Cervical Spinal Disc Herniation — Discotomy With Intervertebral Disc Replacement Prosthesis: treatment in the Best Hospitals in the World
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Department of Spinal Surgery
The Department of Spinal Surgery annually treats more than 960 patients with cervical spinal disc herniation. The specialists remove the affected disc with endoscopic equipment and replace it with prosthesis. The surgery involves the use of a three-dimensional O-Arm x-ray system, which provides a complete protection for the spinal cord. The department is headed by Dr. med. A Bitter, who specializes in microsurgical spinal interventions.
Department of Spinal Surgery
The Department of Spinal Surgery at the Vivantes Auguste-Victoria Hospital all diseases of the spine - both conservatively and operatively. Patients with herniated intervertebral discs, displacement of vertebrae, stenosis of the spinal canal or back pain are treated here. In addition, specialists of the department have a unique experience in the field of complex reconstructive and revision surgeries, which are conducted to continue or correct the previous surgical treatment.
Department of Spinal Surgery
The Department of Spinal Surgery offers the full range of effective treatment methods in the area of its specialization. A highly qualified team of doctors is at the service of the department's patients, who have in their arsenal advanced conservative and surgical treatment methods for pathological changes in the spine. Spinal surgical procedures are performed in modern operating rooms, the technical equipment of which allows spinal surgeons to perfectly perform both major open surgery and sparing interventions: minimally invasive, endoscopic, and microsurgical. Surgical treatment is complemented by a carefully planned course of physiotherapy. This includes procedures such as therapeutic exercises, manual therapy, massage, osteopathic treatment, etc. The department's team of doctors consists of 10 highly qualified specialists who, together with experienced nursing staff, admit more than 1,300 inpatients annually. The medical facility is certified by the German Society for Spine Surgery (DWG) as a level II specialized center. The department's medical team makes every effort to provide each patient with optimal treatment in a pleasant and friendly atmosphere.
Department of Adult and Pediatric Neurosurgery
The Department of Adult and Pediatric Neurosurgery offers the full range of accurate diagnostics and surgical treatment of diseases of the central and peripheral nervous system. The department's surgeons annually perform over 5,000 surgical interventions, which indicates their high professionalism and tremendous experience. The key attention is paid to the treatment of cerebrovascular diseases, diseases of the spine and spinal cord, brain and skull base tumors, peripheral nerve lesions, cerebrospinal fluid circulation disorders, as well as pain therapy (functional neurosurgery). The treatment of neurosurgical diseases in children and adolescents is carried out by a specially trained team of experts.
Department of Neurosurgery and Spinal Surgery
The Department of Neurosurgery and Spinal Surgery offers the full range of modern surgical procedures for patients with diseases of the brain, spinal cord, spine, and peripheral nervous system. The department has state-of-the-art equipment, including navigation systems, monitoring devices, surgical microscopes, intraoperative X-ray diagnostic systems, angiography systems, and laser equipment. In addition, a system for minimally invasive stereotactic interventions has been installed in the department's operating room. The department's neurosurgeons use the latest microsurgical and endoscopic techniques in their work. The medical facility is one of only three in Europe to successfully use the VISUALASE™ device for MRI-guided laser ablation to treat epilepsy. This minimally invasive procedure is highly effective and represents a real breakthrough in epilepsy surgery. The department's neurosurgeons always strive to provide the patient with optimal medical care. They talk in detail about each stage of treatment and are happy to answer the patient's questions. Neurologists and specialists in the field of neuroradiology are often involved in the therapeutic process, which guarantees a comprehensive approach to treatment.
Department of Adult and Pediatric Neurosurgery
The Department of Adult and Pediatric Neurosurgery offers the full range of surgical treatment of diseases of the brain, spine, spinal cord and nerves in adults and children. The department keeps pace with new trends in medicine, as well as contributes significantly to their development. Therefore, the most modern diagnostic and therapeutic methods are available here. An individual approach to each clinical case is crucial to ensure optimal treatment results with the preservation of all neurological functions.
