Who can benefit from Minimally Invasive Spinal Fusion Surgery? - Most Advanced Spine Surgery in India

A person’s spine is subjected to a lot of forces throughout its lifetime. It may be subjected to age related wear and tear or infections like tuberculosis. As a result it undergoes degeneration which gives rise to a variety of problems like spinal osteoarthritis, disc prolapse, spondylolisthesis, osteoporotic fractures, vertebral collapse etc. 

All these conditions manifest as severe pain in the back and radiating pain, numbness, tingling in the upper or lower extremities (lower leg or arm) due to compression of spinal nerves, spinal cord and spinal instability. When these symptoms become debilitating enough to preclude the patient’s day to day activity, a Spinal Fusion Surgery is advised.

Spinal Fusion  Surgery in India

The objective of this surgery is to fuse (join) to or more adjacent vertebral segments that are diseased, so that they grow as one unit and result in a more stable painless spine. The involved segment gives rise to pain due to compression of surrounding soft tissue structures and nerves. Spinal fusion also known as spondylodesis or spondylosyndesis aims at relieving this compression and restoring the surrounding soft tissue elements and nerves to their original shape and size, thereby eliminating the pain. It also provides stability to the affected segments during movement at the spine. The surgery is generally indicated for the lumbar spine as low back bears the maximum brunt, but it may be advised for cervical (neck) or thoracic (mid back) segments also.

                                               

Our spine consists of 33 small bones stacked one on top of the other. They are separated by soft cushion like structures call intervertebral discs which provide shock absorption and facilitate movements of the spine. The Vertebral column encloses the delicate spinal cord within and the spinal nerves leave the vertebral column through openings (foramen) present on the sides. When these discs degenerate, herniated or when the intervertebral distance reduces or when there are bony outgrowths (osteophytes) on the undersurface of vertebral body, they encroach into the passage for the spinal nerves or the spinal cord. This results in compression of the spinal nerves or spinal cord manifesting as severe intractable pain in the back and the lower leg or arm.  

  

 

Who can benefit from Minimally Invasive Spinal  Fusion Surgery?

Patients who are suffering from persistent back pain that has not been relieved by conventional mode of treatment like rest, physical therapy or medication or those suffering from any of the following chronic conditions :-

•degenerative disc disease

•spinal disc herniation

•discogenic pain

•spinal tumor

•vertebral fracture

•scoliosis

•kyphosis (i.e, Scheuermann's disease)

•spondylolisthesis

•spondylosis

•Posterior Rami Syndrome

Types of Spinal Fusion Surgery

There are three types of spinal fusion procedures which differ only in their access towards the affected spinal segment. The basic procedure remains the same in all the three techniques. They are: 

 

1) Anterior Lumbar Interbody Fusion (ALIF):The affected segment is accessed through an incision in the abdomen

2) Posterior Lumbar Interbody Fusion (PLIF): The affected segment is accessed through an

incision in the midline of the back

3) Transforaminal Lumbar Interbody Fusion (TLIF): The affected segment is approached through a paraspinal ( at the side of the midline) incision in the back.The Minimally Invasive TLIF approach is the preferred method at our practice for interbody fusion as it is generally less traumatic to the spine, is safer for the nerves, and allows for quicker recovery.

Minimally invasive type of spine surgery  designed

to accomplish aspinal fusion

• ·         Minimal tissue damage
• ·         Minimal blood loss
• ·         Small incisions and scars
• ·         Minimal post-operative discomfort
• ·         Relatively quick recovery time and return to normal function.

Because of the above factors, it is one of a number of options for spinal fusion that are relatively minimally invasive. The XLIF is a type of interbody fusion, which is a category of fusion in which the disc in the front of the spine is removed and replaced with an implant containing a bone graft to set up the condition for the two vertebrae to fuse together through the disc space.

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FAQ About Minimally Invasive Spine Surgery in India !

When should I consider surgery?

Surgery should always be the last resort when it comes to treating spinal conditions in the neck and back. However, if various non-operative treatments have been attempted without improvement or worsening over a 6-12 month period, then surgical treatment seems reasonable for certain specific conditions such as spinal stenosis, sciatica, spondylolisthesis or degenerative scoliosis. The decision for surgery should be individualized to the patient and the patient’s symptoms, along with their level of function. 

Am I a candidate for minimally invasive spine surgery?

The field of minimally invasive spine surgery continues to grow. Most surgeries today can be treated with some aspect of minimally invasive surgery. However, there are certain conditions that require standard open treatment, such as high-degree scoliosis, tumors and some infections.The best options should be individualized to the patient’s diagnosis and overall patient condition.


