Spinal Surgery

Istituto Ortopedico Galeazzi

key figures 

CLINICAL SERVICES:

  • Degenerative Spinal Disease Treatments
  • Disc Pathology Treatments
  • Vertebral Fractures Treatments
  • Vertebral Infections Treatment
  • Vertebral Deformities Treatments

PROCEDURES PERFORMED PER YEAR:

  • About 250 surgical procedures

Clinical activity is strongly focused on degenerative spinal diseases (cervical, thoracic, lumbar), the disc pathology (cervical, thoracic, lumbar), vertebral fractures (traumatic, pathologic, osteoporosis) and vertebral Infections.

In particular, the interest is addressed to vertebral deformities (scoliosis-kyphosis), congenital infantile neurological pathologies and neuromuscular from childhood, juvenile and adolescent idiopathic rare syndromes.

Teaching activity includes lectures and tutoring for orthopaedic residents from the University of Milan. Dr. Marco Brayda-Bruno is the Director of Spinal Research at the Galeazzi Research Hospital and a Scientific Chairman of the Italian Scoliosis Foundation.  

TREATMENTS

Spine Deformity 

A spine deformity can arise in both pediatric and adult patients.

In pediatric population, our team has a great expertise in diagnosing and treating Adolescent Idiopathic Scoliosis (AIS).   We use low-dose X-Rays for diagnosis and follow up, that are fundamental in defining the position, magnitude and progression of the curve. Conservative treatment is proposed for low and moderate severity curves, and consist sometime in casting and/or bracing with custom made braces based on 3D body surface scans and CADCAM preparation. When necessary, we have a specific experience and skill in surgical treatment:  a personalized surgical plan is proposed to the patient and family. We perform correction either by posterior and anterior approaches, and we use the most recent technologies and mini-invasive corrections when indicated.

Spinal deformity in adults (ASD) can have a major impact in quality of life. Our team is focused in diagnosing and treating such conditions. Diagnosis is based on imaging techniques such as X-Rays, CT and MRI. The type and extent of deformity, as well as associated pathologies are studied, and a personalized treatment plan is proposed. We have great experience and skill in surgical correction of multiplanar deformities, both with posterior and anterior approaches. In particular, by translating basic research in clinical practice, we try to achieve the best long-term results for each patient.

Infantile Patients 

This unit has a broad expertise in treating spinal deformities in infantile and juvenile patients. We have a particular focus on early onset scoliosis, either idiopathic or secondary to congenital anomalies, rare syndromes or neuromuscular diseases and cerebral palsy. Each patient will receive personalized care, based on the most advanced research and innovations translated into clinical practice. Diagnosis is made with physical examination and low dose X-Rays, that are used to determine the location and magnitude of the curve. Our team has a long-time (more than 20 ys) experience with both conservative and surgical treatments. Conservative treatment can consist in serial casting and in the use of personalized braces based on 3D body surface scan. Concerning surgical treatment, several growth friendly systems can be used in patients with a growing spine, to correct the deformity without stopping trunk growth. Among those, we have specific experience with the Shilla growth guiding system and with growing rods, either standard or magnetically controlled.

Back Pain and Degenerative Cervical & Thoracolumbar Spine Patients

Among the volume of spinal diseases that we treat, back pain caused by degenerative conditions is one of the most frequent. Degenerative disorders of the spine are one of the most common condition in the adult population. Since very often some degenerative changes could be encountered in asymptomatic patients, a careful diagnosis of the specific problem is mandatory for proper treatment. Our approach is based on a multidisciplinary diagnostic evaluation, with in depth physical examination and first and second level imaging techniques (CT and MRI). After the diagnosis is established, a personalized treatment plan is proposed. Conservative treatment is based on physiotherapy, use of braces and spinal injections. When indicated, surgical treatment can be a solution. Our unit has a great expertise in both open and mini-invasive approaches to the spine. In particular, the team has expert skills in open and mini-invasive anterior approaches either to the cervical and thoracolumbar spine.

Research Activity

Besides clinical activity, the other main focus of the team is Research in Spinal Pathology. Dr Marco Brayda-Bruno is actually the Director of Spinal Research inside the Galeazzi Orthopaedic Research Institute.  Researches are aimed at a better understanding of physiological and pathological spine biomechanics, of the basis of disc degeneration and to increase the quality of our clinical practice.

Our research program is actually based on:

  • Cooperation with the Biomechanical Lab in elaborating Finite Elements Models of the spine and pelvis, used to test the stress on spinal structures and implant configurations
  • 3-D spine reconstructions using the Ster-EOS software, based on low dose X-Rays, that allows to study the tridimensional structure of the spine and the changes occurring with ageing, disease and surgical interventions
  • Biologic and genetic research projects on lumbar disc together with our Cell BioLab experts
  • Research projects based on clinical practice and registry evaluation used to evaluate the state of current practice and to identify areas for improvement
  • Clinical testing of new devices and surgical strategies

Among the current ongoing research, some projects are worth to be mentioned:

  • Evaluation of lumbopelvic fixation through Finite Elements Model analysis
  • Assessment of different surgical techniques in 3D correction of spine deformity
  • Prospective assessment of the surgery related Adverse Events
  • Cell and genetic study on Vit D receptors inside the lumbar disc, to assess the possible pathways of its degeneration (DDD)