronic abuse and neglect. These problems may range from fractures, strains and sprains to other conditions such as tendon issues, malformed bones and arthritis.

Our team of highly experienced foot and ankle surgeons, orthopaedic specialists and specialized physiotherapists, will provide you with comprehensive care.

With the valuable help of Athens Medical Group’s state-of-the-art diagnostic imaging technology, we can provide a rapid diagnosis of your foot and ankle condition so that our orthopaedic specialists will recommend the treatment that best suits your personal needs and goals.

At Athens Medical Group we provide a full range of treatments for all foot and ankle conditions and injuries, including non-invasive or minimally procedures.

At Athens Medical Group, state-of-the-art equipment is used in order to implement the newest treatment methods for all foot and ankle lesions and injuries, including:

• Ankle Injuries
• Ankle Replacement
• Bunions
• Calluses
• Claw toes
• Corns
• Flatfoot
• Foot and Ankle Arthritis
• Foot and Ankle Fractures’ Malunion
• Foot and Ankle Fractures’ Nonunion
• Hammertoes
• Ingrown Toenails
• Mallet Toes
• Stiff big toe (Hallux Rigidus)
• Mycotic Nails

Neuromas

Athens Medical Group’s Diabetic Foot Clinic was developed to provide expert care to people suffering from the disease through a state-of-the-art diagnosis and treatment. Our team of specialists, al leaders in the prevention, early diagnosis and effective treatment of diabetic foot, consists of such vascular surgeons, infectious practitioners, experts in diabetes, interventional radiologists, orthopaedists, microsurgeons, pediatric endocrinologists, dermatologists, psychologists and nurses specializing in diabetic foot.

At Athens Medical Group we apply the latest techniques in the treatment of vascular diseases of the diabetic foot, such as angioplasty, the combination of laser therapy and angioplasty and intravascular angioplasty.

With these techniques, diabetic leg amputations have been reduced to more than 90%.

The technique of percutaneous osteotomy allows:

• Surgery to take place via one or more small holes.
• The simultaneous correction of various foot deformities, such as hallux valgus, dropped metatarsal, hammer toe and claw toe.

Percutaneous osteotomies are performed without a strapping technique (tournique), with local anesthesia and usually without the use of metallic implants.

The purpose of percutaneous osteotomy is initially to remove swelling of the first metatarsal. Then, in most cases, osteostomy of the first metatarsal is performed with the aim of correcting the pathological angle of the articular surface of the first metatarsal.

Percutaneous osteotomy is usually complemented by a second osteotomy of the proximal phalanx of the great toe.

Throughout surgery, the surgeon checks the osteotomy and the corrections performed with special radiological equipment (Fluoroscopy).

The entire procedure lasts 15-20 minutes.

After the surgery, the patient walks without crutches or walking sticks, wearing a special shoe.

The absence of incisions and the absence of lesions in the soft molecules results in a truly painless technique.

Fifteen days after the surgery the patient may remove the bandage and use adhesive patches of the foot. After that, patients can wear normal – roomy-  shoes and return to their usual activities (driving, walking).

Patients replace the patches themselves on a daily basis for approximately a month, depending on the underlying pathology.

The method of percutaneous osteotomy is applied in the US for over fifteen years and its excellent results have led to its adoption in Europe, as well.

Hand and wrist conditions are very common and affect almost everyone at some point in their lives. Hand Surgery deals with the treatment of all conditions and injuries of the upper extremities. It is applied by our orthopaedics and plastic surgeons who have the necessary expertise and use all the techniques of Microsurgery.

At Athens Medical Group we offer comprehensive diagnosis and treatment for all hand and wrist conditions and injuries. Our highly trained surgeons and orthopaedic specialists are leaders in their area of expertise.

The Hand and Wrist conditions may result due to injuries or chronic diseases. Upper limb injuries account for more than 30% of total body injuries, reaching 60% or 70% of work-related injuries.

