Micro-invasive surgery

The approach to ortomolecolare of the Dr. Adolfo Panfili, only in the Italian and European panorama, guarantee an optimal preparation are for the large ones that for the small surgeries, concurring with the patient to face operating stress with the protect and reactive immune system. In particular the mininvasiva surgery supplies turns out you entusiasmanti especially in is made of recovery and return to the professional, ludiche activities and sport. Fundamental in this optical to ortomolecolare, the assumption of supplements made up of amino acids, minerals and vitamins personalize to you based on the chemical individuality of every patient.

Where can I be advised about micro-invasive surgery and the orthomolecular methodology?

Arthroscopy of the knee

The arthroscopy is one technical surgical that is put into effect with the employment of an instrument for the transmission of the images (artroscopio) that it comes inside introduced of the cavity to articulate of the ginocchio through of the small recordings. A television camera connected to the artroscopio will allow to the orthopaedic specialist prof Adolfo Panfili to see on one screen with clarity and opportune blowup the several inner structures of the ginocchio. Many pathologies of the ginocchio can be recognized and be dealt in arthroscopy.
 

In it she was of the communication also She will be able to assist comfortably rilassata to the event of its directed arthroscopy in. To the iinterno of the ginocchio they will come visualized:

·         Cartilage to articulate

·         Crossed Legamento front

·         Inner and external Menisco

More frequent damages of the ginocchio:

·         Menischi and the legamenti can be damaged to whichever age, with various modalities and causes.

·         Aging and/or traumi can cause the usury of the articular cartilages.

A cartilage fragment can talora inside distaccarsi of the articulation (mobile body to articulate). The directed aging or a trauma can damage the rotulea cartilage, limiting the motilità of the ginocchio. Other times one can be taken place irregular usury of the surface to articulate of the rotula for alterations of the mechanics to articulate tied to one lateral movement of rotula (the rotuleo malallineamento)

LESIONS MENISCALI:

The menischi they are two fibro-cartilaginee structures, to semimoon shape, than incuneano to every side of the ginocchio (menisco inner and menisco external), stabilizing it through interposizione between femore and tibia. These structures have superficial the function to distribute the cargo on more widths, than protect the cartilage to articulate and to stabilize the articulation

LESIONS LEGAMENTOSE

The legamenti are of the fibrous cords that guarantee stability to the ginocchio. Inside of the ginocchio they are present: the crossed legamento front and the crossed legamento posterior.

PATHOLOGIES OF THE CARTILAGES:

The cartilage is woven a much resistant one that covers superficial the articular ones rendering them smooth and favoring the sliding of the bony heads

PATHOLOGIES OF THE ROTULA:

The rotula it is a bone of the ginocchio that it facilitates the action of lever of the muscles that move the articulation.

Most frequent treatments

·         Meniscali lesions: according to the type and of the extension of the meniscale damage orthopaedic dr the Adolfo Panfili can remove the part lesa of the menisco or, more very rarely, to repair it with sutura.

·         Legamentose lesions: it is possible to reconstruct a crossed legamento broken, to the aim to restore one stability to articulate, by means of the substitution of the healthy and sturdy tendineo same legamento with woven (graft) captured in proximity of the ginocchio.

·         Pathologies of the cartilages: with opportune instruments the orthopaedic one can regolarizzare one rough cartilaginea surface. If a cartilage fragment, detaching itself, discovers the below bone they can practice of the holes in the bone in order to increase the blood contribution and to stimulate therefore the processes repaired to you.
It is moreover possible to remove a mobile body to articulate or to capture a fragment of cartilage healthy in order to program a transplant of the same one.

·         Pathologies of the rotula: in order to render smooth and levigata the surface to articulate, orthopaedic dr the Adolfo Panfili can regolarizzare the cartilage to of under of the rotula. If problems of malallineamento of the rotula exist, for arthroscopic way the woven one can be cut that it maintains center outside to it.

The participation of arthroscopy can be executed in anesthesia: native place-regional (block of the nerves sciatico and femoral) spinal and general.

If you want to know more, contact AIMO at +39.06.3115961/06.3315943 or book an appointment

Arthroscopy of the shoulder

The arthroscopy of shoulder has been recognized and accepted like sure and effective technique in the diagnosis and the cure of pathologies of the shoulder single in last the 10-15 years. The technological progresses in the quality of fiber optics, in the resolution of the video and the artroscopico strumentario, with to the most deepened study of the anatomical accesses, have involved an evolution in the arthroscopy of shoulder beginning from the diagnostic techniques until the most sophisticated techniques than treatment.

