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.
  Call Us : +91-9811058159
  Mail Us : care@medworldindia.com

Most Advanced Surgically Back Pain Treatments in India

MinimallyInvasive 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.

Minimally Invasive Surgery for Spine Tumors : Vertebral Fracture Treatments , Vertebroplasty and Kyphoplasty (Vertebral Augmentation)

Minimally Invasive Spine Tumor Surgery

Tumor is abnormal mass of rapidly growing cells without any physiological function. That means it does not perform any function for the body but derives its nutrition from the body.  It can occur anywhere in the body. The cause is unknown. Those tumors that are found in and around the spinal cord are known as spinal tumors. They may be primary tumors whose cells of origin is the spinal tissue, or they may be secondary tumors which have spread (metastasize) via blood stream from some other focus in the body.
 

The Spinal cord is covered by a layer of protective tissue called as meninges. The entire spinal cord is encased within the vertebral column.
 

The Spinal tumor are of three types depending on their location:

• Intramedullary – within the substance of the spinal cord.
• Intradural-Extramedullary- within the layers (meninges) covering the spinal cord
• Extradural- between the meninges an the vertebral body. Most of the spinal tumors are extradural.  

Tumors are also classified as benign and malignant. Tumors that are confined to a particular area in the body are known as benign tumors. Those tumors that spread rapidly to various parts of the body are known as malignant tumor. A tumor can initially start as a benign one and can convert to a malignant one in a few cases. The benign tumors are easier to treat as they are localized in their extent and their complete removal is possible. Whereas incase of metastatic or malignant tumor, the earlier they are detected, the better the chances of their removal. But in the malignant tumor the chances of recurrence are also there as they are rapidly growing tumors.
 

What are the Symptoms of Spinal Tumor?

Tumor may cause generalized symptoms in the body (like persistent low energy levels, unexplainable weight loss, lump formation, enlargement of lymph nodes, malaise, irregularities of menstruation in females etc) as well as symptoms pertaining to the affected organ in the body. In case of spinal tumor the patient may present with any of the following:

• Back pain, often radiating to other parts of the body and worse at night
  
• Loss of sensation or muscle weakness, especially in the legs
• Difficulty walking, sometimes leading to falls
• Decreased sensitivity to pain, heat and cold
• Loss of bowel or bladder function
• Paralysis may occur in varying degrees and in different parts of the body, depending on which nerves are compressed.
• Scoliosis or other spinal deformity resulting from a large, but non cancerous tumor
• Erosion and Destruction of vertebral body

Minimally Invasive Surgery for Spine Tumors

Surgery is considered minimally invasive when it involves small incisions (e.g. ½ inch) and minimal tissue disruption. Most minimally invasive procedures are done on an outpatient basis, meaning that the patient can go home the same day, and have relatively short recovery times.

Vertebral Fracture Treatments
Vertebroplasty and Kyphoplasty, also referred to as vertebral augmentation, are typically reliable procedures designed to provide pain relief for patients who have a vertebral fracture associated with a spinal tumor.

Vertebroplasty
This procedure involves inserting a needle through a small incision in the back so that a medical-grade bone cement can be inserted into a fractured vertebra to fill in the empty spaces and act as an internal cast to stabilize the bone. The treatment is designed to reduce pain, prevent further collapse of the vertebra, and restore the patient's mobility.

Kyphoplasty (Vertebral Augmentation)
Kyphoplasty also involves injecting bone cement into a vertebra, and involves the additional step of first inserting a balloon into the bone and inflating the balloon to create a cavity. This treatment is designed to stop the pain caused by a spinal fracture, and to stabilize the bone via an internal cast.

Transarterial Chemoembolization
This procedure involves a small incision in the thigh for access to the femoral artery. A catheter guided by a wire is directed through the vascular system to the tumor with the aid of imaging. Once the tumor is located, a chemotherapeutic agent is injected directly into the tumor to shrink or destroy the tumor to remove pressure on individual nerve roots or the spinal cord.

