Advantages of PELD(Percutaneous Endoscopic Lumbar Discectomy) - Advanced Minimal Invasive Technique

Percutaneous Endoscopic Lumbar Discectomy (PELD)

Percutaneous Endoscopic Lumbar Discectomy (PELD) is a unique approach which is quickly getting popular amongst patients and surgeons in the treatment of nonsequestrated disc herniation (disc prolapse) as it reduces the post operative hospitalization and recovery time.

An advanced minimal invasive technique, Percutaneous endoscopic lumbar discectomy (PELD) is performed for the decompression of the lumbar disc space and removal of nucleus pulposus via a posterolateral approach. In addition to decompression surgery, the technique has been found effective in management of spinal tumors and structural deformities. This surgery is recommended in patients who fail to respond effectively to conservative treatment with pain killers like NSAIDs (Non Steroidal Anti inflammatory Drugs) or when the pain threshold is low. In this form of surgery, an instrument called endoscope is used and the whole surgery is done under local anesthesia with the patient fully awake during surgery.

Who may require PELD?

Individuals suffering from chronic low back pain and disability may benefit from a PELD procedure. It is often used to treat patients suffering from degenerated discs, bulging discs or herniated discs that compress upon the surrounding structures within the spinal canal causing nerve compression, sciatica and low back pain. It can also be used if the patient fails to respond to conventional management therapies including direct injection therapies for three months or more. The surgery is also found to be successful in resection of spinal tumors, fusion and structural deformities of the spinal cord.

Relevant Anatomy

The human spine is made up of 33 bony segments called vertebrae which are stacked one above the other. These vertebrae are separated by small, soft, cushion like structures called the intervertebral discs that act as shock absorbers. These discs undergo degeneration due to age related wear and tear, resulting in disc herniation or prolapse. They compress the surrounding soft tissues or nerves giving rise to severe pain. If the vertebral discs in the lower back or the Lumbar region are compressed, they result in pain and tingling in the legs and spasms in the back.

Procedure and types of PELD

Percutaneous endoscopic lumbar discectomy is the ultimate form of minimal invasive spine surgery. It is an endoscopic daycare surgical procedure which is conducted in about 60 minutes, under local anesthesia with mild sedation. Patient is made to lie on his front on the operation table and exact entry point is mapped on patient’s body using image intensifier x-ray system. A small incision is made about 8-10 centimeters from the midline on the posterior part of the body. Now there are two different ways in which the inter-vertebral disc material can be removed (i.e. manually or using laser).

• Manual procedure also known as automated percutaneous discectomy involves insertion of a long spinal needle from side of back, directly into the disc, by-passing other bone and ligaments. Through this needle, guide wire is passed and after taking 5mm incision, dilator and working cannula are passed, through which endoscope is inserted. Camera and monitor is attached to endoscope and prolapsed part of disc is removed under vision.
• The laser surgery is referred to as percutaneous laser discectomy (PLD), which uses an external imager called the fluoroscope to direct the probe. The probe delivers laser energy which vaporizes a part of the inter-vertebral disc material and decompresses the nerve root. The most frequently used laser for treatment is Holmium yttrium- aluminum-garnet (Ho:YAG) laser.

In either procedure, the wound is closed with single stitch. Patient gets immediate pain relief and he can go home in 24 hrs and can resume his work soon.

Advantages of PELD

• Surgery is done under local anesthesia with conscious sedation.
• No muscle, ligament or normal tissue damage and minimal blood loss.
• Patient can be discharged in 24 hrs. No prolonged bed rest required after surgery.
• Early return to work.
• Even prolapsed, migrated, extra-foraminal, recurrent discs can be removed.
• Very good technique for old and medically compromised patients.
  
  
  
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Why do so many people suffer from low back pain?

Have you ever asked, "Why do so many people suffer from low back pain?" The answer involves a brief overview of the lumbar spine. Although the entire spine is involved in everyday activities of rest and movement, the low back can be vulnerable to many pain-provoking disorders. Simple sprains and strains from overexertion, a herniated disc from a slip and fall, degenerative disc disease or spinal stenosis from normal aging, and other disorders can cause low back pain.

To help you understand back pain, the following brief and illustrated anatomy lesson is provided.

What Is the Lumbar Spine?