Department of Adult and Pediatric Neurosurgery
According to the Focus magazine, the Department of Adult and Pediatric Neurosurgery ranks among the top German medical facilities specializing in the surgical treatment of brain tumors! The department offers the full range of diagnostics and surgical treatment of diseases of the central and peripheral nervous system. A specially trained team of pediatric neurosurgeons provides treatment for various neurosurgical pathologies in children. During the treatment, the doctors use state-of-the-art equipment, in particular, imaging-guided neuronavigation, functional imaging (fMRI), intraoperative mapping, intraoperative videoangiography, etc.
Department of Adult and Pediatric Neurosurgery, Spinal Surgery
The Department of Adult and Pediatric Neurosurgery, Spinal Surgery offers modern diagnostics and effective treatment of the full range of diseases, injuries, inflammatory processes, tumors and malformations of the brain, spinal cord and their meninges, as well as spinal diseases. Spinal surgery is performed in collaboration with doctors from the Department of Adult and Pediatric Traumatology, Orthopedic Surgery. The department admits adults and children with malformations of the nervous system, brain and spinal cord tumors, drug-resistant epilepsy and other diseases. As one of the largest medical facilities of this kind in Germany, the department's doctors annually perform more than 2,500 surgical interventions on the brain and spinal cord, peripheral nerve endings. The department's specialists also perform over 400 spinal surgical procedures annually. To achieve high success rates of the surgical treatment, doctors use the very latest equipment, including neuronavigation systems. Thanks to this, surgeons not only successfully eliminate the pathology, but also guarantee the patient maximum safety. The department has 78 beds, including 14 beds in the Intensive Care Unit. The priority goal of the department's medical team is to provide high-quality treatment focused on the patient's needs.
Department of Neurosurgery and Spinal Surgery
The Department of Neurosurgery and Spinal Surgery provides top-class medical care for patients with diseases of the central and peripheral nervous systems. The medical facility performs surgery of any complexity on the brain, spinal cord, spine, and peripheral nerves. The department is the largest healthcare facility of this kind in Germany and has a team of highly professional neurosurgeons with long clinical experience. The department's specialists focus on patients with brain tumors (gliomas, meningiomas, and brain metastases), neurovascular diseases (aneurysms, arteriovenous malformations, and dural arteriovenous fistulas), and traumatic brain injuries. Spinal surgeons operate on patients with herniated discs, spinal canal stenosis, spondylolisthesis, spondylodiscitis, spinal fractures, and spinal tumors. The department extensively uses minimally invasive surgical techniques that allow for good therapeutic results with high safety in surgical manipulations. The medical facility has two hybrid operating rooms with state-of-the-art equipment, including the Zeego® intraoperative robotic angiography system and the intraoperative Brainsuite® MRI.
Department of Adult and Pediatric Orthopedics
The Department of Adult and Pediatric Orthopedics is the center of maximum orthopedic care and offers the diagnostics and treatment of all diseases and injuries of the musculoskeletal system. Along with the full range of modern operative and conservative orthopedics, the department specializes in hip and knee replacement surgery using the minimally invasive methods, replacement/revision of prostheses, orthopaedic oncology, foot surgery and patella problems in the patella.
Department of Adult and Pediatric Orthopedics, Trauma Surgery, Foot Surgery
The Department of Adult and Pediatric Orthopedics, Trauma Surgery, Foot Surgery offers the full range of diagnostics, conservative and surgical treatment of musculoskeletal diseases and injuries. The department is a certified Endoprosthetics Center – more than 1,000 primary joint replacement surgeries are performed here annually. The surgeons of the Endoprosthetics Center also specialize in particularly complex clinical cases and revision procedures for the replacement of previously implanted artificial joints. In addition, the department has the status of the interregional Trauma Center certified in accordance with the standards of the German Trauma Society. The department has also been awarded a Certificate of Excellence from the German Orthopedic Foot and Ankle Society (DAF) in the field of foot surgery. A separate area of clinical activity is the treatment of diseases, injuries and congenital malformations of the musculoskeletal system in children. Depending on the severity of the clinical case, both conservative and surgical techniques are used in the treatment of orthopedic pathologies in children. The department's medical team prefers sparing low-traumatic surgery, while open operations are performed only if other therapeutic options are ineffective.
Department of Adult and Pediatric Neurosurgery
The Department of Adult and Pediatric Neurosurgery offers the diagnostics and comprehensive treatment of neurosurgical pathologies, including tumors of the central and peripheral nervous system. The department is the leading Center of Neurosurgery in Northern Germany and is responsible for the implementation of new algorithms for the treatment of patients with brain tumors. To this end, there is an active participation in the international researches and the development of new surgical methods, for example, operations in the waking state. Close interdisciplinary cooperation also contributes to the achievement of optimal treatment results.
