Dr. Gilete

09/03/2026

Cervical collar trial for evaluation of upper craniocervical instability: a non-surgical assessment protocol

Functional Objective

The rigid cervical brace trial is a clinical evaluation method designed to functionally simulate the stabilizing effects that would be achieved through occipital-cervical surgical instrumentation and fixation. By means of sustained rigid cervical orthotic immobilization, the test provides temporary mechanical stabilization of the upper cervical segments adjacent to the skull, allowing assessment of symptom trajectory in response to segmental motion restriction.

Clinical Context and Indications

Surgical stabilization of the craniocervical junction is considered in select patients whose symptoms arise from ligamentous laxity (secondary to connective tissue disorders, prior trauma, or degenerative processes) and manifest as cervicogenic pain, occipital headache, neurological deficits from cranial nerve involvement, or brainstem-mediated symptoms.

The brace trial serves dual purposes:

1. Clinical delineation: Identify which presenting symptoms are motion-dependent (and therefore potentially responsive to stabilization) versus those arising from other anatomic or systemic processes
2. Patient-centered prognostication: Enable informed decision-making by allowing patients direct experience of what functional constraints and symptom amelioration may accompany surgical stabilization, thereby supporting realistic expectations regarding both benefits and limitations

Procedural Implementation - Orthotic Selection and Fitting

Device characteristics:
• Rigid cervical orthoses designed for upper cervical immobilization (e.g., Aspen Vista, Miami J models) are preferred over semi-rigid or soft collars, as inadequate immobilization limits diagnostic utility
• Proper sizing and fitting by certified orthotist is essential, balancing maximal stabilization with ergonomic tolerability
• Patient-reported comfort during brace wear should not compromise structural integrity or motion restriction; minor discomfort during initial days is expected and typically resolves

Prescription documentation:
• Written prescription from primary treating physician required
• Specify trial duration and wear schedule
• Clarify expected use patterns and activity modifications

If you want to learn more about the cervical collar trial, please take a look at our website:
https://drgilete.com/resources/cervical-collar-trial-craniocervical-instability/

27/02/2026

We are grateful to share that on Thursday the 5th of March (16.00CET-17.00CET) Dr. Gilete will be the speaker during a webinar which has been organized in cooperation with the Swedish EDS/HSD Association.

Dr. Vicenç Gilete is a neurosurgeon specializing in a highly advanced protocol for Cranio-Cervical Instability and the comprehensive management of complex spinal instabilities and neurological manifestations associated with Ehlers-Danlos Syndrome (EDS) Hypermobility Type, including the diagnosis and surgical treatment of Occult Tethered Cord Syndrome (OTC).

Dr. Gilete’s institute stands as the sole active EDS Center of Excellence in Europe with neurosurgical activity, capable of comprehensively addressing this pathology.

‘Recognizing that EDS is a multisystemic condition, my clinical vision integrates surgical precision with a pioneering non-surgical immunological approach. By addressing the underlying inflammatory and immunological drivers of spinal symptoms, I provide a holistic treatment framework that optimizes patient outcomes and tries to look for alternative treatments.’

The webinar will touch on the subjects of diagnosis and surgical management of complex craniospinal pathologies in patients with Ehlers-Danlos Syndrome (EDS) and Hypermobility Syndromes.
We will look at the clinical scope, discussing CCI, AAI and OTC as well as comorbid conditions, the diagnostic protocol, patient management and our surgical philosophy.

The webinar will be held in English and after the lecture there will be time for qeustions. Attendance is free for members of the Swedish EDS/HSD Association. It is also open to non-members and international patients after becoming a member.


PLEASE SUBSCRIBE HERE IF YOU WANT TO ATTEND THE WEBINAR:

https://us02web.zoom.us/webinar/register/WN_Jl3CZuS7RGai4NlW_kx00w


For non-members of the Swedish EDS/HSD Association:

"Would you like to become a member?

Please pay 50 SEK (Swedish Crowns) per member via IBAN SE4880000810596940285494
Please include your name and membership in the payment reference.

NOTE!
After making the payment, please send an email with your name to medlemskap@eds-hsd.se confirming that you have paid.

A warm welcome!"

We look forward to seeing you there!

24/02/2026

Meet one of our patients. We wish you all the best in life and on the path of further recovery.

“My experience under the care of Dr Gilete has been life-changing. His knowledge, skill, and clinical expertise are exceptional, but equally remarkable is the compassion and reassurance he provides his patients.