The lumbar spine (low back) is the third major region of the spine; it is below the cervical spine and thoracic spine. Most people have five bones (vertebrae) in the lumbar spine, although it is not unusual to have six. Each vertebra is stacked on top of the other and between each vertebra is a gel-like cushion called an intervertebral disc. The discs help to absorb pressure, distribute stress, and keep the vertebrae from grinding against each other.

Ligaments and Tendons: Connective Lumbar Spine Soft Tissues

The vertebrae and discs are held together by groups of ligaments . Ligaments connect bone to bone, whereas tendons connect muscle to bone. In the spine, tendons connect muscles to the vertebrae. The ligaments and tendons help to stabilize the spine and guard against excessive movement in any one direction.

Lumbar Spine Joints

The spine also has joints that are similar to knees, elbows, and other joints. The spinal joints are called facet joints 

The facet joints have been described as finger-like, and they link the vertebrae together. The facet joints are located at the posterior area of the spinal column (on the back side of the spinal column).

In addition, the facet joints help to make the spine flexible and enable you to bend forward, backward, and side to side.

The lumbar spine has several distinguishing characteristics:

·         The lower the vertebra is in the spinal column, the more weight it must bear. The five vertebrae of the lumbar spine (L1-L5) are the biggest unfused vertebrae in the spinal column, enabling them to support the weight of the entire torso.

·         The lumbar spine's lowest two spinal segments, L4-L5 and L5-S1, which include the vertebrae and discs, bear the most weight and are therefore the most prone to degradation and injury.

·         The lumbar spine meets the sacrum at the lumbosacral joint (L5-S1). This joint allows for considerable rotation, so that the pelvis and hips may swing when walking and running.

·         The spinal cord travels from the base of the skull through the spinal column and ends at about T12-L1 - where the thoracic spine meets the lumbar spine. At that point numerous nerve roots from the spinal cord continue down and branch out, forming the "cauda equina," named for its resemblance to a horse's tail. These nerves extend to the lower extremities (buttocks, legs and feet). Because the spinal cord does not run through the lumbar spine, it is quite rare that a lower back problem would result in spinal cord damage or paralysis.

Lumbar Intervertebral Segment

Physicians usually explain a patient's pathology by focusing on one intervertebral segment, or spinal segment. The lumbar spine has 5 intervertebral segments, termed lumbar segment 1 through 5 (e.g. L1, L2, L3, L4, and L5).

Each lumbar spine segment is comprised of:

·         Two vertebrae, such as L4-L5, stacked vertically with an intervertebral disc between them. A healthy disc is cushiony, with a lot of water, and has a sponge-like substance. It acts like a shock absorber in the spine, allowing flexibility and providing protection from jarring movements.

·         The two adjacent vertebrae are connected in the back of the spine by two small joints called facet joints. The facet joints of the lumbar spine allow movement to bend and twist the low back in all directions.

·         There are nerves that branch off from the spinal column at each level of the spine. They pass through small holes in the back of the lower spine. They then connect together to form the sciatic nerve, which travels into the legs down the back of each thigh and into the calves and feet.

Doctors usually talk about a patient's lumbar disc problem, or nerve or other lower back problem, as the level that includes two vertebrae and the disc between them, such as L3-L4 or L4-L5. If the disc at the very bottom of the spine is affected, that segment is called the lumbosacral joint L5-S1

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Minimally invasive Surgery (MIS) and spinal fusion (mending the spine bones together)

Using innovative technology, a minimally invasive surgery (MIS) spinal fusion (mending the

spine bones together) can now be accomplished using two small poke-hole incisions with

minimal tissue dissection resulting in a faster recovery. Using the MIS procedure, Posterior

lumbar fusions (PLF) and transforaminal lumbar interbody fusions (TLIF) can both be

performed in less time, with less tissue damage, and less pain than traditional open spinal

fusion surgery.

Posterior Lumbar Fusion (PLF) is the general term used to describe the technique of

surgically mending two (or more) lumbar spine bones together along the sides of the bone.

Bone graft is placed along side the spine bones (not in between the disc spaces, which is

called an interbody fusion), and ultimately fuses together. Minimally invasive PLF is

generally always performed in conjunction with instrumentation (use of metal screws/rods)

so as to impart immediate stability while the bone mends and to increase the fusion rate

(percentage of patients where the bone successfully mends together). MIS TLIF includes the

PLF described above, as well as performing an interbody fusion, which means the

intervertebral disc is removed and replaced with a bone spacer (metal or plastic may also be

used). A MIS TLIF involves placing only one bone graft spacer in the middle of the interbody

space, without retraction of the spinal nerves.

