Spinal Disc Protrusions do not require Open Spine Surgery

Percutaneous Disc Nucleoplasty is minimally invasive surgery to reduce the volume of a bulging or herniated disc. In both cases the spinal disc puts pressure on a nerve root or the spinal cord and causes back pain or sciatic pain.

Spinal Disc Protrusions do not require open spine surgery

Many patients with back pain show no clear indication of a herniated disc. However with MRI investigation protrusion of the intervertebral discs can be diagnosed. This protrusion can put pressure on nerves or the spinal cord and can cause persistent, or stress-related chronic back pain. Normally this kind of back pain (lumbar or cervical), responds well to conservative treatment options.

When will your neurosurgeon consider Nucleoplasty?

If after six weeks, conservative treatment has not been successful, your spine specialist should consider an intradiscal procedure: The disc protrusion can be reduced by treating the liquid core of the spine simply by using an injection needle. This needle (cannula) allows a radiofrequency instrument to enter the core of the disc, thereby avoiding all the surgical risks associated with open back surgery. This is essentially the principle of the Nucleoplasty.

Nucleoplasty, as a minimally invasive treatment, covers only smaller disc herniations or disc bulges that have not yet broken through the solid fibre ring of the disc and are therefore are not accessible via an open surgical procedure (surgical removal of the disc material).

Endoscopic Nucleoplasty is safe for patients and is a minimally invasive procedure, which produces very good outcomes, without the risks and postsurgical complications associated with open back surgery.

Disc Nucleoplasty is performed on an outpatient basis, with minimal anesthesia requirements. Fluoroscopic guidance is employed as an introducer needle is placed at the nucleus/annulus junction. A SpineWand is introduced through the passage way, and advanced into the disc nucleus. Using Coblation, tissue is then removed by either creating channels (lumbar spine) or spheres (cervical spine). After sufficient tissue is removed, a bandage is placed on the skin and the patient is discharged home. Patients are then usually placed on a routine rehabilitation program.

Nucleoplasty is recommended for patients who have not responded to rest, medical intervention (including steroid injection), and/or physical therapy.

There are many people across the world who suffers from slipped disc problem. In 90 per cent of these cases, the disc prolapsed is contained or limited to the disc space and are not suitable for the traditional discectomy surgery involving the complete removal of the diseased disc. The open surgery is an overkill leading to unsatisfied results, more complications and costly procedure.

In such clinical circumstances, percutaneous treatment also known as disc nucleoplasty has emerged as the best alternative. Moreover the cost of Disc Nucleoplasty at Medworldindia affiliated hospitals in India is minimal. Conventionally the disc prolapse is treated with bed rest and analgesics but with limited relief.

Many successful Nucleoplasty procedures have been performed in India. This minimally invasive approach to treating contained disc herniations has helped most of the International patients return to active and productive lives with effective cost savings. 

Expert Neuro and Spine Surgeons in India who have ample experience in performing this procedure said that, “Spinal Surgery is fast becoming a major sub-speciality in neurosurgery”. Disc nucleoplasty is an innovative percutaneous method of healing disc disease. Disc prolapse can occur in lumbar as well cervical region causing low back pain, radiating pain and neck pain respectively. Related symptoms are excruciating pain, numbness, tingling sensation in hands and legs, burning and weakness of the limbs. The patient will have restricted movement, walking, bending and doing normal day to day activities becomes very difficult. The severe pain results in incapacitation leading to loss of man hours.

GET BEST RESULT- STEM CELL THERAPY FOR SPINAL CORD INJURY

A spinal cord injury usually begins with a sudden, traumatic blow to the spine that fractures or dislocates vertebrae. The damage begins at the moment of injury when displaced bone fragments, disc material, or ligaments bruise or tear into spinal cord tissue. Some injuries will allow almost complete recovery. Others will result in complete paralysis.

There are several types of treatment in the short term for a spinal cord injury. First, the spine in the area of the injured spinal cord is immobilized (held in place so it can’t move) to prevent further injury to the cord. For injuries to the neck, immobilizing the spine may include placing the head in a “halo” (a device that prevents the head from moving). For spinal cord injuries in the back, casts, braces and straps may be temporarily used to keep the back from moving.