Throughout my treatment and recovery, Dr Gilete consistently made me feel heard, understood, and supported. During a particularly difficult stage of my recovery, he personally spent time at my bedside, offering reassurance and genuine care.

I am profoundly grateful for the chance at a better quality of life that Dr Gilete has given me. His dedication to his patients is truly outstanding.”

13/02/2026

What is the difference between Tethered Cord (TC) and Occult Tethered Cord?

Tethered Cord Syndrome (TCS) is defined as a stretch-induced functional disorder of the spinal cord wherein the caudal spinal cord is mechanically anchored by an inelastic structure. The classical diagnostic criteria mandate the convergence of clinical symptomatology with macro-anatomical radiographic anomalies. Specifically, the conus medullaris is visualized terminating below the L2 vertebral level, often accompanied by a thickened filum terminale (>2 mm) or spinal dysraphisms (e.g., lipomyelomeningocele) [Hertzler et al., 2010; Yamada et al., 2004].

In contrast, Occult Tethered Cord Syndrome (OTCS)—also referred to as Tight Filum Terminale Syndrome with a normal conus—presents a diagnostic challenge. It describes a subset of patients who exhibit the classic metabolic and ischemic symptomatology of TCS but present with a structurally normal conus position (at or above the L1-L2 disc space) and often a filum of normal thickness on standard supine MRI [Steinbok et al., 2007; Warder & Oakes, 1993]. In these cases, the pathology is attributed to decreased viscoelasticity of the filum rather than gross anatomical malposition.

2. Radiographic Assessment: Supine vs. Prone MRI

Standard Supine Lumbosacral Magnetic Resonance Imaging (MRI) remains the gold standard for identifying classic TCS. It effectively visualizes the low-lying conus and associated masses. However, its sensitivity is significantly reduced in OTCS, where the static supine position may mask the mechanical tension of the filum.

To address this, the Prone MRI protocol has emerged as a critical adjunctive diagnostic tool.

• Physiological Rationale: In a prone (face-down) position, gravity should naturally displace a non-tethered spinal cord and filum terminale anteriorly (ventrally) within the thecal sac.
• Pathological Findings: In OTCS, the loss of filum compliance prevents this anterior migration. A lack of anterior displacement, or the visualization of the filum remaining not completely anterior in the thecal sac during prone imaging, serves as a surrogate marker for mechanical tethering.
• Nerve Root Trajectory: Prone imaging may also reveal dorsal angulation of the nerve roots, suggesting posterior traction even in the absence of conus descent.

3. Functional Diagnostics and Symptomatology

Given the ambiguity of static imaging in OTCS, functional verification is mandatory.

• Urodynamics (UDS): Neurogenic bladder dysfunction is a hallmark of occult tethering. Studies indicate that urodynamic abnormalities (e.g., detrusor overactivity, dyssynergia) are present in up to 73% of patients with OTCS and may improve following filum sectioning [Metcalfe et al., 2006].
• Neurophysiology: Somatosensory Evoked Potentials (SSEP) and Motor Evoked Potentials (MEP) provide objective data on dorsal column and corticospinal tract integrity, respectively. While useful, normal SSEP/MEP findings do not rule out OTCS due to the intermittent nature of the ischemic insults [Sala et al., 2007].

Clinical Presentation Profile:

The symptomatology is consistent across both Classic TCS and OTCS, characterized by the triad of:

1. Urological/Gastrointestinal: Urinary frequency, incontinence, retention, recurrent UTIs, and constipation/encopresis.
2. Neurological: Lower extremity paresis, paresthesias, and gait disturbances.
3. Musculoskeletal: Lumbosacral pain (often exacerbated by flexion) and non-dermatomal leg pain.

06/02/2026

We are proud to present Nanette, who is one of our patients. Thank you for your trust, your kindness, your beautiful words and for always making us laugh.

‘Dr Gilete was able to fix my entire spine, took my pain away and straightened me out. I will be forever grateful for what he has done for me.
I know him for 5 years now and I love the fact that he doesnt treat you as just another case. He sees you, he hears you and he will go out of his way to help you. Not just until surgery, but for a lifetime.’

30/01/2026

Official Statement from Promohealth S.L. on behalf of Dr. Vicenç Gilete

In light of the repeated publications appearing on social media and in various media outlets regarding medical fees and costs associated with surgical interventions performed in Barcelona by our team, as well as the alleged need to resort to crowdfunding platforms, we hereby issue the following statement:

1. We have detected that amounts regarding our services are being published on social media that do not correspond to reality in any way, grossly exceeding (in some instances by more than threefold) the official cost estimates that we provide in a personalized manner for each specific case.

