ΑΡΘΡΟΓΡΑΦΙΑ Archives - Neuroxeirourgos.gr

Minimally invasive surgeries applied in the treatment of osteoporotic fractures

Georgios Dimogerontas — Thu, 22 Nov 2018 07:44:01 +0000

Dr. Georgios Dimogerontas, MD, MSc, PhD* explains what the osteoporotic fractures of the spine are and describes their new treatment methods.

What is the cause of the osteoporotic fractures of the spine?

The main causes of the osteoporotic fractures are the primary and secondary osteoporosis. The most common types of the primary osteoporosis are the postmenopausal osteoporosis, the age-related osteoporosis, and the idiopathic osteoporosis.

Which other factors may lead in an osteoporotic fracture?

Factors causing secondary osteoporosis are diabetes, Cushing disease and syndrome (hypercortisolism), hyperparathyroidism, chronic use of corticoids, sickle cell anemia, multiple myeloma, and prolonged immobilization for any reason.

How old are the patients that get osteoporosis?

In Greece, 19% of women and 11% of men over 60 years old get osteoporosis.

How common are osteoporotic fractures in the general population?

25% of women after menopause may get a vertebral compression fracture. The older the age, the higher the percentage. This can reach 40% in women over 80 years old.

Is a lot of force required for an osteoporotic fracture?

Unfortunately, osteoporotic fractures can take place with no special force, even automatically on several cases, that is without the patient suffering an injury. This is because of the fragility of the vertebral bodies that have the texture of a biscuit.

What are the signs of an osteoporotic fracture?

Intense pain in the spine or the lower back that does not respond satisfactorily to painkillers and anti-inflammatories is the most important symptom of an osteoporotic fracture at early stage. If it is left untreated, it can lead to body malformation (kyphosis or scoliosis) and neurological symptoms, such as weakness in walking, leg numbness, and urine and fecal incontinence or retention.

What is vertebroplasty and kyphoplasty?

Vertebroplasty and kyphoplasty are two similar, percutaneous, and minimally invasive surgeries (MIS) that are applied in the treatment of osteoporotic fractures. In both methods, a thin tube is placed in the body of the broken vertebra with the assistance of the portable X-ray machine (C-arm) or the surgical imaging system (O-arm). If the latter is used, acrylic cement is injected in order to strengthen the desalinated bone.

Before the cement injection in kyphoplasty, the doctor first tries to restore the broken vertebra with the assistance of a balloon that inflates within the bone.

What are the benefits of kyphoplasty?

Percutaneous kyphoplasty achieves two goals: pain is relieved with very small incisions in the spine or the lower back and kyphosis is treated, which leads to the restoration of the lost height due to the broken vertebral body.

However, the most important benefit of this method, especially to older patients, is the swift recovery with immediate mobilization and the ability to self-care.

When is the right time for kyphoplasty?

When the conservative treatment of the osteoporotic fractures is unsuccessful, the application of the aforementioned minimally invasive surgeries is required in order to relieve patients from pain and to prevent complications, such as severe kyphosis and the limited inflation of the thorax (that is the decrease of the breath depth), which can lead to pneumonia or pulmonary atelectasis, as well as complications due to chronic bed rest—especially to older patients, such as pressure ulcers, deep vein thrombosis, and lethal pulmonary embolism.

Who else could benefit from the advantages of kyphoplasty?

Tumor patients suffering from pathologic fractures either because of multiple myeloma or because of osteolytic metastases to the spinal bones and patients with painful traumatic fractures without spinal instability of spinal canal stenosis from detached splinters of bone.

How long does the patient need to remain hospitalized after kyphoplasty has been performed?

Patients mobilize immediately after the percutaneous kyphoplasty and are usually discharged in less than 24 hours.

Are there any advancements in kyphoplasty? What are the advantages of the new techniques?

One of the most recent advancements in kyphoplasty and vertebroplasty is the use of the O-arm (surgical imaging system) (Image 3) in combination with Neuronavigation (medical GPS) (image 4). The use of this technology—which is unfortunately only found in some clinics in Greece—gives us the ability to perform this kind of operation very precisely, eliminating the risk of any neurological complications.

To sum up, what are the advantages of the minimally invasive techniques of vertebroplasty and kyphoplasty?

The most important advantages of these techniques are:

Very small incisions
No loss of blood
No postoperative pain
Short period of hospitalization

And, of course, the swift recovery with no bed rest and its complications (pneumonia, pressure ulcers, vein thrombosis in the lower limbs, pulmonary embolism, etc.).

