Medical Tourism in Croatia - minimally invasive spinal surgeries in Zagreb, Croatia. Neurosurgical clinic Vertebralis, Dr Robert Saftic, neurosurgeon. Vertebroplasty, kyphoplasty, PLDD, disc herniation, degenerative disc disease, spinal fusion, endoscopy.

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CROATIAN MEDICAL TOURISM
Neurosurgery
Neurosurgery
Neurosurgical
clinic
Vertebralis
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2. CROATIAN MEDICAL TOURISM 2
Neurosurgery
Neurosurgical clinic Vertebralis
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CROATIAN MEDICAL TOURISM
Neurosurgery
CONTENT
1. About us
2. Diseases
3. Procedures
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4. CROATIAN MEDICAL TOURISM 4
Neurosurgery
Vertebralis spinal surgery
ABOUT US
The advanced techniques of spinal surgery that are being applied in Vertebralis are minimally invasive towards the disc and the
surrounding spinal tissue.
A prompt scheduling of your exam and beginning of treatment in our clinic, operations under local and regional
anesthesia, operations without loss of blood, small and precise incisions, insignificant post-operative scaring, a
reduction in rate of post-operative complications, diurnal minimally invasive spinal surgery, progressive methods used
in physical therapy and pain treatment are just some of the advantages that we offer in neurosurgical clinic Vertebralis.
In Vertebralis we will focus on you and your medical problem and with the use of multidisciplinary approach minimize your distress
with the goal to enable you to lead a normal and fulfilled life despite your spine ailments.
Our team consists of an anesthesiologist trained for treating pain by using standard medicamental and invasive procedures,
physical therapy and rehabilitation specialist, physical therapist, radiology engineer and neurosurgeons with expertise in minimally
invasive procedures for treating the spine, but who are also specialized in applying all other conventional methods of treating spine
diseases.
Our specialties are laser surgeries, endoscopic discectomy with annuloplasty and METRx decompression surgeries. These methods
represent a combination of minimally invasive surgical approach with the maximum effect in treating degenerative diseases and spine
ailments.
If you are looking for the proper diagnosis of your discomfort or if you are considering choosing a minimally invasive procedure as an
alternative over the traditional methods of performing spinal surgery, our qualified staff will be more than glad to see you and give you
advice on all the treatment options that are available to you.
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CROATIAN MEDICAL TOURISM
Neurosurgery
DISEASES
Lumbar disc herniation occurs when the soft inner part of the
disc slips out of its slot into the spinal canal.
The most common symptom of disc herniation in the lumbar
spine is pain which spreads from the lower back along one
or both legs. It is similar with cervical spine when the pain
extends to the arms from the neck.
Intervertebral disc has a tough outer layer or annulus that
surrounds the inner soft, jellylike center called nucleus.
Disc hernia occurs when nucleus exits from its central part
because of a punctured annulus. In this condition disc tissue
compresses neural roots in spinal canal which leads to pain
irradiation along one or both legs and neurological outbursts.
Between each two vertebra there is a disc whose main role
is to transfer the weight along the spine column. The disc
becomes dehydrated with aging and as such it is more prone
to injuries. Slipped disc is a very frequent condition which can
cause a manifestation of symptoms or remain asymptomatic.
As the disc is situated just underneath the spinal roots, slipping of the disc leads to immediate pressure to those structures and
therefore the development of pain as a first warning sign that something ill is happening in the spine.
When this condition occurs it is imperative to apply an adequate diagnostic method and suggest individually tailored treatment to the
patient.
In the process of diagnosing the problem the first step is a clinical exam and then deciding on further diagnostic procedures and the
course of treatment.
A clinical exam enables the doctor to pinpoint the location of the pain based on the information given by the patient and related
procedures and then to order additional tests to confirm its initial finding.
The MRI exam is a test that gives the neurosurgeon the most information about pathological changes on the spine. Nevertheless,
all other radiological and neurophysiologic tests have their place.
When we are confident that herniated disc is the cause of the patient’s discomfort, in most cases the course of treatment implies
resting and medications until the pain syndrome diminishes.
