Spine Surgery – Microdiscectomy
patients in this suffer from severe leg pain or lower back pain due to impingement of the root nerve in the lower spine near the tail bone. Lumbar spine bone is removed to release the pressure on the nerve root.
Patients complaining of severe leg pain for more than past 6 weeks and are not relieved of pain through physiotherapy and conventional treatments are recommended for microdiscectomy surgery.
It is a procedure performed through an incision of 1 to 2 inches in the lower back midline. The patient is given general anesthesia. Then the erector spinea (back muscles) is elevated from the lamina (bone arch) of the spine. The back muscles run vertically so it easy to make way through them. Doing this the surgeon is able to enter the spine by moving the ligamentum flavum (membrane over the nerve root). Now the nerve root is in view using the microscopic glasses and the surgeon removes the herniated disc. The complete procedure may last upto an hour.
Complications and risks are inevitable with spine surgery. Though it is a smooth operation however complications may arise such as: bleeding; contamination; root nerve may get damaged; possibility of leakage of cerebrospinal fluid (dural tear) and maybe bowel incontinence.
These are very rare but probable and possible risks of microdiscectomy.
Spine Surgery – Laminectomy
Laminectomy surgeries are recommended for patients experiencing agonizing lower back pain. They are mainly older patients complaining of intense and multilevel stenosis and some cases may have tumors, then surgery is required.
According to Dr. L Tomar, our Senior Orthopedic Surgeon recommends surgery when conventional medical care fails for a patient. He believes that surgery provides rewarding results in pain relief. Also patients having an issue of sciatica that obstructs them to do their daily chores may too be recommended for surgery.
Laminectomy surgery is also known as open decompression process. An incision of 2 to 5 inches is made on the lower back midline. Then the back muscles on multiple levels both left and right of the lamina are dissected. Now the surgeon advances the spine and removal of lamina gives view to the nerve root. The bones are then trimmed or removed depending upon the decompression required allowing more space for the nerve root.
After the surgery, patients are recommended to remain in the hospital for observation for atleast minimum 1 to 3 days. On satisfaction of the doctor, patients are discharged and advised not to lift, bend or twist excessively for minimum 6 weeks from the date of operation.
Spine Surgery – Lumbar Spine Fusion
Spine fusion instrumentation focuses on giving extra strength to the spine enabling the fusion to take place properly. Various forms of instrumentation are developed with the advent of technology enhancing the spinal fusion success rate. It is observed that fusion best takes place in a confined movement and opting for instrumentation restricts movements to the part that is fusioned.
A vertebral segment that emits pain with unusual and extreme movements accompanied with degenerative disc disease, isthmic, or post laminectomy spondylolisthesis then a fusion option is considered. We also treat conditions like weak/unstable spine, fractures in spine, scoliosis as well as deformities using spinal fusion surgery.
We use 3 major kinds of spine fusion instrumentation namely:
(i) Pedicle screws – it is a way to provide grip to the vertebral part and restricting its movement.
(ii) Anterior interbody cages – it is a device designed to insert into the lumbar disc from the front (anterior approach).
(iii) Posterior lumbar cages – it is a device designed to insert into the lumbar disc from the back (posterior approach).
In the spinal cord at each level there is an anterior disc space and a posterior facet joint. All these segments work together in rhythm while in motion. When a defect or ailment is analyzed between any segment that emits pain say example L3 and L4, then these individual vertebrae are fusioned together so that their movement is limited and they work as one level rather then 2 separate levels.
It is a procedure of bone grafting used from the patient’s body itself so that the two vertebras attach to grow as one. I f incase this is not possible then a substitute like synthetic bone graft or allograft can be used.
Unlike the conventional ways, today technology has advanced so much that there are various spinal fusion options available such as:
(a) Posterolateral gutter fusion – it’s a practice done through the posterior.
(b) Posterior Lumbar Interbody Fusion [PLIF/TLIF] – in this the bone is inserted from the back into the space created when a disc is removed from between two vertebras.
(c) Anterior Lumbar Interbody Fusion [ALIF] – in this the bone is inserted from the front into the space created when a disc is removed from between two vertebras.
(d) Anterior/Posterior Spinal Fusion – in this both front and back sides can be used.