*Dr. Dimogerontas Georgios is a Neurosurgeon – Spine Surgeon, Director at the Neurosurgery Clinic of the METROPOLITAN HOSPITAL

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Migraine and nutrition

Georgios Dimogerontas — Tue, 13 May 2014 13:59:02 +0000

Written by Dietitian-Nutritionist, Dimitra Balaska

A migraine is a chronic neurological condition and its main symptom is intense pain in either half or the entire head. It lasts between 2 and 72 hours and it is accompanied by symptoms such as nausea, vomiting, photophobia (increased intolerance to visual perception of light) or phonophobia (a fear of or aversion to loud sounds). Exact mechanisms leading to a migraine are not known but it is believed that they are caused by a mix of environmental and hereditary factors. It is worth mentioning that fluctuations in hormonal levels can play a part since women suffer from migraines two to three times more compared to men. It is also impressive that migraines stop during pregnancy.
Nutritional factors, such as intolerance to certain foods and defficiency of specific nutrients, as well as stress, can cause migraine attacks.
It is estimated that 20% of migraines are caused by intolerance to a certain food. Foods with vasoconstricting properties can cause migraines to vulnerable groups. Foods with such properties are red wine, beer, yogurt, milk, tea, coffee, sausages, cola-type drinks, chocolate, aspartame, and monosodium glutamate used as flavor enhancer at Chinese restaurants.

Hypoglycemia is another factor that may cause migraines. Foods causing a migraine after hypoglycemia are chocolate, cheese, citrus fruits, banana, nuts, cereal, beans, and pizza.
Finally, riboflavin (vitamin Β2) and magnesium (Μg) deficiency appear to have a correlation with migraines.
However, you need to note that foods causing migraines to someone may not affect someone else and food intolerance limits may vary from time to time, even in the same person!
Because of this reason, there are no general instructions regarding the avoidance of certain foods and the assessment is performed on each patient individually.
It is, therefore, clear that migraine attacks are related to each individual’s nutrition and thus the collaboration of the dietitian and the doctor is important both for the prevention and the treatment of the migraine symptoms.

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Low back pain and weight

Georgios Dimogerontas — Sun, 09 Feb 2014 15:58:06 +0000

Lower back pain and weight

Demeter Balaska

Dietitian-Nutritionist

Lower back pain or lumbago is the pain in the lower part of the back. It is a symptom (not a disease) and it concerns any pain in the lumbar spine regardless of the causing factor. It can appear suddenly after an abrupt movement or gradually and it gets worse as time passes by. Intense pain is felt around the lower back and it may also be felt in the thigh and it may be accompanied by numbness in the toes. It is one of the most common symptoms someone can have since 80% of the population have experienced it at least once in their lifetime.

Lower back pain is the second leading reason for missed workdays among employees while the first leading reason is the flu. It can affect anyone at any age, but it is more common in people between 30 and 60 years old. It has been observed that in younger people, the pain is usually temporary, while in older patients it is usually chronic. Several factors seem to affect it, such as age, gender, heredity, and the general health condition. Obesity is also considered a factor that turns simple lower back pain into a chronic problem. A recent study (Smuck, 2013) in about 7,000 Americans showed that lower back pain appearance depends on the Body Mass Index (BMI), which shows the severity of obesity. The likelihood of getting lower back pain in people with a normal BMI (ΒΜΙ = 20–25) is only 2.9% but it rises to 11.6% in obese people with a BΜΙ > 36. Exercise seems to decrease this risk, especially in people with a BMI from 26 to 36 (overweight and obese people).

How can lower back pain be treated if the patient is obese?

The first step is weight loss and daily exercise. The main muscle groups that need to be exercised are the abdominal, latissimus dorsi, posterior chain, and gluteal muscles. Sports that exercise the entire body, such as swimming, should be preferred. However, each person is unique and everyone should ideally follow a customized exercise program with the guidance of a trainer.

Regarding weight loss, patients can follow the below mentioned tips:

• Breakfast. It is considered one of the most important meals of the day as it “breaks” the night fasting. Numerous studies have proven that those who don’t have breakfast are 4.5 times more at risk to become obese. Moreover, an intervention study showed that people who started to eat breakfast lost up to 7.7 kilos in contrast with those who kept on not having any breakfast.