This is obvious, as the hand is the most exposed part of the body and therefore the most sensitive to injuries. They may be simple injuries (e.g. single fracture of a bone) or even more complex (simultaneous damage to bones, nerves, tendons, skin, etc.).

Hand surgeons are trained in the surgical treatment of all upper extremity injuries that may require fracture osteosynthesis, tendon and nerve transfers, and vascular anastomoses, while the more complex operations involve the replantation of amputated parts:

Injuries

• Fracture osteosynthesis
• Tendon and nerve damage repair, and vascular anastomosis
• Reattachment of amputated limbs

Direct treatment of these injuries guarantees the best possible result.

Chronic diseases involve syndromes due to over-use of the hands, systemic diseases, neoplasias and many others.

Hand surgeons also face chronic hand diseases such as:

Chronic Diseases

• Arthritis
• Carpal tunnel syndrome (endoscopic release)
• Ulnar neuritis
• Trigger finger
• De Quervain syndrome
• Dupuytren condition
• Cysts and ganglia
• Congenital anomalies
• Hand tumors
• Brachial Plexus injuries

For the best surgical practice, knowledge of Microsurgery is essential. According to this, using surgical microscope and special fine tools, surgery is achieved.

Microsurgical technique is necessary in a number of operations, such as the replanting of amputated parts, the surgery of the brachial nexus and the peripheral nerves and the free transfer of tissues (transfer of a piece of skin or muscle from one point of the body to another).

Athens Medical Center’s Department of Hand and Upper Extremity Surgery, Reconstructive Orthopaedic Microsurgery is an accredited Hand Trauma Center by the Federation of European Societies for Surgery of the Hand (FESSH).

The doctors of the Hand Surgery and Upper Extremity Department have extensive experience in restoring war injuries having treated hundreds of such incidents.

Hip problems may affect anybody at any age, despite being usually associated with old age. The common cause of hip problems is osteoarthritis. Other causes include sports injuries, work accidents, falls and congenital diseases.

At Athens Medical Group we offer comprehensive and specialist orthopaedic treatment for all hip problems.

Our team of hip surgeons and orthopaedic specialists are leaders in their area of expertise offering the most up-to-date diagnosis, treatments and surgical techniques.

Athens Medical Group’s orthopaedic surgeons reconstruct thousands of hip joints each year, using innovative methods, with optimal results, such as total and partial hip replacement (arthroplasty), revision of previously replaced joints that are worn out or failed and arthroscopic hip surgery.

Special arthroplasty techniques

Athens Medical Group’s Orthopaedics Departments are International Reference Centers, for the performance of hip arthroplasty, with modern and innovative surgical techniques of minimal invasiveness, such as:

Hip Arthroplasty

• ASI (Anterior Supine Intermuscular)
• L.M.I.S (Antero-lateral-minimally-invasive-surgery)
• AMIS (Anterior-Minimally-Invasive-Surgery)

Total hip replacement (arthroplasty)

Total hip arthroplasty is the classic method of treating hip osteoarthritis. It is a surgical procedure in which the hip joint is replaced with metal, plastic or ceramic implants.

Total hip arthroplasty surgery lasts from 1-1.5 hrs and the patient stays in the hospital for a few days.

ASI total hip replacement

Anterior Supine Intermuscular (ASI) is a painless and minimally traumatic method for total hip replacement that is considered the most modern for the treatment of osteoarthritis of the hip. Athens Medical Center is a reference and training center for the ASI total hip replacement method.

Compared ti other total hip arthroplasty techniques, the ASI method presents significant advantages, such as:

• Intraoperative and postoperative blood loss is significantly reduced.
• The patient can be mobilized immediately, depending on his or her physical condition.
• Hospital stay is limited.
• The risk of inflammation and post-operative dislocation is almost zero.
• The risk of serious post-operative complications associated with long-term bedtime, such as thrombosis and pulmonary embolism, is greatly reduced.
• Return to daily activities is fast.

It is also very important to note that the ASI technique is particularly suitable for overweight patients who until recently were not regarded as candidates for total hip arthroplasty.

