SPINAL SURGERY

Istituto Ortopedico Galeazzi

key figures 

CLINICAL SERVICES:

  • Adult Spine Deformity Surgery
  • Spine Tumour Surgery
  • Revision and Failed Back Surgery
  • Cervical Spine Surgery
  • Minimally Invasive Spine Surgery

PROCEDURES PERFORMED PER YEAR:

  • 150 Cases of complex adult deformity
  • 70 Cases of Spinal Tumour Surgery including:
    • Spinal en-bloc resection
    • Curative tumor resection
    • Neurological decompression and carbon-fiber instrumentation
  • 250+ revision procedures including:
    • Combined anterior and posterior approaches to the spine
  • More than 150 minimally invasive procedures including:
    • XLIF
    • ALIF
    • Micro discectomy
    • Endoscopic herniated disc resections
  • 100 Cervical spine cases
  • 150 Paediatric cases of scoliosis and kyphosis/Scheuermann's disease

The Spinal Surgery Unit, also known as G4Spine, is highly specialized in the treatment of a wide range of spinal pathologies. It is composed of a team of expert surgeons and is widely regarded, on international scale, as one of the best centres for the treatment of complex cases.

The clinical activity is strongly directed to the treatment of the deformity of the spine, with particular regard to the minimally invasive therapy to complex vertebral pathology (mini-invasive anterior arthrodesis with XLIF technique, medullary decompression and microsurgical treatment of thoracic disc herniation by minimally invasive anterior techniques, vertebral stent implantation for osteoporotic fractures, replacement of vertebral bodies for correction of kyphosis deformity in sequelae of severe fractures, micro discectomy for recurrence of lumbar disc herniation. 

 

treatmentS

Adult Spinal Deformity Surgery

The GSpine4 Unit has a widely recognized team specialised in the treatment of adult deformities. The Head Physicians, Dr. Claudio Lamartina and Dr. Pedro Berjano, are recognized worldwide as two of the most eminent experts in adult spinal deformities involving the back, and the head and neck. Complex adult deformity treated with a 5-year record of zero mortality and low infection rate make of the GSpine4 service probably the most reliable and expert group in the continent for this type of conditions. They have extensive knowledge in all the surgical approaches (anterior, posterior, lateral, open and minimally invasive) and techniques, including osteotomies of the spine, to provide tailored solutions to their patients. Dr. Lamartina and Dr. Berjano with their team have innovated spinal care with new techniques such as corner osteotomy, advanced use of hyperlordotic cages through minimally invasive anterior approaches, new classifications of adult deformities that provide guidance to choose the most appropriate procedures. GSpine4 has published more than 100 peer reviewed articles on the topic.  

Main Pathologies Treated:

  • Cases of adult scoliosis
  • Kyphosis
  • Scheuermann's disease
  • Post-fracture deformity of the spine
  • Post-surgical deformity of the spine
  • Forward and side bending position

Top Procedures:

  • Surgical Approaches
    • anterior, posterior, lateral, open and minimally invasive
  • Spinal Osteotomy
    • Corner osteotomy and pedicle subtraction osteotomy (PSO)
  • Advanced Use of hyperlordotic cages
  • Minimally invasive scoliosis treatment

Spinal Tumour Surgery

After the arrival of Dr. Stefano Boriani in 2017 into the GSpine4 Unit, the Galeazzi Institute has become the leading hospital in Europe for spinal tumors based on its numbers. Dr. Stefano Boriani has been treating primitive and methastatic spinal tumors for over 30 years and is one of the world's leading experts. The series of personally treated tumors of Dr. Boriani is one of the largest by volume, and best documented in the world and his numbers alone equal those of some multicenter series for some uncommon spinal tumoral conditions. He is the author of the best recognized classification of primitive spinal tumors that guides the surgical strategy (the Weinstein-Boriani-Biaggini classification). The joint teamwork of a world-class expert tumor surgeons as Dr. Boriani and other top experts in spinal reconstruction (Dr. Lamartina, Dr. Berjano) provides unparalleled standards of surgical care to our patients.

Main Patholgies Treated:

  • Primitive spinal tumors such as:
    • Cordoma, chondrosarcoma, osteosarcoma, giant cell tumors, aneurismal bonde cysts, osteoid osteoma, osteoblastoma, lynphoma, myeloma, spinal hemangioma
  • Methastatic tumors such as:
    • Breast, kidney, thyroid, prostate and others

Top procedures:

  • Spinal en-bloc resection
  • Curative tumor resection
  • Neurological decompression and carbon-fiber instrumentation in combination with advanced radiotherapy such as:
    • Radiosurgery, Gamma Knife and Carbon-Ion Radiation (adrotherapy)

Revision and Failed Back Surgery

GSpine4 is the leading team in revision surgery and the treatment of failed spinal surgery. In the last decade, the Unit has treated one of the largest series of complex revision surgery cases in the world. As defined by Dr. Berjano and Dr. Lamartina, "we are experts in what other surgeons simply don't attempt to treat". Their research work in revision surgery has focused in the use of powerful corrective techniques such as pedicle subtraction and three-column osteotomies of the spine to address severe post-surgical deformities and in its replacement by less-invasive and highly effective techniques as hyperlordotic anterior minimally invasive approaches.

