2010-10-18, 18:13 2010-10-18 18:13:29

Report by Benjamin Engel

Surgical interventions behind closed doors were yesterday: Michael Schubert demonstrates an endoscopic disc surgery (TESSYS technology) in Starnberg, which is broadcast live on the screen.

A lot of people in Germany suffer from back pain. Most of the time, the symptoms go away after a while. In some cases, however, they radiate down the leg and cause severe pain. Then it's probably a herniated disc. This is where tissue from the center of the disc protrudes in the direction of the spinal canal, presses on one or more nerve roots and can therefore be surgically removed. In 2008, according to the Federal Statistical Office, 230,000 people underwent operations on the lumbar spine alone.

Michael Schubert performs an endoscopic disc surgery in Starnberg, which is broadcast live on the screen. (© Franz-Xaver Fuchs)

For the fifth time, the company Joimax (TESSYS) conducted an international workshop on the endoscopic operation of herniated discs in the lumbar region. Together with doctors, she developed this method, which has been in use for seven years and is constantly being refined. Orthopedists and surgeons from all over the world, from Europe to the Middle East, were able to follow two endoscopic disc operations live on the screen in the conference room of the Starnberg Clinic last Friday. Spine surgeon Michael Schubert from the Apex Spine Center in Munich, co-organizer of the event, demonstrated the technique and was available to answer questions.

The most common is still the microsurgical operation with the help of a microscope. For this purpose, however, a four to five centimeter long incision must be made in order to reach the area of the affected vertebrae. In contrast, only five percent of all herniated discs in Germany are operated on endoscopically, although this method is particularly gentle. The instruments are inserted through a channel that is only 7.5 millimeters wide. In addition, local anesthesia is sufficient, which means that the patient remains responsive throughout the operation.

However, adherents of conventional practice consider this treatment to be too risky and reject it for this reason. The Würzburg orthopaedist Florian Maria Alfen, one of the pioneers of this method alongside Michael Schubert, cannot understand these allegations. In his opinion, no one would have to undergo open back surgery any more, as he believes this technique only offers advantages for the patient. Muscles and soft tissues are spared in this way, and no trauma occurs. Some of the patients can take their first steps again after just three hours and can be discharged the next day, as confirmed by Wolfgang Kreil from the Neurosurgery department at the University of Graz.

According to the surgeons present, the main reason for the sluggish implementation of the endoscopic surgical method is the long training period of 20 to 30 interventions with supervision and regular training. Florian Maria Alfen assumes that only ten specialists worldwide can master this practice, even in difficult cases.

According to Wolfgang Ries, founder of the Joimax company, the fact that more money can be earned through the conventional method, for example by inserting screws and implants, also plays a role. Nevertheless, like the doctors involved, he is convinced of the worldwide triumph of the endoscopic method, which is already used in 30 percent of all interventions in South Korea.