Lumbar Laminectomy for Leg Pain and Back Pain Relief - Laminectomy Surgery in India

A lumbar laminectomy is also known as an open decompression and typically performed to alleviate pain caused by neural impingement that can result from lumbar spinal stenosis.

A condition that primarily afflicts elderly patients, spinal stenosis is caused by degenerative changes that result in enlargement of the facet joints. The enlarged joints then place pressure on the nerves, and this pressure may be effectively relieved with the laminectomy.

The lumbar laminectomy is designed to remove a small portion of the bone over the nerve root and/or disc material from under the nerve root to give the nerve root more space and a better healing environment

The surgical results of a lumbar laminectomy are particularly effective for leg pain (sciatica) caused by spinal stenosis, which can be severe. Unfortunately laminectomy surgery is not nearly as reliable for relief of lower back pain.

This is because lumbar stenosis is often created by the facet joints becoming arthritic, and much of the low back pain is from the arthritis.

Although removing the lamina and part of the facet joint can create more room for the nerve roots, it does not eliminate the arthritis. Unfortunately, the symptoms may recur after several years as the degenerative process that originally produced the spinal stenosis continues.

How does the procedure work?

Laminectomy is performed under general anesthesia, in this the patient is usually positioned lying on the side or stomach. Then a small straight incision is made over the damaged vertebra. And then a retractor is used to spread apart the muscles and the fatty tissues covering the spine. When the laminae have been reached, the bony arch is cut in order to get to the ligamentum flavum (which is a band of yellow tissue attached to the vertebra that helps to support the spinal column). Thereby an opening is made in the ligamentum flavum to reach the spinal canal and then to the compressed nerve. At this point the cause of compression will be visible (that may be a herniated disk, tumour, fragmented disk etc) which is then rectified. This Surgery is completed in one to three hours.

Minimally Invasive Spine Laminotomy Surgery in 

India - Laminotomy Surgery 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.

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Minimally Invasive spine surgery in India - (Percutaneous Endoscopic Lumbar Discectomy)

A percutaneous discectomy is a surgical procedure in which the central portion of an intervertebral disc is accessed and removed through a cannula. The percutaneous surgical procedure is for safe and sparing excision of herniated disc material. Even sequestered disc material - regardless of its size and level - that slipped into the spinal channel can be removed with this minimal invasive method.

The discectomy is performed through a cannula inserted through the back into the center of the vertebral disc under local anesthetic using a stylet. After the position of the stylet is confirmed to be correct using AP and Lateral X-ray views it is removed leaving the cannula in place. The disc material may be removed using surgical tools such as the Dekompressor or traditional manual surgical tools, however the manual instruments require a larger cannula and more disruption to the surrounding structures. Both the automated and manual percutaneous discectomy procedures produce similar results and reduction in disc height and pressure on the nerves to result in pain reduction.

What does the procedure involve?

Percutaneous Endoscopic Lumbar Discectomy is a minimal invasive spine surgery. It is an endoscopic surgical procedure which is conducted under local anaesthesia with mild sedation. The patient is made to lie on his/her front and the exact entry point is mapped on patient’s body using image intensifier X-ray system. A small incision of about 8-10 cm is made from the midline on the posterior part of the body. There are two different ways in which the inter-vertebral disc material can be removed:

•            Manual procedure also known as Automated Percutaneous Discectomy involves insertion of a long spinal needle from the side of the back, directly into the disc, by-passing other bone and ligaments. Through this needle, guide wire is passed and after making a 5 mm incision, a dilator and working cannula are passed, through which an endoscope is inserted. The prolapsed part of disc is removed with the guidance of the camera and monitor attached to the endoscope.

•            The laser surgery, referred to as Percutaneous Laser Discectomy (PLD), 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 (YAG) laser.