To reduce swelling in the spinal cord caused by injury, steroid medication is usually given during the first 24 hours following injury. Other medical treatment is often necessary, depending on complications that may develop.

Treatment options

Spinal injury is a devastating event that occurs suddenly and whose consequences range from minimal symptomatic pain to a tragic quadriplegia (total paralysis of all four limbs). The key element in management is prevention of secondary neurological damage occurring during transportation, so whenever a family physician sees a patient with suspected spinal injury the first thing to be done is immobilize the spine which is done with  cervical collar and belts for thoracic and lumbar spine.

Treatment:

1. At the site of accident / clinic of the family physician :mainly deals with immobilization & proper transportation to the hospital.

2. In the hospital: Resuscitaion, haemodynamic stabilization, basic corrective surgery (if required), physiotherapy.

3. Surgeries: basic aims of surgery are decompression of the neural elements, reduction of malalignment and restoration of spinal stability.

    a.    Anterior /posterior

    b.    Decompression / stabilization

Improved emergency care for people with spinal cord injuries and aggressive treatment and rehabilitation can minimize damage to the nervous system and even restore limited abilities. Rehabilitation programs combine physical therapies with skill-building activities and counseling to provide social and emotional support.

STEM CELL THERAPY FOR SPINAL CORD INJURY

Cell therapy, in particular, stem cell implantation has become a feasible therapy for spinal cord injury. Embryonic stem cells and fetal stem cells are the forefathers of the field of stem cell therapy. Extraction ,separation & processing of specific populations of adult stem cells in the laboratories has evolved  such that  they can be converted to various types of specialized cells (eg.neurons, liver cells, heart cells). Thus, adult stem cells will transcend ethical concerns, technical difficulties, and probably immunorejection.

Spinal Surgery at India Best Spine Surgery Hospital in India

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.

Most Advanced Laser Spine Surgery in India : Best Spine Hospitals 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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Most Advanced Back Surgery in India - World Best Spine Surgery Hospitals in India

There are three basic types of back surgery

1. A laminectomy – removing the back part of the bone (called the lamina) over the spinal column. A laminectomy is performed to relieve nerve root compression (pinched nerve) on one or more nerve roots in the spinal column. The compressed nerve root often causes back and leg pain. A segment of the entire lamina can be removed to relieve pressure on a nerve..

2. A discectomy – removing a portion of a disc to relieve pressure on a nerve.

3. A spinal fusion – this involves the permanent fusion of two or more vertebrae for more stability, to correct a deformity or to relieve pain. The surgeon will harvest small pieces of bone from your hip or pelvic bone and place them between the vertebrae. In many cases they will use wires, rods, screws, metal cages or plates to provide immediate stability.

Laminectomy

How is a laminectomy performed?

Step 1: A laminectomy is performed with the patient lying on his stomach or side and under general anaesthesia. The surgeon (an orthopaedic or neurosurgeon) reaches the spinal column through a small incision in the back.
Step 2: He will use a retractor to spread the muscles of the back apart in order to expose the bony lamina.
Step 3: He cuts away part of the lamina to uncover the ligamentum flavum – a ligament supporting the spinal column.
Step 4: In the next step he will cut an opening in the ligamentum flavum to reach the delicate spinal canal containing the compressed nerve.
Step 5: The compressed nerve can now be seen as well as the bundle of nerve fibres (known as the cauda equina) to which it is attached. It is now possible to identify the cause of compression: a bulging, ruptured or herniated disc, or perhaps a bone spur.
Step 6: The source of the pressure can now be removed. This may involve removing the bulging portion of the disc or the bony spurs and scar tissue. The herniated disc is removed after the compressed nerve has been gently retracted to one side. The surgeon will remove as much of the disc as is necessary to take pressure off the nerve. Sometimes a fragment of disc has moved and presses on the nerve root as it leaves the spinal canal. This will often cause more severe symptoms.
Step 7: With the cause of compression removed, the nerve can now begin to heal. The space created by removal of the disc will gradually fill with connective tissue. The incision is closed in several layers, from the inside outwards.
Step 8: The skin layer will be closed with steri-strips, sutures or skin clips. A dressing will be placed over the incision to protect the wound.

