Operative treatment

    Operative treatment I ENANDE

    minimally invasive procedures

    So-called minimally invasive procedures are very alluring, however it must be said that for the most part, these procedures only treat the symptoms, without eliminating the cause of a disorder. With regard to long term prognosis, applicability thus has to be reviewed critically. Microscopic discectomy also still plays a major role when it comes to surgical treatments of the lumbar spine. Endoscopic procedures are also performed but have very limited scope. Other procedures such as IDET (intradiscal electrothermal therapy) or the cryogenic denervation of the facet joints need to be discussed just as critically as nucleoplasty.

    motion-preserving procedures

    The goal of motion-preserving procedures is to rebuild the damaged structure by implanting certain devices and thus restoring mobility in the afflicted segment. In general, we distinguish between devices implanted by anterior approach, artificial discs, and devices implanted by posterior approach. These include dynamic systems using screws, interspinous devices and posterior nucleus replacements. Generally, the use of motion-preserving implants is subject to specific conditions. The extent of structural changes has to be within certain limits, the patient’s age also has to be taken into consideration and there must not be any changes in bone structure. Motion-preserving implants inserted by anterior- or posterior approach display great differences. The anterior approach, especially to the lumbar spine, requires relevant experience. Biomechanically, the various procedures differ considerably. Principally, only artificial disc prosthesis implanted by anterior approach can genuinely replace complete function of the damaged disc. Devices implanted by posterior approach can only do so to a certain extent.

    motion-inhibiting procedures

    The basic goal of motion-inhibiting procedures is to ideally correct the affected spinal segments in order to enable adjacent vertebrae to have normal mobility without any limitations. The concept of fusion surgery in this context is often mistakenly interpreted to cause disadvantages rather than resulting in a positive outcome for the patient. This is not the case. The variety of modern procedures today provides reproducible good results with minimalized surgical approaches. In many cases, we cannot afford to overlook these stabilizing techniques, even though so-called hybrid procedures are being used increasingly. These describe a combination of different motion-preserving and motion-inhibiting procedures.