The document details various spinal surgeries performed by Professor George Sapkas, focusing on orthopedic disorders, techniques, and conditions treated, including degenerative diseases, infections, tumors, and deformities. It emphasizes advancements in minimally invasive surgery and innovations in surgical techniques, such as the use of bioengineering and nanotechnology. Additionally, it discusses patient outcomes and the importance of surgical training and support in improving quality of life for patients with spinal issues.

1. Spinal Surgery
George Sapkas
Professor of Orthopaedics

2. T.B.C.

3. Disorders and Deformities
of the Spine
Injuries
Metabolic diseases – osteoporosis
Rheumatic diseases
Infections
Tumors
Degenerations
Deformities
Minimal Invasive Techniques
Reconstructive surgery

4. Cervical injuries

5. Upper cervical
injuries
C2

6. Den’s fracture of the 2nd
cervical vertebra
Posterior inio-cervical stabilization

7. Middle and Lower
Cervical spine
Posterior stabilization
Anterior stabilization
Burst fracture

8. Thoracolumbar &
Lumbar Spinal Injuries
Posterior and Anterior stabilization
Posterior stabilization
Fracture - Dislocation

9. Sacral
Spinal Injuries
Fracture of the sacrum
Decompression and Posterior stabilization
of the sacrum

10. Metabolic diseases

11. Π.Μ.
F 80
28-7-06
Osteoporosis: T-Score: - 3.5
Posterior Correction & Stabilization

12. Degenerations

13. Discectomy

14. Cervical disc
Discectomy and Anterior stabilization

15. Artificial cervical disc

16. Cervical stenosis - Myelopathy

17. Anterior decompression and stabilization
with Mesh cylinder and plate
Cervical arthritis and stenosis

18. Corpectomies and Anterior stabilization

19. Corpectomy and Anterior stabilization

21. Thoracic stenosis and Myelopathy
•Anterior procedure
•Anterior decompression of the spinal cord
•Stabilization (cage and rods)

22. DiscectomyDiscectomy
Microdiscectromy

23. Lumbar Discectomy

24. Lumbar discectomy
and
stabilization

25. Discectomy
Disc excision

26. Discectomy and dynamic stabilization

27. Discectomy and expansion intervertebral cages

28. LumbarLumbar
degenerationdegeneration
--
instabilityinstability
Dynamic stabilization

29. Lumbar stenosis & instability
Posterior decompression & stabilization
Interbody cages

30. Rheumatic diseases

31. Rheumatoid spondylitis

32. Cervical instability and cord comresssion Spinal cord decompression
and inio-cervical stabilization

33. Angylosing spondylitis

34. •Anterior procedure
•Cage and plate
•Posterior procedure
•Cervico-thoracic
screws and rods

35. Infections

36. Cervical spine

37. Cervical Epidural abscess
•Anterior vertebrectomies
•Evacuation of the epidural abcess
•Cage and stabilization with plate and screws
•Posterior stabilization

38. T.B.C.
Thoracic spine

39. •Anterior vertebrectomies
•Evacuation of the epidural abcess
•Cage and stabilization with plate and screws
•Posterior stabilization

40. Ecchinococus cyst
•Incomplete paraplegia
•Posterior decompression
of the spinal cord
•Stabilization

41. Tumors

42. Thyroid’s metatstasis
Posterior decompression
of the spinal cord
&
Inio-cervical Stabilization
Cervical spine

43. Myeloma

45. Breast’s metastasis
Thoracic spine
•Vertebrectomy
•Cage
•Stabilization

46. Thoracic spine
Anterior – posterior procedure

47. Lumbar spine
•Vertebrectomy
•Cage
•Stabilization

48. Scheuermann H. Kyphosis dorsalis juvenilis,Scheuermann H. Kyphosis dorsalis juvenilis,
Ugekr Laeger, 1920Ugekr Laeger, 1920
Deformities
kyphosis

49. Thoracolumbar kyphosis
•Posterior procedure
•Correction
•stabilization

50. Scoliosis

51. • Idiopathic adolescent scoliosis

52. Posterior procedure

53. Anterior procedure

54. a. Scoliosis
b. Kyphosis
Saggital & Coronal Imbalance
Adult Spinal Deformity

55. Hooks & Rods + transpedicular screws
Correction and stabilization
Hybrid System

56. Decompression and stabilization
(long)

57. • Posterior 3 column stabilization
• Intervertebral cages

58. Adult degenerative Kyphosis – ScolioisisAdult degenerative Kyphosis – Scolioisis
(+) Parkinson(+) Parkinson

60. Spondylolysis - Spondylolysthesis

61. I. Μαυρ.
M. 57
3-3-1998
•Posterior procedure
•Interbody cages
•Stabilization (transpedicular screws and plates)
Spondylolysis – Spondylolysthesis
1st
degree

