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Spine Surgery, Orthopaedics and Neurosurgery

Annual Report 2022

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outpatient consultations
complex spine cases

The specialist Spine Surgery, Orthopaedics and Neurosurgery team treats diseases and injuries of the spine. These include degenerative diseases, deformities and inflammation as well as fractures and tumours. Our scope of treatments ranges from various conservative (i.e. non-surgical) therapies to the most complex surgical interventions including revision surgeries. The highly specialised team uses an interdisciplinary approach with a sound scientific basis.

Tradition and innovation in scoliosis treatment

Schulthess Klinik has the longest tradition of treating scoliosis in Switzerland. This goes back to the time of Wilhelm Schulthess, our founder, who made the treatment of children with spinal curvatures an important part of his life’s work and advanced treatment options in this area.

Thanks to the multidisciplinary collaboration of the Spine Unit, which was founded in 1987, we are able to cover the entire spectrum of conservative and surgical scoliosis treatment. Surgical and conservative departments work hand in hand. Despite the predominantly non-surgical treatment of scoliosis, the number of surgical cases is high (40 major scoliosis surgeries performed in 2022). Our experienced spine surgeons offer all surgical treatment options: open or minimally invasive corrective procedures with a posterior approach, corrective surgery with an anterior approach using fusion or guided growth (with a tethering procedure that allows the patient to retain movement). Complex procedures for severe scoliosis or revision surgery are also included. For more than 20 years, we have been conducting electrophysiological monitoring of the nerve tracts using multimodal intraoperative neuromonitoring in order to avoid complications during demanding spinal operations.

VSS-Tagung: Dr. med. Tamas Fekete referiert
Dr. med. Tamás Fekete on the surgical options for scoliosis.

Scoliosis conference for patients and relatives

In March, a specialist event entitled “Scoliosis – beyond the limits” was held at our clinic in cooperation with the Swiss Scoliosis Association (VSS). The event was a great success with more than 200 patients, relatives and professionals attending. Specialists from various fields provided illuminating insights into the topic from various perspectives, which proved valuable for both the patients and relatives.

A large number of the speakers came from Schulthess Klinik in the fields of spine surgery, physiotherapy, paediatric orthopaedics, internal medicine and neurology. In addition, Dr. med. Omar Zabar from Bad Sobernheim and Dr. med. Fabio Zaina from Milan afforded us a glance into their experiences in the non-operative treatment of scoliosis.

Research and networking to help patients with spinal curvature

Involvement in the European Spine Study Group (ESSG)

Spinal curvature is very common in adults and occurs in approximately 68% of people over the age of 60. The people affected often suffer from pain, restricted movement and limitations in their quality of life. The treatment options are very diverse. This makes it all the more important to find the right treatment for each patient because the choice of treatment can significantly affect the extent to which the patient’s quality of life is improved.

In 2010, a group of passionate spine surgeons set themselves the goal of helping these patients and advocating for their quality of life by gathering scientific research into the subject. As a result, the European Spine Study Group (ESSG) was founded. Since 2012, Schulthess Klinik has been one of five clinics in Europe to become a member. Together with the ESSG’s US-based counterpart, the International Spine Study Group (ISSG), we maintain the world’s foremost prospective database for treatments of this condition, and this forms the foundation for ongoing research projects. In 2022 alone, four manuscripts were published on the subject and our specialists put forward the results of these research projects in 36 presentations at national and international congresses. The results mark important steps in improving the treatment of patients suffering from this condition and also in sharing our knowledge on the subject.

Our involvement in the ESSG is partially financed by the Wilhelm Schulthess Foundation’s Research Fund.

Joint conferences with HSS and Charité Berlin

Our joint hosting of the international “Case Conference” on deformities in 2022 proved yet again to be a fruitful international collaboration. Four times a year, specialists from Schulthess Klinik, led by Dr. med. Frank Kleinstück, meet with their colleagues from the Hospital of Special Surgery (HSS) in New York and the Charité in Berlin to discuss complex cases together. This format is freely available and accessible to all interested spine specialists. The latest “HSS-Charité-Schulthess International Spine Case Conference” can be accessed freely at any time.

Tumour board for spinal tumours

Last year, we established an interdisciplinary neurosurgical tumour board for spinal tumours together with specialists from other hospitals under the leadership of PD Dr. F. Porchet. Neurologists, neurosurgeons, neuro-oncologists, neuroradiologists, neuropathologists and, where needed, radiation therapists sit on the board. We are particularly pleased that the renowned neuro-oncologist Prof. Dr. med. Roger Stupp from Chicago (Chief of Northwestern University Neuro-Oncology) also takes part in the video conferences.

The specialists exchange ideas once or twice a month, discuss patients with spinal tumours and define individual therapy regimens. This means patients receive the best possible care in terms of quality of improvement.

Rapid Recovery for spine patients

Rapid Recovery is an overarching treatment concept with the aim of enabling patients to return to living their normal, everyday life quickly and safely after surgery. We began using Rapid Recovery at Schulthess Klinik in 2019 for patients who have received an artificial hip or knee joint. Starting in 2022, our spine patients now also benefit from this treatment concept.

Thanks to the analysis of the processes involved before, during and after the operation, we have been able to consistently improve the quality of our treatment with optimised processes and maximum efficiency and effectiveness. This includes the rapid surgical, anaesthesiological and nursing assessment of the patient before surgery, the patient coming in on the day of surgery having already fasted at home, getting the patient back on their feet soon after surgery, local infiltration anaesthesia and support in organising follow-up care at home. Patient needs are the main focus. This is evidenced by the “excellent” satisfaction rating given by patients in their assessment of the perioperative phase of their care.

