Spinal / Disc Surgery

Endoscopic operations on the spine

Endoscopic spinal surgery is an innovative technique that enables minimally invasive procedures on the spine. Compared to conventional microscopic procedures, endoscopic spinal surgery offers several advantages:

1. Minimal tissue traumatization
Endoscopic procedures require only small incisions to access the affected areas of the spine. This minimizes the extent of tissue trauma compared to microscopic surgery. Fewer incisions usually mean less pain, less risk of bleeding and faster recovery.

2. Shorter recovery time
Because less tissue is affected, patients often experience a faster recovery. The shortened recovery time allows patients to return to normal activities more quickly and rapidly improve their quality of life. One study showed that competitive athletes were able to return to competition after only 2 months following endoscopic disc surgery, while athletes who had undergone microscopic surgery were only able to compete after 6 months.

3. Lower risk of infection
Endoscopic spinal surgery reduces the risk of post-operative infections. Smaller incisions mean fewer open wounds, which significantly reduces the likelihood of infection.

4. Precise diagnosis and therapy
The use of high-resolution endoscopes gives surgeons a detailed view of the affected area. This enables precise diagnosis and treatment. Surgeons can target the problem and treat it without unnecessarily affecting surrounding healthy tissue.

5. Shorter hospital stays
Due to the reduced invasiveness and faster recovery, patients have a shorter hospital stay after endoscopic procedures.

6. Cosmetic benefits
The smaller incisions in endoscopic procedures result in minimal scarring. This is not only more aesthetically pleasing, but can also help patients to recover more quickly psychologically.

7. Less post-operative pain
Due to less tissue trauma and smaller incisions, patients experience less to no post-operative pain. This can help to reduce or completely eliminate the need for strong painkillers.

8. Maintaining spinal stability
The endoscopic technique allows surgeons to target problematic areas without unnecessarily affecting the surrounding spinal structure. This helps to better maintain the stability of the spine.

Despite these advantages, it is important to note that not all spinal problems can be treated endoscopically, and the choice of the right technique depends on the type and severity of each case. There should always be an individual consideration of the benefits of minimally invasive surgery and the specific needs of the patient. The decision as to whether an operation can be performed endoscopically should be made by a doctor who is highly experienced in endoscopy. This is because, like any other technique, endoscopy requires a lot of practice and training in order to gain experience and then operate safely on more complicated cases.

The most common endoscopic procedures on the spine are:

• Herniated discs in the cervical, thoracic and lumbar spine
• Narrowing of the spinal canal (spinal canal stenosis)
• Facet denervation

If in doubt, it is certainly an advantage to get a second opinion from colleagues who have performed several thousand procedures and have more than 25 years of experience in spinal endoscopy, such as Professor Christian Woiciechowsky.

herniated disc

1. What is an intervertebral disc?
The spine consists of vertebrae that are connected to each other by intervertebral discs. These intervertebral discs act as shock absorbers and enable movement and stability of the spine.

2. What happens with a slipped disc?
An intervertebral disc has a soft, gelatinous core and an outer, fibrous, firm shell. If there are tears in the outer shell, parts of the soft core can protrude outwards. This is known as a herniated disc. This can exert pressure on the surrounding nerves.

3. Symptoms
A herniated disc can cause pain in the lower back (lumbar spine) or neck (cervical spine), which can radiate into a leg or arm. It can also lead to numbness, tingling or weakness in the arms or legs.

4. Causes
Herniated discs can occur as a result of wear and tear as part of the ageing process. Genetic factors, occupational stress or incorrect posture can increase the risk.

5. Diagnosis
A herniated disc is diagnosed through a combination of physical examination and imaging such as MRI.

6. Treatment options
Most herniated discs improve with conservative measures such as rest, physiotherapy and pain medication. In certain cases, injections directly to the nerves, so-called periradicular therapy (PRT) under imaging can also help. If conservative therapy is not successful within a period of 6-12 weeks, surgery may be necessary. In most cases, this can be performed endoscopically. This is almost always possible in the spine. In the cervical spine, herniated discs are operated on both endoscopically from behind and microscopically from the front. The choice of procedure depends on the localization of the herniation. If surgery is performed from the front, an implant must also be placed in the intervertebral space. This is either a cage, in which case the spine is stiffened, or an artificial disc, in which case the spine remains mobile.
Only a doctor with experience in all techniques can decide which procedure to use in each individual case and then make the right choice for their patient.

Spinal canal stenosis

1. What is the spinal canal?
The spinal canal or spinal canal is the space inside the spine that surrounds the spinal cord or spinal nerves. The spinal cord or spinal nerves are a kind of “cable” that transmits signals between the brain and the body. This is how muscles are controlled or touch is perceived

2. What is spinal canal stenosis?
This space narrows in the case of spinal canal stenosis. This narrowing can lead to the nerve roots being compressed (squeezed).

3. Causes
The main causes of spinal canal stenosis are signs of wear and tear on the intervertebral discs, facet joints and thickening of ligaments.

4. Symptoms
The most common symptoms of spinal stenosis are leg pain, numbness or weakness. These symptoms worsen when walking and improve when sitting or bending forward. The walking distance is often shortened. Patients often have to sit down after a few meters.

5. Diagnosis
The diagnosis is made by a combination of physical examination and imaging such as MRI.

6. Treatment options
Treatment depends on the severity of the symptoms. In mild cases, physical therapy, painkillers or injections into the spinal canal can help. In more advanced cases, surgery may be necessary to relieve the pressure on the nerves. This surgery can very often be performed endoscopically, avoiding the need for implants.

Intervertebral disc replacement

1. What is an intervertebral disc?
The spine consists of vertebrae that are connected to each other by intervertebral discs. These intervertebral discs act as shock absorbers and enable movement and stability of the spine.

2. Why might an intervertebral disc be replaced?
If surgery is performed on the cervical spine from the front, the intervertebral disc is removed. This must then be replaced. This is possible with either a cage or an artificial disc. The cage results in a stiffening, while the artificial disc allows the cervical spine to remain mobile.

3. How does an artificial intervertebral disc work?
The artificial disc often consists of 2 metal plates that are connected to each other by a polyethylene core. This enables a more natural movement and in certain cases also shock absorption.

4. Advantages
Compared to traditional fusion surgery, in which two vertebrae are fused together, the artificial disc allows the mobility and flexibility of the spine to be maintained. This can help to relieve the adjacent segments and prevent so-called subsequent degeneration.
It is important to emphasize that the decision for an artificial disc should be made on an individual basis and must be made in close consultation with the attending physician. In certain cases, this intervention can be a promising option for relieving pain and maintaining or restoring the functionality of the spine.