If the pain does not reduce, consider using ESI and other infiltrations aimed to relieve the pain. After restoring control over the pain
syndrome, individually adjusted physical therapy can begin.
If there is no significant improvement in the functional state of the patient within a month, you should consider undergoing a
neurosurgical treatment. Be advised that postponing of indicated surgery for longer than 4 months since initial diagnosis diminishes
the success of the procedure.
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Neurosurgery
Stenosis of the spinal canal - Spinal stenosis syndrome
represents a group of diverse symptoms caused by chronic
degenerative spinal disease. It is mostly manifested as back pain
or leg pain caused by standing or a brief walk. The pain diminishes
after resting.
Stenosis of the spinal canal is a chronic degenerative spinal
disorder which results with the narrowing of the vertebral or spinal
canal through which spinal cord and nerve roots run.
Like all degenerative spinal diseases, spinal stenosis begins with
disc disorder. Due to degenerative disc disease, biomechanics of
the spine change and relative instability develops. To protect itself
from an unstable position, the spine reacts with strengthening of
other structures that carry the weight of the body – bones, joints
and ligaments.
This process results in cohesion of degeneratively changed facet joints and mostly yellow and interspinal ligaments with the spinal
canal and the narrowing of the canal.
The changed discs often slip out which, along with osteofits that grow of the vertebra body, additionally narrows the spinal canal.
There is little known about the cause of this disorder. It is not common to any race or gender but can be congenital. An inherent
stenosis of the spinal canal is more recurrent and first symptoms usually manifest when patients reach 60 years of age.
It generally occurs in lumbar and cervical spine but can also appear in thoracic spine. The symptoms of stenosis of the spinal canal
develop due to degeneratively changed disc and pressure to nerve roots. The most frequent symptoms are pain in the legs (one or
both), leg numbness, limping, loss of sensation in the legs, loss of bladder and bowel control, leg weakness and back pain.
After neurological exam and CT and MRI scans it is necessary to perform electrophysiological tests to properly asses the state of the
patient and to be able to give an adequate recommendation for further treatment.
The treatment of spinal stenosis begins with medication therapy and physical therapy (with the aim to a raise the level of physical
fitness) and epidural infiltration.
The goal of the operative treatment is to widen the narrowed canal and decompress the adjoining neural structures with the purpose
of stopping nerve tissue deterioration and therefore improve neurological status and relieve pain.
After unsuccessful conservative treatment you should consult your neurosurgeon and consider all the available options of surgical
treatment to select the method best suited for you.
Degenerative Disc Disease (DDD) - Degenerative disc disease is the basis of all spine ailments. This condition is mostly connected
with lower back and neck pain because these are the places where the spine has the widest range of movement.
Although DDD is a condition often seen on x-ray images, only a small number of patients experiences pain caused by this disorder.
As we age, so do our discs.
The first sign of disc aging is dehydration which can be seen on an MRI as so called “black disc”. This condition is not painful in most
cases but if disc damage occurs, it is very likely that DDD will develop into a pain syndrome.
The disc is made up of thick adhesive layer in the shape of concentric rings whose main function is to centralize the soft part of the
disc called nucleus pulposus in the central area.
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CROATIAN MEDICAL TOURISM
Neurosurgery
If a tear or puncture of these connective layers occurs, the soft part of the disc protrudes sideways in a different degree which is
called herniation in the final stage. However, in previous stages it causes chemically induced inflammatory reaction that results in
pain syndrome.
Disc degeneration is a common condition among older population but it can also affect younger people. It is not completely clear
why it occurs but there are very distinct congenital connections.
Apart from heritage, physical burdening of the disc also plays a substantial part as it occurs when a body bends, lifts weight and
makes sudden rotational movements.
When a degeneratively changed disk gets damaged in this manner, an acute pain syndrome develops and, if not treated, turns into
chronically painful condition. The pain mostly spreads to lower back area, hips, and thighs and can extend to legs and arms.
It cannot be precisely determined which range of movements induces disc damage and the pattern of manifestation of pain syndrome
is entirely individual.