62. Spondyloptoses
•Posterior procedure
•Trans S1 – L5 fibular graft
•Posterior stabilization (transpedicular screws and rods)

63. Minimal Invasive Techniques

64. Kyphoplasty

65. Kyphoplasty
kidney’s metastasis

66. V.B.S. System
Vertebral fracture
Kyphoplasty - Expansion cage

67. Kyphoplasties

68. • Osteoporosis
– Vertebroplasty
– Kyphoplasty

69. Endoscopic
Discectomy

70. Spondylodesia
Percutaneous

71. Spondylodesia percutaneous
& Interbody spacer

72. Percutaneous spondylodesia
and interbody spacer

73. Post operative
mobilization
following
percutaneous
spondylodesia

74. 8-9-2018
Metastatic tumor
(prostate)

75. Spinal cord
decompresion
and
percutaneous
spondylodesia

77. Reconstructive surgery

78. Late post traumatic Lumbar instability and Kyphosis

79. Pre operative plan

80. Intraoperative correction and stabilization

81. Post operative x-rays
Lumbar – Sacral – Iliac
stabilization

82. Pre - operative

83. Post operative

84. Late post operative saggital imbalance

85. Treatment
• Osteotomy L3 vertebra
• Spondylodesia’s extension to Sacrum - Ilium
Lumbar lordosis and saggital balance restoration

86. Late post operative destabilization
due to vertebral collapse

87. Lumbar – Sacral –Iliac
stabilization and
Interbody cages

88.  Ο. Ρ.Ο. Ρ.
F –F – 7070
 ((Failed Back SurgeryFailed Back Surgery
Syndrome)Syndrome)

90. Factors associated
with
spinal surgery evolution
1. Bio-engineering
2. Implants
3. Molecular Biology – Nanotechnology - Biomaterials
4. Operation rooms
5. Technical support
6. Trained medical and paramedical personnel
7. Intensive Care Unit (I.C.U.)
8. Spinal surgeons training
9. Spinal Societies
10. Financial factors

91. Bioengineering

92. Biomechanics
of the Spine
Bonescrew
1st
load
step
2nd
load
step
Symmetry
axis
Threaded
holeScrew
hosting
material
Symmetry
axis
Screw
hosting
material
Bonescrew
50% of 1st
load
step
50% 2nd
load
step
100% of 1st
load
step
100% 2nd
load
step

93. Biomechanics of the
Spine.
Parameters Evaluation
and
Deformities Treatment

94. • Sagittal imbalance
is a multifactorial
pathology that
causes back pain
and neurological
involvement,
with a significative
decrease in patient’s
quality of life.

95. Clinically, the deformity
appears as :
1.fixed lumbar flexion
2.inability to stand
3.erect without
compensatory
hip extension
and
knee flexion.
This results in muscle
fatigue and activity-related
pain.

96. Spino – Pelvic
Parameters

97. Incidence Angle (Duval-Beaupere)
Normal Values No 709 subjects
PI= 52.60 +- 10.4 (31 to 83.5)
PT= 13 +- 6.8
SS=39.6 +- 7.9
There is no difference between Men and Women
Normal Values
PT should be <PI/2
SS should be > PI/2
Interpretation of Pelvic Parameters
Anatomical Constant. Every one has his/her own
Pelvic Incidence Angle for the whole life.
(Stops Increased after Skeletal Maturity)
It is a characteristic of the Sagittal width of Pelvis
There is no good or bad PI

98. Gravity line
and
Sagittal Vertical
Axis
(SVA)
Femoral head
S1 Gravity Line
Center
of
Gravity
C7
Plumb
SVA

99. Sagittal-Coronal
balance -
imbalance
S1
Coronal imbalance
Sagittal imbalance

100. Implants

101. Kaneda 1979

102. Titanium – Mesh
Cylinder

103. Expandable
cages

105. Bryan Cervical Disk Replacement

107. The Prodisc-C:
Concept for
Cervical Disk
Arthroplasty
(semi-constrained)

109. Chord compression at C4-C5 left side
Lateral view after
Prodisc-C implantation
ΑΡ view after
Prodisc-C implantatio
MRI pre-surgery.
DDD multilevels -
Chord
compression at
C4-C5

110. Nucleus replacement
implants/ partial disc prosthesis
• The optimal indication for
artificial nucleus
replacement is
monosegmental
degenerative discopathy.
• Lumbar pain should be the
main symptom.
• For a PDN prosthesis, the
disc height should be at
least 5 mm.