2. Our company name or the name of our Lead Surgeon is being used without our express authorization; in some cases, without us even having issued any official quote or medical estimate whatsoever.

3. Appeals are being made to the public's goodwill to conduct crowdfunding campaigns utilizing our name and reputation, without the knowledge, consent, or authorization of Promohealth S.L.

4. Promohealth S.L. does not participate in nor endorse said financing initiatives, and is unaware of the final destination of the amounts raised via crowdfunding. Promohealth S.L. hereby disclaims any and all liability regarding the ultimate use of funds collected through such platforms, as well as regarding any fraudulent, undue, or irregular use of said funds by prospective patients or third parties.

5. In order to safeguard the reputation of Promohealth S.L. and that of our Lead Surgeon, as well as to protect the rights of all those individuals who, in good faith, have made contributions to crowdfunding campaigns, we inform you that our legal counsel has received express instructions to pursue all appropriate legal actions against any unauthorized or undue use of our name, brand, or professional reputation. This applies to publications on social media, print media, or any other communication channels, including television, radio, or digital platforms.

Comunicado oficial de Promohealth S.L. en representación del Dr. V. Gilete

Ante las reiteradas publicaciones aparecidas en redes sociales y en distintos medios de comunicación en relación con los honorarios médicos y los costes asociados a diferentes intervenciones quirúrgicas realizadas en Barcelona por nuestro equipo, así como con la supuesta necesidad de recurrir a plataformas de financiación colectiva (crowdfunding), emitimos el presente comunicado:

1. Hemos detectado en redes sociales que se publican importes de nuestros servicios que no se corresponden en absoluto con la realidad, excediendo en mucho (hasta más del triple) los presupuestos que realizamos de manera personalizada, para cada caso.

2. Se utiliza nuestro nombre de empresa o el nombre de nuestro cirujano principal sin nuestra autorización expresa, en algunos casos sin tan siquiera haber emitido nosotros presupuesto oficial alguno.

3. Se está apelando a la buena voluntad de la gente para hacer crowdfunding utilizando nuestro nombre y reputación, sin conocimiento ni autorización de Promohealth SL.

4. Promohealth SL, no participa ni avala dichas iniciativas de financiación, siendo desconocedora del destino final del importe recaudado por Crowfunding. Promohealth SL rechaza de toda responsabilidad respecto del destino final de los fondos captados a través de dichas plataformas, así como de cualquier uso fraudulento, indebido o irregular que de los mismos se realice por parte de eventuales pacientes o terceros.

5. Con el fin de salvaguardar la reputación de Promohealth SL. y la de nuestro cirujano principal, así como de proteger los derechos de todas aquellas personas que, de buena fe, realizaron aportaciones en campañas de crowdfunding, les informamos que nuestros abogados han recibido instrucciones expresas para ejercer cuantas acciones legales resulten procedentes frente a cualquier utilización indebida de nuestro nombre, marca o reputación, ya sea a través de publicaciones en redes sociales, medios impresos u otros canales de comunicación, incluidos televisión, radio o cualquier otro medio.

27/01/2026

Why is the world coming to us? 🌍✈️

Being an International EDS Center of Excellence means providing care that is worth traveling for. We are thrilled to share that we are now attending to an average of 350 patients per year from 37 different nations.

The shift in 2025 has been incredible. We are seeing a massive surge in patients crossing oceans to seek our specialized medical-surgical assessments.

Look at the confidence our patients are placing in us:
🚀 USA: Clients nearly tripled (+166.7%)
🚀 Netherlands: More than doubled (+146.7%)
🚀 Germany: doubled (+100 %)
🚀 Canada: +75 %
🚀 New Markets: We are seeing rapid growth from Finland (+300%), Denmark (+200%), and Australia (+200%).

Whether you are traveling from Canada, the UK, or as far as Guatemala, our commitment remains the same: world-class excellence for every single patient.

Thank you for choosing us as your reference center. 💙

14/01/2026

RETROSPECTIVE STUDY: Clinical outcomes of cranio-spinal surgery in patients with Ehlers-Danlos syndrome and hypermobility syndrome

Study description:
Craniocervical instability (CCI) can be difficult to understand.
This retrospective study aims to examine how patients with Ehlers-Danlos syndrome and hypermobility syndrome progress before and after CCI surgery.

Study population:
Patients who have undergone surgery for craniocervical instability at our center in
previous years, with a minimum postoperative period of 6 months and a maximum of 10 years since the intervention.

