In addition to tumour and vascular diseases of the central (brain and bone marrow) and peripheral nervous system, our clinic has acquired a particular specialisation in the field of spinal diseases (spinal surgery/disc replacement). Our extensive range of medical services includes fusion surgery on lumbar and cervical vertebrae, as well as vertebral replacement, surgery for the treatment of all injuries to the cervical spine, tumour surgery, implants of pain pumps and stimulator systems.
Tumour diseases of the spinal cord and surrounding structures.
Treatment of degenerative diseases of the spine
Infiltration of the nerve root and facet joint, additional diagnoses using myelography.
A surgical solution to the problem may be necessary to address changes in the intervertebral discs, the small vertebral joints or narrowing of the spinal canal leading to neurological malfunctions such as paralysis, numbness between the legs and spontaneous voiding of the bladder or the bowels, as well as for conditions that cannot be adequately resolved by conservative methods. In this regard, we adhere to the principle of "as small as possible, as large as necessary." In a nutshell, this means that we identify the problem afflicting each individual patient and then use purposeful methods for its treatment. What this means in terms of minimally invasive surgery is that, for example, we only perform surgery on the acute disc prolapse/narrowing of the nerve root canal/the narrow segment in order to restore the same degree of spinal mobility as prior to the operation. This form of procedure is particularly suitable if acute pain is radiating into the arms (cervical spine) or legs (pelvic spine).
It is also a good way of treating spinal canal stenosis, provided there is no concomitant instability due to spondylolisthesis.
Some patients experience back pain due to degenerative changes of the spinal column, which may be associated with the radiation of symptoms into the arms or the legs. They include spinal canal stenosis caused by an enlargement of the small vertebral joints, the ligamentous apparatus and spurring on the edges of the vertebrae themselves. We are among the only clinics in Saxony to offer dynamic-functional surgical techniques that are nevertheless stabilising. Besides disc prostheses – which are frequently requested but unfortunately only truly appropriate in a small number of cases – this may involve U-shaped implants that are placed on the cervical spine and the pelvic spine and which have yielded excellent results in our treatments for many years. It is important that the spinal canal stenosis is rectified at the same time. We also use pedicle screw-based implants for the treatment for severe excess mobility of the pelvic spine, which restrict the movement of the damaged segment to a defined range.
Each section of the spine, but mostly the lower pelvic spine, may experience such severe instability that spondylolisthesis may form, caused by pronounced degeneration of the spine or congenital fissure formation. The consequent step-like displacement of the vertebrae leads to stenosis of the spinal canal. Aside from the back pain experienced even at rest, these patients also suffer from claudicatio spinalis (intermittent claudication due to narrowing of the spinal canal). As a result, the distance they are able to manage on foot will be reduced from year to year or even from month to month. Provided there is no permanent paralysis, numbness between the legs or spontaneous voiding of the bladder or bowel, this results in a "relative indication for surgery", so an "optional reason". This means that the patient decides if and when the situation has become unbearable. However, this procedure (naturally) leads to an irreversible – also progressive – narrowing of the spinal canal, so that sooner or later the patient will request surgery.
The spine will experience significant destabilisation when vertebrae are destroyed by osteoporosis fractures, injuries or tumours; in many cases this will prevent effective healing, for instance of a broken vertebra. In bygone days, the common practice was to place patients in a plaster bed for several weeks. In some cases it was even impossible to alleviate the situation when vertebrae had been destroyed by tumours. The transfer of treatment concepts used in general traumatology now allows us to fit implants into the spine such that functionality is restored as a genuine alternative treatment for our patients. Besides placeholders, which are positioned in place of the diseased vertebrae, this involves the use of complex holding systems. We cooperate closely with our colleagues from the Clinic for Trauma Surgery when treating the thoracic and pelvic spine. Problematic cases affecting the cervical spine are traditionally the preserve of the Clinic for Neurosurgery. After reconstruction of vertebrae destroyed by tumours, the patients are frequently referred for further treatment by our colleagues in the Clinic for Oncology and Radiotherapy.