Total hip replacement (arthroplasty)

Total hip arthroplasty is the classic method for treating hip osteoarthritis. It is a surgical procedure in which the hip joint is replaced with metal, plastic or ceramic implants.

Total hip arthroplasty surgery usually lasts from 1 to 1.5 hours and the patient stays in the hospital for a few days.

Hip Arthroscopy

Athens Medical Group’s Orthopaedics Departments provide fully specialised monitoring and care for patients with traumatic or chronic hip joint disorders as well as for the treatment of undiagnosed pain.

The diseases that are treated with hip arthroscopy include the acetabular labral tear, femoroacetabular impingement or friction (CAM and pincer types), cartilage lesions and others.

This category also includes young patients with a history of sports injuries.

According to international medical bibliography, hip arthroscopy protects the hip from further damage that in the future may lead to its complete destruction, namely osteoarthritis.

Hip arthroscopy is performed through small holes on the skin from which a camera and other special, thin, arthroscopic tools are inserted.

Advantages

Hip arthroscopy not only accurately identifies and treats the pathological conditions of the joint, but also offers the advantage of:

• rapidly mobilizing the patient
• short hospital stay
• quick recovery
• minimum trauma

The knee is an active, weight-bearing joint and as such it is placed under a lot of stress and strain. The result is often pain and various problems for many people.

At Athens Medical Group we tailor the most suitable solution for you regardless of the cause of your knee problem.

Our team of orthopaedic surgeons, specialists, nurses and physiotherapists are leaders in their field and will provide you with comprehensive care.

At Athens Medical Group we offer all the orthopaedic services you need, from diagnosis to surgery to physical therapy. Our facilities are specially designed to make your care easy and comfortable.

Athens Medical Group’s orthopaedic surgeons reconstruct thousands of knee joints each year, using innovative methods, with optimal results, such as total and partial knee replacement (arthroplasty), revision of previously replaced joints that are worn out or failed and arthroscopic knee surgery.

Replacement of joints with arthroplasty is the classic method for treating osteoarthritis.

It has made a significant contribution to improving the quality of life of patients who who would permanently suffer from pain and disability.

Damaged parts of the joints are replaced with artificial implants.

Athens Medical Group’s Orthopaedics Departments are International Reference Centers, for the performance of knee arthroplasty, with modern and innovative surgical techniques of minimal invasiveness, such as:

• MIS (Minimal Invasive Surgery)
• Custom Knee Arthroplasty
• Unicompartmental knee arthroplasty
• Robotic Asssisted Knee Surgery (soon to be performed)

Knee replacement is the surgical procedure for the treatment of advanced osteoarthritis.

Knee osteoarthritis is the most common cause of knee arthritis and its frequency increases significantly with age.

With knee replacement, worn parts of the knee are replaced with artificial materials. Modern prostheses have a long life and simulate the mechanics of a natural knee.

Knee arthroplasty can be done with general or epidural / dorsal anesthesia. The patient enters the hospital one day before surgery for preoperative check up. Knee replacement surgery usually lasts from 1 to 2 hours and generally the patient’s stay in the hospital is limited to a few days. The stitches are removed approximately two weeks after the surgery.

Postoperatively, a special physiotherapy program is followed for 3-4 weeks until the patient is able to climb stairs, unassisted.

The artificial knee currently used is the result of the advancement of digital and robotic technology. The artificial knee is constructed after taking into account all the information about the anatomic particularities of each patient.

Unicompartmental knee arthroplasty

It is a method that is constantly gaining ground and is recommended for localized symptomatic knee osteoarthritis.

Although it can be applied to all knee compartments (medial, lateral and patellofemoral), the main application of the unicompartmental knee arthroplasty is the replacement of the medial part of the joint, which is most often affected by idiopathic osteoarthritis of the knee.

Unicompartmental knee arthroplasty is a reliable solution for the treatment of localized knee osteoarthritis. The method is associated with better knee function and less postoperative pain compared to total knee replacement or high tibial osteotomy.