The MIS PLF technique is often favored as the 2nd staged procedure when a multiple level

ALIF is performed, and a laminectomy is not necessary. A MIS TLIF is commonly performed

when one or two spinal levels are being fused in conjunction with a partial posterior

decompression (facetectomy and laminectomy), and interbody fusion is indicated.

MIS PLF and MIS TLIF are commonly performed for a variety of spinal conditions, such as

spondylolisthesis and degenerative disc disease, among others.

Surgical Technique

The surgery is performed utilizing general anesthesia. A breathing tube (endotracheal tube)

is placed and the patient breathes using a ventilator during the surgery. Preoperative

intravenous antibiotics are given. Patients are positioned in the prone (lying on the

stomach) position, generally using a special operating table/bed with special padding and

supports. The surgical region (low back area) is cleansed with a special cleaning solution.

Sterile drapes are placed, and the surgical team wears sterile surgical attire such as gowns

and gloves to maintain a bacteria-free environment.

A 1 inch (depending on the number of levels) poke-hole incision is made on each side of the

low back, directly over the involved spinal levels. The fascia and muscle is gently divided

using special cannulated retractors and sleeves. The pedicle screws and rods are implanted

and the facet joints are fused through the two tiny incisions under x-ray guidance. If a TLIF

is to be performed, a partial laminectomy (removal of lamina portion of bone) and complete

facetectomy is performed to allow visualization and removal of the intervertebral disc. The

intervertebral disc is then removed using special biting and grasping instruments (such as a

pituitary rongeur, kerrison rongeur, and curettes), an operating microscope, and x-ray

guidance. Special distractor instruments are used to restore the normal height of the disc, as

well as to determine the appropriate size spacer to be placed. A bone spacer (metal or plastic

spacers may also be used) is then carefully placed in the disc space.

The wound areas are usually washed out with sterile water containing antibiotics. The deep

fascial layer and subcutaneous layers are closed with one or two sutures. The skin can

usually be closed using special surgical glue, leaving a minimal scar and requiring no

bandage.The total surgery time is approximately 2 to 3 hours, depending on the number of

spinal levels involved.

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Latest Back Pain Treatments in India

Minimally Invasive Lumbar Discectomy (MILD) for Back Pain

One of the safe procedures to cure Lumbar Spinal Stenosis is called MILD. If you have pain or numbness in your lower back when you are standing upright or tingling when you walk, you might be having Lumbar Spinal Stenosis. MILD is an effective treatment option which can deliver significant pain relief for patients with Lumbar Spinal Stenosis.

Lumbar Spinal Stenosis is a condition, where the spinal canal narrows and compresses the spinal cord nerves in the lower back. It may occur as a result of natural wear and tear due to ageing. Other factors that cause narrowing of the spinal canal are:

• Formation of excess bone
• Compression or bulging of discs
• Thickening of ligament tissue etc.
  
  

Pain and numbness are the main symptoms of Lumbar Spinal Stenosis. As the disease progresses, the symptoms also will increase. When other medications and therapies fail to cure the disease, the doctor will suggest for MILD procedure.

MILD is a short outpatient procedure done using a small incision. The procedure does not require anesthesia, implants or stitches. The doctor will use an imaging machine and specialized tools for the procedure. During the procedure, the doctor will remove excess ligament tissue and small pieces of bone through the small incision in the back. This will help to restore the space in the spinal canal and decreases the nerve compression. So that, the patient will get relief from pain and can restore mobility.

The patient will be able to go home on the same day of surgery itself. The doctor may suggest you to avoid strenuous physical activities. Reliable surveys have found the fact that, MILD has given significant results to about 79% of patients. MILD has proven to be a very low risk procedure. But, it can be complicated for people who have other health issues. All the people may not be apt for the procedure. Talk to your doctor in order to confirm how far the procedure is suitable for you.