In the event of pathologies to cargo of the Acromio-Clavicolare articulation x-ray with cefalica inclination of 10° can be useful one of the tube with 50% of reduction of kilovolts of one the normal Rx.

Much profit turns out to be the ecografico examination that supplies information on the state of the cap of the rotatori and on you stretch some of the Long Head of the Bicipite. In the cases of lesion of the cap of the rotatori us a particular type of RMN is taken advantage frequently of the Scan Limb (Nuclear magnetic resonance), while in the cases of instability beyond to the RMN the x-ray with projection of Westpoint can find employment.

Micro-invasive surgery: Percutaneous Vertebroplasty (VPP)

Dr. Panfili has specialized in Ortopedia near the Policlinico Augustin Twin and has carried out its practical medical training near the University of the Sacred Heart in Rome in quality of aid of prof the Carl Ambrogio Logrsocino, Director of Department of Sciences Ortopediche and Traumatologiche (Dip). 

Its huge resume mentions between the hundreds of banns, conferences, conventions, television interviews, presences, moreover a carried out professorato diamond near the University of the Studies of Siena in the within of the instruction of Anatomia and human Istologia that has concurred to it to deepen its ulteriorly already very radicate orthopaedic and chiropratiche acquaintances deepened through the study and the four-year diploma in Omeopatia, Omotossicologia and Agopuntura, achieved in Germany with the maximum of the profit in years 90, when in such fields in Italy the experts could themselves be counted on the fingers of one single hand. An expert of the round vertebral column to all that the column knows it from all the possible and imaginable angles-shot very well, attaraverso innumerevoli trainings super specialistici carried out in quality of aid with the greatest surgeons of the column, to begin from prof the Carl Ambrogio Logrsocino, Director of Department of Sciences Ortopediche and Traumatologiche (Dip) of the Policlinico - University of Twin the Sacred Heart of Rome, to prof the Carl Carmine Primary Cerciello of the Combined hospitals of Rome - vertebral Department of Surgery - Saint Camillo - Rome, of the pioneer of the vertebral surgery of the past century prof. Jhon Howard Moe, of the prof Giulio Maira, Director of the Institute of Neurosurgery of the University Policlinico “Augustin Twin” in Rome, and many others. Prof the Adolfo Panfili draft vertebre and postura from the beginning of its trentennale professional activity, are from the seen point surgical that manipolativo being among other things first the orthopaedic one in Europe To graduate itself in Best Chiropratica.

watch the virtual anatomy animation

Made these right premises, the fact that prof. Adolfo Panfili promotes the Transcutaneous Vertebroplastica does not astonish sure, since in its professional style constant emerges which the Americans define: “Committment to excellence” (preplace to the excellence, nda), that is to propose to the patient the best indication for the resolution of the pain and the vertebral emergency that if not faced with extreme competence and professionality, can cause to permanent invalidity and incoercibile chronic pain. All that spouse then with sanitary costs extremely reduced.

The Transcutaneous Vertebroplastica is an minium-invasive therapeutic procedure of Interventistica Radiology for the treatment of the painful vertebral fractures developed in France in the half of years 80 ' but that only recently it has had spread in other European countries and the United States. In the first place it is opportune to specify that draft of a mininvasiva procedure of surgery to closed sky, than does not demand uses it of the classic bistoury, neither cuts, neither points of sutura and that it concurs an immediate recovery works them of the patient. This type of procedure could be compared to a arthroscopy simplified that it consists in the injection through a metallic needle purposely conformed, introduced under the arranged guide of Computerized Tomography (TAC) and of the digital fluoroscopia them, of a bony concrete to low viscosity, already for a long time employed in orthopaedic participations. Such concrete (polimetilmetacrilato or PMMA) is diffused inside of the fractured vertebral body, preventing ulterior yieldings.

 Modality of introduction of the concrete inside of the vertebral body with the VPP

In order it makes a practical idea of the transcutaneous vertebroplastica thoughts to the perforation of a tire for which the cylinder to expanded foam is used that in little second ones concurs to resume the interrupted march. With analogous modalities the iniettato concrete inside of the vertebral body, rimodella the vertebra fractured conferring them the lost stability and the resistance with one an immediate remission of the pain concurring the patient injured person to find again serenity, autonomy and mobility in the passage of times painless expresses and.

