Spine Surgery – Microdiscectomy
What are the indications for Microdiscectomy Surgery?
The microdiscectomy process does not change mechanical structure of patient's lumbar spine. The surgery is an option for relieving pressure on nerve root as well as speed-up up the healing process.
For whom Microdiscectomy Surgery is recommended?
Microdiscectomy is recommended for patients who:
· Experience leg pain for at least six weeks
· Have not got sufficient pain relief with conservative treatment including physical therapy
How is the Surgery performed?
Normally after microdiscectomy patient stays overnight in hospital and returns to normal level of daily activities quickly. Some of the body restrictions surgeons put post surgery for first six weeks includes:
· Bending
· Lifting
· Twisting
However, as patient's back is mechanically same, patients can return to reasonable body movements (as advised by the surgeon) immediately following spine surgery.
What are the risks and complications in Microdiscectomy Surgery?
As with any other form of spine surgery, there are risks and complications associated with microdiscectomy procedure. These include:
· Nerve root damage
· Dural tear (cerebrospinal fluid leak)
· Bowel/bladder incontinence
· Bleeding
· Infection
However, the above listed complications are very rare in microdiscectomy spine surgery.
Spine Surgery – Laminectomy
What are the causes that lead to Laminectomy Surgery?
With most common site of back pain being lower back, some of these that may require Laminectomy Surgery include:
· Older patient with severe and multilevel stenosis.
· Tumors
What are the considerations for Laminectomy Surgery?
Senior Orthopaedic Surgeon Dr. Tomar believes that surgery often produces gratifying relief when conservative medical treatment has failed. Further, the surgery option may also be considered for patients with frequent recurring sciatica that interferes with their ability to work/do daily activities.
What is the process of Laminectomy surgery?
Lumbar laminectomy (open decompression) operation begins with an incision (two-inch to five -inch) made on the midline of back depending upon the levels of decompression required. This follows dissecting the left and right back muscles off the lamina on both sides as well as at multiple levels. After spine is approached, lamina is removed allowing visualization of nerve roots where facet joints directly over nerve roots are undercut (trimmed) so as to give nerve roots more room.
What is the Post Surgery process for Laminectomy?
Post laminectomy, patients remain in hospital for one to three days with individual patient's mobilization largely dependent on their pre-operative condition and their age. However, doctors do recommend patients to avoid excessive bending, lifting or twisting for six weeks post surgery.
Spine Surgery – Lumbar Spine Fusion
What is the Aim of this Surgery?
The basic aim of spine fusion instrumentation is providing additional spinal stability while at the same time also helping fusion to set up. With the advancement in technology, different forms of instrumentation have been developed that have greatly assisted in improving rates of successful spinal fusion.
Further, as bone tends to fuse better in environment where there is little motion, instrumentation option assists in the fusion process by limiting motion at fused segment.
What is Fusion Option?
A fusion option is considered for patients if abnormal and excessive motion at vertebral segment results in severe pain with the following conditions:
· Degenerative disc disease
· Isthmic, degenerative/postlaminectomy spondylolisthesis
Apart from these, some of the other conditions that can be treated by us involving spinal fusion surgery include:
· Weak/unstable spine
· Fractures
· Scoliosis
· Deformity
What are the different instrumentation types for Spine Fusion?
Three primary types of spine surgery instrumentation are used. These include:
Pedicle screws - Providing means of gripping onto vertebral segment as well as limiting its motion.
Anterior interbody cages - Devices made for insertion into lumbar disc space through anterior (from the front) approach.
Posterior lumbar cages - Devices made for insertion into lumbar disc space through a posterior (from the back) approach.
How Spinal Fusion Surgery Works?
There is disc space in front and paired facet joints in back at each level in the spine. These structures while working together define motion segment help in achieving multiple degrees of motion. Under this surgery, two vertebral segments are required to be fused together for stopping motion at one segment, so that L4-L5 spinal fusion is actually becomes one-level spinal fusion.
What does the surgery involves?