• Adequate sleep. There is a correlation between obesity and lack of sleep. A study has shown that those who sleep less than 5 hours a night are 65% more likely to become obese in comparison with those who sleep 7 hours a night.

• Frequent meals. This means three main meals and two small meals in between. Several studies have proven that frequent meals help in hunger and portion control as well as in the prevention of junk food consumption. On top of that, blood glucose
levels are kept balanced.

• Mediterranean diet. This is the first draft of a balanced diet. To follow this diet, fibers such as wholegrain cereal, fruit, and vegetables need to be consumed on a daily basis along with 2–3 servings of dairy and a bit of olive oil. On a weekly basis, 1–2 servings of cooked vegetables, 1–2 servings of fish or seafood, 1–2 servings of legumes, and 1 serving of chicken should be consumed. Finally, red meat should only be consumed twice a month.

• Portion control in each food group. Portion control is necessary for a successful weight loss attempt and also a balanced diet. You can find more information about this in the medNutrition awareness campaign “size…matters!”

• Adequate water consumption. Correct hydration of the body enables nutrients to be absorbed by the cells as well as the toxins to be released.

Finally, it should be noted that quite often, lower back pain needs to be treated surgically. If the patient is obese, they need to follow a weight loss program both preand postoperatively because the extra weight encumbers the spine and this makes recovery more difficult. In these cases, weight loss should be achieved gradually and under the dietitian’s guidance, always in collaboration with the spine doctor (usually a neurosurgeon or rarely an orthopedic surgeon).

You can find information about the surgical treatment of spinal diseases on this website.

Bibliography

Μa Y., Bertone ER, Stanek EJ. Association between eating pattems and obesity in a free-living US adult population. Am J Epidemiol. 2003;158(1):85-92.

Smuck M, Kao MC, Brar N, Martinez-Ith A, Choi J3, Tomkins-Lane CC.Does physical activity influence the relationship between low back pain and obesity? Spine J. 2013;Nov 12. pii: S1529-9430(13)01649-5. doi: 10.1016/j.spinee.2013.11.010

Zoumbaneas Ε. Manolarakis Μ.
How are we supposed to eat, what will you cook… today mom? P. 15-21 Athens: Ellinika grammata.

Papalazarou Α. Knowledge, Thinner in 5 steps. P. 82-119 Athens: Ellin.

Symeonidis P. Diseases and injuries of the Musculoskeletal System, Orthopedics. P. 174-178 Thessaloniki. University Studio Press.

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Discoplasty with Discogel

@dmin_gd28 — Tue, 05 Nov 2013 09:28:40 +0000

Discoplasty is one of the most modern and minimally invasive treatment methods for lower back pain without sciatica, for dorsodynia, and also the neck pain caused by discopathy (degeneration of intervertebral discs, black disc) or a disc herniation.

It can be combined effectively with the MAST treatment in order to treat this disease. Discoplasty and MAST treatment

It consists of the subcutaneous placement of a viscous solution (gel) that contains ethyl alcohol, cellulose, and an imaging material (tungsten) in the inside of the degenerated intervertebral lumbar or cervical disc.

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The role of Minimally Invasive Surgery in modern neurosurgery

@dmin_gd28 — Tue, 05 Nov 2013 08:34:43 +0000

In 1762, Dr. Hunter wrote about surgeries in general: “Knowledge will turn surgeries into operations without a knife and with no blood loss!” The end of the 20th century was marked by the establishment of the laparoscopy. Since then, operations are being performed with the smallest incision possible. At the same time, along with minimally invasive surgeries, Μinimal Invasive Neurosurgery started to develop regarding brain and spinal diseases. Rapid technological advancements boosted the application of this concept in almost every neurosurgical disease, spanning across the most common one to the rarest one.

Brain Minimally Invasive Surgery

Modern models of Neuronavigation help the neurosurgeon to navigate in the treatment, even of the most inaccessible brain damages from craniotomies of a few square centimeters (keyhole craniotomy). Benign (meningiomas, acoustic neuromas, pituitary adenomas, craniopharyngiomas, hemangioblastomas) and malignant
(astrocytomas) brain tumors, primary or secondary (brain metastases), aneurysms, and arteriovenous malformations (AVM) are nowadays surgically treated with the assistance of Neuronavigation and microsurgery tools under a surgical microscope.

Read the rest of the article by clicking on the link below:

The role of Minimally Invasive Surgery in modern neurosurgery

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