Some of the other latest back pain treatments are :

• Endoscope Assisted Discectomy
• Ozone Arthroplasty

Endoscope Assisted Discectomy

Discectomy is the surgical procedure employed to remove herniated discs from the spinal canal. Endoscope assisted disectomy is a minimally invasive method which makes use of endoscope and small surgical tools. Herniated disc will cause compression of nerve roots and spinal cord. Fragment of the spinal disc that is putting pressure on the nerves is so removed.

Discectomy is performed under a light anesthesia. A very small incision is made in the middle of your back neck. A small metal tube is inserted into the herniated disc through this incision using x-ray fluoroscopy. This will help your surgeon to locate the herniated disc using x-rays and camera. The inserted tube acts as a passage for endoscope and surgical instruments. Then surgical tools and an endoscope with small camera will be guided through this passage. After identifying the disc, fragments that put pressure on the nerve is removed using special instruments. Camera attached with the endoscope will visualize live the damaged disc which is to be removed.

After all fragment tissues are removed, your surgeon will withdraw tools from the spine and dress the incision using bandages with utmost care.

ADVANTAGES

• Less tissue injury and scar formation
• No need of large skin incision
• Shorter recovery period
• Very little blood loss

Ozone Arthroplasty

Each bone in the spine is separated by cushion like disc called intervertebal disc which acts as shock-absorbers. Any damages to this disc or its rupturing can cause protrusion of jelly like nucleus of disc outwards. This condition is called disc herniation which causes compression of nerve roots and spinal cord. It ultimately leads to lower back pain or leg pain.

Many people show no symptoms from herniated disc. To relieve symptoms of herniated disc, pain medications and muscle relaxers may be prescribed to patients. If the pain continues or persists, inflammation-suppressing steroid injections would be given.

Physical therapies like heat or ice application or electrical stimulation may be useful.

But sometimes, least number of patients may need surgery to heal their disc hernation. Protruded or bulged portion of disc shrinks over a time within a few weeks after surgery. Herniated disc would be removed during the surgery.Apart from these treatment options, a new method has been innovated called ozone arthroplasty.

Ozone artroplasty is a new practice performed by some physicians to cure herniated discs. In this procedure, ozone gas would be directly injected into the herniated disc. This injected ozone gas will fill the disc and bubbles out through protrusion. The chemical reaction of the gas with the nucleus of the disc causes the shrinking of herniated portion of disc. The pressure on the nerves become relieved. Consequently, symptoms of leg pain and lower back pain start to disappear. Recent studies reveal that it can produce long lasting results with a single ozone injection.

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Best Spine Hospitals in India | Low Cost Scoliosis Surgery in India

Our spine is an engineering marvel that supports our weight and ties our body together. The spinal column consists of a stack of small bones that range in size from 2-3 inches to 5-6 inches in diameter. When viewed from the front, the spine appears to be straight, but when looked at from the side, the normal spine has two gentle S-curves. 

Scoliosis is an abnormal curvature of the spine. In scoliosis, the spine curves to the side when viewed from the front, and each vertebra also twists on the next one in a corkscrew fashion. 

Scoliosis affects girls twice as often as it affects boys. About three to five of 1,000 people are affected. Scoliosis usually occurs in those older than 10 years, but the condition can be seen in infants. 

What causes scoliosis? 

In most cases, the cause of scoliosis is unknown (idiopathic). This type of scoliosis is described based on the age when scoliosis develops. If the person is less than 3 years old, it is called infantile idiopathic scoliosis. Scoliosis that develops between 3 and 10 years of age is called juvenile idiopathic scoliosis, and people that are over 10 years old have adolescent idiopathic scoliosis. 

Another surgery option for scoliosis is an anterior approach, which means that the surgery is conducted through the chest walls instead of entering through the patient's back. The patient lies on his or her side during the surgery. During this procedure, the surgeon makes incisions in the patient's side, deflates the lung, and removes a rib in order to reach the spine.

What are various types of scoliosis?

Functional Scoliosis

In this type of scoliosis, the spine is normal, but an abnormal curve develops because of a problem somewhere else in the body. This could be caused by one leg being shorter than the other or by muscle spasms in the back.

Neuromuscular Scoliosis

In this type of scoliosis, there is a problem when the bones of the spine are formed. Either the bones of the spine fail to form completely or they fail to separate from each other during fetal development. This type of scoliosis develops in people with other disorders, including, birth defects and muscular dystrophy and cerebral palsy, or Marfan's disease. People with these conditions often develop a long C-shaped curve and have weak muscles that are unable to hold them up straight. If the curve is present at birth, it is called congenital. This type of scoliosis is often much more severe and needs more aggressive treatment than other forms of scoliosis.