The surgery involves making use of bone graft from patient's own body that helps two vertebral bodies to grow together into one long bone. If it is not possible to take bone graft from the patient's own body, then it is harvested from allograft bone or a synthetic bone graft substitute is used.
What are the available options for Spinal Fusion Surgery?
With the advent in modern day science, there are different types of spinal fusion surgery options present today. These include:
Posterolateral gutter fusion-- Procedure done through the back.
Posterior lumbar interbody fusion (PLIF/TLIF)-- Procedure done from back that includes removing disc between two vertebrae and insertion of bone into space created between two vertebral bodies.
Anterior lumbar interbody fusion (ALIF)-- Procedure done from front that includes removal of disc between two vertebrae and inserting bone into space created between two vertebral bodies.
Anterior/posterior spinal fusion-- Procedure done from both front and the back.
What are the advantages of Spinal Fusion Surgery?
Dr L.Tomar has vast national and international experience in spinal surgeries which helps in giving pt the optimum and most advanced treatment for spinal surgeries like lumbar spine fusion.
Spine Surgery – Vertebroplasty and Kyphoplasty
WhyVertebroplasty and kyphoplasty procedure is used?
Vertebroplasty and kyphoplasty are used by us for treating:
· Painful vertebral compression fractures in spine (mostly due to result of osteoporosis)
· Vertebroplasty is performed in patients with problematic pain that require hospitalization or for conditions limiting pt to bed rest and pain medications
· Patients who are too elderly/frail to tolerate open spinal surgery
· Patients whose bones are too weak for carrying out surgical repairs
· Patients having vertebral compression due to malignant tumor
· Younger patients with osteoporosis because of long-term steroid treatment/metabolic disorder
For achieving highest probability successful treatment, Vertebroplasty and kyphoplasty process need to be completed within eight weeks of acute fracture.
What is the preparation required for Vertebroplasty and kyphoplasty?
The preparation process for the surgery includes:
· Clinical evaluation including blood tests, diagnostic imaging, physical exam, radioisotope bone scan/magnetic resonance (MR) and spine x-rays
· Imaging done to confirm presence of compression fracture as well as to evaluate which treatment among vertebroplasty or kyphoplasty will benefit
more
· Doctors should be introduced with all medications that are being taken
· Doctors should be introduced with information on allergies, especially to local anaesthetic medication/general anaesthesia/materials containing
iodine
· Women should inform physicians and x-ray technologists if there is possibility of their pregnancy
· Blood drawn for tests prior to procedure for determining blood clots normally
· Other surgery procedures to be followed
What is the procedure for Vertebroplasty?
This process involves injecting cement mixture into empty spaces within weakened vertebrae. This helps in giving them desired strength as well as providing relief from pain. The process is done using image-guidance technique where hollow needle called trocar is passed through skin into vertebral body for injecting cement mixture into vertebra.
What is the procedure for kyphoplasty?
In this process a balloon is first inserted through trocar into fractured vertebra where it is inflated for creating cavity for cement injection. The balloon is removed prior to injecting of cement into cavity created by balloon.
What is the Post Operation process for Vertebroplasty and kyphoplasty?
Approximately an hour after the procedure, patients should be able to walk. The interventional radiologist may also recommend follow-up visit after the procedure is complete that may include processes like:
· Physical check-up
· Imaging procedure
· Blood or other lab tests
What are the derived benefits for Vertebroplasty and kyphoplasty?
Vertebroplasty and kyphoplasty treatment helps in increasing patient's functional abilities as well as allow them to return to previous level of activities without use of any form of physical therapy/rehabilitation and help in stabilizing the vertebra. Some of the other benefits include:
· Vertebroplasty and kyphoplasty are both safe and effective procedures
· For alleviating pain caused by vertebral compression fracture
· Vertebroplasty helps patients to regain lost mobility and become active, thus helping in combating osteoporosis
· The procedure helps bed ridden patients to be mobile, thus reducing risk of pneumonia
· Increased activity also helps in building more muscle strength
· Incision sites closed with single stitches
Spine Surgery – Nucleoplasty
Who are Candidates for Nucleoplasty?
