A New Era of Excellence

Over the past decade, the evolution of spine surgery has advanced into a new era embracing a profound yet simple idea «less is more» meaning the less invasive a procedure is, the less time it takes to recover and the more its benefits. New developments sound very thrilling, very technical and technological, however, the main idea here is what this means to you, the patient!. Contrary to the long endorsed common belief, there are contemporary minimally invasive treatments for almost every patient with a spine pathology, chronic back or neck pain problem.

The Cairo Spine Clinic (CSC) is a comprehensive facility devoted to the management of spinal disorders, from diagnosis to multimodal treatment options to aftercare. The focus is entirely on providing exceptional, world-class minimally invasive spine treatment. In this regards, we integrate cutting-edge technology, the same used today in countries like the United States, Japan, Germany and France. This has provided our patients with innovative treatment solutions for even the most complex spinal conditions. To date, we have been privileged for having treated patients from all over Egypt, as well as other countries such as Saudia Arabia, Kuwait, Palestine, Yemen, Sudan, Syria, and Nigeria with our minimally invasive techniques.

Knowledge, Dedication, Distinction

You can expect a thorough understanding and evaluation of your case and medical history to pinpoint your individual spinal condition, and then a discussion of your treatment options. We exclusively pioneer state-of-the-art, minimally invasive definitive spine treatments that have achieved consistently positive results for our patients.

The Concept of Minimally Invasive Spine Care

In essence, the specialty of minimally invasive spine treatment involves the address of an entire spectrum of spinal diseases via minor approaches. Minimally invasive spine care is a philosophy not just an approach that encompasses a variety of tools and a collection of techniques that are associated with minimal trauma and maximal benefit. It involves an optimal combination of highest sophistication in diagnosis and planning, for each individual patient, and the implementation of the most effective treatment procedure. These procedures may be performed using general, epidural or even local anesthesia according to each specific case.

Although, in many cases non-surgical options are advocated, when surgery is indicated, endoscopic procedures are at the top of minimally invasive treatment options. Compared to traditional open spine surgery, endoscopic procedures are less damaging to the muscles and other soft tissues around the spine. Among its numerous short and long-term benefits, a quicker recovery from surgery and a lasting improvement are anticipated.

Endoscopic Surgery of the Spine

Endoscopic approaches offer excellent outcomes, shorter

recovery periods and superior results with regards to

postoperative pain and disability. They are utilized in treatment

of a wide range of spine pathologies, painful disc conditions,

neck, arm, back, and leg pain. Patients are typically able to

resume normal activities sooner, easier and fitter. Not only is

the skin incision smaller, but the incision in the muscle and

nearby tissue is also smaller and bone removal is minimal, thus

minimizing injury to muscles, bone, joints, and ligaments. The

results achieved means far less strain for the patient!

Clinical Benefits of Endoscopic Vs. Conventional Open Spine Surgery in a Nutshell

Direct access, better targeted, minimally invasive approach= Absolute surgical precision, exceeding accuracy that utilizes cutting-edge technology, highly specialized tools and customized instrumentation

An anatomical and functional procedure= strong back, preservation of intervertebral, bone, joints, ligaments, muscles, and other soft tissue structures. No restrictions or limitation of movements or activities after surgery. No need for metal or other prosthesis.

No restrictions= fully ambulatory after surgery, no constraints on everyday life, hobbies, and sports.

A safe and effective treatment for your spinal or pain condition = no undue trauma to tissues, ligaments, blood vessels, bone, and joints.

A more cosmetic surgery=minimal scarring, smaller, less noticeable scars and a better look.

Shorter hospital stay and recovery time= early return to favorite activities, discharge to home is typically the morning after

Reduced postoperative short and long-term discomfort= far less postoperative psychological and physical pain, smaller doses of pain relievers, reduced risk of infection, far less postoperative adhesions.

Sustained results= effective, long-lasting relief

Endoscopic Surgery of the Lower Back (Lumbar Spine)

The lumbar spine are the lower 5 ver-tebrae (L1-L5). The lowest vertebra of the lumbar spine, L5, connects to the top of the sacrum. Some people have an extra, or sixth, lumbar vertebra which is considered a normal variant.

The problem of prolapsed lumbar intervertebral disc is common because of the fact that the lumbar region is the highest stress-bearing area of the spinal column. Prolapsed lumbar discs may cause altered nerve sensation and nerve root pain ‹sciatica›.