Advantaages of PELD (Percutaneous Endoscopic 

Lumbar Discectomy)

• ·         Surgery done under local anesthesia with conscious sedation
• ·         Very good technique for old and medically compromised patients.
• ·         No muscle, ligament or normal tissue damage
• ·         It saves the time and the costs. 75% of the patients discharged on the same.
• ·         Due to rapid recovery, comparing to open surgeries, it is recommendable for the workers or students with the desire of early return-to-work.
• ·         Even prolapsed, migrated, extra-foraminal, recurrent discs can be removed.
• ·         Very good technique for old and medically compromised patients.
• ·         Even prolapsed, migrated, extra-foraminal, recurrent discs can be removed.

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Is surgery for Neck or Back pain necessary ?

Is surgery for neck or back pain necessary? The answer is: sometimes. It is reasonable to consider spine surgery if the pain has not diminished after several months of non-surgical treatment, if your pain does not respond to narcotic medications, or if you are unable to complete basic daily activities. But fear not - there's a wide array of surgery options. Some are minimally invasive procedures (e.g. microdiscectomy for a herniated disc) allow for a quick recovery, while other types of surgery (e.g. a posterolateral fusion for degenerative) are more extensive and have a much longer recovery time.

The primary purpose of back surgery or neck surgery is to correct an anatomical lesion in individuals who fail to show improvement with conservative (nonsurgical) treatment. Surgery is not an option for patients when an anatomical lesion accounting for their pain cannot be identified.

Surgery is only useful to change a patient’s anatomy (e.g. remove a disc herniation). There is almost never any reason to consider exploratory surgery to “look” for a cause of pain.

Failing conservative treatment is not in and of itself an indication for surgery. An identifiable anatomic lesion is also necessary.

Advancements in Spine Surgery

Modern spine surgery has made major advancements in both technique and

spinal instrumentation/implants over the past couple of decades, but by far the most significant advancement in spine surgery has been better preoperative imaging techniques, which have greatly improved the ability of surgeons to identify accurately and correctly an anatomic lesion as a cause of pain.

There is a rapid increase in technology that allows the MIS physician to treat patients with minimally invasive spine surgery procedures. Some of these techniques are now well established, while others remain new and continue to evolve. The best MIS (Minimally Invasive Spine Surgery) technique will depend on the specific character of the problem. While the list of MIS (Minimally Invasive Spine Surgery) techniques continues to expand, the most commonly employed today include:

•          Minimally Invasive Tubular Microdiscetomy
•          Minimally Invasive Lumbar Laminectomy
•          Cervical laminoforaminotomy
•          Endoscopic Discectomy
•          Minimally Invasive Transforaminal Interbody Lumbar Fusion                  (TILF) 
•          Minimally Invasive Transforaminal Interbody Lumbar Fusion                  (TILF)
•          Minimally Invasive eXtreme Lateral Interbody Fusion (XLIF)
•          Minimally Invasive eXtreme Lateral Interbody Fusion (XLIF)
•          Microsurgical Discectomy
•          Posterior Lumbar Interbody Fusion (PLIF)
•          Kyphoplasty
•          Nucleoplasty or Percutaneous Discectomy

Comparing Minimal type of Invasive Spine surgery to Invasive Spine Surgery:

Minimal Invasive Spine surgery comes with more benefice than invasive spine surgery.

1.    Less scar tissue is created thereby not leaving the patient to recover with huge and ugly scar marks.
2.    Pain associated with this procedure is effectively less severe as small incisions are made. Also less soft tissues are damaged.
3.    Less blood is lost and therefore the patients don’t have to be at a medication for long periods of time
4.    Procedure is more accurate and leaves the patient with better results.
5.    The cost for such a surgery is quite lesser as compared to an Invasive Spinal surgery.

