Spinal canal stenosis (spinal stenosis) is the narrowing of the space at one or more locations along the spinal canal. A narrowed spinal canal can lead to compression of the nerve structures (spinal cord and nerve roots) that pass through the spinal column. Spinal stenosis is most commonly found in the lumbar and cervical regions. Some patients with spinal stenosis may have no complaints, while another group of patients may experience symptoms such as pain, numbness, decreased sensation, and muscle weakness. These symptoms may intensify and worsen over time.

Treatment of spinal stenosis varies depending on the severity of symptoms and the exact location of the stenotic segment. Lack of response to conservative treatment and the presence of persistent pain or progressive neurological deficit and pelvic reservoir disorders necessitate surgical intervention.

The choice of surgical technique is of exceptional importance, as the type and extent of the surgical intervention are determined by the nature of the stenosis. Decompression of the affected nerve elements is necessary without causing spinal instability. Removal of hypertrophied bony segments requires exceptional care to avoid causing additional damage to neural structures in the narrowed space.

Implant-free treatment of spinal stenosis using the microsurgical method!

This method aims to perform decompression in the respective area of spinal canal narrowing without placing foreign bodies (implants) in the patient's body. With this method, the narrowed canal is widened from the inside out. This is one of the most modern methods for treating spinal stenosis and has numerous advantages compared to classical surgical techniques. Some of these advantages are:

• The surgical intervention is much shorter in duration compared to classical open surgery.
• The patient's postoperative treatment period is significantly alleviated, and therefore the recovery period is much shorter.
• The patient can return to their normal daily life and work in a much shorter time.
• Due to the fact that no implants are used, the risk of potential postoperative infection is minimized.
• The risk of complications such as paralysis, nerve damage, etc. is much lower compared to classical open surgery.

For the above-mentioned reasons, implant-free treatment of spinal stenosis using the microsurgical method is also preferred for elderly patients with accompanying conditions.

Spondylolisthesis is the displacement (slippage) of one vertebral body of the spinal column relative to another. The displacement can occur in all directions - forward, backward, or sideways, and can lead to compression of nerve roots and narrowing of the spinal canal. This can lead to compression of the spinal cord and serious damage to some neurological functions.

Spondylolisthesis most commonly affects the lower part of the lumbar region of the spinal column. It can manifest at all ages. The initial stages of the disease may progress without symptoms for varying periods of time. In the advanced stages of the disease, as compression on the nerve roots and/or spinal cord increases, pain gradually begins in the area of slippage along with neurological complaints. The pain and sensations may spread to the lower extremities and can cause muscle weakness in the limbs, muscle spasms, numbness, and tingling along the path of the affected nerves.

The main causes of spondylolisthesis are congenital vertebral displacement, trauma from accidents or sports activities, and degenerative changes of the spinal column. The most commonly encountered form of the disease is degenerative spondylolisthesis. It is the result of changes that occur in the vertebrae during the aging process.

TREATMENT OF SPONDYLOLISTHESIS

With advancing age, the vertebrae begin to lose their stability, dehydration occurs, which in turn leads to their cracking. This creates favorable conditions for the displacement of vertebrae from their original position.

In mild forms of the disease, treatment is primarily carried out through physiotherapy and rehabilitation, balneotherapy, and strengthening of the muscles of the affected segment of the spinal column. Patients are also prescribed pain-relieving medications, as well as vitamins and minerals to strengthen the skeletal system. Wearing a special supportive medical corset also alleviates the patient's condition.

In more severe forms of the disease, vertebral displacement leads to increasing pain symptoms and the possible appearance of neurological deficit. This in turn leads to serious risks of permanent damage and necessitates surgical treatment.

Surgical treatment of spondylolisthesis includes decompression of nerve structures, restoration of normal anatomical relationships between vertebrae, and stabilization for the purpose of fusion. In surgical treatment, classical operative techniques for decompression are combined with modern instrumental stabilization, with spinal implants placed to achieve spinal stability.

The goal of the surgical intervention is to achieve complete surgical decompression of neural structures and maximum stability of the damaged segment of the spinal column.

Every living organism is composed of numerous cells of different types. Sometimes, under the influence of various and very often unclear causes, some of our cells change their normal development cycle. These cells begin to divide abnormally and uncontrollably, thus forming a new growth - a tumor. When this new growth develops in the brain, it is identified as a brain tumor.

There are various types of brain tumors. Depending on the classification criteria, brain tumors are classified in several different ways.

The majority of brain tumors are formed from cells of the brain tissue itself. Brain tumors that originate from brain tissue, brain membranes, and cranial nerves are classified as primary brain tumors. Secondary brain tumors, also called metastatic brain tumors, originate from organs and tissues outside the brain (when an oncological disease in another part of the body spreads to the brain) and reach it through the bloodstream.

Depending on the differentiation of the cells and tissues from which they are composed, brain tumors are classified as benign and malignant.

TREATMENT OF BRAIN TUMORS

Treatment of brain tumors is a complex process and often requires the involvement of a team of specialists. The treatment method is determined depending on the exact location, size, and type of the tumor and other individual characteristics of the patient.