Stenotic lumbar canals are another entity where there is no disc pro-lapse but the lumbar canal or its foramens are extremely tight causing pressure on the nerves and pain and may lead to a particular type of pain known as neurogenic claudication. Surgical options are usually considered for more rapid relief or with fail-ure of non-surgical treatment such as medications and physiotherapy.To remove a disc prolapse or decompress lumbar canal and nerve roots, surgeons have traditionally relied on the open technique known as lam-inectomy and discectomy. This involves a large incision and extensive dissection with excessive bone and ligament removal.

Endoscopic lumbar surgery is performed through a small «stab» skin in-cison in the lower back. An endoscope is inserted at the targeted level. Using specialized miniature endoscopic instruments, only a portion of the prolapsed lumbar disc that presses the nerve, or nerves, is resected or a stenotic area is decompressed. Muscles and ligamentous structures are conserved; therefore, there is much less discomfort after the proce-dure. Hospital stay is overnight.

Endoscopic Lumbar Surgery

Endoscopic Resection of Lumbar Disc Prolapse a. Root retractor on Dura b. Disc removedc. Disc forceps d. Suction

Endoscopic Lumbar Canal Stenosis Decompresssiona. Decompressed lumbar Cord b. Suction

Benefits of Endoscopic Lumbar Surgery in a Nutshell

Preservation of intervertebral joints, ligaments, muscles, and other soft

tissue structures =strong back

A truly minimally invasive procedure= No unnecessary injury to body

tissue

Direct access to herniated disc= precise surgery

Small incision =minimal scarring, reduced risk of infection, minimized

blood loss

Markedly less postoperative pain=minimal patient distress

Fully ambulatory after surgery= speedy recovery, discharge home on

second day of surgery

No limitation of movements, restrictions or constraint on activities after

surgery=full return to your favorite activities, hobbies, sports - many

patients can return to work in just few days

Functional Surgery= effective, long-lasting relief, not having to deal with

long-term convalescence of large wounds and extensive approaches

Endoscopic Surgery of the Neck (Cervical Spine)

The cervical spine constitute the spinal column in the neck region which consists of seven vertebrae and their intervertebral discs in between. The intervertebral discs do not exist between the the first two cervical vertebra (atlas and axis). As most bending motion in the cervical spine occurs at the C4-5, C5-6 and C6-7 levels, disc herniation, cervical canal stenosis and bone spurs occur typically at those lower levels. Cervical disc herniation includes soft disc herniation and/or hard disc protrusion, the latter is often associated with bone spurs build-up along the spine edges and occurs in older ages. The bone spur or disc may compress the central cervical canal directly putting pressure on the spinal cord itself and nerve roots that supply the arms at the corresponding level. This typically results in neck pain, arm pain or weak-ness. Central pressure on the spinal cord may result in symptoms such as spasticity, leg weakness or gait disturbances and even walking difficulty. Sur-gery is advised when patients show no improvement within an appropriate time of conservative treatment.

Traditionally open surgery has been the main treatment for cervical spine pathology. Unlike endoscopic procedures, open surgeries with bone fusion or metal plate-screw/cage implantations partly eliminate functioning motion in the neck and cause a disturbance in the biomechanics of the cervical spine motion segment, associated with an inherent potential for long-term pain and discomfort.

Minimally invasive endoscopic cervical spine surgery is performed via a small skin incision at the front or less commonly the back of the neck. The endo-scope is introduced at the targeted level and a small foraminotomy keyhole is then made at the side of the affected cervical level and the herniated disc material and any compressing bone spurs are removed using specialized miniature instrumentation, thus relieving pressure from over the spinal cord or affected nerve root. Following surgery, patients can start moving their neck normally and can typically return home on the second day. If severe cervical spondylosis is present and most of the compression on the spinal cord is from the back or there is difficulty in accessing the spine from the front for any reason, posterior endoscopic cervical laminotomy could be per-formed rather than a posterior traditional laminectomy to provide extra-room for the cervical cord/nerves posteriorly or to resect a herniated cervical disc.

Benefits of Endoscopic Cervical Surgery

Endoscopic cervical surgery is disc preserving, anatomy-maintaining and function-preserving. The majority of disc material and bone is left undisturbed preserving the normal spine motion. Recovery is quick, with most patients being able to do routine daily activities starting the second day of surgery. Postoperatively, patients do not wear a cervical collar and will have normal neck motion immediately. This endoscopic technique accomplishes efficient enlargement around the spinal cord or its nerves and maintains the structural strength of the cervical spinal column while avoiding bone fusion or metal plate-screw implantation as to maintain neck motion. Patients can usually be discharged home the following day without the need for a neck collar.

