Dr. Marko Aleksić is specialist in orthopedics with traumatology. His specialist approach are painful conditions of the spinal column, treatment of disc herniation, degenerative stenosis, spondylolisthesis, spinal deformities in children and adults, tumors of the spine and diseases of the cervical spine. At the Atlas General Hospital, Dr. Marko Aleksić was preparing for two spinal surgeries, one of which was spinal nerve decompression.
Spinal nerve decompression
Dr. Marko Aleksić: “ First, I perform a facet block – the block of the medial branch of the sensitive root of the lumbar spine, which is a very common cause of severe lumbar pain. Low back pain is very often caused by pain in the small joints of the spine, they are called facet joints. In that way, we give medicine to the joints, we denervate the nerve that innervates that joint. In this way we remove the pain. Under X-rays, special needles are used to insert the drug and anesthetic, and quite long-lasting effects are obtained. ”
This procedure has a double meaning, primarily in terms of diagnosis, which is important for further treatment.
Dr. Marko Aleksić: ” If we get a significant loss of discomfort and disappearance of pain, later we can count on some more serious procedures to lead to permanent loss of pain and permanent improvement. With certain medications, we remove problems for patients in the long run, so that they can be pain free for six months or even a year with this procedure. This procedure is very successfully performed in the lower lumbar spine, that is, the fourth and fifth lumbar vertebrae and the first sacral vertebrae. ”
While watching the magnetic resonance imaging, Dr. Aleksić was preparing for the second operation.
What is the diagnosis and what procedure will be applied?
Dr. Marko Aleksić: ” Two years ago, the patient had disc herniation surgery in another institution, without stabilization. There is now a neurological worsening, as well as a worsening of the pain, due to the resulting, practically, iatrogenic instability of the lower lumbar spine. We are planning revision surgery. Decompression of the spinal canal, roots and stabilization with instrumentation, with the system, with screws as well as fixation of that complete segment. This should completely reduce the patient’s discomfort, with a single 360 degree lumbar fusion. We will work between the discs of the intervertebral vertebrae as well as the back of the spine, so it is a complex procedure. Revision surgery is always complex and you never know what may be encountered, unlike the first surgery. ”
The patient is a young man who had great difficulties that eventually brought him to the surgeon.
Dr. Marko Aleksić: ” The patient is 38 years old and the primary causes were disc herniation and sciatica. Although surgery without instrumentation can remove problems in the short term, in the long run, in patients who have arthrosis, ossification and damage to the joints of the spine, it is not a very good solution and surgery with instrumentation should be done. This would prevent late consequences such as post-axial instability, severe lumbar pain and worsening of the condition, which then requires a much more extensive procedure. ”
What does spinal surgery with instrumentation mean?
Dr. Marko Aleksić: “For the first time, a simple surgery was performed, without instrumentation, without implants. The extruded part of the disc- the disc that entered the canal and pressed on the nerves, was removed. A more complex procedure is now being performed with screws, implants that go between the vertebral bodies. The complete segment is being fixed with the revision procedure of releasing all nerve structures, leaving grafts which later lead to fusion or fixation of the spine. ”
The difference between orthopedists and neurosurgeons who deal with spinal surgery
When we say orthopedist, we usually think of the knee, hip, shoulder, but Dr. Aleksić is an orthopedist – a spinal surgeon. So far, we have met neurosurgeons who are also spinal surgeons, and we were interested in what the difference is.
Dr. Marko Aleksić: “ Orthopedists and neurosurgeons deal with the spine, essentially, the spine is dealt with by someone who knows the job, whether he is an orthopedic surgeon or a neurosurgeon. In the case of hand surgery, where the specializations of plastic and orthopedic surgery intertwine, this is the sphere of intertwining neurosurgery and orthopedic surgery. ”
Orthopedists who deal with the spine deal exclusively with the spine issues. Our interlocutor belongs to the younger generation, but he already has a lot of experience.
Dr. Marko Aleksić: ” I have been working in the spine department for twelve years – that is my job exclusively, I have been specialist for five years. I have been working at the Institute for Orthopedic Surgery for twelve years at the Spinal Center. ”
There is practically no man that is always spine pain-free, it is a disease of modern man. Modern medicine has made a lot of progress in this area. How much do we in Serbia monitor and apply these achievements?
Dr. Marko Aleksić: “Atlas Hospital uses cutting edge technology, we use the latest methods, and spinal surgery is the branch of orthopedics and neurosurgery that is advancing in the fastest possible way. Spinal surgery is galloping forward with the latest technologies and we are following these technologies with accuracy. ”