This operation is normally performed within one or two hours, depending on the number of levels that are decompressed.

After surgery
A plastic drain will run from inside the wound to remove any accumulating blood. In most cases, the drain can be removed on the second day after surgery.

An intravenous line to administer medication may remain connected through a vein in your hand or arm for two to three days.

Pain can and should be well controlled. Usually the acute pain subsides after a day or two. Pain may be most severe in the lower back. Leg pain may be caused by swelling of the previously compressed nerve and the trauma of the surgery. Muscle spasms across the back and down the legs are not uncommon and this can be relieved by muscle relaxants.

A physiotherapist will help you to begin standing and walking again, and show you how to get in and out of bed and how to sit, stand, and sleep.

 What about new and less invasive procedures?
The era of less invasive surgery has dawned – also in back surgery. Smaller keyhole incisions are replacing large surgical cuts. These less invasive techniques include:

• Endoscopic discectomy – this technique employs a disposable scope that the surgeon inserts through a small incision. The protruded disc that is compressing the nerve is then removed using specially designed instruments.
• Vertebroplasty – the injection of bone cement into a fractured vertebrae. The hardened cement will seal and stabilise the fracture and relieve pain. People suffering from severe pain because of a compression fracture will be considered for this procedure, especially if they have difficulty standing and walking.
• Kyphoplasty – the insertion of a “balloon” to expand a compressed vertebra and the injection of bone cement
  
  
  

Treatment and Surgery for Back Pain in India

There are many ways to prevent low back pain problems from developing. Commonly people have created problems in their back themselves. What that means is that problems are self-inflicted, such as poor posture or poor moving and handling techniques.

Poor posture usually involves excessive flattening of the low back (slouching), and is associated with a forward slippage of the head resulting in a flattening of the neck curves. This puts extra stress on the muscles and ligaments in the neck and shoulders. Commonly this causes tension in the muscles which is felt as pain, and an increased likelihood of trapping nerves in the neck. Slouching in the low back results in the neck ligaments taking more strain on a daily basis. This results in the extra strain ultimately causing an misalignment of the spine and resultant nerve entrapment. Effects of this include low back pain pins and needles, sciatica, referred leg pains, and low back spasms and aches.

Although back pain is fairly common these days, there are times when the pain becomes unbearable. Here are the top 5 modes of treatment your doctor is likely to prescribe in case of severe back pain. 

Main Modes of Treatment

 Rest: The first step in the treatment of low back pain is to rest the spine. Because most cases of back pain are due to muscle strain, it is important to avoid further irritation to the spine and the muscles that surround the spinal column. Bed rest is fine, so long as this only lasts two to three days. Prolonged bed rest can actually lead to more persistent back pain. Once the acute back pain eases, avoid lifting, twisting, and physical exertion.

Oral Medication: Anti-inflammatory medications (NSAIDs) are helpful in treatment of both back pain and the associated inflammation. There are both over-the-counter and prescription NSAIDs, and both work well in the treatment of back pain. Side-effects of NSAIDs include problems of gastro-intestinal bleeding, and these medications should be avoided in patients with stomach ulcers. Sometimes, muscle relaxing medications are prescribed. They help to relieve muscle spasm, but may also make patients quite drowsy.

Physiotherapy and Exercises: Strengthening of back muscles is probably the most important step in treatment of most causes of back pain. By increasing strength and flexibility of back muscles, weight is better distributed, and less force is placed on the spine. Other modalities that can be used in the treatment of back pain if the exercises alone do not help include aquatherapy, ultrasound, electrical stimulation, short-wave diathermy and others.

Epidural steroid injections: They are an option for back pain treatment and inflammation around the spinal nerves. An epidural steroid injection is performed using an x-ray to guide the medication to the area adjacent to the inflamed spinal nerve.

Spine Operation: Spine surgery is rarely an initial treatment for back pain; there are a few emergencies, however, that may require surgical treatment. In the vast majority of patients, spine surgery is only considered after a long course of conservative therapy. Back pain often takes quite some time to resolve. Rushing into spine surgery, therefore, may not be the most sensible idea. Most commonly, doctors will advise at least 3 to 6 months of conservative treatment before considering spine surgery.

