Endoscopic spinal surgery

Minimally invasive spinal surgery: impossible became real and affordable.

«Do you suffer from back ache? Only yesterday you did skydiving, chuted, lifted heavy objects, played with children? Today you have an awful pain at rest, pain when walking, inability to turn over on a side, you can’t control your own hands and legs? Is the reason spinal disc injury with pinched nerve roots? Do you dream everything turned back? Only yesterday it was a serious disease, but today you have a chance to heal everything with one half-hour surgery and recover your health!» — tell Professor Ralph Wagner (Germany) and Candidate of Medical Science I. Iu. Malakhov (Russia).

The text below is addressed to all forward-thinking patients, who take care about their health and who want to entrust it only to true professionals, as well as to allied trade doctors such as neurologists, osteopathologists, chiropractics, computer and magnetic resonance tomography doctors, radiologists, basically to all specialists who make a spinal disc herniation diagnosis for the first time.

If you make spinal disc herniation diagnosis in any region of spine from cervical to lumbar or a diagnosis of multiple hernias, then send us your medical report and a link for video archive with magnetic resonance tomography (MRT) and computer tomography (CT) and we will kindly comment this materials for free in order to define the opportunity of performing conservative, minimally invasive endoscopic spinal surgery and returning a patient to an active work.

I, Malakhov Igor Iurievich, neurosurgeon, and I will, for one, answer all your questions. My e-mail: cc@medica24.ru

If the situation is very difficult, for example in case of multiple hernias, we will invite professor Ralph Wagner (Germany), our main ideologist and developer, as well as rehabilitation therapists who take part in comprehensive treatment of our patients, to join us at our board of doctors.

Have you heard anything about noninvasive curative treatment of spinal disc hernias without using of metal implants?

In 2000 German doctors under the charge of Professor Ralph Wagner developed and patented a technology of endoscopic spinal surgery, that got a name TESSYS. Treatment with this methodology is an ideal way to forget such words as lumbago, ischias, pain in a leg, back ache, intermittent lameness and «to lose the address of your neurologist and massage therapist», — says Professor Ralph Wagner. According to our practical experience the process of these diseases of Russian patients differs, because 90% of patients visit a doctor at advanced stage of a disease having a variety of other medical problems in addition to hernia. So it is unlikely to forget all those words forever.

Curative and secure pain management in neck, back and lumbus!

  • More than 100,000 patients have successfully thrown off pain forever with Joimax methodology at 500 medical centers in 30 different countries.
  • More than 2,000 surgeons from different countries have been trained by a group Joimax teachers at 3 main training centers in the world;
  • For now Joimax technology in Russia is represented only in 3 clinics including Medicine 24/7.

Подготовка к эндоскопической операции по удалению грыжи позвоночника

The second in Russia endoscopic surgery on central stenosis of spinal canal at L4-L5 and L3-L4 levels through a single approach has been performed at Clinic Medicine 24/7 by Doctor Malakhov.

Who are our patients for spinal hernia excision surgery?

We invite all the patients for treatment, who suffer from spinal disc hernias and spinal stenosis.

Some of the patients (almost 10%) caught a disease during last 4–6 weeks after a little physical exercise, injury, more rarely after work-related incident. These patients complain of a significant pain, that can’t be removed with common painkillers. Almost all of them feel complete release from pain right after the surgery. After discharge patients don’t need much time for rehabilitation. In 3–5 days they are able to come back to work and daily routine.

However in most cases we see patients on advanced stages of disease. They ineffectively appealed to self-treatment and treatment with traditional remedies went to see chiropractic or massage therapist. They refused undergoing MRT (magnetic resonance therapy) in order to rule in or rule out spinal disc injury.

In most cases the hernia of such patients changes into marked discus protrusion and even into formation of sequester. As a result there is a significant «lightning» pain in lumbus, clunes or hip joint or even spreading pain in hip or ankle. Many patients have pain associated with acute pains, itch, burning pain from sensory nerve roots disorder. Then we see desensitization of extremities and finally developing weakness in hands and legs. We discharge such «advanced» patients during 3–5 days after the surgery. Almost all patients need a complex rehabilitation with help of rehabilitation therapist, neurologist, physiatrist, chiropractic and massage therapist.

Don’t be afraid of a surgery! Diagnostics with MRT-scan and endoscopic surgery with postoperative follow-up — basic premise to your curation in 24 hours. In Clinic Medicine 24/7! You hold the keys to the kingdom!
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In case of which diseases is endoscopic surgery with Tessys technology used?