Main Pathologies Treated:

  • Pseudarthrosis
  • Implant failure and loosening
  • Screw or rod breakage
  • Non-union, persisting spinal or sciatic pain
  • Postsurgical infection of the spine and any other condition in the operated spine that jeopardizes quality of life

Top Surgical Procedures:

  • Revision procedures including:
    • Combined anterior and posterior approaches to the spine
    • Only posterior approaches to fix persistent symptoms after surgery

Minimally Invasive Spine Surgery

Dr. Berjano has led the development of advanced techniques in minimally invasive spinal surgery in Europe for the last 10 years. His research has helped the development of innovations in the fields of lateral access minimally invasive surgery, percutaneous fixation in complex cases, minimally invasive transthoracic procedures, including the treatment of spinal cord compression for giant calcified thoracic disc herniation. Together with Dr. Lamartina they have created a leading team that includes Dr. Damilano, Dr. Cecchinato and Dr. Pejrona that annually train surgeons from all around the world. In recent years they have also extended the field to the treatment of lumbar disc herniation with endoscopic techniques for faster recovery of patients. Dr. Paolo Lepori is an expert in minimally invasive microsurgical treatment of lumbar and cervical conditions and has a 25-year experience in this field.

Main Pathologies Treated:

  • Back pain
  • Spinal stenosis
  • Spondylolisthesis
  • Adult spine deformity
  • Disc herniation
  • Thoracic disc herniation with spinal cord compression

Top Procedures:

  • Minimally invasive procedures including:
    • XLIF, ALIF, micro discectomy and endoscopic herniated disc resections

Cervical Spine Surgery

Dr. Paolo Lepori has treated, for the last 25 years, degenerative conditions and neurological tumours in the cervical and lumbar spine and leads the group in the field of cervical spine pathologies. He is expert in anterior and posterior procedures with and without internal fixation, microsurgical technique and neurosurgical methods for the treatment of neurological tumours of the spine.

Main Pathologies Treated:

  • Neurinoma
  • Ependymoma
  • Meningioma
  • Schwannoma
  • Cervical disc herniation
  • Spondylotic myelopathy
  • Cervical deformity
  • Odontoid conditions
  • Cervical instability

Top Procedures:

  • cervical spine cases covering all the range of this pathology

Thoracic Disc

Surgery for thoracic disc herniation is one of the most challenging fields in spinal science. Patients with severe cases of thoracic disc herniation are at risk for neurological deterioration potentially leading to loss of the ability to walk or lower limb paralysis (paraplegia). The surgical treatment of this very uncommon condition (many spine surgeons never get to treat a case in their professional life) needs expertise and top surgical skill, as improper surgery might lead to the same complications. Dr. Berjano and Dr. Lepori have accumulated broad experience in the treatment of giant, calcified thoracic disk herniation with minimally invasive approaches including microsurgical, transthoracic MIS approaches, even in cases with unsuccessful previous surgery.

Main Pathologies Treated:

  • Thoracic disc herniation
  • Calcified giant thoracic disc herniation

Top Procedures:

  • Minimally invasive surgical procedures
    • microsurgical, transthoracic MIS approaches

Paediatric Deformity Surgery

Dr. Gianluigi Siccardi has joined the GSpine4 Unit to increase the offering previously provided by Dr. Claudio Lamartina in the treatment of the deformities of the paediatric spine. In his first 20 years of experience Dr. Siccardi was trained and then co-worked with Prof. Alberto Ponte, one of the most respected names in the field of spine deformity surgery in the last decades.

Main Pathologies Treated:

  • Adolescent idiopathic scoliosis
  • Kyphosis
  • Scheuermann's disease

 

NOTABLE ADVANCED TECHNOLOGICAL EQUIPMENT

  • O-Arm for intraoperative CT-Scan and navigation guidance of implant placement
  • 3-d Ziehm C-Arm for intraoperative guidance of spinal implants
  • Brainlab navigation technology
  • Surgical microscopes
  • Full XLIF platform
  • Advanced use of percutaneous spinal implants
  • 3-d printed patient-specific guides for increased safety in pedicle screw placement
  • Intraoperative somatosensorily evoked potentials
  • Motor evoked potentials
  • Pedicle screw direct EMG stimulation for increased intraoperative safety  
  • Intraoperative advanced hemodynamic monitoring for safer anaesthesia
  • Postoperative intensive care
  • Advanced imaging including:
    • 3 MRI scans, 2 CT scans, full radiology equipment, interventional radiology, interventional pain therapy and low-radiation, standing 3-d imaging with EOS device for safe evaluation for adults and children