5 Operations commonly carried out for back pain are:

1. A Discectomy is a procedure to remove a portion of the disc that rests between each two vertebrae. A herniated disc is the most common reason for spine surgery. In this type of spine surgery, the protruding, herniated disc is removed and this relieves the pressure on the nerves.
2. A Foramenotomy is also a procedure used to relieve pressure on a nerve, but in this case, the nerve is being pinched by more than just a protruding disc. The surgery removes a portion of bone and other tissue that may be compressing the nerve as it exits the spinal column.
3. A Laminectomy is performed to relieve pressure on the spinal cord itself.  It is most commonly used to treat conditions such as spinal stenosis and spondylolisthesis, where the spinal column is seen slipping forwards. Depending on the amount of bone removed, this procedure may be done with a spinal fusion to prevent instability.
4. A spine fusion is surgery that is done to eliminate motion between adjacent vertebrae to treat a problem such as spondylolisthesis (an unstable spine), or it may be done because of the extent of other surgeries such as a Laminectomy.
5. Spinal disc replacement is a new surgery that is still quite uncommon. It is done to treat specific types of back pain, while avoiding the problems associated with spine fusion surgery.
   
   
   
   
   
   

The PLIF and TLIF approach has an advantage over the posterolateral gutter fusion : Transforaminal and Posterior Lumbar Interbody Fusion in India

As with all spinal fusion surgeries, the PLIF and TLIF procedures involve adding bone graft or bone graft substitute to an area of the spine to set up a biological response that causes the bone to grow between the two vertebral elements and thereby stop the motion at that segment.

The success rate for posterior fusion in the treatment of refractory discogenic back pain is only 60-70%. The selection of the appropriate patient for this surgery has been blamed for the relatively poor results. Other possible causes of poor results are that the actual pain-causer, the disc, is not addressed. Studies have shown continued significant movement of the disc despite solid posterior fusion. One study showed that patients with continued back pain after solid posterior fusion were improved after anterior fusion of the disc space.

In an attempt to improve the results of fusion surgery, fusion of the disc has been performed to directly address the most common source of pain. Unlike the posterolateral gutter fusion, the PLIF achieves spinal fusion by inserting bone graft and possibly instrumentation directly into the disc space. The disc excision and fusion can be performed anteriorly, or through a posterior approach. When the posterior approach is used to remove and fuse the disc, this is called a PLIF, Posterior Lumbar Interbody Fusion.

An alternative approach is used to minimize retraction of the dura. By resecting the facet joint, a farther lateral approach can be used to remove the disc. This approach, with removal of the facet, is called a TLIF - Transforaminal Lumbar Interbody Fusion.

THE GENERAL PROCEDURE:

1. First, the spine is approached through a three-inch to six-inch long incision in the midline of the back and the left and right back muscles (erector spinae) are stripped off the lamina on both sides and at multiple levels.

2. After the spine is approached, to perform the PLIF procedure (shown below), the lamina is removed (laminectomy) which allows visualization of the nerve roots. The facet joints, which are directly over the nerve roots, are usually undercut to give the nerve roots more room and more room for performing the fusion and/or instrumentation. For the TLIF procedure (shwon below), the entire facet joint is removed.

3. The nerve roots are then retracted to one side and the disc space is cleaned of the disc material. Bone graft is then inserted into the disc space with or without interbody cages. For a standard PLIF procedure, the bone graft and/or instrumentation is performed on both sides. For the TLIF procedure, the disc space is accessed from one side, reaching over to remove and replace the disc on the other side.

The TLIF approach is shown below, with removal of the disc. Bone graft, bone from the bone bank, or instrumentation in the form of a cage can be placed through this approach.

The PLIF and TLIF approach has an advantage over the posterolateral gutter fusion in that the large spinal muscles do not need to be dissected off the transverse processes, so there is less scarring of the muscle and associated pain for the patient. The major advantage of PLIF and TLIF is that there is significantly more surface area for fusion in the disc space as compared to the posterolateral gutter.