Recovery

Recovery after tumor surgery is a relatively slow process as the patient is weakened by the tumor and all the medications, chemotherapy and radiotherapy, he has been subjected to. Regular follow ups are required to detect any recurrence of tumor. Positive mindset combined with a strong support system can work wonders for the patient’s recovery. The patient should take nutritious diet to replenish his body reserves. 

Tumor or cancer as it is referred to in common man’s language, is a much feared disease. Many of those who are affected feel their world go crumbling around them with the mere mention of such a diagnosis. They go through a variety of emotional phases from denial to acceptance to defeat against the killer. Not only the patient but also the caretaker or the family member is totally drained out while attending to the patient. The picture may seem very dismal, but tumor patients still have a hope to live a normal life, provided the condition is detected early and the remedial measures are begun in time. We provide these patients with a world class diagnostic setup to detect tumors as early as possible and also advanced surgical techniques to treat them. We provide a multidisciplinary approach towards handling of such patients as they require medical, surgical, emotional and psychological support. We make the stay of the patient as well as that of the caretaker as comfortable as possible and try our best to allay their fears and anxieties. All this is offered at our hospitals at very affordable costs.

Minimally Invasive Posterior Lumbar Interbody Fusion (PLIF) in India - Spine Surgery Treatments offered at Best Hospital in India

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.This image shows a side view of an instrumented spine. The arrow shows the force of gravity which is diverted from the disc to the posterior instrumentation. One can imagine how the disc space could continue to have motion despite solid posterior fusion.

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 posteriorapproach. 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 PLIFprocedure (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 instrumentationin the form of a cage can be placed through this approach.                                  

AFTER SURGERY

Risks include:

• Nerve Injury
• Adjacent disc disease
• Infection
• Bleeding
• Non-union

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).

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Most Advanced Minimally Invasive Lumbar Fusion Surgery in India

Lumbar spinal fusion is a common technique to help patients with back pain, who have failed non-operative treatment. Once you and your physician have decided that you need fusion of your lumbar spine, you should realize that there are many different ways this procedure can be done. The choice of which technique is best for you is dependent on what is wrong with your spine. Your surgeon may have more experience with fusion techniques from the front of the spine (anterior), the back of the spine (posterior), or some of the newer, less invasive approaches. These newer techniques are often called Minimally Invasive Spinal (MIS) surgery. The goals of all these techniques remain the same, to achieve a lumbar fusion, and lessen the patient's pain.

The most common method of spinal fusion involves the posterior approach, with an incision along the back of the patient's spine. Often, this procedure is used if bone spurs, thickened ligaments, or disc ruptures need to be removed to alleviate pressure on the nerves. The fusion procedure then involves placement of metal screws, rods and bone graft. Anterior spinal fusions require an incision through the abdomen. After removal of the degenerated disc, a metal cage with bone graft is usually placed between the spinal bones (vertebral bodies). Some patients will require both front and back procedures.

There are many new surgical techniques that are being developed to improve the results of lumbar fusions. Minimally invasive spine surgery for lumbar fusion is one of these newer techniques. MIS procedures have smaller incisions, cause less trauma to the surrounding normal tissues, and hopefully results in a faster recovery for the patient. One of these MIS techniques is a procedure known as extreme-lateral lumbar interbody fusion (XLIF). During the XLIF procedure the lumbar spine is approached from the side through a small skin incision. The surgery is performed through a muscle that lies next to the lumbar spine known as the psoas muscle.

With the XLIF procedure, approximately 2/3 of the disc can be safely removed. After the disc is removed, an artificial graft is placed in between the vertebrae, to allow the bones to fuse together. For a single level XLIF procedure, the surgery can be usually be performed in about an hour. Most patients stay in the hospital for 24 hours following the procedure, and do not require a brace. Occasionally, weakness may be noticed while lifting your leg after surgery. This psoas muscle weakness should return to normal fairly soon after surgery.

Not everyone is a candidate for this surgery, once conservative (non-operative) treatments have failed, you should consult a surgeon to see if you are an appropriate candidate.

The major advantage of all of these  minimally invasive techniques is that there is less damage caused to the surrounding tissues. Unfortunately, in traditional spinal surgery it is necessary to cut through muscles and move them out of the way in order to reach the spine. This can cause a large amount of pain following surgery, and it can lengthen the recovery time. Instead of cutting and moving muscles, the minimally invasive techniques can more gently spread through the muscles to allow access to the spine. This is much less painful for the patient, and it does not require as long of a recovery period for the muscle to heal.