Long-term results, justify the application of unicompartmental knee replacement, as it is better than osteotomy and at least equal to total arthroplasty. Proper patient selection combined with precise surgical technique and material development can provide the best possible result to patients with knee osteoarthritis.

The advantages of unicompartmental knee arthroplasty compared to other surgical methods, especially when performed with limited access, include:

• the retaining of the ligaments and normal articular cartilage in the unaffected parts of the knee
• lower postoperative pain
• less blood loss
• faster mobilization of the patient
• more natural kinematics and knee functionality.

Knee arthroscopy

During arthroscopy, the physician inserts special surgical instruments through two small holes, thereby acting diagnostically and therapeutically.

With these tools the doctor normalizes the damaged articular cartilage of the knee, removes the free particles (parts of the cartilage or meniscus), “cleaning” the joint and removing the inflammation.

If there is a rupture of the meniscus or the ligament, a simultaneous repair is carried out during knee arthroscopy.

Early arthroscopy of the knee may delay the progression of osteoarthritis, hence the need for more serious surgical procedures such as arthroplasty.

Arthroscopy is recommended for the following conditions of the knee:

• Osteochondritis dissecans of the knee
• Degenerative knee arthritis
• Patellar pathology
• Cruciate ligament ruptures
• Meniscal tears

The shoulder comprises of joints that combine with tendons and muscles to allow a wide range of motion in the arm. As such, the shoulder is very prone to injuries and other problems, resulting in pain and movement difficulty.

Shoulder conditions can be caused in many ways. They may be congenital or a result of injury. Arthritis can also play a major part.

Regardless of the cause of your condition, our team of experts at Athens Medical Group will offer you comprehensive care. Our highly trained orthopaedic surgeons, specialists and nurses are leaders in their area of expertise and will tailor a solution to your shoulder problem that best suits your needs and goals.

Treatment for a shoulder injury may include first aid measures, physical therapy, medicine, and, in some cases, surgery, depending on:

• The location, type, and severity of the injury
• How long ago the injury occurred
• Your age and overall health condition

Athens Medical Group’s shoulder surgeons and orthopaedic specialists treat all problems and conditions of the shoulder using innovative methods, with optimal results, such as shoulder arthroscopy and total arthroplasty. Conditions of the shoulder may include:

• Osteoarthritis
• Rheumatoid arthritis
• Frozen shoulder
• Tendon disorders, such as rotator cuff tears
• Traumatic anterior instability of the shoulder
• Cartilage damages
• Acromioclavicular joint dislocation
• Fracture / dislocation of the shoulder

Shoulder arthroscopy is a surgical procedure that helps surgeons to inspect, diagnose and treat any problem within the elbow joint.

It is a minimally invasive approach in which the surgeon makes small incisions. As a result, blood loss during surgery is significantly reduced, post-operative pain is minimized and recovery is faster.

Shoulder arthroplasty is a surgical procedure applied for the finite and effective treatment of shoulder osteoarthritis. In total, in shoulder arthroplasty articular surfaces are replaced with artificial implants. When the tendons are intact, then anatomic total arthroplasty is selected, whereas when there is a massive rupture of tendons, reverse total arthroplasty is preferred.

The Spine Department is staffed with highly specialized scientists with long-lasting experience in the contemporary treatment of deformities, diseases, tumors and injuries of the entire spine, from the neck to the sacrum, covering all ages.

In collaboration with the relevant specialties, our spine surgeons treat all conditions of the axial skeleton, both urgent and chronic.

To date, thousands of incidents have been effectively dealt with in the hospitals of Athens Medical Group.

In collaboration with the relevant specialties, such as neurology, neurosurgery and orthopaedics, our spine surgeons effectively treat all the conditions of the axial skeleton, both urgent and chronic, applying the most advanced minimally invasive surgical methods, the cutting edge of scientific and technological developments.