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Cost of Disc Nucleoplasty in India at Best Spine surgery Hospitals in India

Nucleoplasty is a relatively new advancement in the field of spine surgery. It is a procedure used to reduce disc pressure in patients suffering from discogenic (disc related) backache. It is a percutaneous procedure in which some of the disc material is disintegrated to relieve the intra discal pressure using a low temperature resistor. As it does not require any incision over the body, it is beneficial for patients complaining of back pain with disc pathology and unwilling to undergo full fledged discectomy.

The intervertebral discs are soft, cushion like structures between two adjacent vertebral bones in the human spine. Their main function is shock absorption. These discs are hydrated and are made up of a central structure called the nucleus pulposus and a surrounding structure called as annulus fibrosis. But with age they lose their water content and the disc becomes hard and begins to degenerate.

The wear and tear process is aggravated by faulty spine movements, faulty posture, lack of exercise, obesity etc. The inner disc material pushes the outer annulus wall causing it bulge. This bulge can be large enough to compress the surrounding structures like the spinal cord and the spinal nerves resulting in severe back pain and radiating pain in the arm or leg. This condition can affect the cervical (neck) or lumbar (low back) region of the spine. 

Candidates for Disc Nucleoplasty

You are a candidate for disc nucleoplasty if:

• If you are suffering from chronic back pain, back fatigue and rest, medications, medical interventions like steroid injections and physical therapy has not been of help.
• If you suffer from disc herniation
• If you suffer from contained spinal disc herniation, i.e, pain radiating down the leg or arm accompanied by back pain not improving with medication and physical therapy.
• Inflammation and chronic pain, particularly in cases where the nerve roots are pinched or irritated.

Details of the Procedure

This is a minimally invasive procedure performed under local anesthesia and is completed within 30-45 minutes. It performed on an out patient basis and the patient is allowed to go home after the procedure on the very same day.

Under fluoroscopy, a needle is advanced into the involved disc. A specialized catheter is then introduced through the needle into the disc and positioned where the ablation is desired. The catheter has a low-temperature resister at its tip which generates a plasma field. This plasma field disintegrates disc material into its hydrogen and oxygen constituents which escape through the needle. The tissue ablation and thermal treatment create a series of channels within the disc, reducing the pressure from the contained disc herniation or the nerve root and other pain generating structures. The patient is relieved immediately after the procedure .

If The Disc Nucleoplasty Does Not Work, Will It Cause A Problem If I Then Need An Open Spine Surgery? 

No. If the nucleoplasty is not effective, there will be no problem if the patient decides or ultimately requires an open spine surgery. The nucleoplasty does not damage or alter the tissue around the spine, nor does it change the internal spine anatomy except for the expected and desired changes inside the disc itself. 


If I Have Had Previous Spine Surgery, Can I Still Have A Disc Nucleoplasty? 

Maybe. If there has been previous spinal fusion at the level of concern, it will be difficult, if not impossible, to perform a nucleoplasty. If the disc in question is outside the area of previous spine surgery, it is quite possible that a nucleoplasty can be performed. 


Who Should Not Have A Disc Nucleoplasty? 

If you are on a blood thinning medication, if you have an active infection, or if you have poorly controlled diabetes or heart disease, you should not have the procedure. Also, if you have a large extruded disc without an intact disc wall or disc rim, nucleoplasty may not be helpful. 

Benefits of DiscNucleoplasty for herniated or slipped disc, chronic lower back pain, Sciatica

• Outpatient procedure done under local anaesthesia and thus no risks associated with general anaesthesia
• Procedure time is less than an hour
• Minimally invasive
• No scars
• Minimal pain and discomfort to the patient
• Quick recovery
• Quick relief

Cost of Disc Nucleoplasty in India at Best Spine surgery Hospitals in India

The all inclusive cost of Disc Nucleoplasty spine surgery in India varies between $5500- $7000.

The Cost includes 4 days stay in a Private Room where a Companion can stay with the patient, surgeon's fee, medicines and consumables, nursing care, food and Airport Pick & Drop.

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Herniated Disk - Spinal Disk Problems Treatment in India

What Are Spinal Disk Problems?