Another benefit of less muscle damage is less blood loss and thus a reduced need for blood transfusions using the minimally invasive techniques. There is often less need for narcotic pain medications following this form of surgery, and a shorter hospital stay.

 

Benefits of Balloon Kyphoplasty Balloon Kyphoplasty for Spinal Fracture

Because Kyphoplasty is a minimally invasive procedure, no hospitalization or general anesthesia is required, no surgical incision is needed—just a small nick in the skin—and no stitches are required.

Most patients who undergo Kyphoplasty for spinal fractures report that their pain is gone or significantly better within 48 hours and that they return to normal activity shortly after the procedure. Studies have shown that 75 to 90 percent of people treated with Kyphoplasty will have complete or significant reduction in pain.

What Causes Spinal Fractures?

Spinal fractures, also called compression fractures, are caused by a weakening of the bone in the spine. A fracture occurs when the weakened vertebrae of the spine collapse, usually in the middle (thoracic) or lower (lumbar) spine.

In older adults, osteoporosis—a progressive weakening of the bone over time—is the primary cause of spinal fractures. Fractures typically occur in women over the age of 60 who are affected by osteoporosis. Spinal fractures can also occur among younger people whose bones have become fragile due to the long-term use of steroids or other drugs to treat diseases such as lupus, asthma and rheumatoid arthritis.

The balloon is then filled with bone cement that then can permanently keep the vertebrae in position. It has proved popular because it is a relatively simple procedure that can be performed in an outpatient clinic.

Fast and Effective

The procedure is beneficial because the patient can be treated and sent home without requiring an extended stay in hospital. It is normal for the patient to have the procedure while under a local anesthetic so that they quickly recover and can be sent home on the same day. This is because it does not involve an incision and only requires the use of a large needle to place the balloon, inflate it and then when it has positioned the vertebrae correctly add the bone cement.

Low Impact

Unlike many other procedures that are used on a patient’s back this procedure will allow them to be able to walk immediately after they have recovered from the effects of the anesthetic. It is commonly done under a local anesthetic but can also be done with a general anesthetic.

The patient can then be driven home and is generally advised to stay in bed for the next day. Restricted activities are recommended for the next four to six weeks so that the area can fully heal. After this period they can resume all activities after being checked by the Doctor.

What Is It Used To Treat

The Kyphoplasty procedure is used for people that have compression fractures of the spine. It can be used on people that have had an injury that has caused compression fractures, people that have cancer that affected the spine and people with osteoporosis.

It is normally recommended if there is severe pain associated with the compression fracture. In some cases the patient will first be given time to recover with bed rest and physical therapy. This time period is usually from 60 to 90 days but can vary according to the severity of the pain, amount of damage and assessment of the chances of the likelihood of recovery without intervention.

Complications

One of the main benefits of this procedure is the use of a single needle to complete the necessary work. This lowers the risks of post operative infection and speeds recovery time.

There is a small risk that the bone cement can leak into the surrounding tissue. In some cases when this happens the spine or nerves can be affected and this may cause pain in the area. This procedure has a very low risk of complications and you should speak to your Doctor so that you can fully understand the risks compared to the possible benefits in your particular situation. Then you can make an informed choice to proceed with Kyphoplasty.

Kyphoplasty at Best Spine Surgery Hospitals 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.

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.

Call Us : +91-9811058159

Mail Us : care@medworldindia.com

Most commonly, laminectomy is performed to treat spinal stenosis

Laminectomy or Laminotomy (a partial laminectomy) is sometimes called a decompression procedure and is a spinal procedure to remove a portion of the vertebral bone called the lamina. The lamina is a posterior arch of the vertebral bone lying between the spinous process, which juts out in the midline and the more lateral of each vertebra. The pair of lamina, along with the spinous process, make up the posterior wall of the bony spinal canal.  Although the procedure indicates excision of the lamina, the operation called conventional laminectomy, removes the lamina, spinous process and overlying connective tissues and ligaments, cutting through the muscles that overlie these structures. Minimal surgery laminectomy is a tissue preserving surgery that leaves the muscles intact, spares the spinal process and takes only one or both lamina. Laminotomy is removal of a mid-portion of one lamina and may be done either with a conventional open technique, or in a minimal fashion with the use of tubular retractors and endoscopes.

