Surgical treatment of cervical neurinoma in Academic Hospital of the University of Bonn Mechernich

About the department

The Department of Adult and Pediatric Spinal Surgery at the Academic Hospital of the University of Bonn Mechernich offers a full range of conservative and surgical treatment in its area of ​​specialization. The medical facility treats patients of all ages, including young children and adolescents. Each patient receives the most effective treatment using the very latest developments and therapeutic methods. The specialists of the department devote sufficient time to personal consultations with the patient, which allows for the creation of an optimal treatment plan, taking into account the patient's individual needs and wishes. The team of spinal surgeons focuses on patients with degenerative and inflammatory spinal diseases, benign and malignant spinal tumors, and spinal deformities and injuries. The department performs more than 800 spine surgeries annually, most of which are considered highly complex. The department has been awarded the prestigious quality certificate of the German Spine Society (DGW), while healthcare facilities of this profile with such certification are considered to be among the best in Germany, with remarkable treatment success rates. The operating rooms of the department are equipped with cutting-edge technology, which plays a key role in achieving good results in the treatment of spinal pathology. It is also worth mentioning the high professionalism of the team of doctors and nurses of the department: the specialists have impressive clinical experience, surround the patient with care during the entire therapeutic process, and are always ready to help.

The Head Physician of the department is Prof. Dr. med. Robert Pflugmacher. He is well known in the German medical community and is considered one of the best spine surgeons in the country. Prof. Pflugmacher was awarded the Master Certificate of the German Spine Society (DGW). In addition, under his leadership, the department underwent the DGW certification process, confirming its exceptional competence in its area of ​​specialization. Dr. Robert Pflugmacher is highly qualified and has performed thousands of successful spine surgeries.

A large number of patients come to the department with the diagnosis of intervertebral disc herniation caused by protrusion of the nucleus pulposus of the intervertebral disc as a result of damage to the integrity of the fibrous ring. The main manifestation of the pathology is severe pain. As the disease progresses, there are also limitations in mobility, changes in the sensitivity of the upper and lower extremities (depending on the location of the herniation), and other serious symptoms. The most informative diagnostic methods for suspected intervertebral disc herniation are imaging tests: after a clinical examination and study of the patient's complaints and medical history, doctors prescribe X-ray, computed tomography, and/or magnetic resonance imaging, with MRI being the preferred option of the department's specialists in most cases. As far as treatment is concerned, in many situations it is possible to achieve pain relief with conservative methods, which means that surgery is not necessary. If conservative therapy does not provide the desired results, the option of performing a spinal block is considered. This involves the targeted injection of a solution of corticosteroids and local anesthetics. The procedure is performed under CT guidance to ensure accuracy and safety. Pain relief occurs only for a certain period of time (at least 3 months), after which the patient may be indicated for a repeat spinal block. In some cases, conservative treatment may fail, and then the only option to eliminate a herniated disc is surgery. These procedures are performed in the department using a minimally invasive approach under image guidance and with the use of the most advanced surgical microscopes. The essence of the surgical procedure is the removal of the affected disc and the implantation of a special prosthesis in its place, called an intervertebral fusion cage.

The department has a great clinical experience in the medical care of patients with spinal stenosis, which is one of the most common pathologies in spinal surgery. This chronic condition is characterized by pathological narrowing of the spinal canal, which causes compression of the nerve fibers passing through it. Stenosis most often affects the lumbar spine. The pathology causes symptoms such as severe pain, numbness, burning, tingling, limited spinal mobility, heaviness and discomfort when walking, and rapid fatigue. Magnetic resonance imaging is the gold standard among all currently available diagnostic modalities for suspected spinal stenosis, as it allows the presence of narrowing of the spinal canal to be detected, the degree of stenosis to be determined, and the presence of other spinal pathologies (for example, tumors, hematomas, or infectious lesions) to be excluded. The department's specialists offer three effective treatment options for spinal stenosis: conservative therapy, periradicular infiltration therapy, and surgery. Conservative treatment is indicated for patients with stenosis without concomitant damage to the nerve tissue in the spinal cord (myelopathy). It is based on wearing a special corset, drug therapy with anti-inflammatory drugs, and physiotherapy procedures. In more complex cases, periradicular infiltration therapy is recommended. The essence of the procedure is an X-ray guided "drug block" of the pathological focus with a solution of cortisone and local anesthetics. The last line of treatment is spinal microsurgical decompression. This procedure is indicated for patients with spinal canal narrowing associated with myelopathy. If clinically indicated, decompression is supplemented by spondylodesis, which is a stabilization operation aimed at immobilizing adjacent vertebrae by fusing them.

The treatment of vertebral fractures is also an integral part of the daily clinical practice of the department. These traumatic injuries are most often the result of improper axial loading, osteoporosis, infectious lesions of the spine, and bone metastases. A vertebral fracture carries a high risk of recurrence, so it is extremely important for the patient to receive timely treatment. The data obtained during the clinical examination and review of the patient's medical history, as well as the computed tomography scans, play a key role in developing the most effective treatment plan for the patient. In the case of stable compression vertebral fractures, the doctors of the department often use only comprehensive conservative treatment with medications, special corsets for spinal immobilization, and physiotherapy procedures. If the preliminary diagnosis reveals an unstable vertebral fracture, surgical intervention is the basis of treatment in most cases. Depending on the specific clinical indications, the spine surgeons in the department perform vertebroplasty or kyphoplasty. In both procedures, a special bone cement is injected into the body of the fractured vertebra through a minimally invasive approach to strengthen it and eliminate pain.

The department is an expert medical facility in the correction of scoliosis in adults and children. Scoliosis is an abnormal lateral curvature of the spine. The deformity can cause potentially serious physical health problems, including breathing difficulties and chest and back pain, as well as being an aesthetic defect. The department uses the Cobb method to determine the degree of spinal curvature: if the angle of curvature is 40 degrees or more, the patient requires surgical correction of scoliosis with the implantation of special screw and rod systems (in young patients, the operation is performed after the child has completed the growth phase); in other cases, conservative treatment is usually recommended.

The department specializes in the diagnosis and treatment of the following spinal diseases:

• Herniated discs
• Facet joint syndrome
• Sacroiliac joint syndrome
• Spinal stenosis
• Scoliosis
• Spondylitis and spondylodiscitis
• Spondylolisthesis
• Chronic back pain
• Vertebral fractures
• Spinal tumors
• Other spinal diseases

The range of medical services provided by the department includes the following:

• Conservative treatment
  • Drug therapy with tablet medications
  • Spinal blocks
  • Physiotherapy
  • Therapeutic exercises
• Surgical treatment
  • Facet joints and sacroiliac joint endoscopic denervation
  • Minimally invasive kyphoplasty and vertebroplasty for vertebral compression fractures
  • Minimally invasive and endoscopic surgery for herniated discs
  • Minimally invasive and endoscopic surgery for spinal stenosis
  • Minimally invasive prosthetic repair of intervertebral discs of the cervical and lumbar spine
  • Minimally invasive stabilization surgery on the cervical, thoracic, and lumbar spine
  • Spinal fusion
  • Coccygectomy (the surgical removal of the coccyx for chronic coccyx pain)
  • Minimally invasive and endoscopic surgery for degenerative spinal changes
  • Minimally invasive surgery for scoliosis and kyphosis in adults and children
  • Minimally invasive surgery for spondylitis and spondylodiscitis
  • Revision spinal surgery after primary unsuccessful surgical treatment
• Other conservative and surgical treatments