As per Senior Orthapeadic Surgeon Dr. L. Tomar the patients who should undertake this surgical process are ones who suffer from contained disc herniation and are not responding to conservative care. Some of the typical signs of contained disc herniation are:
· Primary pain radiating down leg accompanied by back pain
What is the treatment technique for Nucleoplasty?
Nucleoplasty procedure is performed on outpatient basis, with very little anaesthesia requirement. The process involves percutaneous insertion of cannula positioned in disc space on same side as patient's pain. This is followed by insertion of a catheter under fluoroscopic guidance via needle into disc space and it’s positioning at place where surgeon requires to ablate disc material.
What are key procedure elements for Nucleoplasty surgery?
Some of the key procedure elements followed in the surgery includes:
· Procedure performed under guidance of specialists in the field of physiatrist, pain management, interventional radiology and surgeons
· Fluoroscopic guidance employed as introducer needle and placed at nucleus/annulus junction
· SpineWand introduced through passage way into disc nucleus
· Tissue removal by creating channels (lumbar spine) or by spheres (cervical spine)
· Removal of some tissue from center of disc causes reduction in disc pressure, thus easing the symptoms
· After sufficient tissue removal a bandage is placed on skin and patient is discharged home
· Patients usually placed on routine rehabilitation program
What is the recommended rehabilitation protocol for Nucleoplasty surgery?
A rehabilitation protocol is recommended by us that is based on same guidelines as followed in other interventional spine procedures. The rehabilitation procedure incorporates:
· Progressive use of stretching and strengthening exercises
· Staged return to normal daily activities
What are the derived benefits of Nucleoplasty surgery?
Some of the derived benefits of Nucleoplasty include:
· Successful decompression of Spinal Disc
· Reducing VAS pain
· Minimally invasive
· Elimination of general anaesthesia requirement
· Elimination of complications resulting from open surgery
· No overnight hospitalization required
· Rapid recovery time
· Patients can go home on the day of treatment
· Quick symptom relief within two weeks for most of the patients
What are the indications for Microdiscectomy Surgery?
The microdiscectomy process does not change mechanical structure of patient's lumbar spine. The surgery is an option for relieving pressure on nerve root as well as speed-up up the healing process.
For whom Microdiscectomy Surgery is recommended?
Microdiscectomy is recommended for patients who:
· Experience leg pain for at least six weeks
· Have not got sufficient pain relief with conservative treatment including physical therapy
How is the Surgery performed?
Normally after microdiscectomy patient stays overnight in hospital and returns to normal level of daily activities quickly. Some of the body restrictions surgeons put post surgery for first six weeks includes:
· Bending
· Lifting
· Twisting
However, as patient's back is mechanically same, patients can return to reasonable body movements (as advised by the surgeon) immediately following spine surgery.
What are the risks and complications in Microdiscectomy Surgery?
As with any other form of spine surgery, there are risks and complications associated with microdiscectomy procedure. These include:
· Nerve root damage
· Dural tear (cerebrospinal fluid leak)
· Bowel/bladder incontinence
· Bleeding
· Infection
However, the above listed complications are very rare in microdiscectomy spine surgery.
Spine Surgery – Laminectomy
What are the causes that lead to Laminectomy Surgery?
With most common site of back pain being lower back, some of these that may require Laminectomy Surgery include:
· Older patient with severe and multilevel stenosis.
· Tumors
What are the considerations for Laminectomy Surgery?
Senior Orthopaedic Surgeon Dr. Tomar believes that surgery often produces gratifying relief when conservative medical treatment has failed. Further, the surgery option may also be considered for patients with frequent recurring sciatica that interferes with their ability to work/do daily activities.
What is the process of Laminectomy surgery?
Lumbar laminectomy (open decompression) operation begins with an incision (two-inch to five -inch) made on the midline of back depending upon the levels of decompression required. This follows dissecting the left and right back muscles off the lamina on both sides as well as at multiple levels. After spine is approached, lamina is removed allowing visualization of nerve roots where facet joints directly over nerve roots are undercut (trimmed) so as to give nerve roots more room.