BRIEF ABOUT THE PROCEDURE

There are many variations of laminectomy, in the most minimal form small skin incisions are made, back muscles are pushed aside rather than cut and the parts of the vertebra adjacent to the lamina are left intact. After an incision is made in the midline of the neck or back, the muscle is moved away to expose the lamina, which are the bony shingles that overlay the neural (nerve) elements. The lamina can be removed in whole or in part to expose a single nerve root or more of the neural elements as needed. In the case of a lumbar disc herniation, a laminotomy, or partial removal of the lamina is usually sufficient to gain access to the affected nerve root.  The nerve root will usually be visible just beneath the lamina, with a disc herniation underneath it. The nerve root is gently held out of the way with a retractor and the disc herniation can be accessed. The traditional form of laminectomy (conventional laminectomy) excises much more than just the lamina, the entire posterior backbone is removed, along with overlying ligaments and muscles. The usual recovery period is very different depending on which type of laminectomy has been performed: days in the minimal procedure and weeks to months with conventional open surgery. A lamina is removal is done to break the continuity of the rigid ring of the spinal canal to allow the soft tissues within the canal to expand or as one step in changing the contour of the vertebral column, or in order to allow the surgeon access to deeper tissues inside the spinal canal. Conventional open laminectomy often involves excision of the posterior spinal ligament and some or all of the spinous process and facet joint. Removal of these structures, in the open technique, requires cutting the many muscles of the back which attach to them. Laminectomy performed as a minimal spinal surgery procedure, however, allows the bellies of muscles to be pushed aside instead of transected and generally involves less bone removal than the open procedure. The recovery period after laminectomy depends on the specific operative technique; minimally invasive procedures having a significantly shorter recovery period than open surgery. Removal of substantial amounts of bone and tissue may require additional procedures to stabilize the spine, such as fusion procedures and spinal fusion generally requires a much longer recovery period than simple laminectomy. Most commonly, laminectomy is performed to treat spinal stenosis. Laminectomy for Spinal Stenosis Spinal stenosis is the single most common diagnosis leading to any type of spine surgery and laminectomy is a basic part of its surgical treatment. The lamina of the vertebra is removed or trimmed to widen the spinal canal and create more space for the spinal nerves and thecal sac. Surgical treatment that includes laminectomy is the most effective remedy for severe spinal stenosis, however most cases of spinal stenosis are not severe and do not require surgery. When the disabling symptoms of spinal stenosis are primarily neurogenic claudication and the laminectomy is done without spinal fusion, there is generally a very rapid recovery with excellent long term relief. However, if the spinal column is unstable and fusion is required, there is a recovery period of months to more than a year and relief of symptoms is less likely.

Treatment and Surgery options for Spinal Cord Injury : Best Spine Hospitals in India

There are a variety of treatment and surgery options for Spinal Cord Injury depending on the affected area of the spine.

Spinal cord injury

Is the result of a traumatic injury such as a bruise or contusion, a partial tear or a complete tear in the spinal cord. It can also result indirectly from damage to surrounding bones, tissues or blood vessels. 

Spinal Cord Injury Diagnosis

Spinal cord injuries are very serious. If you are suffering from any symptoms of spinal cord injury, it is very important to seek immediate medical attention. In order to diagnose your condition, your doctor will perform both a physical and neurological exam. If the location of the injury is not known, one of more of these tests will help locate the exact point of injury:

·         CT scan or MRI – shows the location and extent of the damage. These scans can also reveal internal problems such as hematomas or blood clots.

·         Spine X-rays – show damage or fractures to the bones in the spine

·         Myelogram – Dye is injected into the fluid-filled space between the bones in your spine. The dye is able to move through the space in order to allow the spinal cord and nerve roots to be seen more clearly. This is used in rare cases to find the source of a problem that was not detected by other tests.