Degenrative Scoliosis

Unlike the other forms of scoliosis that are found in children and teens, degenerative scoliosis occurs in older adults. It is caused by changes in the spine due to arthritis known as spondylosis. Weakening of the normal ligaments and other soft tissues of the spine combined with abnormal bone spurs can lead to an abnormal curvature of the spine. The spine can also be affected by osteoporosis, vertebral compression fractures, and disc degeneration.

What type of surgery is done for treatment of scoliosis in India?

If the curve stays below 40 degrees until the person is finished growing, it is not likely to get worse later in life. However, if the curve is greater than 40 degrees, it is likely to continue to get worse by 1-2 degrees each year for the rest of the person's life. If this is not prevented, the person could eventually be at risk for heart or lung problems. The goals of surgery for scoliosis are correcting and stabilizing the curve, reducing pain, and restoring a more normal curve and appearance to the spinal column.

There are various techniques used for scoliosis surgery. One type of surgery involves posterior spinal fusion with instrumentation and bone grafting. This surgery is performed through the patient's back while the patient lies on his or her stomach.

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Most Advanced Laser therapy for spine Treatment in India

Laser therapy for spine Treatment in India Laser therapy is the use of monochromatic light emission from a low intensity laser diode (250 milliwatts or less) or an array of high intensity super luminous diodes (providing total optical power in the 1000-2000 milliwatt range). Conditions treated include musculoskeletal injuries, chronic and degenerative conditions and wounds. The light source is placed in contact with the skin allowing the photon energy to penetrate tissue, where it interacts with various intracellular biomolecules resulting in the restoration of normal cell morphology and function. This also enhances the body's natural healing processes. The following chart outlines some of the specific effects of Low Intensity Laser Therapy.  

The underlying science behind cold laser therapy is sound. Studies have shown that light of certain wavelengths can reduce pain and inflammation. Lasers can offer very focused beams of light which can be used to target specific areas, which means that in theoretical use, a low intensity laser calibrated to emit light of a specific wavele ngth could potentially be used very effectively to treat areas of inflammation on the body. However, like all medical devices, cold lasers need to be carefully evaluated for safety and efficacy.

Doctors generally recommend cold laser therapy as part of an overall pain management program. For people dealing with chronic pain, cold laser therapy is an option which could be used to reduce the pain, while people with persistent inflammations may also benefit. However, this therapy should not be undertaken without medical supervision, and it is generally not recommended as a replacement for other forms of medical treatment, such as the use of physical therapy to manage chronic pain.

Some practitioners of acupuncture have suggested that cold laser therapy could be used much like acupuncture and acupressure, with the beams of the laser targeting specific points on the body. These practitioners of alternative medicine rely on their training and experience to support their beliefs about the use of cold laser therapy. Stimulation of pressure points can be used to treat a number of conditions treatable with acupuncture. 

A number of terms are used to refer to cold laser therapy, including low power laser therapy (LPLT), low level laser therapy (LLLT), biostimulation, soft laser, and laser acupuncture. In all cases, the technique involves exposing the skin to targeted laser beams for set periods of time and at set intervals. The light in the laser is supposed to stimulate damaged cells to promote healing and a reduction in inflammation and pain. The "cold" refers not the temperature of the laser, but to the fact that the laser is of low intensity, rather than high intensity lasers, which can burn the skin. 

Our network hospitals have the most advanced spine surgery facilities. The spine surgeons here use minimally invasive and computer guided techniques in spine surgery. In a Minimally Invasive spine surgery the surgeon makes a few small incisions unlike the open surgery where a single large incision is made. 

Minimally Invasive spine surgery has several important benefits for the patients. If you have been advised spine surgery your first choice should be the latest minimally invasive technique developed by our world best hospitals in India. Most advanced Technology like Intra Operative MRI, Brain Suite and Computer Assisted Navigation System are deployed by highly trained surgeons for accurate and safe Spine Surgeries through a small incision.

Why should you choose to get Indian hospitals offer the best spinal surgery treatment in India at affordable prices. MedWorld india associated best spine surgery hospitals in India have the latest technology and infrastructure to offer the most advanced spine surgery at low cost.