What is the Post Surgery process for Laminectomy?
Post laminectomy, patients remain in hospital for one to three days with individual patient's mobilization largely dependent on their pre-operative condition and their age. However, doctors do recommend patients to avoid excessive bending, lifting or twisting for six weeks post surgery.
Spine Surgery – Lumbar Spine Fusion
What is the Aim of this Surgery?
The basic aim of spine fusion instrumentation is providing additional spinal stability while at the same time also helping fusion to set up. With the advancement in technology, different forms of instrumentation have been developed that have greatly assisted in improving rates of successful spinal fusion.
Further, as bone tends to fuse better in environment where there is little motion, instrumentation option assists in the fusion process by limiting motion at fused segment.
What is Fusion Option?
A fusion option is considered for patients if abnormal and excessive motion at vertebral segment results in severe pain with the following conditions:
· Degenerative disc disease
· Isthmic, degenerative/postlaminectomy spondylolisthesis
Apart from these, some of the other conditions that can be treated by us involving spinal fusion surgery include:
· Weak/unstable spine
· Fractures
· Scoliosis
· Deformity
What are the different instrumentation types for Spine Fusion?
Three primary types of spine surgery instrumentation are used. These include:
Pedicle screws - Providing means of gripping onto vertebral segment as well as limiting its motion.
Anterior interbody cages - Devices made for insertion into lumbar disc space through anterior (from the front) approach.
Posterior lumbar cages - Devices made for insertion into lumbar disc space through a posterior (from the back) approach.
How Spinal Fusion Surgery Works?
There is disc space in front and paired facet joints in back at each level in the spine. These structures while working together define motion segment help in achieving multiple degrees of motion. Under this surgery, two vertebral segments are required to be fused together for stopping motion at one segment, so that L4-L5 spinal fusion is actually becomes one-level spinal fusion.
What does the surgery involves?
The surgery involves making use of bone graft from patient's own body that helps two vertebral bodies to grow together into one long bone. If it is not possible to take bone graft from the patient's own body, then it is harvested from allograft bone or a synthetic bone graft substitute is used.
What are the available options for Spinal Fusion Surgery?
With the advent in modern day science, there are different types of spinal fusion surgery options present today. These include:
Posterolateral gutter fusion-- Procedure done through the back.
Posterior lumbar interbody fusion (PLIF/TLIF)-- Procedure done from back that includes removing disc between two vertebrae and insertion of bone into space created between two vertebral bodies.
Anterior lumbar interbody fusion (ALIF)-- Procedure done from front that includes removal of disc between two vertebrae and inserting bone into space created between two vertebral bodies.
Anterior/posterior spinal fusion-- Procedure done from both front and the back.
What are the advantages of Spinal Fusion Surgery?
Dr L.Tomar has vast national and international experience in spinal surgeries which helps in giving pt the optimum and most advanced treatment for spinal surgeries like lumbar spine fusion.
Spine Surgery – Vertebroplasty and Kyphoplasty
WhyVertebroplasty and kyphoplasty procedure is used?
Vertebroplasty and kyphoplasty are used by us for treating:
· Painful vertebral compression fractures in spine (mostly due to result of osteoporosis)
· Vertebroplasty is performed in patients with problematic pain that require hospitalization or for conditions limiting pt to bed rest and pain medications
· Patients who are too elderly/frail to tolerate open spinal surgery
· Patients whose bones are too weak for carrying out surgical repairs
· Patients having vertebral compression due to malignant tumor
· Younger patients with osteoporosis because of long-term steroid treatment/metabolic disorder
For achieving highest probability successful treatment, Vertebroplasty and kyphoplasty process need to be completed within eight weeks of acute fracture.
What is the preparation required for Vertebroplasty and kyphoplasty?