Diagnosing this condition begins with a clinical examination and complete neuroradiological work-up that includes RTG and MRI of
the spine.
The damaged disc shows up on an MRI scan as black disc, but not all black discs hurt. Due to this fact, making a proper diagnosis
requires a lot of effort by both doctor and patient.
Discography, one of invasive diagnostic methods, plays a vital role in diagnosing DDD. After making the diagnosis, treatment of
these ailments begins in most cases conservatively, i.e. not surgically.
Individually tailored and carried out physical therapy aimed at selective strengthening of certain part of paravertebral musculature
leads to relieving discomfort in most patients.
Physical therapy is combined with ESI infiltration, methods of neurostimulating facet joints as well as RF rizothomy. If physical therapy
does not lead to improvement and pain syndrome relief, the patient is a potential candidate for surgical treatment.
Some minimally invasive methods as interspinal spacer and TLIF aim to stabilize painfully damaged disc and enable self-healing
which should result in pain reduction. It is very important to consult your doctor and discuss which method would be most suited for
treating your degeneratively changed disc.
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Neurosurgery
Osteoporosis spinal fractures - More than 40 thousand Croats suffer from osteoporosis, the disorder that gradually weakens the
bone matrix.
Osteoporosis can lead to bone fractures or breakage if not diagnosed on time and treated. Along with a hip and joint fracture,
osteoporosis often leads to so called compression fractures of the spinal column.
When this happens, the vertebra shortens which as a result causes severe pain, deformation and loss of height.
In Croatia compression fractures of the spinal column occur annually in more than a 1000 patients. Hip fractures are more common
and often result in longer period of disability followed by extremely painful symptoms.
Up to a few years ago the treatment of osteoporotic spinal fractures was limited to medicament therapy, resting and invasive methods
of spinal stabilization.
Nowadays there are two therapeutic and preventive procedures for treating osteoporotic spinal fractures. They are called
vertebroplasty and kyphoplasty.
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Neurosurgery
PROCEDURES
Epidural steroid infiltration – ESI
Is a certified method of treating radicular pain. The success of ESI has been proven by many controlled case studies, including meta-analysis.
The initial treatment of any lumboishialgy is well known and consists of resting, pain medication, anti inflammatory drugs and physical therapy.
This regime is carried out through a period of six weeks, but physical therapy is indicated as soon as the pain syndrome regresses. If
the pain is severe and constant, ESI can lead to pain relief, reduction of localized nerve inflammation and make a positive impact on
the beginning of physical therapy.
This method is safe, reliable and practically painless and shows excellent results in most patients.
Cervical, thoracic and lumbar facet joints injections – FACET BLOCK
Facet joints are a common cause of back pain and the most frequent cause of LBP syndrome.
If the pain is not caused by a slipped disc and is not radicular, if it spreads to hips, neck, causes headache and back stiffness in the
morning, the most probable cause is inflammatory process in facet joints in the adjoining spinal area.
Patients who suffer from facet joint damage have problems with prolonged standing, often cannot turn their head to the side so
instead they have to turn their whole body and have difficulty getting up from a chair.
Facet joints are in charge of all spine movements. The damage occurs due to arthritis when these joints get swollen and hurt. These
types of injections are used when there is certainty that facet joints are the cause of the pain syndrome.
Minimally Invasive Discectomy
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Selective endoscopic discectomy
A method of spinal surgery that announced the beginning of the period of minimally invasive spinal neurosurgery in the nineties of
the past century.
Since 1991, with the advance of technology and acquiring new knowledge about disc ailments, endoscopic spinal neurosurgery has
been rapidly evolving worldwide.
The concept of this type of operative procedure has derived from relatively unfavorable results of present conventional spinal surgery and
the fact that patients who have undergone traditional surgeries have difficulty with prolonged return to work and to their normal activities.
The main principle of this method is minimally invasive approach that enables:
- painless surgeries performed under local anesthesia
- surgeries performed on all types of disc hernia
- outpatient surgery
- rapid recovery and timely start of physical therapy
- prompt return to normal activities.