Salient features of these hospitals are:

Comprehensive management of spine disorder from birth defects to degeneration of tumor and trauma.

Dedicated team of International trained and vastly experienced Spine Surgeons, Rheumatologists, Neurologist, Physicians and Physiotherapist.

Expert evaluation of spinal problems by dedicated team of experienced spine Surgeons, Rheumatologists, Neurologist, Physicians and Physiotherapist.

Latest Generation Diagnostic and Imaging facilities including dynamic digital X rays, Spiral CT scanning , MRI and Electrophysiology unit all under one roof.

Physiotherapy and Rehabilitation by experts after the surgery help you regain functional abilities quickly helping in vastly improved overall results.

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Discectomy and Microdiscectomy : Advantaages of Minimally Invasive Spine Surgery

 Minimally Invasive Spine Surgery 

The trend in spine surgery has moved toward minimally invasive procedures. More than 20 years ago a similar trend started with knee surgery. At that time if a patient had torn knee cartilage the surgical procedure required opening the knee. It took several weeks or months for the patient to recover. Now many knee surgeries are performed through small keyhole incisions using an arthroscopic tube. Similar advances continue to be made in spinal procedures. Devices are now available that use microscopic fiber optics that transmit anatomical images to a monitor similar to a television. The equipment is made with built-in magnification that enables the surgeon to view tiny structures through a portal. 

Open Surgery versus Minimally Invasive 
Spine surgical procedures are often referred to as an open procedure or minimally invasive. Open procedures require larger incisions, muscle stripping, more anesthesia, operating time, hospitalization and, the patient usually needs more time to recuperate. Minimally invasive surgical techniques utilize portals or tiny incisions made in the skin (percutaneous) through which small, specialized instruments are inserted. For example, an endoscope allows the surgeon to see an illuminated and magnified view of the operating field through a tiny incision.

Today many different types of spine surgery can be performed utilizing minimally invasive techniques. Some types of minimally invasive spine surgery use laser technology. Lasers may be used to separate or eliminate tissue. New instruments for use in minimally invasive spine surgery have been developed and continue to be refined.

Discectomy and Microdiscectomy are terms that mean the surgical removal of part or an entire intervertebral disc. The difference between these terms is that microdiscectomy uses microscopic magnification. These procedures are performed to remove a herniated or ruptured disc. The advantage to microdiscectomy is that the procedure is minimally invasive. The incision and instruments are small, which enables the patient to recover quickly.

Our network hospitals have the most advanced spine surgery facilities. The spine surgeons here use minimally invasive and computer guided techniques in spine surgery. In a Minimally Invasive spine surgery the surgeon makes a few small incisions unlike the open surgery where a single large incision is made. 

Minimally Invasive spine surgery has several important benefits for the patients. If you have been advised spine surgery your first choice should be the latest minimally invasive technique developed by our World's Best hospitals in India. Most advanced Technology like Intra Operative MRI, Brain Suite and Computer Assisted Navigation System are deployed by highly trained surgeons for accurate and safe Spine Surgeries through a small incision.

Why should you choose to get Indian hospitals offer the best spinal surgery treatment in India at 
affordable prices. MedWorld india associated best spine surgery hospitals in India have the latest 
technology and infrastructure to offer the most advanced spine surgery at low cost.

Salient features of these hospitals are:

• »
• Comprehensive management of spine disorder from birth defects to degeneration of tumor and trauma.
• »
• Dedicated team of International trained and vastly experienced Spine Surgeons, Rheumatologists, Neurologist, Physicians and Physiotherapist.
• »
• Expert evaluation of spinal problems by dedicated team of experienced spine Surgeons, Rheumatologists, Neurologist, Physicians and Physiotherapist.
• »
• Latest Generation Diagnostic and Imaging facilities including dynamic digital X rays, Spiral CT scanning , MRI and Electrophysiology unit all under one roof.
• »
• Physiotherapy and Rehabilitation by experts after the surgery help you regain functional abilities quickly helping in vastly improved overall results.
  
  
  
  For more information visit:          http://www.medworldindia.com    
                      https://www.facebook.com/medworld.india
  Please scan and email your medical reports  to us at care@medworldindia.com and we shall get you a Free Medical Opinion from India’s Best Doctors.
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