However, the PLIF requires substantial retraction of the nerve roots to gain access to the disc space. Significant traction can injure the nerve root and has the potential to result in chronic leg pain and back pain. The pain associated with this type of nerve root injury can be severe, and there are no effective options for treatment. The TLIF requires less retraction of the dural sac, but nerve injury can occur at the level of the nerve cell bodies (dorsal root ganglion). Pain associated with manipulation of the DRG can also be very severe and debilitating. Fortunately, these complications are rare with meticulous care of the nerves.

There are numerous veins (epidural veins) over the disc space, and surgery in this area creates the potential for excessive blood loss during the surgery.

Recurrent pain after a successful spinal fusion procedure is more likely due to a “transfer” lesion at the motion segment above or below the fusion, because stress is transferred to the next level and may cause that vertebral segment to degenerate and breakdown.

Nonunion rates of between 0% and 20% have been quoted in the medical literature. Nonunion rates are higher for patients who have had prior surgery, patients who smoke or are obese, patients who have multiple level fusion surgery, and for patients who have been treated with radiation for cancer.

Other than nonunion, the risks of a spinal fusion surgery include infection or bleeding. These complications are fairly uncommon (approximately 1% to 3% occurrence).

Post-Operative Care

Most patients are usually able to go home 1-3 days after surgery. Patients will typically stay longer, approximately 2-5 days, if an anterior spinal surgery is also performed. Before patients go home, physical therapists and occupational therapists work with patients and instruct them on proper techniques of getting in and out of bed and walking independently. Patients are instructed to avoid bending at the waist, lifting (more than five pounds), and twisting in the early postoperative period (first 2-4 weeks) to avoid a strain injury. Patients can gradually begin to bend, twist, and lift after 4-6 weeks as the pain subsides and the back muscles get stronger.

Brace

Patients are generally not required to wear a back brace after surgery. Occasionally, some patients may be issued a soft or rigid lumbar corset that can provide additional lumbar support in the postoperative period, if necessary.

Wound Care

The wound area can be left open to air. No bandages are required. The area should be kept clean and dry.

Shower/Bath

Patients can shower immediately after surgery, but should keep the incision area covered with a bandage and tape, and try to avoid the water from water hitting directly over the surgical area. After the shower, patients should remove the bandage, and dry off the surgical area. Patients should not take a bath until the wound has completely healed, which is usually around 2 weeks after surgery.

Driving

Patients may begin driving when the pain has decreased to a mild level, which usually is between 7-14 days after surgery. Patients should not drive while taking pain medicines (narcotics). When driving for the first time after surgery, patients should make it a short drive only and have someone come with them, in case the pain flares up and they need help driving back home. After patients feel comfortable with a short drive, they can begin driving longer distances alone.

Return to Work and Sports

Patients may return to light work duties as early as 1-2 weeks after surgery, depending on when the surgical pain has subsided. Patients may return to moderate level work and light recreational sports as early as 1-2 months after surgery, if the surgical pain has subsided and the back strength has returned appropriately with physical therapy. Patients who have undergone a fusion at only one level may return to heavy lifting and sports activities when the surgical pain has subsided and the back strength has returned appropriately with physical therapy. Patients who have undergone a fusion at two or more levels are generally recommended to avoid heavy lifting, laborious work, and impact sports.

Benefits of Arthroscopic techniques in minimally invasive spine surgery

This type of minimally invasive surgery is performed on an outpatient basis using a local anesthetic. Since general anesthesia is not used, surgical risks are less. Arthroscopic surgery and use of endoscopic tubes minimizes muscle and other soft tissue damage. Patient benefits include less bleeding during surgery, reduced postoperative discomfort, fewer and smaller incisions, minimal scar tissue formation, and a speedier recovery. In addition, patients can avoid hospitalization and spinal fusion.

Arthroscopic Spine Procedures

Depending on the patient's diagnosis and surgical needs, sometimes more than one procedure is performed during a single surgery.

There are 4 primary arthroscopic spine procedures : -

1. Foraminotomy : - A foraminotomy helps to relieve symptoms caused by nerve root compression. The foramen are passageways between the vertebrae through which nerve roots exit the spinal canal. A foraminotomy may be performed to treat foraminal stenosis, bulging or herniated discs, pinched nerves, scar tissue formation, bone spurs (osteophytes), spinal arthritis, or sciatica.
   
