Decompressive-stabilizing intervention: effective treatment in Ternopil

Complications of DDZH

In degenerative-dystrophic diseases of the spine , primarily osteochondrosis, spondyloarthrosis and spondylosis, complications often arise in the form of:

• herniated intervertebral discs,
• scoliosis (curvature of the spine),
• stenosis (narrowing) of the spinal canal,
• spondylolisthesis (“slipping” of vertebrae from each other),
• the appearance of spinal instability.

This leads to a disruption of the normal anatomy of the spinal canal, as a result of which the nerve structures located in it – the spinal cord and its roots – suffer.

Manifestations

This, in turn, leads to the appearance of neurological deficits in the form of:

• movement disorders,
• sensitivity,
• pelvic organ functions, etc.

Combined surgical intervention

In this situation, the most appropriate thing for a neurosurgeon is to help the patient with a combined surgical intervention – a decompressive and stabilizing operation, which involves:

• decompression (elimination of compression of nervous structures by a pathological substrate)
• and stabilization of the spinal column with the restoration of its axis and biomechanics, and therefore, the normalization of its physiological functions.

Example

When performing operations to remove herniated intervertebral discs on:

• cervical,
• chest
• or lumbar levels, the installation of interbody cages is used to prevent instability in the spinal motor segment and subsequent “sag” of the vertebrae.

Cage System

A cage is a small “washer”-like structure that is inserted between the vertebral bodies after a disc is removed and keeps the vertebrae in an optimal position throughout life. Essentially, a cage is a prosthesis for the removed intervertebral disc .

In some cases, a special titanium plate is used for additional stabilization, which is installed in front of the bodies of adjacent vertebrae, between which a cage has already been installed.

In some cases, our department installs various types of cages at the lumbar level after removing herniated discs (the so-called PLIF technique, with fixation of adjacent vertebrae with titanium screws and beams).

One of the most effective methods of surgical treatment of spinal stenosis (narrowing) is considered to be a combination of microsurgical decompression and dynamic interspinous stabilization. During decompression, the formations that compress the nerve root are removed:

• bone growths (osteophytes),
• yellow bundle,
• intervertebral (facet) joints, etc.

Dynamic interspinous spinal fixation systems

They are called so because they allow you to maintain some mobility in the operated segment of the spine.

They are divided into:

• constructions using screws,
• screw-free designs (interspinous implants).

Such systems allow for more physiological fixation and prevent fusion of the intervertebral joints, which occurs when using other systems with more rigid fixation.

Dynamic spinal stabilization

involves the use of so-called flexible fixation systems:

• movable intervertebral disc prostheses,
• flexible rods for fastening implants and bone structures of the spine,
• as well as so-called shock absorbers – flexible intervertebral implants that regulate the range of motion of the affected vertebrae.

The essence of using dynamic spinal stabilization systems is to restore the natural anatomical geometry of the spine while preserving its biomechanical properties, without rigid locking of the vertebrae, with maximum physiological mobility in the spinal motor segments.

Examples of dynamic spinal stabilization include the following:

• systems that are installed between the spinous processes of the vertebrae (Coflex);
• dynamic transpedicular systems (DSS), using titanium rods and screws passed through the roots of the vertebral arches;
• Dynamic cervical spine stabilization (DCI) systems, which involve the installation of a special implant between the bodies of the cervical vertebrae via anterior access instead of the removed intervertebral disc.

A distinctive feature of dynamic spinal stabilization systems is that they allow to eliminate the development of instability in the affected segment and prevent the development of degenerative changes in adjacent spinal motor segments. Preservation of mobility in the operated and adjacent segments ensures the physiological fullness of spinal functions.

Advantages

The installation of interbody and interspinous dynamic implants allows:

• normalize the height of the intervertebral disc and/or eliminate the narrowing of the intervertebral foramina, which ensures the free location of the nerve roots and spinal cord in their natural places;
• dynamic stabilization allows you to remove excessive load from the intervertebral (“facet”) joints;
• prevent the development of their degenerative damage with the formation of the so-called “disease of adjacent levels.”

In cases of spinal canal stenosis combined with vertebral instability or multi-level stenosis, our department performs reconstructive and stabilizing surgeries using specially designed minimally invasive stabilizing systems.

They allow neurosurgeons to install screws and rods that create a supporting “framework” for the affected parts of the spine through several small (up to 1.5 cm) skin incisions, rather than making a large and deep “half-back” wound to gain the necessary access to the spine.

The installation of these systems is not done “blindly”, but under dosed X-ray control at any stage of the operation. The undoubted advantages of this technique are its low-traumaticity, cosmetic appearance, reduced blood loss during the operation and its shorter duration. At the same time, the patient, as a rule, can be lifted to his feet on the day of the operation.