Minimal Invasive Surgery

We always offer the minimal and most effective non-invasive surgical methods, handling our patients in what we feel would most help them. Invasive surgical therapy is offered individually according to the patient’s needs and as a final resort. Minimally invasive procedures for treating back pain, neck pain and disc prolapse problems have undergone great recent development globally and are done under local anesthesia to solve most of back and neck complaints. All those procedures are available at Montreal International Clinic performed by our highly-experienced Neuro-spinal consultants with global experience in Europe, Canada and the USA.

New technology allows the use of these techniques:

• Transforaminal epidural block
• Disco gel injection
• Facet joint and sacroiliac joint block
• Radio frequency neurotomy

These procedures are minimally invasive and are done under local anesthesia with no hospital stay.

About Minimally Invasive Back Surgery

Advanced technology now enables surgeons to perform surgical techniques, which formerly required long incisions, with minimally invasive techniques where the incisions are very small. This sophisticated technology is continually being refined but is already available for several back/spine problems that cause chronic pain or disability.

Several forms of minimally invasive surgery exist, each ending in “scopy” to indicate that the procedure is performed through a small scope. Each procedure treats a specific area. Epiduroscopy is the specific surgery for the back and spine. Its name refers to the epidural space and the scope technique. A fiberoptic scope reviews the epidural area around the spinal cord for scarring that can cause irritation and pain on the nerves. Removing the scars from the nerve roots can relieve the pain often more successfully than other back treatments. The surgeon performs minimally invasive surgery through a series of several incisions or punctures rather than the large incisions of traditional surgery. Each incision is typically less than an inch in diameter. The surgeon then introduces a thin, lighted tube an endoscope through one of the incisions. A tiny camera shows a video view of the patient’s body on screens. This enables the surgeon to view the surgical area closely. Specially designed, thin surgical instruments also go through other incisions. Computer guidance helps the surgeon navigate precisely and monitor the nerves during the procedure. The small incisions are sutured and protected by surgical tape.

The procedures used in minimally invasive back surgery have improved and expanded over the years to cover a wide variety of back problems. Although not every back problem can be treated this way, many can, and others are being added as the technology and surgical training evolves. Among the conditions that can currently be treated are back pain, neck pain, sciatica, herniated discs, spinal stenosis, deformities such as scoliosis, spondylolisthesis, degenerative disc disease, spine fractures, spinal fusion, infection and tumors.

Advantages

• The small incisions used in minimally invasive spine surgery have numerous benefits for the patient, including less pain after the surgery and less trauma to the surrounding muscles, nerves and soft tissue. In traditional surgeries, these often result in the need for the patient to have physical therapy to regain his strength. Less invasive techniques result in less loss of blood and fewer, lighter scars. Recovery from the surgery is dramatically shorter, from the potential year-long recovery from major back surgery to a few months or less, with the patient able to return to work and his normal activities much sooner. In fact, some back procedures can even be performed as outpatient surgery.

Epidural Nerve Block

Epidural nerve blocks are corticosteroid injections, which are used to decrease pain and inflammation caused by a herniated disc, sciatica, or spinal stenosis. Safe and effective, this treatment option may offer you substantial pain relief without surgery. With the help of today’s technology, the pain specialists accurately diagnose, target, and relieve the source of pain, to help you return to an active lifestyle.

What is an epidural nerve block?

An epidural nerve block is the injection of corticosteroid medication into the epidural space of the spinal column. This space is located between the dura (a membrane surrounding the nerve roots) and the interior surface of the spinal canal formed by the vertebrae.

After a local skin anesthetic is applied to numb the injection site, a spinal needle is inserted into the epidural space. To ensure accuracy and safety, our physicians perform the procedure under fluoroscopic (x-ray) guidance, using a contrast agent to confirm needle placement. Local anesthetic and corticosteroid anti-inflammatory medication are delivered into the epidural space to shrink the swelling around nerve roots, relieving pressure and pain.

How long does it take?

Epidural nerve blocks are performed on an outpatient basis. The procedure typically requires 20 to 30 minutes, including preparation time. It is followed by 45 minutes of observed recovery time.

How often should this procedure be done?

Up to three injections may be given within a six-month time frame. Usually, the injections are performed two to three weeks apart. A set of three injections is the norm; however, you may gain considerable relief after the first or second injection. In that instance, further injections may not be necessary.

What are the expected results?

Epidural nerve blocks are very effective in providing pain relief. The benefit of these injections will typically occur two days following the procedure. In conjunction with physical therapy, many individuals enjoy a pain free lifestyle.

Stop pain from interfering with your life. Resolve your symptoms with help from the board-certified pain specialists at Capitol Spine & Pain Centers.