Patients have the advantage of being in the hands of Dr. L Tomar who has both national and international experience in spinal surgeries assuring them of the best, most optimum and advanced treatment like lumbar spine fusion
Spine Surgery – Vertebroplasty and Kyphoplasty
We implement Vertebroplasty and Kyphoplasty to treat excruciating painful vertebral compression fractures in spine caused due to osteoporosis. Patients that require hospitalization or are bed ridden due to pain and strong medications are considered for vertebroplasty. We also consider patients who are elderly and whose bones structure is too weak to endure the open spinal surgery or out surgical repairs. There maybe young patients with osteosporosis condition caused due to elongated usage of steroids and metabolic disorders too. All these kinds of patients we consider for these procedures.
Vertebroplasty and kyphoplasty process has to be completed within 8 weeks of the condition/fracture to attain maximum optimum successful treatment rate.
There are detailed preparations done before commencing the treatment. Complete clinical examination like blood tests, MR (magnetic resonance) or radioisotope bone scan, spine X-rays and diagnostic imaging needs to be done. Imaging helps the doctors to decide whether the patient requires vertebroplasty or kyphoplasty and also confirms the presence of compression fracture. The treating doctor must be informed of all the medications the patient has been taking and any allergies whatever it may be if the patient is prone to. In case of a woman, the x-ray technicians and physicians must be informed if she is pregnant. Blood tests must indicate any abnormalities like clotting in the blood. And lastly patients past operative history also must be disclosed to the treating doctor. These are essential pointers one must note.
Vertebroplasty is a procedure where in cement mixture is injected into the empty spaces between the weak vertebral segments in the vertebral column. This strengthens the weak segments and relieves the patient from the pain. A trocar (hollow needle) is passed through the skin reaching the vertebral segment that needs to be injected with the mixture via image guidance technique.
Kyphoplasty is a process in which the fractured vertebrae is inserted with a balloon and then inflated to create a cavity or space. Once the space is created then the balloon is removed and then the cement mixture is injected into the cavity.
Patients post operation should be able to walk within an hour. Doctor may set follow-up visits post operation for blood tests, physical check-up and imaging procedure.
Both these treatments are quick in nature bear a lot of benefits.. Patients find improved working capacity and are able to return to their normal chores without going through the hassle of physiotherapy and have a strengthened vertebral column. Vertebroplasty and Kyphoplasty are both proven very safe and successful methods in eliminating pain caused due to compression fractures. Patients tend to recover their mobility lost due to osteoporosis and become active. Risk of pneumonia is eliminated by bed ridden patients who are now mobile and improves muscle strength. And lastly the incisions are blocked with single suture.
Spine Surgery – Nucleoplasty
Our Senior Orthopedic Surgeon, Dr. L Tomar suggests that the best candidates for Nucleoplasty are patients suffering from disc herniation and conventional methods of treatment are not working on them. Typical disc herniation symptom is back pain extending to the legs downwards.
Nucleoplasty requires very less anesthesia and is done on the basis of outpatients. In this the cannula is percutaneously inserted and placed in the disc space at the side where the patient feels the pain. Then a catheter is inserted into the disc space using a needle and is placed where the disc needs to be ablated. This insertion is done using guidance of a fluoroscope.
Nucleoplasty follows certain characteristic procedure such as:
• Experts from various fields of physiatrist, pain management, interventional radiology and surgeons must be present during Nucleoplasty.
• The needle is inserted, guided and placed at annulus junction using fluoroscope.
• Disc nucleus receives spinewand through passage way.
• The patients are relieved of the symptoms when the disc pressure reduces when tissue from the centre of the disc is removed.
• After this the patient is bandaged and discharged.
• The patients are then enrolled for regular rehab program.
We recommend our patients to rehab protocol on the basis of other interventional guidelines. We stress on stretching and strengthening exercises and gradual return to normal chores.
Nucleoplasty is beneficial in many ways. Fisrtly, it is a very successful decrompressive method of the spinal disc. It is less insidious and reduces VAS pain. There is no need for general anesthesia. Does not require overnight stay in the hospital and patients are discharged the same day. No risk of complications and a quick recovery.