Minimally invasive TESSYS surgeries are assigned in case of following pathologies:

  • Spinal hernias of lumbar spine (nowadays there is all necessary equipment, that allows to perform interventions on a neck). According to statistics 75% of cases don’t demand any surgery. The question rises up if pains last during 6 weeks with use of conservative therapy or if there are significant movement, sensitivity disorders, uroclepsia and gatism.
  • Spinal stenosis is a state when osteophytes appear on spinal bones as a result of degenerative changes and neurocanal gets narrower. An adult’s spinal medulla ends at the first lumbar vertebra. Only nerve roots stretch lower. In case of neurothlipsia pains and other symptoms appear.

Грыжа позвоночника

During surgical interventions on spinal hernias protruding part of discus that puts pressure on spinal nerves is removed. In case of spinal stenosis the surgeon removes unnecessary ostein.

Advantages of Tessys, iLESSYS and CESSYS technologies

  • Pain syndrome in cervical, posterior and lumbar spine that have been troubled you for years completely goes away in 1–3 hours after the surgery.
  • Radicular syndromes (malfunction of major nerves) for example in case of ischias or lumbago will recover in 2–3 days.
  • During the surgery bone elements aren’t removed and ligamentous apparatus of spinal column isn’t damaged, pressure on nerve roots reduces.
  • Duration of the surgery is from 45 minutes to 2 hours.
  • Discission size isn’t wider than 5 mm (in fact, nyxis). Blood loss is no more than 10–15 ml.
  • You can stand up in one hour after the surgery. Free walking is allowed the next day after the surgery (even if it was on the lumbar spine).
  • Regularly the surgery is performed under video monitoring and X-ray control. During the surgery ready single-use appliances from industrial manufacturer are used. This makes the process completely safe for the patient.
  • Patient can return to physical exercises in 2–3 weeks after discharge.

Methodology of Tessys (Transforaminal Endoscopic Surgical System)

Tessys methodology is instrumental system for performing endoscopic surgeries on lumbar spine with a use of transforaminal approach.

Primary indications for performing Tessys methodology surgeries:

  • Lumbar spine sequestered hernias;
  • Lateral and foraminal stenosis;
  • Hypertrophic yellow ligament;
  • Osteophytes;
  • Recidivation after upfront surgery (we bypass surgical scars);
  • Ventral cyst of facet joints.

Main features of Tessys methodology:

  • Approach through natural intervertebral foramen. It’s safe for neurocanal;
  • Direct removing of the hernia’s or osseous structures’ tissue without moving nerve roots aside;
  • Appliance kit developed specially for endoscopic spinal surgery;
  • Appliances, endoscopes, endoscopic equipment, supplement and expendable materials — from a single manufacturer.


Methodology of iLESSYS (Interlaminar Endoscopic Surgical System)

iLESSYS methodology is an instrumental system for performing endoscopic surgeries on lumbar spine with a use of intralaminar approach.

Primary indications for performing iLESSYS methodology surgeries:

  • Lumbar spine sequestered hernias that migrated in a dorsal way;
  • Dorsal cysts of facet joints;
  • Central stenoses and lateral recess stenoses;
  • Cervical foraminal hernias, dorsal stenoses with radiculopathies.

Main features of iLESSYS methodology:

  • Used for lower levels of lumbar spine (big intralaminar windows);
  • Removing of tissues with graspers and kerrisons straight through the endoscope;
  • Special diamond burs for endoscopic decompression;
  • Used for decompression in case of central stenosis;
  • Unilateral and contralateral approach with fully endoscopic control.

What are disadvantages of other classical surgery interventions?

The main disadvantage of classical spinal surgery interventions is that surgeon has to make a serious damage to tissues:

  • When getting an approach to spinal hernia with a classical way surgeon faces many nerve roots. He has to move them aside. Any of such manipulations with nerve structures cause injures and function disorder.
  • During endoscopic spinal hernia removal we fully exclude any space contact between hard formation in coat of spinal cells and periosteal part of spine that includes tissue aggregations and vein plexuses.
  • Classical approach always requires severing of intervertebral and intercostal muscles. After that they need some time to get fused. The scar left in muscular tissue can become a source of chronic diseases.
  • In case of posterior approach it is necessary to remove a part of osseous tissue from spinal bones. In case of endoscopic surgery there is no need to perform bone resection, there is no instability of an operated locus and thereby there is no need to firm it with metal implants.