·         Somatosensory evoked potential (SSEP) – Test which evokes response from the nervous system through magnetic stimulation. It can show if nerve signals are able to pass through the spinal cord, or if an injury is blocking the transmission.

Nonsurgical Treatment for Spinal Cord Injury
Since spinal cord injury is such a serious and time-sensitive condition, it is critical to seek treatment as soon as possible. Time between injury and treatment will have a huge impact on the outcome. Some nonsurgical treatment options for spinal cord injury include:

·         Methylprednisolone – Steroid medication used to decrease inflammation at the site of the injury as well as reduce damage to nerve cells. If given within eight hours of injury, you will experience mild improvement.

·         Immobilization – This is done to stabilize and/or realign your spine after injury. Immobilization can be accomplished by using metal braces and a body harness to keep your head from moving. A special bed or neck brace can also be used to secure your head and prevent movement of the spine.

·         Experimental treatments – Scientists are working on methods to prevent cell death, promote nerve regeneration and control inflammation.

Surgery for Spinal Cord Injury 
In many cases, spinal cord surgery is necessary to remove bone fragments, herniated discs, foreign objects, fractured vertebrae and anything that may be compressing your spine. Because there are different types of injuries and different sections of the spine that can be injured, there are many different types of surgery for spinal cord injury:

·         Lumbar discectomy – surgical procedure used to remove all or part of a herniated or ruptured disc in the lower part of the spine

·         Cervical discectomy – surgery used to remove one or more discs from the neck

·         Microdiscectomy – Minimally invasive surgery on a ruptured disc in the neck or back. This procedure aims at removing a small part of the ruptured disc in order to alleviate pain while avoiding any possible instability in the spine.

·         Spinal fusion – Surgical procedure for fusing or joining two or more vertebrae. There are different types of this surgery for different areas of the spine:

•Anterior Lumbar Interbody Fusion – In this procedure, the spine is operated on from the front. The surgeon removes a disc from the lower part of the spine and replaces it with bone graft. The desired result is for the two surrounding vertebrae to grow or fuse together into one solid bone.

•Posterior Lumbar Interbody Fusion – This procedure is virtually the same as the anterior fusion except that the surgeon approaches the spine from the back.

•Transforaminal Lumbar Interbody Fusion – In this procedure, the spine is approached from the side.

·         Laparoscopic Fusion – A minimally invasive surgical alternative to open surgery that requires a much smaller incision in the back to gain access to the spine. Recuperation time and pain levels are significantly reduced compared to other types of spinal fusion surgery.

·         Intradiscal Electrothermal Therapy – Minimally invasive treatment for lower back pain. This procedure utilizes fluoroscopic (x-ray) guidance and an electrothermal catheter to heat up the affected lumbar disc. The goal is to destroy pain receptors in the disc.

·         Surgical Decompression – A small portion of the bone over the nerve root is removed to allow more space for the nerve root while helping it to heal. There are different types of surgical decompression:

•Foraminotomy – The foramen, or opening where the nerve root comes out of the spinal column, is widened by shaving away a portion of the bone.

•Laminotomy – Partial removal of the lamina, or bony arches in the canal of the spine

•Laminectomy – Complete removal of the lamina, or bony arches in the canal of the spine

•Corpectomy – The entire degenerated vertebrae is removed and replaced by bone graft.

•Laminoplasty – The lamina, or bony arches in the spinal canal, is cut open on both sides to create an open flap to relieve pressure on the spinal cord. The bone flap is propped open with small wedges or pieces of bone.

·         Kyphoplasty/Vertebroplasty – Kyphoplasty and vertebroplasty are both minimally invasive procedures that treat pain and other symptoms caused by a spine fracture resulting from osteoporosis. Each procedure can also restore vertebral body height lost due to a compression fracture.

·         Anterior Cervical Disectomy and Fusion – Surgical procedure used to treat neck problems resulting from fractures, herniated discs and spinal instability.

·         Spinal Cord Stimulation – This procedure uses an electrical current to treat chronic back pain by implanting a small pulse generator in the back. The pulse generator sends electrical pulses to the spine in order to block the nerve signals which make you feel pain.

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