Spinal surgeons perform world-class surgery in Estonia

3. May 2016

Spinal problems becoming more and more common around the world and the importance of timely treatment is increasing.

Last year, orthopaedic specialist Taavi Toomela presented one young woman’s case to colleagues from around the world in Davos, Switzerland. She was brought to East-Tallinn Central Hospital’s spine surgery centre with a first lumbar vertebra fracture. The vertebra was completely shattered and the bone pieces were pressing on the spinal cord. The woman was partially paralysed and her spine had shifted. The case was very difficult for both the patient and the doctors.

“The surgery we managed to perform was minimally invasive, which is to say through tubes,” Toomela explains. “There is no classical incision or a large wound in that case. Incisions are only made to insert wires, rods and screws, with each incision measuring one-and-a-half centimetres. The rods and screws are connected under X-ray and the position of the spine is corrected.” The patient is turned on their side, and via a small incision between the muscles, the pieces are removed from the spinal cord and the vertebra is fixed, if necessary. The patient recovered well, and her paralysis was reduced.”

This solution greatly impressed even the world’s foremost surgeons, who have seen and experienced a great deal. Toomela brought the minimally invasive method to Estonian spinal surgery in 2008. The same method is used in spinal surgery centres that were established a year later in cases of tumours, infections and wearing of the spine in addition to traumas. Thanks to this it is now possible to treat a large percentage of spinal traumas.

Patients for whom treatment was not even an option 10 years ago are today being referred to the centre.

More and more cases

Back pain is one of the most frequent complaints with which people turn to doctors, and there are more and more patients with spinal problems. Part of the reason for this is that people have begun to realise that a poor quality of life is not something that has to be accepted when something can be done. Dr Toomela, the head of the spinal surgery centre, has not kept count of who turns to them with spinal trouble – men or women, old or young. Patients are approached individually, on a case-by-case basis. In any event, the spinal problems of Estonians do not differ from the rest of the world in their nature or frequency.

“Severely injured people reach us fast enough,” he says. “It’s more complicated with those whose back or leg pain doesn’t keep them in bed. There’s a perception that spinal surgery – especially having screws in your spine – reduces your quality of life. But the goal of surgical treatment is to always improve your quality of life. The right surgery has to be assigned to the right patient. Timely treatment will help a patient quickly return to high-level sport as well as to normal life.” Besides, treatment does not always mean surgery – in the spinal centre they are rather conservative in this regard.

Spinal surgery is based on scientific medicine, developments in which have been extremely rapid in recent decades. “We offer a world-class level of service to our patients, but it would be great if there were more doctors interested in spinal surgery,” Toomela says. “In Estonia, you gain that knowledge on the job, which means 15 or 16 years of training. The area has so much potential and there are so many patients we could help, but unfortunately there aren’t that many specialists.”

At the moment, the team at the centre comprises four doctors, who are supported by a neurophysiologist if needed. The North Estonia Medical Centre and Tallinn Children’s Hospital each have their own spinal surgery specialist.

Spinal surgeons are known for carrying out the longest operations in Estonia. “Yes, there have been operations that have taken up to 14 hours,” Toomela says. It takes this long to stabilise the spine so that the patient can start moving again right away after ‘cracking’ the spine. Patients with malignant spinal tumours and those with extremely curved spines are on the table for an especially long time. “Sometimes surgery takes an entire day, and some patients have been operated on over two consecutive days,” Toomela explains. “In tumour surgery, thoracic, vascular and plastic surgeons have also been involved in addition to spinal surgeons. Everyone does their part.”

Around 300 patients are operated on each year, accounting for approx. 15% of all orthopaedic surgery. “A hundred operations per spinal surgeon is a reasonable amount if 75% of their work is complex surgery,” Toomela says.

Source: Eesti Päevaleht; Photo: Õhtuleht