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Neurosurgery
Coflex interspinous implant
Patients who suffer from spinal stenosis syndrome indicated on one or two levels are ideal candidates for interspinous implants. After
conservative methods of treatment fail, the treating of these patients is continued surgically.
Interspinous implant overcomes the therapeutic gap between conservative and aggressive surgical methods of treatment and
enables remission of patients discomfort along with minimal surgical risks. Main indications for coflex interspinous implant are:
radiographically confirmed moderate to severe stenosis of the spinal canal with clinical signs of neurogenic claudication and/or
foraminal stenosis syndrome caused by a degenerative process on the spine. Coflex implant is indicated to 1 or 2 levels in the region
of L1 to S1. Non-fusion procedures will allow for the spine to stabilize and restore its natural anatomical function and in some cases
will lead to reduction of unnatural movements and healing of the damaged disk.
The procedure of inserting a coflex implant is a minimally invasive procedure that takes less than an hour and does not require a
general anesthesia.
METRx surgeries
The minimally invasive revolution has impacted virtually every surgical field. The primary objective of neurosurgery of degenerative
spinal disease is decompression of the neural structures, spinal cord and nerves and the stabilization of the spine.
METRx ® tubular system for spinal surgery is a less invasive version of traditional spine surgery in which tubular retractor is
applied by using microsurgical techniques to achieve nerve and spinal cord decompression and spine stability. The METRX
system combines the reliability of conventional microsurgical methods with the advantages of a minimally invasive technique.
The advantage of METRX system over traditional microsurgical methods is that now the neurosurgeon can perform spine surgery by
using segmental dilators and tubular retractors and apply a technique that minimizes the amount of damage to muscle tissue which
is the main factor of spine stability.
Laser disk decompression – PLDD
Percutaneous laser disc decompression (PLDD) is a type of surgery in which a laser probe is inserted into the intervertebral disc
space and laser energy applied for achieving decompression and neuromodulation thereby relieving the pain.
PLDD is a minimally invasive procedure that falls into the category of percutaneous intervertebral surgeries with the aim to significantly
reduce the patient’s pain and recover neurological deficit. It is performed under local anesthesia. By a specially designed laser, with
a coefficient of absorbing energy adjusted for soft discus tissue, specific amount of heat is sent to achieve the evaporation of the
water from the disc without additional thermal damage thus achieving decompression and creation of a stable intradiscal scar that
will prevent herniation from reoccurring.
Alleviation of the symptoms (pain) is manifested instantly or in the next 2 til 10 weeks depending on the disc structure. In this period
the pain can disappear and reoccur, new and previous symptoms can manifest, which can all be treated by traditional pharmacological
pain treatment. This is the main reason why it is crucial to schedule a follow-up exam after 2-3 months to analyze the result of the
procedure.
The procedure is performed under x-ray guidance and requires very rigid safety measures because of the cumulative effect of the
x-ray exposure on the operator whereas the patient is at no risk. The surgery lasts between 30 and 45 minutes and the patient can
be discharged after resting in our clinic for about 2 or 3 hours.
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Kyphoplasty and Vertebroplasty
Treatments for Compression Osteoporotic Fractures. Nowdays osteoporotic vertebral fractures are a frequent clinical problem. This
incidence is substantially increasing with an increasing life expectancy. Like vertebroplasty, kyphoplasty is a minimally invasive
procedure that can alleviate up to 90% of pain caused by compression osteoporotic fracture. In addition to pain relief, kyphoplasty
can also stabilize fractures, restore height of the vertebra and the patient and decrease spinal deformity. The potential of these
procedures is in enabling prevention and treatment of compression spinal fractures, pain reduction, diminishing the chance of fracture
happening and correcting spinal deformities caused by fractures.
Additional benefits of these procedures are:
- Short surgical time
- General or local anesthesia required
- Average hospital stay is a few hours up to one day
- Patients can quicky return to their normal everyday routine
- The strenghtning of the vertebra that might develop a fracture
Both vertebroplasty and kyphoplasty use cement as a material which is injected directly into the vertebral fracture. This stabilizes the
fracture and significantly decreases the pain.
“Please, contact us to request more informa on about
neurosurgical clinic Vertebralis .”
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