   During a foraminotomy, the surgeon arthroscopically removes bone and tissue compressing the spinal nerve root. The endoscope is slowly removed to allow muscles and other soft tissues to move back into place. Occasionally, a stitch or two is needed to close the small incision.

2. Laminotomy : - A laminotomy is performed to increase the space around nerve roots and the spinal cord. The procedure helps to remove (decompress) pressure from these neural tissues. The lamina is the bony plate covering each vertebra's posterior arch, or entryway to the spinal canal and nerve structures.
   
   A laminotomy may also be performed to remove the ligamentum flavum. This is the spine's largest ligament. Sometimes the ligamentum flavum becomes thick and compresses the spinal cord contributing to spinal stenosis. When the surgeon removes part of the lamina, he can access the ligamentum flavum for removal.
   
   A laminectomy is similar to a laminotomy. The difference between the procedures is a laminectomy is usually performed during a traditional open back surgery to remove the entire lamina. A laminotomy does not remove the entire lamina, but only a portion of the bony plate
   
   A laminotomy is performed to treat bone spurs (osteophytes), bulging and herniated discs, pinched nerves, scar tissue, spinal arthritis, and spinal stenosis.

3. Percutaneous Arthroscopic Discectomy : - Percutaneous means through the skin. A percutaneous arthroscopic discectomy is the surgical removal of bulging or herniated disc material. Bulging and herniated discs are a common cause of nerve root and spinal cord compression.
   
   During this minimally invasive procedure, the surgeon uses a laser to vaporize disc material to reduce pressure on the spinal cord and nerve roots. When the procedure is completed, the endoscopic tube is slowly removed to allow muscles and soft tissues to move back into place. A percutaneous arthroscopic discectomy is a short procedure only taking 30 to 45 minutes.

4. Facet Thermal Ablation : - A facet thermal ablation is performed to treat facet disease, facet joint syndrome, facet hypertrophy (enlargement), facet arthritis, or facet joints affected by degeneration. The facet joints are the spine's joints. Found at the back of the spine, 2 vertebrae share 1 facet joint.
   
   Thermal ablation refers to disabling or destroying a nerve using a laser. During the procedure, the surgeon uses a laser to clean the facet joint and deaden the nerve that innervates the joint and causes pain.
   
   After a local anesthetic is administered, a small incision is made and the endoscope is inserted. The endoscope (about the size of a straw) helps protect surrounding anatomical structures from damage during thermal ablation. The procedure only takes about 40-minutes.

Laser Spine Surgery : -

The most commonly performed spinal operation in the United States is the lumbar discectomy. Lumbar discectomy is the cornerstone of surgical treatment of disc herniations. A disc herniation is a protrusion of the inner core of disc material beyond the confines of the disc space to compress on the lumbar nerve root(s). This nerve root compression causes a variety of symptoms, but most notable is that of sciatica. Sciatica is a radiating pain from the low back around the hip joint into the leg and down the leg to the foot. Fortunately, 80% of symptomatic disc herniations respond to non-surgical treatment. For the remaining 20%, lumbar discectomy is the treatment of choice 

How long does surgery typically last?

The average spine procedure lasts about an hour. When the procedure is complete, the surgeon removes the tube to let the tissue and muscle go back to their natural position. The last tube is gently removed and absorbable sutures are used to close the incision. The patient is wheeled into the post-anesthesia care area where their vital signs are monitored, medications are given as needed and some light refreshments can be enjoyed. That same day, patients are encouraged to walk around. Soon after, they are discharged home or to their hotel.

What's the recovery process like?

After a day of rest and recovery, the patient returns for a postoperative appointment. An epidural injection may be given to reduce swelling and increase range of motion. Physical therapy may be prescribed. Physical therapy consists of a series of stretching exercises, walking, ice or heat, gentle electronic stimulation and a nice relaxing massage. Each patient is given instructions for postoperative activity and limitations. Over the weeks and months to come, gradual and continuous improvement will be seen, as the nerves and tissues heal. With time and exercise, the body can repair any damage, gain strength, and a gradual increase in daily activities can occur.