Surgical removal of benign brain tumors is a reliable treatment method with a high success rate. If the patient's case allows complete removal of the benign tumor during the surgical intervention, the problem will be resolved without the need for additional treatments. This procedure is a surgical procedure with a very high success rate and provides the opportunity for full recovery.

Unlike other tumors in the body, brain tumors are distinguished by one important characteristic feature - they develop in the cranial cavity, which represents a closed space with rigid boundaries. For this reason, it is accepted that all brain tumors are relatively malignant, since the human brain has nowhere to "retreat" when compressed by the tumor. Another important characteristic of brain tumors is that even the presence of a small tumor located in a functionally significant area of the brain (motor centers, sensory zones, the speech center of the brain, etc.) can lead to serious damage and significantly worsen the patient's quality of life.

Treatment of malignant brain tumors often requires comprehensive treatment encompassing neurosurgical operation, radiation therapy, chemotherapy, and rehabilitation. If the brain tumor is prognosticated as malignant, it is of primary importance to determine the exact type of tumor for establishing the treatment plan. In this way, planning of the patient's entire treatment can begin. For this purpose, a biopsy is performed (taking a small part of the tumor through a small opening in the skull for detailed analysis).

If there are already serious negative effects on the patient's overall health condition, treatment procedures can begin directly with surgical interventions aimed at minimizing the negative effects of the brain tumor. Sometimes, due to the location of the brain tumor, it is not possible to remove it entirely during the surgical intervention. In such cases, subsequent treatment methods such as radiation therapy and chemotherapy are necessarily applied.

Performing surgical intervention in this area of the human body requires the use of microsurgical methods. Due to the presence of numerous fine nerve formations in this area of our body, even the smallest problem can have major consequences. Therefore, surgical intervention on brain tumors is performed with the aid of neuronavigation (neuromonitoring). Through this system, the neurosurgeon monitors the patient via signals from electrodes placed on the patient's face, arms, and legs. When signals decrease, the doctor receives a warning that they are in a sensitive area of the brain. Thanks to this system, the risk of paralysis and unwanted negative consequences from the surgical intervention are minimized.

The success of the surgical operation is of determining importance for the overall treatment of brain tumors.

WHAT IS DISC HERNIATION?

The vertebrae forming the spinal column are arranged one on top of another and are connected to each other, forming the spinal canal. The spinal column protects the spinal cord from external influences. In addition to vertebrae, the spinal column contains the spinal cord, nerve endings, and cartilaginous tissue discs that provide flexibility to the spinal column. The outer wall of each of these round discs, located between the vertebrae, consists of elastic and firm tissue. The inner part of this cartilaginous tissue (disc) has a gelatinous structure. As a result of wear or injury to the outer wall of the cartilaginous disc, the gelatinous material located in the center begins to press the outer wall from the inside out. If the disc is very worn or severely damaged, the gelatinous material prolapses outward, thus forming disc herniations. The more commonly encountered types of disc herniation are lumbar and cervical disc herniation.

DIAGNOSIS OF DISC HERNIATION

A number of imaging studies are used in diagnosing disc herniation. Nowadays, Magnetic Resonance Imaging (MRI) is accepted as the most modern method and the gold standard for diagnosing spinal column diseases. After a physical examination and MRI, the specialist will be able to inform you in more detail about your current condition and the treatment necessary in your case.

TREATMENT OF DISC HERNIATION

Most patients do not visit a doctor because they fear that surgical intervention will be recommended, but only 10% of patients with lumbar and cervical disc herniations require surgical intervention, i.e., the remaining 90% can be treated non-surgically. The treatment plan for lumbar and cervical disc herniations is determined based on the patient's complaints, clinical condition, and imaging diagnostic results. Excluding emergency conditions, the first step in treatment is conservative therapy. If necessary, treatment continues using invasive surgery methods - trigger point injections, epidural injections, spinal anesthesia, and intradiscal manipulations. Surgical treatment is resorted to when conservative therapy is not sufficiently effective or in cases of muscle strength loss, urinary incontinence, and severe pain unresponsive to medication.

In our Neurosurgery clinic, surgical interventions for disc herniation treatment are performed primarily using the microsurgical method. Before the surgical intervention, based on the physical examination and MRI, a decision is made regarding the most appropriate surgical method for the specific case.

One of the most commonly applied modern treatment methods in this area of medicine is "Microscopic Discectomy." The term "Microdiscectomy" refers to the removal of the herniated part of the intervertebral disc through a minimal skin incision, using a surgical microscope under high magnification and with the help of special microsurgical instruments. The fundamental principles of microsurgery are preserving the maximum anatomical integrity of tissues. The operative incision is without cosmetic defect.

The microsurgical approach has numerous advantages over standard surgical intervention:

➤ Significantly reduced operative time and minimal incision.

➤ Fewer risks of postoperative complications to musculature and nerves.

➤ Possibility of easy application in patients being treated for osteoporosis and/or diabetes.

➤ Fewer risks of postoperative infections.

➤ Significantly reduced hospital stay.

➤ Short recovery time and quick return to normal daily life.