• The conditions treated in the Spine Department are:
• Cervical disc herniation (cervical discopathy)
• Thoracic disc herniation (thoracic discopathy)
• Lumbar disc herniation (discopathy),
• Spinal stenosis
• Idiopathic adolescent scoliosis
• Child scoliosis
• Baby Scoliosis
• Congenital scoliosis
• Paralytic scoliosis
• Juvenile kyphosis
• Adults kyphosis
• Cervical myelopathy
• Persistent localized backache
• Iatrogenic spine instability
• Back pain
• Neck-arm pain (cervical syndrome)
• Spinal fractures due to metastases
• Spondylolisthesis
• TARLOV cysts
• Cauda equina
• Ankylosing spondylitis
• Bertolotti syndrome
• Flat back
• Osteoporosis

At the European Interbalkan Medical Centre in Thessaloniki, the innovative, painless and non-invasive technique of the Transforaminal Endoscopic Surgical System (TESSYS) is realized with great success, for the treatment of disc herniation in the lumbar spine.

The TESSYS technique has been applied in recent years internationally, with great success. More than 100 incidents have already been treated at the European Interbalkan Medical Centre.

The TESSYS technique is performed in the operating room and it involves an 8 mm incision, under local anesthesia. The operation lasts about 30 minutes, the patient is able to walk one hour later, and leaves the clinic the same day or the next day.

Surgery is performed in all ages to patients who have not previously received conservative methods of treatment.

Patients suffering from acute and chronic waist problems, due to herniated discs, disc degeneration and lateral spinal stenosis, may benefit from the latest minimally invasive surgical techniques, such as endoscopic microdiscectomy.

European Interbalkan Medical Centre in Thessaloniki was selected as a Reference Centre for training doctors in Southeastern Europe in the surgical method of endoscopic microdiscectomy for the treatment of spinal disc herniation.

The excellent results of this endoscopic surgical method in the Spine Clinic resulted to receiving full accreditation by the parent company, Joimax GmbH (Germany).

Endoscopic microdiscectomy (MISS) surgery is performed with local anesthesia and it involves a very small incision of only 8 mm, from which an endoscope is inserted in order to remove the hernia. Its duration is less than 45 minutes; the patient is able to walk one hour later, leaving the clinic the same day or the day after the operation.

Endoscopic discectomy surgery is non-invasive, with no cutting of soft and bone elements. Moreover, it causes minimal post-operative pain and offers immediate relief from back pain. Post-operative complications (inflammation, neurogenic damage, and hematoma) are less than 2%.

Discoplasty is the most modern and non-invasive method of treating discopathy, either of the Cervical or Lumbar Spine. It is a minimally invasive surgical technique.

The method involves percutaneous injection of specific gelatinous material into the degenerate spinal disc.

The patient does not need general anesthesia. Local anesthesia is performed at the specific entrance points of the fine needles that are used for the operation.

The substance is injected into the damaged disc under x-ray monitoring by means of special equipment so that the surgeon maintains control throughout the operation.

The substance, injected into the centre of the disc, exerts osmotic action, gradually absorbing the liquid herniated material from the periphery to the centre of the nucleus. As a result, a new disc core is recomposed, simultaneously decompressing the hernia.

In addition, Discogel seals any fracture of the disc covering (fibrous ring) due to its degeneration, preventing the inflammatory substances from reaching the nerve roots.

Advantages

Discoplasty may be applied for the treatment of herniated discs both in the neck and in the lumbar.

• One of its many comparative advantages is that treatment may be done simultaneously with more than one spinal discs that may suffer.
• A further advantage of the method is that it can be combined with injecting anesthetic and cortisone into the vertebral joints. Thus, the patient can, at one session, permanently deal with a chronic problem that negatively affects his or her personal and professional daily routine.
• The whole procedure does not last more than 15 min and the patient leaves the clinic 3-4 hours later. Heavy work is to be avoided for the first week, after which the patient returns to his or her normal life without any remaining pain.
• When the technique is applied with the right indications, success rates are over 75%.
• The technique is percutaneous and does not involve conventional surgery.
• The patient avoids general anesthesia.
• There are no surgical incisions, bleeding or risk of inflammation, or stitches to be removed.
• The patient does not need to be hospitalized and may leave the hospital after the operation.
• Reduced scar tissue formation, no fibrosis.
• Based on recent studies, up to about 90% of patients who underwent discogel discoplasty avoided heavier and more painful surgeries in the future.