Department of General Orthopedics and Orthopedic Oncology
The Department of General Orthopedics and Orthopedic Oncology offers the full range of conservative and surgical treatment of all musculoskeletal diseases. The department ranks among the largest medical facilities of this kind in Germany, as well as among the specialized authoritative departments for the treatment of bone and soft tissue tumors in the European medical arena. The treatment is carried out both on an outpatient and inpatient basis, including the outpatient operations. In addition to its successful clinical activities, the department is proud of its productive research work, which has given birth to many innovations in orthopedics, for example, the department's specialists have patented the very latest prosthetic systems, particularly in the field of orthopedic oncology.
Department of Adult and Pediatric Neurosurgery
The Department of Adult and Pediatric Neurosurgery offers the full range of modern services in this medical field. The high level of technical equipment in the department allows for the performance of all highly specialized surgical interventions to treat pathologies of the central and peripheral nervous system. The clinical practice mainly focuses on the diagnostics and surgical treatment of diseases, injuries of the brain, spine, spinal cord, intervertebral discs, nerve plexuses, functional neurosurgery and the treatment of neurosurgical pathologies in children.
Department of Adult and Pediatric Neurosurgery
The Department of Adult and Pediatric Neurosurgery offers all modern surgical interventions for the treatment of pathologies of the nervous system. The clinical focuses include the treatment of oncological diseases of the nervous system (neuro-oncology), skull base surgery, vascular neurosurgery, spinal surgery and functional neurosurgery, including the surgical treatment of epilepsy. As a state-of-the-art medical facility, the department has the advanced systems for deep brain stimulation, multimodal neuronavigation devices, intraoperative neuronavigation using CT, ultrasound systems, fluorescence imaging devices and endoscopy equipment. Thus, the department has all the possibilities to ensure effective treatment according to the international standards.
Department of Orthopedics, Trauma Surgery and Foot Surgery
The Department of Orthopedics, Trauma Surgery and Foot Surgery provides a full range of modern diagnostics and conservative and surgical treatment of musculoskeletal diseases. The primary clinical interest of the department's team of doctors is the medical care of patients with diseases of large joints, spine, and foot, bone and soft tissue sarcomas, injuries of any severity, including multiple and geriatric. The department includes a specialized Maximum Care Joint Replacement Center (EndoCert and ClarCert certified), which successfully performs partial and total knee and hip arthroplasty. It should be noted that these operations are performed through a minimally invasive approach, which allows for postoperative restoration of mobility in the shortest possible time. The department also has a well-developed area of arthroscopic surgery of the knee, hip, and shoulder joints and offers modern methods of treatment of foot and ankle pathologies. The high quality of medical care is confirmed by numerous prestigious certificates, such as the certificate of the German Spine Society (DWG), the certificate of the German Foot and Ankle Society (DAF), the certificate of the German Society for Orthopedics and Trauma Surgery (DGOU), the certificate of the German Cancer Society (DKG), the certificate of the German Knee Society (DKG), the certificate of the German Trauma Society (DGU), and others.
Herniated disc in the cervical spine occurs about 5 times less often than in the lumbar one. It not only affects the quality of life due to pain and impaired sensitivity in the innervation zone of the cervical spinal nerves, but also threatens life, as it increases the risk of ischemic stroke due to compression of the vertebral artery. In the foreign hospitals, hernias can be removed using a minimally invasive endoscopic technique, without long recovery, safely, with a minimum risk of recurrence.
Content
Types of hernias
Herniated disc of the cervical spine is divided into three types, depending on its severity:
- Protrusion is the bulging of the nucleus pulposus without damaging the annulus fibrosus
- Prolapse is a burst of the annulus fibrosus
- Sequestration is a total separation of a fragment of the nucleus pulposus, its extension beyond the disc
According to the localization of the cervical herniated disc, it can be:
- Median (central)
- Lateral
- Foraminal
Symptoms
Symptoms of a cervical herniated disc are caused by the compression of the spinal nerve roots. Stages of the disease are:
- "Soft disc" is an acute phase of the disease caused by protrusion of the nucleus pulposus.