The preparation process for the surgery includes:
· Clinical evaluation including blood tests, diagnostic imaging, physical exam, radioisotope bone scan/magnetic resonance (MR) and spine x-rays
· Imaging done to confirm presence of compression fracture as well as to evaluate which treatment among vertebroplasty or kyphoplasty will benefit
more
· Doctors should be introduced with all medications that are being taken
· Doctors should be introduced with information on allergies, especially to local anaesthetic medication/general anaesthesia/materials containing
iodine
· Women should inform physicians and x-ray technologists if there is possibility of their pregnancy
· Blood drawn for tests prior to procedure for determining blood clots normally
· Other surgery procedures to be followed
What is the procedure for Vertebroplasty?
This process involves injecting cement mixture into empty spaces within weakened vertebrae. This helps in giving them desired strength as well as providing relief from pain. The process is done using image-guidance technique where hollow needle called trocar is passed through skin into vertebral body for injecting cement mixture into vertebra.
What is the procedure for kyphoplasty?
In this process a balloon is first inserted through trocar into fractured vertebra where it is inflated for creating cavity for cement injection. The balloon is removed prior to injecting of cement into cavity created by balloon.
What is the Post Operation process for Vertebroplasty and kyphoplasty?
Approximately an hour after the procedure, patients should be able to walk. The interventional radiologist may also recommend follow-up visit after the procedure is complete that may include processes like:
· Physical check-up
· Imaging procedure
· Blood or other lab tests
What are the derived benefits for Vertebroplasty and kyphoplasty?
Vertebroplasty and kyphoplasty treatment helps in increasing patient's functional abilities as well as allow them to return to previous level of activities without use of any form of physical therapy/rehabilitation and help in stabilizing the vertebra. Some of the other benefits include:
· Vertebroplasty and kyphoplasty are both safe and effective procedures
· For alleviating pain caused by vertebral compression fracture
· Vertebroplasty helps patients to regain lost mobility and become active, thus helping in combating osteoporosis
· The procedure helps bed ridden patients to be mobile, thus reducing risk of pneumonia
· Increased activity also helps in building more muscle strength
· Incision sites closed with single stitches
Spine Surgery – Nucleoplasty
Who are Candidates for Nucleoplasty?
As per Senior Orthapeadic Surgeon Dr. L. Tomar the patients who should undertake this surgical process are ones who suffer from contained disc herniation and are not responding to conservative care. Some of the typical signs of contained disc herniation are:
· Primary pain radiating down leg accompanied by back pain
What is the treatment technique for Nucleoplasty?
Nucleoplasty procedure is performed on outpatient basis, with very little anaesthesia requirement. The process involves percutaneous insertion of cannula positioned in disc space on same side as patient's pain. This is followed by insertion of a catheter under fluoroscopic guidance via needle into disc space and it’s positioning at place where surgeon requires to ablate disc material.
What are key procedure elements for Nucleoplasty surgery?
Some of the key procedure elements followed in the surgery includes:
· Procedure performed under guidance of specialists in the field of physiatrist, pain management, interventional radiology and surgeons
· Fluoroscopic guidance employed as introducer needle and placed at nucleus/annulus junction
· SpineWand introduced through passage way into disc nucleus
· Tissue removal by creating channels (lumbar spine) or by spheres (cervical spine)
· Removal of some tissue from center of disc causes reduction in disc pressure, thus easing the symptoms
· After sufficient tissue removal a bandage is placed on skin and patient is discharged home
· Patients usually placed on routine rehabilitation program
What is the recommended rehabilitation protocol for Nucleoplasty surgery?
A rehabilitation protocol is recommended by us that is based on same guidelines as followed in other interventional spine procedures. The rehabilitation procedure incorporates:
· Progressive use of stretching and strengthening exercises
· Staged return to normal daily activities
What are the derived benefits of Nucleoplasty surgery?
Some of the derived benefits of Nucleoplasty include:
· Successful decompression of Spinal Disc
· Reducing VAS pain
· Minimally invasive
· Elimination of general anaesthesia requirement
· Elimination of complications resulting from open surgery
· No overnight hospitalization required
· Rapid recovery time
· Patients can go home on the day of treatment
· Quick symptom relief within two weeks for most of the patients