111. Lumbar Intervertebral
Total Disc Replacement

112. SB Charité
• The endplates
grip the adjoining bony
endplates by means
of three metal teeth,
which are attached
anteriorly and posteriorly
and run diagonally.

113. Maverick Implant Design
HA Coating
• Calcium phosphorus
• Provides a geometry
which is conductive to
bony on growth
• Rough surface provides
increased friction for a
press fit

114. Maverick Implant Design
Inferior Component
Six sizes available:
Width
32mm (S)
35mm (M)
39mm (L)
Superior Component
Eighteen sizes available:
Height
10mm
12mm
14mm
Lordosis
6°, 9° or 12°
Depth
25mm (S)
27mm (M)
30mm (L)

116. Extension Bending
(Standing)
+2°
(Total 15° ROM)

117. +4°
Lateral Bending

118. -4°
(8° Total ROM)
Lateral Bending

119. 3D - print

120. Molecular Biology
Nanotechnology – Biomaterials

121. BiomaterialsBiomaterials
withwith
Antimicrobial andAntimicrobial and
Osteoinductive PropertiesOsteoinductive Properties
applied toapplied to
Spinal SurgerySpinal Surgery

122. AgNPs

123. • AgNPs are clusters of
silver atoms with
diameters ranging
from 1 to 100 nm.
AgNPs have become
highly interesting for
medical applications
because of their:
– antimicrobial,
– anti-inflammatory,
biocompatible and
– wound-healing-
favoring properties
Chaloupka, K., et al, Trends Biotechnol.
2010

124. Qaternised Chitosan

125. • Chitosan, a
naturally-derived
polycationic
polymer, has been
made into various
biomedical devices
due to its
– proper
biodegradability,
– good
biocompatibility
– and antimicrobial
activity
Rabea, E.I., et al, Biomacromolecules
2003

126. • Quanternized
chitosan could
also effectively kill
antibiotic-resistant
bacteria, such as
Methicillin-
resistant
Staphylococcus
aureus

127. Copper

128. • Copper ions, upon
contact with microbes,
• generates electric
deregulation and
disorder the pump of
K – Na which is
located in the cell
membrane .
• This action creates
osmotic problems in
the cell, thereby killing
the microbes .

129. Mechanism of copper ions Action
SYTO-9SYTO-9 PIPI
Cu+
/Cu2+
Cu2+
Metallic Copper as an Antimicrobial Surface .Marc Solioz et al,*Appl Environ Microbiol. 2011 77(5):
1541–1547
Deregulation
and disorder
the pump of K –
Na

130. • Schematic graph depicting the
four different carrying modes
of both antibacterial and
osteoinductive drugs in
biomaterials aiming to treat
infected bone defects.
– (A) Superficial adsorption with or
without physicochemical bonds;
– (B) A co-encapsulation;
– (C) A mixed carrying mode with
encapsulated antibacterial drugs
and superficially adsorbed BMPs;
– (D) surface coatings:
• (D1) both drugs are immobilized by
chemical bonds;
• (D2) both drugs are encapsulated in
coating layers with separation layers
for a controlled release.

131. Operation rooms

134. Technical support

135. Neuro monitoring

136. Navigation system O-Arm

137. Robotic Spine Surgery

141. Trained personnel
• Doctors
• Nurses
• Technical advisors
• Physiotherapists

142. Medical Personnel
• Anesthesiologists
• Thoracic Surgeons
• Vascular Surgeons
• General Surgeons
• Radiologists
• e.t.c.

143. Nurses
• Theater staff
• Nursing staff
members

144. Technical advisors

145. Intensive Care Unit

147. Spinal Surgeons training

148. • Workshops
• Seminars
• Congresses
• International
meetings
• Further training as
fellows
• Publications

149. Spinal Societes

150. • Hellenic Association of Orthopaedic
Surgery and Traumatology (H.A.O.S.T.)
– Spinal Disorders Dept H.A.O.S.T.
• Neurosurgery Society
• Hellenic Spinal Society (2007)
• Scoliosis Research Society
• Eurospine (1998)

151. Financial Factors

153. Purpose
Better quality of life

154. Double Spinal Deformity: a) Idiopathic adolescent
scoliosis
b) Spondylolysis - spondylolisthesis

155. Post operative correction

156. kyphoscoliosis
P.Chr.
67 yrs old
Pre - operative

157. Post – operative correction of the stature

158. Osteoporotic fractures
E.M.
90 yrs old
4 ½ yrs Post - operative

159. Limassol - Cyprus 2018Idiopathic Adolescent Scoliosis Operated
Metropolitan Hospital 2010