Эндоскопическая операция по удалению грыжи позвоночника

All that leads to that the patient needs much time for rehabilitation after the surgery. Normally the rehabilitation period lasts up to 3 months. There is a risk of adverse events for example spine stability disorder.

In which way is spinal hernia excision surgery with Tessys technology performed?

In case of surgical interventions with Tessys technology surgeon uses thin endoscopic appliances, approach is performed through intervertebral foramen. These foramens are situated right and left between vertebral arches of contiguous spines. Spinal nerves permeate through these foramens. If the appliance is inserted into definite place and at definite angle these nerves won’t be touched.

In order to choose an approach point, position and angle accurate surgeons use actinography, computer tomography (CT), magnetic resonance tomography (MRT).

Эндоскопическая операция при межпозвоночной грыже

During the surgery the patient is put on a stomach or on a side. Due to a minimal invasiveness of this surgery general anesthesia isn’t needed. Spinal anesthesia will be enough. Patient is conscious and can talk to his doctor. Intervention lasts 40–50 minutes. During this procedure patient doesn’t feel anything. When the anesthesia effect is over pains never return.

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Удаление позвоночной грыжи в Москве операция Малахова

TESSYS methodology has very few counterindications and can be applied almost to any person:

  • Of any age;
  • Of any weight;
  • Aged people;
  • People who had undergone a surgery but a relapse happened.
«One more advantage of such surgical interventions is that the general anesthesia is not needed. This means that there are no risks that refer to it. Your surgeon will talk to you before the surgery and you will discuss all possible risks and adverse events» — Igor Iurevich Malakhov, operating neurological surgeon, vertebrologist for Clinic Medicine 24/7.

The most frequently-asked questions from patients with spinal hernia.

Can hernia be left without any treatment?

Maybe it will dissolve by its own? You mustn’t leave hernia without a treatment. Moreover the faster it is operated on, the better is for a patient. Putting up with pains for a long time, cutting them short with painkillers, correcting them with physical medicine and massage you turn a little surgery into a big one. In a half of a year or a year you’ll surely face intervertebral disk atrophy, hernia bulging will turn to sequester and as a result everything will end up with apoplexy of one hand or a leg or even both. That’s why you shouldn’t hold back on defining the opportunity of surgical treatment.

Other doctors tell me completely different things: such surgery can lead to unknown consequences, hard adverse effects. The methodology isn’t verified and unpopular.

Minimally invasive endoscopic spinal hernias treatment methodology has been being developed for almost 18 years. It is true that endoscopic technologies have made a huge step forward during this time. But the gained experience from more than 100 000 successfully operated patients in 500 medical centers in 30 different countries of the world speaks volumes. More than 2000 surgeons in 3 main training centers of the world were taught Joimax methodology these years. Unfortunately this methodology came to our country relatively late. The first demonstrational surgeries have been performed by Joimax specialists foremost by the founder — Professor Ralph Wagner — since the end of 2016 — the beginning of 2017.

Why then the surgeries are not performed at Priorov Center for Intensive Education Technologies (CIET), at Institute of Sports Traumatology and Orthopedics or at Burdenko Institute of Neurosurgery?

These are distinguished leaders of national traumatology and orthopedics. However, nowadays introduction of advanced technologies in these institutions faces quite intrinsic problems due to bureaucratic runaround and inserting amendments in Treatment Federal Standards that needs from 1 to 10 years of constant work with Ministry of Health and Obligatory Health Insurance Funds. If this methodology is implemented in Federal Standards it will be necessary to make a revision of all other treatment methods. There is just no money in budget for this. Moreover check the manufacturer’s web-site — https:/www.joimax.ru/kliniki. (it is available in Russian). There you will find dozen and a half clinical and scientific data bases. Call them and try to arrange a visit. Define the cost and sign up for a waiting list. But the main thing is to ask a question how many surgeries have they performed. The answer will surprise you — the majority will answer that they have performed single surgeries within the framework of scientific workshops and seminars. Why didn’t they master it despite having both equipment and personnel at their disposal? Find the answer to this question yourself.

Why spinal hernia should be treated at your clinic?

Result. Firstly, the result of each certain person matters. You came to us with a problem, we solved this problem completely and for sure within a day. At Clinic Medicine 24/7 we manage with almost all types of chronical and severe pain syndromes. Secondly, we guarantee comprehensive and permanent solution to a problem. If we talk about single cervical, dorsal or lumbar spine hernias then we will operate on you the same day you visited us after passing a complete express-examination including spine tomography with a use of our own high-resolution scanners. If we talk about multiple cervical spine hernias then in some cases a detailed examination will be needed after which professor Wagner and we make a decision about an opportunity of performing the surgery in Moscow or in high-risk cases an obligatory surgery at Joimax reference-clinic in Germany. Thirdly, we give a hope to patients! You can watch «Wonder-stories» on a clinic’s web-site or YouTube channel and you’ll make the right choice!