In total, 276 patients benefited from the Rapid Recovery concept in 2022, whom we were able to discharge home safely and without any postoperative complications. This not only increased the satisfaction of these patients, but also shortened the waiting time for other patients thanks to the shorter period of hospitalisation.

Commitment to continuing education

Postgraduate education B status for neurosurgery

At the beginning of 2022, the Swiss Institute for Postgraduate Education and Continuing Professional Development (SIWF) awarded Schulthess Klinik “postgraduate education B status” for neurosurgery under the direction of PD Dr. F. Porchet. The SIWF is an autonomous body of the Professional Association of Swiss Doctors (FMH) whose experts examine the quality of training centres. During a visit, the experts analysed our training concept in detail.

Previously, we had postgraduate education C status, which meant that the neurosurgical training in our department was recognised as one year of experience. The new status means this is now recognised as two years of specialist practice. This demonstrates the FMH’s acknowledgment of the quality of the services provided by our department in the interest of our patients. This includes the quality of complex spine surgery, the high volume of patients, the watertight follow-up registries and, of course, the very close and competent supervision of our trainee specialists.

Continuing professional development for GPs and physiotherapists

Over 370 people attended our training for GPs and physiotherapists in November 2022, the focus of which was on neck pain from various causes. Our spine surgery and physiotherapy specialists presented the current conservative and surgical treatment approaches. Participants were able to attend in person or virtually.

Markus Loibl zeigt vor beim AO-Spine-Operationskurs
PD Dr. med. Markus Loibl demonstrating the TLIF surgical technique, which is performed about 450 times a year at Schulthess Klinik.

Passing on knowledge as an AO Spine Center

Spine Surgery at Schulthess Klinik is one of four certified AO Spine Centers in Switzerland, alongside the St. Gallen Cantonal Hospital and the University Hospitals of Bern and Basel. Commitment to training and development is an important criterion for this certification and aligns with Schulthess Klinik’s guiding principle of passing on the knowledge of our specialists and developing the next generation of medics. We did this intensively in 2022:

Once again, we welcomed guest doctors from all over the world. Joining us was Dr. Hiroyuki Nakarai from Tokyo, who sums up his three-month AO Spine Fellowship with us as follows: “I was impressed by the careful and efficient treatment of numerous complex spinal diseases in well-organised operating theatres. I've also been fortunate enough to work on research projects with top researchers.”

In addition, two AO Spine courses and an AO Spine seminar were held in Switzerland in 2022, with Schulthess Klinik strongly represented both as a faculty and amongst the participants. PD Dr. med. Daniel Haschtmann and PD Dr. med. Markus Loibl showed the participants various surgical techniques: the insertion of pedicle screws into the thoracic and lumbar spine, transforaminal lumbar intersomatic fusion (TLIF) and pedicle subtraction osteotomy (PSO).

In November, an AO Spine Basis seminar was held at Schulthess Klinik to prepare candidates for the specialist examination on spinal conditions. Twelve experienced spine surgeons from large centres across Switzerland took the time to prepare 32 specialist candidates for their upcoming examination.

Referenten AO Spine Fortbildung in der Schulthess Klinik
Twelve experienced spine surgeons passed on their knowledge to the next generation of doctors at Schulthess Klinik:

Front row from left to right: PD Dr. med. David Bellut (University Hospital Zurich), PD Dr. med. Martin Stienen (St. Gallen Cantonal Hospital), PD Dr. med. Markus Loibl (Schulthess Klinik), PD Dr. med. Sven Hoppe (Salem-Spital Bern)

Back row from left to right: Dr. med. Tamás Fekete (Schulthess Klinik), Dr. med. Lukas Urbanschitz (University Hospital Basel), Dr. med. Benjamin Martens (St. Gallen Cantonal Hospital), Dr. med. Harry Gebhard (Baselland Cantonal Hospital), Dr. med. Tobias Pötzel (SPC Nottwil), PD Dr. med. Kai Sprengel (St. Anna Lucerne), PD Dr. med. Christoph Albers (University Hospital Bern), PD Dr. med. Ralph Schär (University Hospital Bern).

Our specialists’ involvement in associations

For years now, our physicians have been extensively involved in Swiss and international associations and organisations relating to the field of spine surgery.

For example, Dr. med. Frank Kleinstück has been coordinating the research activities of the European Spine Study Group (ESSG) within Schulthess Klinik for many years. The international research group ESSG wants to help adults with spinal curvature by creating a scientific database on the subject.

EUROSPINE is an international society which aims to promote the exchange of knowledge and innovation in the field of research and prevent and treat spinal disorders within Europe and worldwide. Dr. med. Tamás Fekete has been involved in EUROSPINE for 12 years. He is currently a member of the Education Committee. Previously, he served on the Programme Committee of the annual EUROSPINE Conference, including as Chair from 2019 to 2021. PD Dr. med. Daniel Haschtmann has been a member of the committee since 2022.

PD Dr. med. Daniel Haschtmann is also on the Commission for Quality and Methodology at “swiss orthopaedics”, the Swiss Society for Orthopaedic Surgery, and Dr. med. Frank Kleinstück has been a member of the Expert “Spine” Commission for a number of years.

PD Dr. med. Markus Loibl has been on the Country Council of AO Spine Switzerland since 2018, including serving as “Ortho Officer” from 2019 to 2021. He has been Chair of AO Spine Switzerland since 2021 and is a strong proponent in this role for orthopaedic and neurosurgical education in Switzerland.

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