Therapy of Disc Herniation with DiscoGel

The latest development in this area is the intra-discal micro-therapy with DiscoGel®. This treatment method, which was developed by French researchers, utilizes a congealed alcohol mixed with a contrast agent, which is injected through a thin cannula directly into the intervertebral disc. The compound results in a loss of the water storage capacity of the intervertebral disc by denaturation the proteoglycan matrix of the nucleus pulposus. This, in turn, results in a progressing decompression of the affected spinal nerves within hours to a few days.

The interventional procedure can be carried out on an out-patient basis in local anesthesia and without pain. The success rates are high: 80 – 90 % of all patients are without symptoms and free of complaints within three months after treatment.

A: Disc herniation with nerve root compression. B: DiscoGel® injection into the nucleus pulposus of the prolapsed disc. C: Beginning contraction of nucleus pulposus and disc herniation with partial relief of nerve root and pain relief. D: Complete retraction of disc prolaps with complete relief of nerve root.

Advantages of DiscoGel® in Comparison with other Treatment Methods

• Minimally invasive method with low risk
• No surgical access to the spinal canal necessary
• No scarring,  no ‘failed back syndrome’, no impediment to future therapies (including surgery)
• Out-patient procedure, hospital stay not necessary
• No need for lengthy post-surgical physiotherapy
• High success rate (80 – 90 %)

Diagnostic and Micro-Therapeutic procedure for Disc Herniation

To assure optimal treatment results, diagnostic workup, indication for treatment and actual therapy are carried out in an interdisciplinary fashion by a team of Radiologist, Orthopaedic Surgeons, Neurologists and Anaesthetists.

• Medical history-taking and re-view of medical records from other institutions (patients should bring all already existing medical records with them)
• Special MRI-diagnostics, in necessary under axial load
• Neurological diagnostic work-up, if necessary
• Diagnostic micro-therapy with local anesthesia of the irritated nerve root for precise identification of the source of the complaints
• Treatment with DiscoGel®, if necessary, in combination with peri-radicular therapy
• Follow-up MRI, 10 days after the procedure and in 3 and 6 months

How long does it take?

The treatment with DiscoGel® takes between 20 to 40 minutes and is carried out under local anesthesia. Additional general relaxation of the patient during the treatment is affected by medication that causes mild sedation and analgesia (pain relief). After the treatment, a two-hour period under medical observation in one of our private patient lounges is recommended. A longer stay as an in-patient is not necessary.

Three months after Discogel treatment: Sagittal (left) and axial (right) T2w-MRI-images of the same patient: The disc herniation has disappeared completely. The patient was free of symptoms at the time of the treatment.

Facet Block or Selective Nerve Root Block

What is a Facet Block (Injection)?

The facet joints are paired joints on the side of the midline at each level of the spine. A facet block is a procedure in which a needle is placed into the facet joint under imaging guidance for the nerve root block injection of a local anesthetic and/or steroid. A facet joint injection may be performed at one or multiple levels and on one or both sides (right/left) of the spine. Chief of Neuroradiology, heads our team of imaging physicians, nurses and technologists who specialize in this procedure.

Why Has My Doctor Ordered a Facet Block?

The facet block is a diagnostic test to localize the source of your pain by determining if your pain responds to the injection of medication. Alternatively, this procedure is used to treat symptoms arising from facet joint arthritis.

How is the Facet Block Procedure Performed?

The precise location for the needle placement is determined with imaging guidance. You may experience brief, temporary sensations of pain or an electric shock sensation down the leg. Iodinated contrast is injected to confirm the location of the needle tip.

A radio frequency neurotomy is a type of injection procedure in which a heat lesion is created on certain nerves with the goal of interrupting the pain signals to the brain, thus eliminating the facet pain.

A medial branch neurotomy affects the nerves carrying pain from the facet joints, and a lateral branch neurotomy affects nerves that carry pain from the sacroiliac joints.

These medial or lateral branch nerves do not control any muscles or sensation in the arms or legs so there is no danger of negatively affecting those areas. The medial branch nerves do control small muscles in the neck and mid or low back, but the loss of these nerves has not proved harmful.

Success Rates of Radio frequency Neurotomy for Pain Relief

Before this procedure is undertaken, the joints and branch nerves will have already been proven to be painful by a diagnostic form of spinal injection, and will not have responded to other treatment methods. If effective, the neurotomy should provide facet or sacroiliac joint pain relief lasting, at least, nine to fourteen months, and sometimes much longer. After this period of time, however, the nerve will regenerate, and the facet or sacroiliac joint pain may return.

Success rates vary, but typically about 30% to 50% of patients undergoing this procedure will experience a significant facet or sacroiliac joint pain relief for as much as two years. Of the remaining patients, about 50% will get some pain relief for a shorter period.