The doctors at the famous Balgrist University Hospital, which celebrated its centenary a few years ago, are highly specialized in the evaluation and treatment of diseases of the musculoskeletal system. This is a place where high quality care is provided, where unique methods are being developed and applied and where research is performed in the interests of the patients.
Our interlocutor is Doctor Mazda Farshad, one of the hospital’s renowned specialists, the Head of Spine Surgery and the head of the unit for clinical and applied research. Around a thousand spine surgeries are performed per year at his hands and the hands of his team! We began our conversation about the things they face during their work.
– Doctor Farshad, what are the most frequent problems you are asked to help with?
– Most interventions in spine surgery are done to treat the results of degenerative processes of the spinal elements. Such processes can cause compression and damage of neural tissue with associated symptoms, such as nerve compression (radiculopathy), or central spinal canal stenosis in the lumbar region (claudication) or the cervical region (myelopathy). They can also cause severe deformations, such as degenerative kyphoscoliosis, a condition that can limit the mobility of an individual and cause excruciating pain. Further, we evaluate and treat patients with tumors, infections, and inflammation and trauma of the spine. We are also specialized in the evaluation and treatment of severe deformities of the spine, which often need a university hospital setting to be best managed. Another field of our specialty lies in revision surgery – that means surgery on a spine that has been operated on before. Such cases are challenging because often the anatomy is disrupted and the neural structures are scarred.
– What is the main cause of degenerative changes?
– Degeneration of the spine is determined by several factors. Genetic predisposition is probably the most relevant factor. Another factor is age. Non-physiological loads on the spine can also contribute to accelerated degeneration. But the relevance of the contributing factors and their potential interaction are not yet fully understood. But part of our research activities aim to illuminate such aspects.
– Can these degenerative changes be prevented?
– The detailed mechanisms of degeneration are still not yet clear to science and therefore a specific prevention regime does not exist. The process of degeneration is largely guided by genetic factors and age, which are determinants that an individual cannot influence. Other factors that could be potentially influenced by an individual are avoiding non-physiological loads to the spine and enjoying a healthy lifestyle, including sustaining a healthy balanced musculature of the paravertebral and abdominal muscles.
– What kind of sport would you recommend to strengthen the spine?
– A good musculature sustained by, for example, a healthy fitness regime supports the spine in one of its main function, namely bearing the weight of the trunk. Sports that create a more axial load, e.g. jogging, tennis, etc. should be avoided if the patients suffer from disc disease, as they can increase the symptoms. Swimming and bicycle riding is usually well tolerated by most of the patients, as the impact on the spine is less.
– You have achieved impressive results in the treatment of scoliosis. At what age do you operate on patients with this disease?
– It depends on the kind of scoliosis and the degree of deformity as well as the growth potential of the patient. Congenital scoliosis is caused by incorrect formation or segmentation of the spine’s bony structures. Such conditions usually need early surgical intervention to avoid a severe deformity of the spine in future.
Infantile scoliosis appear by definition in very young children, and if surgical treatment becomes necessary, the surgeon should avoid fusion of the spine. Rather, a growth-friendly option should be used, such as magnetic or mechanical growing rods (stretchable fixation systems).
The most common type of scoliosis among teenagers is the so-called idiopathic adolescent scoliosis. Idiopathic implies that it is not clear what the exact cause of the disease is, but a large factor seems to be genetics. Surgical treatment is not always needed. If surgery is needed, several options are possible: while the standard technique is considered to be correction and fusion by a dorsal approach to the spine, other techniques, such as minimally invasive techniques through an anterior (front) approach, can allow a smaller amount of spinal fixation and therefore more mobility of the spine. Over the years, this latter technique has been improved upon and can be considered a valuable alternative for surgical treatment of scoliosis.
– When should a patient present themselves to a doctor?
– If back pain is severe or lasts longer than 6 weeks. If neurological symptoms such as numbness, weakness, bladder dysfunction, gait instability, etc are present. Also, if a patient has a back pain with fever.
– How do you decide on the need for surgical intervention in general?
– It depends largely on pathology, age, comorbidities and individual factors. Generally speaking, surgery can be suggested if conservative therapy has failed and the symptoms find an accurate patho-anatomical correlate (that means a diseases structure, for example in MRI or X-ray), if neurological structures are in danger and if the progression of a disease is not manageable with conservative treatment and the surgical method could be useful.
– Are there any age restrictions for surgery on the spine?
– Age is taken into consideration in making a decision on one or the other methods of treatment. Extensive procedures might not be tolerated in an aged patient with severe comorbidities (other diseases). Therefore, sometimes it seems wiser to instead perform a focused, minimally invasive procedure to treat the main symptom rather than large-scale surgery for the sake of a nice radiograph. However, two individuals of the same age can differ in regard to medical fitness. The decision on which procedure can be performed on which patient is multifactorial and needs careful attention.
– When can a patient go home after surgery?
– It depends largely on the surgery performed. Usually, 2–7 days of hospitalization are required. During this time our physiotherapy specialists instruct the patient on how to move and behave in order to achieve optimal healing.
– Doctor Farshad, do you think that the number of people with spine problems has gone down, if compared with previous years?
– The prevalence of degenerative diseases is expected to increase as the population ages.
Private-Docent (university lecturer) in Orthopedic Surgery, Doctor of Medicine, Master of Public Health. He graduated from the Medical Faculty of the University of Zurich in 2007 and passed all United States medical licensing examinations with top scores.
He spent his internship in the general surgery and traumatology units at the city hospital Triemli (Zurich), had residency training at the department of orthopedic surgery, and was a staff member at the University Hospital Balgrist.
He was appointed as Chief Spine Fellow during his official clinical fellowship in Spine Surgery at the Hospital of Special Surgery in New York, was appointed as Senior Clinical Associate at Cornell in New York, returned to Switzerland (Geneva) in 2013, where he was Chef de Clinique at the University Hospital, and then finally came back to Zurich, where, in 2014, he was appointed the Deputy Head of Spine Surgery at the University Hospital Balgrist, and is currently the Head of Spine and Scoliosis Surgery.
Doctor Farshad is the author of several scientific publications and a member of editorial boards for prestigious medical journals, is a member of the Swiss Society of Orthopedics and Traumatology (SGOT), the Federation of Medical Specialists in Switzerland (FMH), and several renowned Spinal Societies.