Only a person who has experienced a damaged spinal disk understands the agony and helplessness it brings. The pain can be excruciating. Every movement seems to make it worse.

This pain is a warning signal that you should heed. If you take appropriate action, the discomfort usually stops, and the problem can be corrected.

Spinal disks are rubbery pads between the vertebrae, the specialized bones that make up the spinal column. Doctors call them intervertebral disks. Each disk is a flat, circular capsule about an inch in diameter and one-quarter inch thick. They have a tough, fibrous, outer membrane (the annulus fibrosus), and an elastic core (the nucleus pulposus).

The disks are firmly embedded between the vertebrae and are held in place by the ligaments connecting the spinal bones and the surrounding sheaths of muscle. There is really little, if any, room for disks to slip or move. The points on which the vertebrae turn and move are called facet joints, which stick out like arched wings on either side of the rear part of the vertebrae. These facet joints are separate from the discs and keep the vertebrae from bending or twisting excessively, which could damage the spinal cord and the vital network of nerves that runs through the center of the spinal canal formed by the stack of vertebra.

The disk is sometimes described as a shock absorber for the spine, which makes it sound more flexible or pliable than it really is. While the disks do separate the vertebrae and keep them from rubbing together, they are far from spring-like. In children, they are gel- or fluid-filled sacs, but they begin to solidify as part of the normal aging process. By early adulthood, the blood supply to the disk has stopped, the soft inner material has begun to harden, and the disk is less elastic. By middle age, the disks are tough and quite unyielding, with the consistency of a piece of hard rubber. These changes related to aging make the outer protect

Understanding Spinal Disk Problems --Herniated Disk

Under stress, a disk's inner material may swell, pushing through its tough outer membrane. The entire disk can  become distorted or bulge in spots. With an injury, all or part of the core material may protrude through the outer casing at a weak spot, pressing against surrounding nerves. If further activity or injury causes the membrane to rupture or tear, the disk material may further extrude, causing pressure on the spinal cord or the nerves that radiate from it. This may result in extreme pain. In the beginning, there may be spasms in the back or neck which will greatly limit your movement. If nerves are affected, you may develop pain that moves into a leg or an arm.

Disk herniation is most often the result of a gradual, aging-related wear and tear called disk degeneration. As you age, your spinal disks lose some of their water content. That makes them less flexible and more prone to tearing or rupturing with even a minor strain or twist.

Most people can't pinpoint the exact cause of their herniated disk. Sometimes, using your back muscles instead of your leg and thigh muscles to lift large, heavy objects can lead to a herniated disk, as can twisting and turning while lifting. Rarely, a traumatic event such as a fall or a blow to the back can cause a herniated disk.

Minimally Invasive Spine Laminotomy Surgery in India 

The laminotomy procedure is a minimally invasive endoscopic surgery carried out on an out patient basis.Laminotomy is a surgical procedure that helps to decompress the spinal cord or the spinal nerves that emerge from the vertebral column. It is done with aim of removing any structure that narrows the spinal canal and free the entrapped nerves.

In this procedure a small incision is made in the lamina as opposed to laminectomy where the entire lamina is removed. As a result laminotomy procedure decompresses the spinal cord without compromising with the spinal stability.

When is  Laminectomy recommended ?

Laminectomy is recommended when one or more of the following symptoms and disorders that affect the lower back are seen in the body:

• ·         Ankylosing spondylitis
• ·         Degenerative disc disease
• ·         Herniated disc
• ·         Sciatica
• ·         Spinal stenosis
• ·         Spondylosis (also known as spinal osteoarthritis)

How does the procedure work?