That that you would have to know on the vertebroplastica
The Transcutaneous Vertebroplastica comes executed in local anesthesia and demands the shelter of a day, therefore preferibilmente in regimen of Day Surgery. Necessary E' introduction of little cc. of concrete that determines the immediate consolidation of the bone with consequent resolution of the pain. The patients who benefit of such procedure report one timely and complete remission of the painful symptoms concurring to abandon the busto orthopaedic and/or to reduce or to suspend the analgesic drug assumption and to improve therefore the quality of the life.

 

Indications

§         Painful vertebral fracture from refractory osteoporosis to the medical therapy

§         Painful vertebral fracture or osteolysis to fracture risk due to benign or malignant tumors (angioma, metastasis, mieloma, lymphoma)

§         Associate painful fracture vertebral with osteonecrosi (Kummell' s disease)

§         Patients with multiple yieldings for which ulterior yieldings would represent one respiratory compromissione

§         Chronic traumatic fracture in healthy bone with lacked consolidation fragments or cistica degeneration

Osteoporotica Vertebra in patient serious affection from cifosi, before and after the treatment of vertebroplastica for cutaneous eseguibile in day surgery.

 

Treatment of the painful bony metastases and the fractures from osteoporosis with cementoplastica.

One ulterior application of the vertebroplastica percutaneaè the Bony Cementoplastica, anch'essa carried out in local anesthesia under guide TAC and fluoroscopica, in the painful bony metastases of osteolitico type, or fratturative lesions from osteoporosis. The executive modalities of the cementoplastica are anch' fast they and painless and they are based inside on the positioning of an appropriate needle of the bony lesion with successive Bony Concrete injection. This procedure guarantees a almost immediate analgesic effect with particular reference to those bony segments subordinates to remarkable “biomeccanico cargo works them” with elevated fracture risk. In some cases the Cementoplastica can be preceded, in the cases of neoplasie, from the Termoablazione with Radio frequencies in order to ulteriorly reduce the woven quota neoplastico.

 

Absolute contraindications:

§         Asymptomatic stable fractures

§         Effective medical therapy

§         Interested osteomyelitis in the vertebra from fracture

§         Not correctable Coagulopatia

§         Allergy to the members uses you

§         Spondilodiscite sistemiche or local infections ()

Relative contraindications:

§         Pain to radicolare or radiculopatia caused from not correlated compressiva syndrome to the vertebral fracture

§         Fragment dislocated posteriorly with compromissione > 20% of the vertebral channel

§         Extensive tumor inside of the epidural space

§         Acute traumatic fracture of vertebra not osteoporotica

§         Strict jam of the vertebral body (vertebra glides down)

§         Fracture stabilized without pain dated persistent from more than a year

 

If you want to know more, contact AIMO at +39.06.3115961/06.3315943 or book an appointment

 

Day-op. treatment of the hernia of the disc: the Endoscopic Discectomy

On purpose of mininvasiva surgery like not speaking about the treatment of the hernia of the disc for endoscopica way. The Endoscopic Discectomy (DE) can supply an effective one half in order to decompress and to repair discs damages without having to you to resort to the participation “to open sky”.

The DE represents an effective approach and to low risk regarding the previous one and among other things concurs a faster return with the working and daily activity. After the participation the patient comes discharged in the course of the same day with a simple one wraps of lumbar support. Draft of a ambulatoriale surgery that drastically lowers the costs of the sanitary expense and reduces the absenteeism from the job, perfected in the course of last the twenty years of experience concurring to prepare equipments virtually technical sluices of surgery of the vertebral column to the vanguard.

The lumbar discs are the structures, that they act as from shocks-absorber between vertebre and vertebral column. The center of the disc, called the nucleus, is motivatings force and elastic and absorbs the sollicitations works induced them from the station in feet, of the deambulation, etc the external part, called the ring (anulus fibrosus), supplies instead the structural resistance of the disc. The ring is constituted from the driven in one interlaces of woven layers of fibrous that wrap and maintain in native place the nucleus.