Spinal Fusion Benefits : Get Facts About Surgery and Recovery Time

Spinal Fusion Surgery

Lumbar spinal fusion is a type of back surgery in which a bone graft is inserted in the spine so that the bones in a painful segment of the spine fuse together. The fusion aims to stop the motion at a vertebral segment, which should decrease the pain caused by the joint. After the surgery it will take several months (usually 3 to 6, but sometimes up to 18 months) before the fusion is set-up. This surgery has been improved over the last 10 to 15 years, allowing for better success rates, and shorter hospital stays and recovery time. 

Indications and contraindications for spinal fusion
The vast majority of people with low back pain will not need fusion surgery and will be able to manage the pain primarily with physical therapy and conditioning. A fusion surgery may, however, be recommended for patients with: 

• Low back pain caused by degenerative disc disease that limits the patient's ability to function (after non-surgical treatments, such as physical therapy and medication, have failed)
• Isthmic, degenerative or postlaminectomy spondylolisthesis
• A weak or unstable spine (caused by infections or tumors), fractures, or deformity (such as scoliosis)

Before beginning the main part of a spinal fusion procedure, your surgeon will need to gather material for a bone graft, which is used later on to join the targeted spinal bones together. Depending on individual circumstances and your surgeon’s preferences, this graft material can come from bone harvested from one of your own hips or ribs, from bone harvested from a special donor cadaver, or from artificial materials such as plastics or ceramics.

Once the graft material is ready, your surgeon will make an incision and create an opening that exposes the site of the fusion. Potential locations of this incision include your abdomen, your back and the side of your neck or torso. After exposing the site of procedure and removing the spinal disc that sits between your spinal bones, your surgeon can place the bone graft in one of several ways. First, he can place the graft material directly into the empty space left by the removed spinal disc. Alternatively, he can place the graft material inside a device called a spacer or cage, then insert this device into the gap between your spinal bones. Your surgeon can also lay the graft material over the rear surfaces of the targeted spinal bones.

All of these techniques will lead to fusion of your bones and incorporation of the graft material by triggering your body’s natural healing process. Frequently, bone grafts are held in position by metal rods or plates and screws during this healing period.

Spinal Fusion Uses

Problems in your spinal column that can lead to a need for spinal fusion include a form of bone slippage called spondylolisthesis, debilitating forms of abnormal spinal curvature or deformity, and mechanical spinal instability caused by problems such as accidents or injuries. Surgeries that can produce enough spinal instability to require fusion as a follow-up procedure include complete or partial removal of a damaged spinal disc (discectomy); removal of all or part of the section of spinal bone that forms the back of the spinal canal (laminectomy); and widening of the gaps in your spinal column that allow nerves to pass through from your spinal cord (foraminotomy).

Spinal Fusion Benefits

The rigidity and stability provided by spinal fusion can prevent dangerous degrees of spinal motion, ease pain and other symptoms associated with unwanted or excessive spinal motion, and help prevent damage in the soft tissues situated near your spine. In the vast majority of cases, these benefits are either permanent or remain for extremely extended periods of time.

Success rates for fusion

Fusion surgery success rates vary between 70% and 95%, and there are several factors that will impact the success rate of the surgery, including:

• Spine fusion for conditions that arise from gross instability (e.g. isthmic or degenerative spondylolisthesis) tends to be more successful than surgery done for pain alone (e.g. degenerative disc disease).
• Individuals with only one badly degenerated disc (especially L5-S1) but an otherwise a normal spine tend to fare better than those undergoing multilevel fusions. Fusion surgery is generally considered for one or possibly two levels, and multilevel fusions should be avoided except in cases of severe deformity.
• Individuals who have significant disc degeneration usually find more pain relief from a fusion than those with only minor degeneration on the MRI scan (e.g. still have a tall disc).

The most important success factor in fusion surgery is confirming that a patient's back pain is truly caused by degenerative disc disease, rather than some other condition. This is done by a combination of a careful review of the patient's history, a physical exam, and diagnostic tests (such as x-ray and MRI), and/or possibly a discogram.

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