- "Hard disk" is the chronic phase of the disease, in which bone growths appear.
At the "soft disk" stage, patients usually complain of pain in the arms which gets worse after a physical exertion. Headaches and movement disorders are possible in the form of weakness of certain muscle groups.
At the "hard disk" stage the listed symptoms are accompanied by local pain in the hernia area, which is determined during palpation. The onset of paresthesias (unusual sensations) in the area of innervation of the spinal nerves (more often on the hands) is possible. There are also cases of a strong decrease in skin sensitivity. When the roots of the motor nerves are compressed, a sharp decrease in muscle strength (paresis) is observed.
Treatment principles
The hernia is treated conservatively, if possible. It does not disappear physically, but hernia-related symptoms alleviate. Patients take painkillers and anti-inflammatory drugs. The following non-drug treatment methods are often used:
- Physiotherapy
- Exercise therapy
- Reflexology
- Massage
- Orthoses that limit the movement of the neck
Some patients need surgery. It is carried out in the presence of the following indications:
- Symptoms persist for more than 3 weeks without improvement, conservative therapy is ineffective
- Clinical picture of radiculopathy (compression of the spinal nerve roots) corresponds to the level of damage determined by MRI or CT scan
Open surgeries
Open surgical interventions through large incisions have been used in neurosurgery to remove hernias since the 1940s. These treatment methods are still used in countries with poorly developed medicine.
Microdiscectomy is a standard surgery to repair hernias. A hernia is removed through an incision 3-4 cm long. However, this type of surgery has significant disadvantages, as the surgeon has to resect bone structures in order to get to the intervertebral disc. As a result, spinal instability may develop, which will require additional treatment in the future. In addition, microdiscectomy is a traumatic intervention with long postoperative rehabilitation. Therefore, such interventions are rarely carried out in developed countries. Physicians prefer less invasive and safer endoscopic techniques.
Intervertebral disc replacement is the most radical treatment option. The disc is removed totally. An implant is placed instead. Modern disc prostheses are wear-resistant and have long service life. They allow the patient to maintain the full mobility of the spinal column.
Countries with low medicine levels usually perform discectomy without a disc replacement. The vertebral bodies are simply held together motionlessly. As a result, adjacent segments bear increased load and are often damaged, which will require additional operations in the future. After the removal of the disc abroad, it is replaced with a prosthesis, so pathologies of the adjacent segments do not develop.
Endoscopic surgeries
In most cases, herniated discs are treated with minimally invasive procedures and endoscopic interventions. These treatment options are minimally traumatic, have a short rehabilitation period, and do not impair spinal stability. In most cases, there is no need to remove bone tissue during surgery at all, or the volume of resection is minimal.
Endoscopic nucleotomy is excision of a hernia through a puncture in the neck. The surgeon inserts a guide needle first. The procedure is performed under X-ray guidance. The hernia is excised with the help of a nucleotom. It is usually a spiral-shaped rotating probe. The intervention can be supplemented with electrothermal intradiscal therapy, when the physician heats the disc to 90 degrees Celsius in order to destroy the nerve endings, "seal" small fissures in the annulus fibrosus, strengthen it and reduce the risk of hernia recurrence.
Radio wave nucleotomy is the destruction of a fragment of a disc using radio wave energy. The affected disc is divided into parts and removed. At the same time, radio wave nucleoplasty is performed to strengthen the annulus fibrosus and prevent hernia recurrence.
Endoscopic discectomy is the most effective endoscopic surgery, which, unlike the two above mentioned treatment options, can be used even for large hernias. Its efficiency in the best European clinics reaches 98%. The intervention is performed using an endoscope, through a 0,4 mm incision. The instruments are inserted through the natural vertebral openings, so the bone tissue is preserved. Muscles are practically not damaged. Within a few hours after the operation the patient can walk, and the next day he is discharged from the hospital. The rehabilitation period is short, which is especially important for young, physically active people: they can quickly return to physical work or sports.
You can undergo diagnostics and treatment of the cervical spine disc herniation abroad. Please, use the Booking Health service to compare prices in different hospitals and book a medical program at an affordable price.
Authors:
The article was edited by medical experts, board-certified doctors Dr. Vadim Zhiliuk and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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