Laminectomy is performed under general anesthesia, in this the patient is usually positioned lying on the side or stomach. Then a small straight incision is made over the damaged vertebra. And then a retractor is used to spread apart the muscles and the fatty tissues covering the spine. When the laminae have been reached, the bony arch is cut in order to get to the ligamentum flavum (which is a band of yellow tissue attached to the vertebra that helps to support the spinal column). Thereby an opening is made in the ligamentum flavum to reach the spinal canal and then to the compressed nerve. At this point the cause of compression will be visible (that may be a herniated disk, tumour, fragmented disk etc) which is then rectified. This Surgery is completed in one to three hours.

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Spinal Cord Injury Treatment in India - Understanding Spinal Cord Injury

Your spinal cord is a bundle of nerves that runs down the middle of your back. It carries signals back and forth between your body and your brain. A spinal cord injury disrupts the signals. Spinal cord injuries usually begin with a blow that fractures or dislocates your vertebrae, the bone disks that make up your spine. Most injuries don't cut through your spinal cord. Instead, they cause damage when pieces of vertebrae tear into cord tissue or press down on the nerve parts that carry signals.

Spinal cord injuries can be complete or incomplete. With a complete spinal cord injury, the cord can't send signals below the level of the injury. As a result, you are paralyzed below the injury. With an incomplete injury, you have some movement and sensation below the injury.

A spinal cord injury is a medical emergency. Immediate treatment can reduce long-term effects. Treatments may include medicines, braces or traction to stabilize the spine, and surgery. Later treatment usually includes medicines and rehabilitation therapy. Mobility aids and assistive devices may help you to get around and do some daily tasks.

Each patient's injury is unique. Some patients require surgery to stabilise the spine, correct a gross misalignment, or to remove tissue causing cord or nerve compression. Spinal stabilisation often helps to prevent further damage.  Some patients may be placed in traction and the spine allowed to heal naturally.  Every injury is unique as is the course of post injury treatment that follows.

Spinal Cord Shock

When a spinal cord injury is caused due to trauma, the body goes into a state known as spinal shock. While spinal shock begins within a few minutes of the injury, it make take several hours before the full effects occur. During spinal shock the nervous system is unable to transmit signals, some of which may return once spinal shock has subsided, the time spinal shock lasts for is approximately 4-6 weeks following the injury. In some rare cases spinal cord shock can last for several more months.  The loss of these signals will effect the persons movement, sensation and how well the body’s systems function. Often the persons loss of movement and sensation below the level of the spinal cord injury may appear complete soon after the injury. This may mask the real extent of the damage. Usually, over the first few weeks the some of body systems adjust to the effects of the injury and their function improves. Therefore, during this time and the early stage of ANY new injury it is unlikely that an accurate prediction of any recovery or permanent paralysis can be made.


Surgery

Depending on the circumstances, when surgery is required, it may be performed within 8 hours following injury. Surgery may be considered if the spinal cord is compressed and when the spine requires stabilization. The surgeon decides the procedure that will provide the greatest benefit for the patient.

Different tissue and bony structures including vertebrae misaligned from the force of injury, a herniated disc, or a haematoma can cause spinal cord compression. An unstable spine may require spinal instrumentation and fusion to build in support.

Spinal instrumentation and fusion can be used to provide permanent stability to the spinal column. These procedures correct, join, and solidify the level where a spinal element has been damaged or removed .

Instrumentation uses medically designed hardware such as rods, bars, wires and screws. Instrumentation is combined with fusion (bone grafts) to permanently join two or more vertebrae.

Healing Broken Bones Without Surgery

Surgery isn't the only way to repair broken bones in the neck and back a more conservative and less invasive approach is to allow the bones to heal naturally with the help of halo traction where needed.  This approach may mean up to two months complete bed rest.
 

Recovery

Once the patient is stabilised, care and treatment focuses on supportive care and rehabilitation. Family members, nurses, or specially trained carers give supportive care. This care might include helping the patient bathe, dress, change positions to prevent bedsores, and other assistance.

Rehabilitation often includes physical therapy, occupational therapy, and counselling for emotional support. Each program is designed to meet the patient's unique needs. 

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