I’ve been looking so long for the answers to questions «how much will it cost to remove a spinal hernia in an endoscopic way?» and «who is the best surgeon in endoscopic treatment of hernia?» Then are you the one and only neurosurgeon-orthopedist in Moscow who can perform such surgery?

Unfortunately, now it’s almost true. I regret stating that despite the teaching more than 20 surgeons from Moscow this methodology (according to Professor Ralph Wagner’s data), I am the one who is practicing it actively in Clinic Medicine 24/7. But in general now we perform almost 50% of all endoscopic interventions on spine using Joimax-methodologies in Russia.

How can I find out if it is possible for me to be eased from pain using this technology?

The majority of patients who come to the clinic for a surgery do it by the assignment of experienced neurologists who have already worked with our clinic and know the capabilities of TESSYS technology. In addition to that part of the patients comes being tired of hundreds of ineffective massage sessions, physical medicine and reflex therapy and having spent a lot of money on painkillers. In developed countries of Europe a visit to neurosurgeon or orthopedist-vertebrologist is obligatory if within 4–6 weeks of conservative treatment a mend didn’t came. In our country conservative treatment can last for years.

In which way will the consultation at neurosurgeon’s be held?

Neurosurgeon, sometimes with neurologist, makes up the examination program. Don’t do conduct any examinations by your own. At present time we scarcely put on neither spine sonography for observing the state of intervertebral discs, nor plain or stress radiograph. To solve the question of surgery it is enough to see a full-scale clinical picture of neurologic impairment — chronic pain in upper or lower limb, muscular weakness or atrophy, irritability disorders or pathological irritability, reflex decrease. Moreover we conduct advanced computed or magnetic resonance tomography. Both observations — computed tomography (CT) and magnetic resonance tomography (MRT) — give a full-scale clinical picture of pathological changes in spine and opportunities of its surgical correction. Key-indications for type and extent of surgery are intervertebral disc destruction degree, destruction of its fibrous ring, size of hernia bulging, stenosis (arctation) of spinal canal.

Is there any probability of hard adverse effects? Is it possible to become a disabled person after such surgery?

TESSYS is more delicate surgery comparing with all methods that were used earlier. The risk of adverse effects after it is minimal. The doctor doesn’t do a big discission, soft tissues remain almost undamaged, bone resection is not performed.

When will the pains disappear?

Pain syndrome will disappear right after the surgery. You’ll be able to feel it when the anesthesia effect is over. Next day you will be able to leave clinic without anyone’s help. Very soon you can come back to your daily routine and work.

Can any recidivations appear after the surgery?

You need to understand that the surgery only helps to remove a paraplasm. The surgeon won’t be able to change biochemical and other processes that are going on in your spine. That’s why hernia can appear again even in another place. In spite of that the recidivations frequency after TESSYS methodology surgeries is very low — less than 5%.

How we perform endoscopic surgery on treating the spinal stenosis:


  1. Zorin Nikolai Aleksandrovich, Kirpa Iuurii Ivanovich, Zorin Nikolai Nikolaevich. Comparative efficiency analysis of endoscopic transforaminal microdiscectomy and open discectomy in treating lumbar spine hernias / UNZh. 2014/ No.3.
  2. Kobets Iu. v. Transforaminal and transsacral stenosis blocks in lumbar spine / Scientific evidence. BelGu. Series: Medicine. Pharmacy. 2016. No.12 (233). URL: https:/ cyberleninka.ru/article/n/transforaminalnye-i-transsakralnye-blokady-pri- stenoze-poyasnichnogo-otdela-pozvonochnika (access date: 14.11.2018).
  3. E. A. Esetov, G. I. Murzagaliev, E. I. Shulga, N. v. Shchedrova, S. A. Bezus, A. A. Zhalgasbaev. Endoscopic assisted treatment of lumbar spine hernia / «Neurosurgery and neurology of Kazakhstan» — magazine. 2009. No.2–3 (15–16).
  4. Gioev Petr Mikhailovich, Khudiaev A. T. Aspects of comprehensive treatment of lumbar spine osteochondrosis / Orthopedics genius. 2009. No.3.
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