The pain to the back and the reported sciatico pain are the price that the human beings pay to the mistaken posture. The extended parking in the position seated the execution of efforts reiterati in bending or torsion of the same column goes to confliggere on the lumbar feature where they converge the greater part of the biomeccanico cargo sollicitation. The woven one of the nucleus comes therefore subordinate to excessive pressure much to cause to the breach of the ring and/or the erniatura of the nucleus through the fissurazioni of the same ring. Just as verification with the classic egg in frying pan laddove the red one is corresponded to the nucleus that accidentally once damaged road is made through the analogabile egg white the anulus.

      watch the virtual anatomy animation

If the fessurazioni of the anulus happen in progressive way and graduate them, from woven near (the periosteum, legamenti etc.) they are formed of the throws of is gone neoformati inside of the disc and with they also of nervous fibers: the disc, from structure not innervata, becomes therefore innervata and therefore center of painful nervous stimuli. This is the phase in which the lombalgica symptomatology is prevailing and, if we are still in the phase of the protrusion, is possible to take part with an participation of discale decompression for endoscopica way (DE: endoscopica discectomia).

The RMN here over extension a discale hernia to lumbar level. The spinal channel in white man is compressed from one great erniazione to shape of mace from golf indicated with the arrow white woman. The arrow of red color indicates instead the spinal nerves that are rejecting the erniazione of the disc. The arrow of blue color indicates the spinal liquid white man.

Fortunately, the greater part of the sciaticas is resolved in 6-8 weeks, in case the symptoms did not demonstrate to improvement or resolution, the manipolativa therapy or the physical therapy happening represents options with good rates, in contrary case and the conservativo approach is not resolutive is opportune to resort to a Endoscopic Discectomy in order to reduce the jam on the nerves and to avoid damages gets worse.

You deepen the argument with the prof. Adolfo Panfili and reserve one seen specialistica.

Diagnosis of the Discale Hernia

With passing of the time the human body is dehydrated progressively and the intervertebral discs are those that of it they pay scotto it more immediate being constituted mostly of water. When to the phenomena of degenerate type posture are added scorrette, like that they are kept to a writing desk, as an example, or in automobile, and it does not come carried out a suitable physical activity, are created of the conditions of instability of the column, that they can hesitate in one erniazione of the disc.

When to the phenomena of degenerate type posture are added scorrette, like that they are kept to a writing desk, as an example, or in automobile, and it does not come carried out a suitable physical activity, are created of the conditions of instability of the column, that they can hesitate in one erniazione of the disc.

If the disc slips posteriorly towards the medullary channel (formed front from the vertebral bodies, laterally from the peduncoli and posteriorly from sheets), these it can imprint the durale bag, from which fuoriescono the nervous roots that go to constitute the sciatico nerve. The this large nerve, most large of our body, innerva the inferior limb, and is this the reason for which an insult that has origin to level of vertebre ripercuote on the leg (the sciatalgia): a pain that to departure from the back is irradiated to the inguine but much is more probably caused from one syndrome of the articular facets.
 

Type of Ernia Discale

Various they are the degrees of spillage of the disc from the own center: it is gone from the protrusion (you see design), contained from the posterior longitudinal legamento, that it slides along the posterior part of the vertebral bodies, until the true and own hernia, when that is the intervertebral disc is completely outside center.

The hernias can be classified in:
 

CONTAINED HERNIA E' the type more frequent than discale hernia: in the fibrous ring widths are formed fissurazioni are radial that circumferential that catch up the surface of the disc. The erniario woven one makes road incuneandosi in the fissurazioni, but it does not perforate the anulus and in it it remains contained.   EXPELLED HERNIA In this variety the erniario woven one fuoriesce partially or completely from the disc, but migra not moving itself at a distance. It can, according to the followed distance, in its turn to distinguish itself in: Sottolegamentosa, when it does not perforate the posterior longitudinal legamento; Translegamentosa, when a part of it perforates the legamento without to exceed it and the remaining part remains sottolegamentosa; Retrolegamentosa, the hernia perforates the free legamento and in the channel without migrare.   HERNIA MIGRATA In this condition (obvious in the figure over) the fragment expelled migra at a distance from the origin disc, more frequently in tail direction (low) or intraforaminale (in the forame of coniugazione where fuoriesce the nerve and where the conflict with the same one can be taken place)

And' important to remind that not always the symptomatology of the discale hernia is proprorzionale to the real entity of the erniato material; hernias of practically asymptomatic considerable dimensions can be taken place, in spite of the important signs of print on the durale bag and on the nervous roots and of against small protrusions they can evoke intense often recalcitrante pain to common anti-inflammatory analgesic drugs/.