How long will I be in the hospital?

In general, minimally invasive spine surgery decreases the hospital stay by one-half. In a typical endoscopic discectomy, the surgeries are performed in the same day, and the patients go home shortly after surgery on the same day.

For various types of lumbar fusion surgery, the patient typically goes home in 2-3 days, where previously they stayed in the hospital 5-7 days. Furthermore, the immediate post-operative period is marked by much less pain when using minimally invasive techniques. 

When can I goback to work after minimally invasive back surgery?

The decision to return to work should be individualized to the patient, as well as the patient’s occupation. For patients with sedentary jobs, such as office work, a minimally invasive discectomy would allow that patient to begin part-time work within 1-2 weeks. For a larger surgery such as a fusion, this may take 4-6 weeks. Again, return to work is much faster using minimally invasive surgery vs. standard open surgery but this decision is individualized to special needs of each patient. 

How long is the recovery?

Recovery from each surgery is different. Some patients return to full activity in 6 weeks while other patients require more time. We encourage all patients to participate in a physical therapy program to safely begin the process of returning to all normal activities. 


After surgery, how long will my pain last?

On average, patients who have had minimally invasive spine surgery are discharged in half the time of traditional surgery and the pain usually follows this rule. Each procedure will have a different rate of recovery. 


Will I need physical therapy after I get minimally invasive spine surgery?

Physical therapy is an important component of a rapid recovery. This is individualized to the patient, but in most cases, physical therapy started 2-6 weeks after surgery, depending on the surgery performed and the patient’s overall condition. 

Do you uselasers for minimally invasive back surgery?

Minimally invasive spine surgery utilizes a wide variety of advanced techniques, including lasers, endoscopes, operating microscopes, as well as computer-assisted navigation systems, so that procedures typically done with a large, open decision can be done through small openings.

By necessity, advanced technologies are needed to accomplish the same task that we would otherwise do with an open procedure using more basic equipment. The decision to use one or other types of advanced technologies depends on the individual condition and the surgery performed.



Which type ofsurgery has a greater success rate?

At present, the long-term results of minimally invasive surgery are not well studied. These assessments are ongoing. The short term success of minimally invasive spine surgery is well established. It is clear that minimally invasive surgery allows more rapid recovery and return to work/sports. There is less post-operative pain and shorter hospital stay.

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Low Cost Percutaneous Endoscopic Lumbar Discectomy (PELD) - Minimal Invasive Spine Surgery in india

Percutaneous Endoscopic Lumbar Discectomy (PELD)

PELD or Percutaneous Endoscopic Lumbar Discectomy is an advanced minimally invasive spine surgery done for the decompression of the lumbar disc space and removal of nucleus pulposus via a posterolateral approach. PELD is also a good treatment option in management of spinal tumors and structural deformities also in patients whose pain threshold is low or who are not responding well to conservative treatments like pain killers, anti inflammatory drugs and rehabilitation.

Percutaneous Endoscopic Lumbar Discectomy (PELD) is not the Conventional excision but a treatment which in between the conservative and open surgery. Therefore, it does not disrupt the normal soft tissue or the vertebral structures. After inserting a thin wire into the skin, the surgeons treat the herniated disc with laser and radio-frequency thermal effect under endoscopic guidance.

What is Percutaneous Endoscopic Lumbar Discectomy (PELD)?

Percutaneous Endoscopic Lumbar Discectomy (PELD) is a unique approach for the treatment of non-sequestrated disc herniation (disc prolapse). An advanced minimal invasive technique, PELD is performed for the decompression of the lumbar disc space and removal of nucleus pulposus via a posterolateral approach. In addition to decompression surgery, the technique has been found effective in management of spinal tumors and structural deformities.

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.

In either procedure, the wound is closed with single stitch. The patient gets immediate pain relief.

Duration: 60 minutes

Risks

• Improper placement may result in nerve damage
• Inadequate decompression may result in the need for a second operation, using a different technique

Benefits

• Surgery is done under local anaesthesia
• No muscle, ligament or normal tissue damage and minimal blood loss
• No prolonged bed rest required after surgery
• Early return to work
• Even prolapsed, migrated, extra-foraminal, recurrent discs can be removed
• Very good technique for old and medically compromised patients
  
  
  
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What are various types of scoliosis? Scoliosis Treatment in India

What are various types of scoliosis?