Based om recent studies up yo 90% of patients who underwent Discogel Discoplasty avoided heavier and more painful surgeries in the future.

Percutaneous Endoscopic Discectomy is the most up-to-date treatment available for dealing with intervertebral disc herniation, as it is the only type of discectomy surgery that allows the preservation of anatomical structures.

Advantages

Percutaneous Endoscopic Discectomy offers many advantages when compared with other surgical techniques, such as:

• No blood loss
• The operation can be performed under local anesthesia
• Short duration, lasting from 20 to 25 min
• No muscle is detached or cut
• The operation involves an 8mm long incision that leaves nerves and ligaments intact. Since there is hardly any tissue damage, the risk of neurogenic complications is very low.
• A special endoscope is used in order to make sure that only the hernia and NOT the entire disc is removed
• There is no instability, as the structures that stabilize the spine remain intact. This is a major difference over microscopic discectomy
• Already two hours after surgery, the patient is able to walk without pain
• The patient is discharged the same day, able to walk after, only, 4 – 5 hours
• The results are immediate. The patient is mobilized from day 1
• The infection rate is very low (less than 0.01%), as access is through a small incision (8 mm)
• In most cases, immediately after surgery, patients do not feel any pain
• Less to no scarring in the nerve roots area
• Already, after a few days, you can resume your normal daily activities
• After one or two weeks the patient can go back to work, after 6 weeks he/she can resume their sports activities.
• Percutaneous Endoscopic Discectomy is an operation with high success rates. The international scientific literature mentions a success rate of around 95%. Our statistical evaluation for endoscopic discectomy produced a 97% success rate.

Post-operative recovery

• The patient uses a low back band to avoid relapse for a period of 6 weeks after the operation. Physical therapies start after one week. In the period of one to two weeks after the operation patients, usually, begin simple office and light physical work.
• After about three weeks, patients are able swim or ride a bike.
• In six weeks after the operation, the patients are advised to start strengthening exercises for the back and abdominal muscles.
• At the same time they can gradually return to their normal sports activities.
• Hard physical work should be avoided during the first six weeks.

Athens Medical Center has been acknowledged as a World Reference Center for the performance of Percutaneous Endoscopic Discectomy for Intervertebral Disc Herniation.

The Endoscopic Sacrolumbar Facet Joint Denervation is a technique that involves the infusion of local anesthetic and cortisone in the affected sacrolumbar facet joint to reduce inflammation and relieve pain in the patient.

It is performed in the operating room using imaging equipment, C-Arm, in order achieve real time guiding of the needle precisely at the points of injury.

Endoscopic Sacrolumbar Facet Joint Denervation is a true minimally invasive procedure in which the surgeon removes the pain transmitting nerve fibers. As a result, patients experience significant relief from symptoms to total pain relief immediately after surgery. The operation is performed under local anesthesia and controlled sedation, involving an incision of a few millimeters, while the patient is discharged on the same day.

Athens Medical Center has been granted the status of World Reference Center for the performance of Infusion or Endoscopic Sacrolumbar Facet Joint Denervation.

The Spine Department offers a multitude of other surgical treatments, such as:

Lumbar Microdiscectomy

Lumbar Microdiscectomy involves making a small incision in order to open a port of about 3 – 4 centimeters in diameter in the spine, through which anything that may cause nerve root compression is removed.

The small incision is made after x-ray examination in the midline of the spine, at the point of the intervertebral disc hernia in the lumbar spine.