- (refer also to "Vertebral replacement and complex reconstruction of the spine")
The spine is a complex system that consists of stabilising, mobilising and protective components. It follows, therefore, that each injury presents a complex and highly individual problem. At times it may be necessary for this reason that a variety of disciplines are included in the treatment. Patient-adapted treatment is only possible with close cooperation between radiology, traumatology, neurosurgery and intensive care.
In rare cases it may be necessary, but in the interests of the patient, to consider transfer to an even more specialised facility (clinic run by the employers' liability insurance association, paraplegia centre).
Treatment of neurovascular diseases such as aneurysm and angioma
This heading is largely generic and refers to conditions such as stroke, brain haemorrhage, subarachnoid haemorrhage or haemorrhage due to arteriovenous malformation (for instance haemangioma on the brain) that were not caused by an accident, so by a trauma.
We have an efficient partner to assist us in the diagnosis of these conditions thanks to the state-of-the-art equipment at the Institute for Diagnostic and Interventional Radiology.
Stroke patients are primarily treated in the Stroke Unit within the Clinic for Neurology. Neurosurgeons will only become involved in the event of complications such as bleeding or uncontrollable swelling.
For the treatment of aneurysmal subarachnoid haemorrhage (special form of bleeding on the surface of the brain caused by burst vascular spasms), we are able to perform surgery, as well as interventional treatment due to our cooperation with the University Hospital Dresden as part of the certified Neurovascular Network in Saxony.
Transcranial doppler, intensive care capacities and continuously available theatre facilities are provided as a matter of course as minimal requirements for the treatment of these conditions.
Diseases and injuries of the peripheral nerves
Neurosurgeons have always focused not only on the brain and the spinal column, but also on diseases and injuries of the peripheral nerves.
We are among the few clinics to offer diagnostic measures, in addition to surgical procedures. For this purpose, we operate our own Electro-Neuro-Physiological Department together with our colleagues from Neurology. It allows us to perform intra-operative monitoring, in addition to analyses of nerve conduction velocities.
The most familiar disease of the peripheral nerves in our field, namely carpal tunnel syndrome, is caused by a painful narrowing of the nerves in the metacarpus at the wrist, which we treat as an outpatient procedure. In addition, our clinic frequently treats other compression syndromes.
We cooperate with our colleagues from traumatology, as well as from plastic and reconstructive surgery, to perform nerve reconstruction procedures using interposition grafts or the primary implantation of neuro-stimulation electrodes.
Nerve sheath tumours represent another area in which diseases of the peripheral nerves are treated.
Invasive forms of pain treatment
One of the most distressing forms of pain conditions is trigeminal neuralgia. It involves the sudden incidence of invasive, sharp neuropathic pain in the face, which occurs either spontaneously or is precipitated by certain triggers. The precise cause of this painful condition is not known with sufficient certainty, although some people are found to have vascular loops where the facial nerves exist the brain stem. Many years ago, a neurosurgeon named Janetta used this insight to develop his eponymous neurovascular decompression procedure. This involves inserting a pad, usually Teflon wadding, between the vascular loop and the nerves. To perform this surgery, however, it is necessary to create an opening in the skull behind the ear, in order to expose and pad the origins of the facial nerves at the brain stem. Although this procedure has yielded excellent results, the possible complications mean that it is reserved mainly for patients who do not experience adequate alleviation through medicinal treatment or who suffer from intolerable adverse reactions.
For the treatment of chronic pain, our clinic uses implantable pump systems for the administration of analgesics to the cerebral fluid, as well as stimulation systems. A consultation in the Pain Outpatient Centre is a convenient opportunity to discuss which of these treatment options is best suited in a particular instance (refer to the contact details and surgery hours).
Reconstruction of skull and cranium defects
For many years now, the Clinic for Neurosurgery at the Städtisches Klinikum in Görlitz has used implants constructed using 3D procedures to reconstruct bone defects of the skull. We were the first to establish the unilateral approach in tumour surgery. Here, the required implant is not manufactured based on the actual bone defect; instead the anticipated effect is defined prior to the tumour operation, which enables the production of a matching implant and a template before the operation. This means that the continuity of the cranium and the skull can be restored in one procedure. A second intervention is therefore unnecessary.
We also use this procedure in cooperation without colleagues from ear, nose and throat medicine to perform surgery on the face, for instance to treat tumours of the orbital walls or the paranasal sinuses.