C1-C2 instability (degenerative, congenital, tumors, fractures): cage-assisted C1-C2 fixation

The first (atlas) and second cervical vertebra (odontoid) are crucial for maintaining the stability of the head over the body and ensuring protection to the spinal cord while allowing rotation, flexion and extension. Several conditions (trauma, tumors, and inflammatory diseases) may affect the stability of C1-C2 joint. Avaton Surgical treats these conditions with an innovating technique, which consists in placing titanium spacers between the C1 and C2 vertebrae and fixating these vertebrae with screws under image guidance and neuronavigation. This innovative technique has shown in our series superior rates of bone fusion when compared to other surgical procedures. 

Lumbar disc herniations: exoscope enhanced tubular discectomy

Lumbar disc herniations are common conditions requiring treatment in almost 1/3 of symptomatic patients. The aim is to relief untreatable pain and/or ensuring neurological recovery in case of loss of strength and other neurological damages. Avaton Surgical treats lumbar disc herniation with tubular retractors, which allow to access the spinal canal with minimal muscular retraction and less need for bone resection. Lumbar muscles are distracted and not detached from bone with less postoperative pain and faster return to normal life.

Lumbar stenosis: Minimally invasive lumbar decompression

Spine degeneration frequently causes proliferation of bone and ligamentous tissues in the spinal canal at lumbar level with compression of nerve roots. Patients with lumbar stenosis develop symptoms in the legs such as neurological claudication and shortening of walking distance. Avaton Surgical treats lumbar spinal stenosis with the use of minimally invasive techniques. Through a 2.5-3 cm incision, dilating tubes are introduced to access the spinal canal with minimal muscle dissection, while the use of neuronavigation intraoperatively permits to achieve precise decompression of neural tissues.

Spine tumors : minimally invasive tumor resection

Spine tumors may locate in the epidural space (such as metastasis), in the intradural space (meningiomas) or intramedullary (gliomas). According to the relative location of these tumors to the spinal cord, Avaton Surgical use expanding tubular retractors to achieve tumor resection. Precise exposure of spinal tumors is possible because image guidance (intraoperative fluoroscopic images and MRI) and neuronavigation permit to visualize the tumor and to plan precisely skin incision and bone resection. Tumor and resection is accomplished under exocope guidance with augmented precision.

Vertebral column instability at the cervical, THORACIC, lumbar and sacral region (traumatic and pathological fractures)

Avaton surgical treats spine instability with different surgical techniques depending on the location of the instability: cervical pedicle screw fixation and lateral mass screws fixation, percutaneous thoracic and lumbar pedicle and cortical screw (MID-LIF) fixation. All spinal fixation and fusion procedures are performed under navigation guidance and all instruments are recognized by the navigation software to augment the precision.

Cervical disc herniations: ACDF and  transtubular foraminotomy

Cervical disc herniations are responsible of pain in the neck and arms with specific distributions (cervico-brachialgia) or they may cause compression of the spinal cord leading to myelopathy.  According to the location and characteristic of cervical disc herniations (hard of soft disc), Avaton Surgical treats these conditions with two different surgical procedures: 
 

1. Anterior cervical discectomy and fusion (ACDF) with  removal of the cervical disc, the decompression of neural element and the insertion of titanium 3D printed spacers to promote the fusion between the involved vertebrae.
    
2. Mimimally invasive anterior cervical foraminotomy with no implants: image guidance allows the placement of a tubular retractor directly at the level of the compressed nerve root permitting disc removal and direct nerve decompression with no need for spine implants and vertebral fusion (original techniques available on PubMed).

Thoracic disc herniations: Minimally invasive costo-transversectomy

Thoracic disc herniation are rare affection, touching 1 patients over 1 million of habitants. Due to the frequent compression of the thoracic spine and nerve roots, surgical access to thoracic disc herniation is challenging.  Avaton Surgical uses expandable tubular retractors and neuronavigation to locate the corresponding rib that locate the involved thoracic disc. Through a postero-lateral bone resection, the spinal canal and neural foramen are exposed and the disc herniation is removed through a minimally invasive partial vertebrectomy.

Degenerative disc disease and deformity: MIS-TLIF and XLIF

Disc degeneration if a condition that may require surgery in case of nerve root compression with leg pain, back pain of severe loss of spine alignment. Avaton Surgical treats degenerative disc disease and deformity with minimally invasive surgical procedures;

1. Transtubular transforaminal lumbar interbody fusion (MIS-TLIF) to remove a disc that is the source of back or leg pain and to fuse spinal vertebrae with bone grafts. Inserting the graft from the side one side with a wide bone opening avoids manipulation of the nerve roots during the procedure. The involved vertebrae are consolidated using navigated percutaneous screws. The minimally invasive technique allows smaller incisions than traditional open spinal surgeries, less damage to paraspinal muscles with enhanced patient recovery.
    
2. Extreme Lateral Lumbar Interbody Fusion (XLIF) to accesses the spine from incisions on the side of the abdomen though the retroperitoneal space. XLIF allows the treatment a variety of conditions including herniations, degenerative scoliosis and vertebral instability. Avaton Surgical perform XLIF procedures in association with navigated percutaneous screw fixation to obtain immediate stabilization of the spine and promote bone fusion.

Revision and “salvage” surgery

A large number of patient may lose spine alignment their global sagittal balance as consequence of previous surgeries (decompression, fusions). Malalignment and umbalanced spine may cause chronic back pain and progressive deformity requiring further surgical treatment. Avaton Surgical treat correct malalignment and umbalanced spine thought surgical procedure involving osteotomies and multi-level spine fusion. Preoperatively, patients are evaluated with full spine Xray and a careful surgical planning is formulated to achieve spine realignment and pain relief.