Images TAC and RMN are most useful in order to contribute to formulate diagnosis, but it is opportune to remind that they are not always they are inequivocabilmente reliable since they are alone photograms of the real situation of the discale suffering that can enormously vary from one determined position to an other (of usual sdraiati and at rest) and it is not said that a moment after, under stress the situation cannot change.

Different projections of RMN that they represent the presence of lumbar discali hernias to deal with DE (Endoscopic Discectomy)
 

Artroscopica Minisonda penetrated inside of the disc erniato in course of one normal DE  (Endoscopic Discectomy)

This is that that the surgeon can see with microendoscopio during the participation. The material white man in the posterior part is the erniato disc.

Symptomatology

• Pain in the extended position seated, exasperated from the foldings/extensions/torsions, than is attenuated with the deambulation;

• Often inabilitante pain;

• Weakness, intorpidimento and/or formicolio to the inferior limbs;

• Lessening and/or loss of the sfinteriale tone (blister-intestine).

In the greater part of the cases the painful symptoms of the hernia of the disc revert with the simple rest to bed, physical therapy, posturale riabilitazione and drugs. However, many patients are not therefore fortunate. When a disc is erniato, it can more generate jam against one or of the spinal nerves triggering pain, paraesthesias, intorpidimento and asthenia from the lumbar feature, along the passed one of the sciatico nerve, from the legs until the feet.
 

Advantages of the Endoscopic Discectomy
The main advantage of this endoscopica procedure that is come true in regimen of Day ambulatoriale Hospital beyond to that one not demanding some ospedalizzazione is the absolute lack of surgical aggressiveness.

A serene and calm participation and without pains since in the executive procedure interferences are not come true on muscles, boneses, articulations, the structural anatomy of the woven ones in how much is respected is not previewed tractions and pressures on the nervous roots.

Less traumatic surgery low impact and in every sense therefore, also from the psychological point of view.

It is rerun to a good local anesthesia eventually deepened from blanda a sedazione made up of Diprivan without to resort to the annoying intubation, that it reduces risks and uneasiness for the patient.

In some cases (especially that chronic) Dr. Panfili executes the DE under the general anesthesia with the neurofisiologico control of upgrades evokes them to you.

After the sedazione and the local anesthesia milimeter is proceeded little more to the introduction of a microscopical guide than 2 than diameter through the cute and under the aid of i beams X, the disc with one is caught up 2 hardly purposely planned microprobe for the aspiration. The disc comes therefore visualized with a endoscopio and is sucked for approximately 10 minuteren. The greatest fragments of the disc are removed with appropriate miniums clamp anch' it purposely planned. The entire ambulatoriale procedure usually does not demand more than 20 - 30 minuteren.

And' important to emphasize that it comes only removed the erniata part of the disc correspondent to approximately 10% of the disc, while remaining 90% come left intact saving the height meaningfully. To save the greater part of the disc concurs to prevent in the time eventual ulterior structural damages on the column, talora induced from too much demolitive discectomie.

Since the only microwound is those necessary for the insertion of the small artroscopio that it passes through muscles like a simple needle, you cannot be surgical scar around the nervous roots. The patient can optionally begin a program of exercises facilitated you of back school that they come quite prescribed the same day of the procedure. The cost of the surgical participation is approximately 30% in less regarding the conventional procedure.

The fallen back one in terms of tangible advantages on the medicine of the job is enormous and the economic saving for employs to you, professionals and employers achieve to minor the necessary time for the phase riabilitativaper the recovery.

Sometimes the patients with fragments of discali hernias expelled in the spinal channel, like documentabile through Magnetic resonance, can equally benefit from the artroscopica procedure. Of these patients approximately 90% he reports improvement of the painful symptomatology. 10% of these remaining persons in case did not find improvements, after tre-sei weeks can take in consideration one micro laminectomia and/or surgical discectomia, to second of the circumstances.

The execution of the microdecompression and/or endoscopica spinal discectomia before microsurgery to open sky does not seem to have some harmful effect.

He turns out to you clinicians with the Endoscopic Discectomy, regarding the surgical procedures alternatives are:
 

Conclusions

• The minimal uneasiness (small hurt of puncture in the skin);

• No permanent paralysis or other neurological complications (only 10-15% is removed);

• The short Ospedalizzazione;

• Fast return to the normal activity;

• Meaningful cost reductions.

The scientific topics published above are addressed to the operating ones of the field interested to articular pathologies. For the patients the information available in these pages have only an indicative value and they cannot replace a medical opinion.