Functional Scoliosis

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

Neuromuscular Scoliosis

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

Degenrative Scoliosis

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

Expected Results

Scoliosis surgery in India which involves spinal fusion is quite successful in stopping the curve from growing. With sophisticated techniques, doctors can straighten the curve to a great extent which improves the patient's appearance and functioning to a great extent.

Recovery

You would have a lot of pain after the surgery which would be controlled with pain medications. You would stay at the hospital for about a week to ten days to make sure you are on the right healing path. The surgeon would advise you to start walking on second or third day of the surgery and physical therapy would begin on the third or fourth day of the surgery.

Most people return to school and work in 3-4 weeks. Full recovery can take from 4-6 months and most people can resume other activities and even sports after an advice from the surgeon.

Scoliosis Surgery in India

Owing to availability of state of the art hospitals, a lot many patients come to India for scoliosis surgery. Scoliosis surgery in India is being performed by highly experienced orthopedic surgeons and doctors. Besides quality of treatment, the cost of the surgery in India is much less than the cost of the surgery in USA, UK or Canada.

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Causes of Pain in the Lumbar Spine (lower back problem) - Spine Best Hospital in India

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

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

What Is the Lumbar Spine?

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

Ligaments and Tendons: Connective Lumbar Spine Soft Tissues

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

Lumbar Spine Joints

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

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

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

The lumbar spine has several distinguishing characteristics:

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

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

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

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

Lumbar Intervertebral Segment

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

Each lumbar spine segment is comprised of:

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

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

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

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

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Treatment of Vertebral Compression Fractures in the Spine - Benefits of Kyphoplasty

What is Kyphoplasty

If you have been diagnosed with a spinal fracture caused by osteoporosis, cancer or benign tumors, balloon kyphoplasty is a treatment option you may want to consider. Balloon kyphoplasty is a minimally invasive procedure that can significantly reduce back pain and repair the broken bone of a spinal fracture. The procedure is called balloon kyphoplasty because orthopaedic balloons are used to lift the fractured bone and return it to the correct position. Before the procedure, you will have a medical exam and undergo diagnostic studies such as X-rays, to determine the precise location of the fracture. 

Balloon kyphoplasty can be done under local or general anesthesia—your physician will decide which option is appropriate for you. Balloon kyphoplasty takes about one hour per fracture treated. It can be done on an inpatient or outpatient basis, depending on medical necessity. After the procedure, you will likely be transferred to the Recovery Room for about an hour for observation. The aim of Kyphoplasty is to reduce the pain of fractured vertebra, to reinforce the weakened bone and to restore normal vertebral height.

To confirm the presence of a compression fracture following tests needs to be done after a physical examination:

• Blood tests,
• Spine x-rays
• Radioisotope bone scan or
• MRI

How is Kyphoplasty Performed ?

Kyphoplasty is performed under local or general anesthesia. Using image guidance x-rays, two small incisions are made and a probe is placed into the vertebral space where the fracture is located. The bone is drilled and a balloon, called a bone tamp, is inserted on each side. These balloons are then inflated with contrast medium until they expand to the desired height and removed. The balloon does not remain in the patient. It simply creates a cavity for the cement and also helps expand the compressed bone. 

The spaces created by the balloons are then filled with PMMA, the same orthopaedic cement used in vertebroplasty, binding the fracture. The cement hardens quickly, providing strength and stability to the vertebra, restoring height, and relieving pain.

Recovery from kyphoplasty

Pain relief will be immediate for some patients. In others, elimination or reduction of pain is reported within two days. At home, patients can return to their normal daily activities, although strenuous exertion, such as heavy lifting, should be avoided for at least six weeks. 

Patients should see their physician to begin or review their treatment plan for osteoporosis, including medications to prevent further bone loss. 

Candidates for kyphoplasty

Kyphoplasty cannot correct an established deformity of the spine, and certain patients with osteoporosis are not candidates for this treatment. Patients experiencing painful symptoms or spinal deformities from recent osteoporotic compression fractures are likely candidates for kyphoplasty. The procedure should be completed within 8 weeks of when the fracture occurs for the highest probability of restoring height.

Benefits of Kyphoplasty

Limitations in the traditional treatments of vertebral compression fractures have led to the refinement of such procedures as kyphoplasty. This procedure provide new options for compression fractures and are designed to relieve pain, reduce and stabilize fractures, reduce spinal deformity, and stop the "downward spiral" of untreated osteoporosis.

Additional benefits of kyphoplasty include:

•         Short surgical time
•          Only general or local anesthesia required
•          Average hospital stay is one day (or less)
•          Patients can quickly return to the normal activities of daily living
•          No bracing required

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