Endoscopic Cervical Disc Surgery

Injection Therapy

How has back pain affected your life? Has back pain forced you to lose your old self? Quit your favorite sport? Made is difficult to even pick up your kids or walk in the mall? Just generally taken the fun and excitement out of your life?

At Cairo Spine Clinic, one of our most exciting advancments is in treating patients suffering from acute or chronic pain conditions related to their spine. Almost all structures that form the musculo-skeletal system have the potential to produce pain and may be the cause of the patient’s suffering. The source of pain may not be due to a neurogen-ic origin (like a pinched nerve due to a prolapsed disc or stenotic spinal canal), it may be a joint(s), facet joint(s), ligament(s), muscle(s), tendon(s), or a combination of those. These structures can additionally radiate pain to other areas such as the chest, neck, arms, buttocks, and legs.

In patients who have failed conservative measures such as medication, bed rest and physical therapy, we do not mask your pain with more analgesics, repeated medication, steroids, or unnecessary treatments; rather we focus on treating its underly-ing cause via injection therapy. This distinctive kind of therapy, involves direct injection into the painful area to correct the underlying cause of pain, thus eradicating it and regaining normal function.

In our injection therapy, we combine unique knowl-edge of three different types of injection therapy; Regenerative Injection Therapy (RIT) also called prolotherapy, Neural Therapy (NT) and Trigger Point Injection (TPI) - no steroid or steroid derivatives are used).

BENEFITS of Injection Therapy

Treating your pain pemanently, restoring your health and mobility may seem the greatest benefit of all!

Injection therapy is an outpatient procedure. The patient can leave the office shortly after session and there is no activity restrictions following it

Injection therapy is a greatly safe procedure when done with expert hands.

The procedure stimulates the body to naturally heal problematic area triggering its repair and regeneration, thus lasting relief is obtained by restoring structural integrity

Faster, better results than alternative therapy modules commonly used by people with chronic pain such as physical therapy and prescription pain killers.

Unfortunately, the side effects and dependence associated with long-term use of prescription drugs far outweigh the benefits . Many people find prescription drugs a burden, rather than a relief.

Although the idea of receiving injections is understandably unpleas-

ant for some patients, most patients who have suffered with chronic

pain problems find that the discomfort of the injections is entirely

bearable. You are given a local anesthetic; the mild discomfort and

the injection process itself passes fairly rapidly.

Who may be candidate for our procedures?

Patients with disc herniation or spinal canal stenosis whether lumbar, cervical or dorsal

Patient with neck, low back and mid-back, strain or sprain

Patients with chronic spine pain conditions

Patients with spine related arm or leg pain

Patient who had a failed back surgery

Patients with degenerative disc disease

Patients with spine or spinal cord tumors

Patients with spinal instability conditions such as spondylolysis and spondylolithesis

Children or newborns with congenital anomalies of the spine

About Mohamed Kabil, MD

Medical Director, The Cairo Spine ClinicFor Minimally Invasive Spine Treatments and Procedures

Dr.Mohamed S. Kabil

Dr. Mohamed S. Kabil is an active advocate of redefining the practice of the subspecialty of spine surgery and the methods of treatment. He trained in general neurosurgery, microneurosurgery, endoscope-assisted neurosurgery, and endoscopic skull base and brain surgery before focusing his practice on minimally invasive, fully endoscopic spine surgeries and procedures.

He obtained his medical degree in 1996 from the Faculty of Medicine, Ain Shams University where he presently serves as a staff member at the Department of Neurosurgery. His basic neurosurgical training and residency were completed at the same reputable institution, where he earned a Masters and Doctorate degrees in Neurosurgery and learned the art amongst its eminent professors and staff. Further specialty training and fellowships were then completed in the United States, Germany and France.

Dr. Kabil contributed to numerous publications in international medical journals, is the first Co-Author of the international book, Endoscopic Skull Base Surgery, authored book chapters, and gave many presentations about minimally invasive and endoscopic neurosurgery and spine surgery. He maintains memberships in several medical societies including the American Association of Neurological Surgeons (AANS), the World Federation of Neurological Surgeons (WFNS) and the Egyptian Society of Neurological Surgeons (ESNS).