With the help of a surgical microscope, all tissues surrounding the nerve root are removed. Next, the nerve root is mobilized with very fine manipulations in order for the surgeon to access the intervertebral disc and the disc material that protrudes pressing the nerve root is removed.

Since microdiscectomy does not alter the mechanical structure of the lumbar spine, there occurs no destabilization of the trunk and therefore there is no instability pain, nor any need for spinal fusion to stabilize the spine at the level of the intervention.

Laminectomy

Laminectomy is the basic surgical treatment of spinal stenosis in which a portion of bone is removed at the back of the spine (lamina) to create space so that the spinal cord or nerves are not compressed.

When there is stenosis at some point in the spinal canal and the spinal cord is pressed, then the removal of the lamina in that area compresses the nerve tissue.

Laminectomy may be accompanied by foraminotomy, if and when there is intraforaminal stenosis, or by spinal fusion if there is instability-displacement of the vertebrae and it is deemed necessary.

Laminectomy is performed under general anesthesia.

The skin incision is limited to a minimum after imaging confirmation in the operating room.

The surgery is now performed with minimal invasive methods, percutaneously and using an endoscope, thus avoiding the detachment of the transverse vertebral muscles.

Kyphoplasty

If a recent spine fracture is diagnosed with accompanying symptoms, such as severe pain that restricts mobility or quality of life, severe spinal deformity or neurological complications, then the most appropriate treatment is a surgical technique called kyphoplasty.

Kyphoplasty is performed under general anesthesia. It does not involve an incision but, rather, the entry of a large “needle” with imaging guidance inflating a special balloon that restores the original vertebra shape. The latter is immediately withdrawn and a special type of cement is injected into the cavity stabilizing the vertebra.

The patient may be mobilized on the same day and discharged the same or (usually) the next day.

Percutaneous Spinal Fusion

Percutaneous Spinal Fusion is a surgical method performed through small incisions in the skin, without detachment or cutting of the spinal muscles.

Percutaneous spinal fusion is a minimally invasive technique and when compared to conventional spinal fusion, it allows for faster recovery, less postoperative pain, no blood transfusion, shorter duration of the operation and shorter hospital stay, as well as faster return to daily activities.

It is carried out under general anesthesia. Hospitalization is required for 24 hours after which the patient is discharged.

Percutaneous spinal fusion is regarded safer than conventional, open spinal fusion surgery.

Anterior Cervical Discectomy and Spinal Fusion

A patient with constant significant problems of the neck or arm (radicular arm pain), despite conservative treatment, is a candidate for neck surgery.

Anterior cervical discectomy and Spinal Fusion is the most common surgery to treat the symptoms owed to degeneration and herniation of the intervertebral disc.

In this procedure, the entire affected disc is removed and replaced with a cervical cage that is inserted between the vertebrae without the use of plaques and screws and without the complications of dysphagia and difficulty to swallow after surgery.

The purpose of this surgery is twofold:

• Initially, the disc and osteophytes that compress the nerves and spinal cord are removed.
• The intervertebral space is then immobilized to reduce the pain associated with the movement of that space.
• The access is anterior to the cervix, not posterior. The whole process if performed with the use of a high resolution and sharp microscope.
• The operation lasts about an hour, while the patient remains at the hospital the same day and is discharged the morning after.
• Over 95% of patients with some degree of disease show improvement of symptoms. The same surgery can be performed for multiple levels in the cervical spine.
• As a rule, there are no serious complications other than a dysphagia that most patients experience for one to two days.

Posterior Cervical Decompression

In some cases, the posterior approach (from the back of the neck) for a cervical decompression is preferred.

The choice of access from the back is based on a number of criteria, such as posterior pressure, older patients, and normal lordosis of the cervical spine.

The surgery involves access from the back of the neck through an incision, 5-10 long. The muscles are set aside, the spinous process and the lamina of the vertebrae involved in stenosis are removed and the spinal cord is relieved. The corresponding nerves are then released into their foramina. The procedure is usually combined with spinal fusion.