Procedures and data sources:
Participation in this study is limited exclusively to the review of clinical information
already available in the medical records and the completion of an online
questionnaire, in order to assess postoperative evolution and current quality of life.
No additional visits or interventions will be required, and no changes will be made to the usual clinical follow-up.

Confidentiality and data protection:
All data will be handled confidentially and in accordance with the current
regulations on personal data protection. All information will be coded and
anonymised, and no identifying data will be used in the analyses or in any
publications arising from the study.

Information and contact:
All patients operated on at our center who meet the above-mentioned inclusion
criteria have recently been contacted and invited to take part in this study.
If you have undergone surgery at our clinic in recent years and, for any reason, have
not received our message or have not been able to view it, and you would like to
receive further information about this study or confirm your participation, you can
contact the research team at the following email address: research@drgilete.com.

ESTUDIO RETROSPECTIVO: Resultados clínicos de cirugías cráneo-espinales en
pacientes afectos de síndrome de Ehlers Danlos y síndrome de hipermovilidad.”

Descripción del estudio:

La inestabilidad cráneo-cervical (CCI) puede ser difícil de interpretar.

Este estudio se centra en el análisis de la evolución clínica previa y posterior a la
cirugía en pacientes con síndrome de Ehlers Danlos y síndrome de hipermovilidad
tratados en nuestra clínica.

Población de estudio:
Pacientes que han sido intervenidos quirúrgicamente por inestabilidad
craneocervical en nuestro centro en años previos, con un periodo postoperatorio
mínimo de 6 meses y máximo de 10 años desde la intervención.

Procedimiento y fuentes de datos:
La participación en este estudio se limita exclusivamente a la revisión de información clínica existente en las historias clínicas y a la cumplimentación de un cuestionario en línea, con el fin de evaluar la evolución postoperatoria y la calidad de vida actual. No se requerirán consultas ni intervenciones adicionales, ni se realizarán modificaciones en el seguimiento clínico habitual.

Confidencialidad y protección de datos:
Los datos serán tratados de forma confidencial y conforme a la normativa vigente en materia de protección de datos personales. Toda la información será codificada y anonimizada, y no se utilizarán datos identificativos en los análisis ni en las publicaciones derivadas del estudio.

Información y contacto:
Todos aquellos pacientes intervenidos en nuestro centro que cumplan con los
criterios de inclusión mencionados han sido contactados recientemente por nosotros e invitados a participar en este estudio.

Si usted ha sido intervenido en nuestra clínica en los últimos años y, por alguna
razón, no ha recibido nuestro mensaje o no ha podido visualizarlo, y desea recibir
información adicional sobre este estudio, o confirmar su participación, puede
contactar con el equipo investigador a través del siguiente correo electrónico:
research@drgilete.com

20/05/2025

How is EDS diagnosed? Dr Francomano geneticist from The Ehlers-Danlos Society explains:

24/04/2025

With over a decade of dedicated specialization in neurosurgical conditions associated with connective tissue disorders, in our ongoing effort to better understand, diagnose, and treat these complex and often misunderstood conditions, we are pleased to announce that Dr. Vicenç Gilete—Medical Director of PromoHealth and Dr. Gilete Neurosurgery & Spine Surgery—has successfully completed advanced training in Immunology.
He has earned the HMX Pro Certificate in Immunology: Novel Therapies for Chronic Inflammation, Autoimmunity, and Allergy from Harvard Medical School.
This expanded expertise, informed by clinical experience, research, and continued medical education, strengthens our ability to address the biological drivers that may underlie or exacerbate mechanical conditions such as Craniocervical Instability (CCI) and Tethered Cord Syndrome. Our goal is to provide earlier and more accurate diagnoses that can lead to improved patient outcomes and potentially reduce the need for invasive surgical interventions.
Our clinic has increasingly encountered patients presenting with chronic immunological and inflammatory diseases. While many of these individuals do not meet the diagnostic criteria for a genetic connective tissue disorder, they often exhibit overlapping clinical features and comorbidities. Conditions such as Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), Lyme disease, post-acute COVID-19 syndrome, and related disorders now comprise nearly half of our patient population.
We are now incorporating advanced diagnostic tools into our clinical practice, including biomarker screening for inflammatory, autoimmune, and autonomic dysfunction markers. Immunological checkpoints treatment modalities could be indicated in some cases. Both biological and biomechanical evaluation are important in the diagnosis and recommendations of non-surgical or/and surgical treatments for our patients.

26/03/2025

MCAS/MCAD in the news:

You name it, I can’t be near it. Even kissing my boyfriend is risky

04/03/2025

The...