Advanced Minimally Invasive Techniques for Brain Tumor Treatment in India

What is Brain Tumour?

The human brain is the hub of the nervous system. The function of the brain is to supervise and control the actions and reactions of the body. It controls the bodily functions as it obtains sensory information rapidly analyzes such data

Abnormal growth of cells within the brain or the central spinal canal is called brain tumor. Brain tumors can initiate anywhere from the brain cells, the membranes around the brain (known as meninges), nerves, or glands. Tumor causes inflammation, consequently placing pressure within the skull and compressing the brain tissues. Because of its insidious and infiltrative character in the intracranial cavity all such tumours are intrinsically serious and life-threatening.

Factors used to classify Brain tumors include the sites of the tumour, the type of tissues involved. They can either be cancerous or non-cancerous. Different types of brain tumors include:

• Acoustic neurinoma : Benign tumor occurring in the 8th cranial nerve (the acoustic nerve) between the pons and the cerebellum. Possibly associated with neurofibromatosis. The term "acoustic neuroma" is actually a misnomer since it this a primary intracranial tumor of the myelin forming cells called "Schwann cells" (schwannoma).
• Astrocytomas : represent the most common type of glioma. They develop from the supporting cells of the brain, which are star-shaped glial cells called astrocytes.
• Oligodendroglioma : These are tumours that are made up of cells known as oligodendrocytes, which produce the fatty covering of nerve cells: the myelin sheath. They are usually slower-growing than astrocytic tumours.
• Ependymoma : Tumor arising from the ependymal cells found along the ventricles and central canal of the spinal cord.
• Brain stem glioma : The tumor occurs in the lowest part of the brain. Brain stem gliomas most often are diagnosed in young children and middle-aged adults
• Craniopharyngioma :This is a benign, congenital tumor. It is cystic and occurs primarily in children and adolescents. Craniopharyngiomas occur in the sellar region. They often involve the third ventricle, optic nerve, and pituitary gland. These are localized tumors that grow by expansion. Malignancy and metastasis are unknown.
• Medulloblastoma : This tumor usually arises in the cerebellum. It is the most common brain tumor in children. It is sometimes called a primitive neuroectodermal tumor
• Meningioma : Benign tumor arising from the meninges, the membranes covering the brain and spinal cord. Meningiomas represent approximately 20% of all primary brain tumors and occur most commonly in middle-aged women.
• Germ cell tumor of the brain : The tumor arises from a germ cell. Most germ cell tumors that arise in the brain occur in people younger than 30. The most common type of germ cell tumor of the brain is a germinoma.
• The pineal gland is just below the area where the two cerebral hemispheres join. Tumours in this part of the brain are extremely rare. They can be made up of different types of cells. The most common tumors are germinomas; others include teratomas, pineocytomas and pineoblastomas.

Primary Malignant Tumor

Tumors that begin in brain tissue are known as primary brain tumors. Although primary brain tumors often shed cancerous cells to other sites in the central nervous system (the brain or spine), they rarely spread to other parts of the body.

Secondary Malignant Tumor

When cancer cells spread to the brain from another organ (such as the lung or breast), is called as a secondary tumor or metastatic tumor. Secondary tumors in the brain are far more common than primary brain tumors.

Causes of Brain Tumour

Brain tumours develop due to many possible risk factors like:

• Radiation Exposure.
• The risk of brain tumors is augmented by hereditary conditions, including neurofibromatosis, Von Hippel-Lindau syndrome, Li-Fraumeni syndrome, and Turcot syndrome.

Brain Tumour Symptoms

The most universal symptoms are:

• Plain Headaches or headaches accompanied by nausea, perplexity, double vision, weakness or lack of sensation.
• Convulsions in older adults
• Difficulty in ADLs like walking, swallowing, smelling, speaking, reading or writing.
• Dizziness or Vertigo
• Eye abnormalities like drooling of eyes, Contraction or relaxation of Pupils, uncontrollable movements.
• Shivering of hands
• Failure to control the bladder or bowels
• No sense of balance and coordination.
• Weakness in muscles of face, arm, or leg (usually on just one side)
• Personality, mood, behavioral, or emotional changes

Diagnosis of Brain Tumors

A brain tumor diagnosis usually involves several steps, which can include a neurological examination, brain scan(s) and/or a biopsy. A neurological examination is a series of tests to measure the function of the patient's nervous system and physical and mental alertness. The doctor also examines the eyes to look for swelling caused by a tumor pressing on the nerve that connects the eye and brain.

• MRI (Magnetic Resonance Imaging): is a scanning device that uses magnetic fields and computers to capture images of the brain on film. The MRI detects signals emitted from normal and abnormal tissue, providing clear images of most tumors.
• CT Scan (Computed Tomography): combines sophisticated x-ray and computer technology. CT can show a combination of soft tissue, bone, and blood vessels. CT images can determine some types of tumors, as well as help detect swelling, bleeding, and bone and tissue calcification.
• PET Scan: The PET scan measures the brains activity and sends this information to a computer, which creates a live image. Doctors use PET scans to see the difference between scar tissue, recurring tumor cells, and necrosis (cells destroyed by radiation treatment).
• Biopsy: The removal of tissue to look for tumor cells is called a biopsy. A pathologist looks at the cells under a microscope to check for abnormal cells. A biopsy can show cancer, tissue changes that may lead to cancer, and other conditions. A biopsy is the only sure way to diagnose a brain tumor.

Advanced Minimally Invasive Techniques for Brain Tumor Treatment in India

• Brain Suite - Intra-operative MR Navigation Microsurgery
• Trans-Nasal Endoscopic Removal of brain Tumor through the nose
• Stereotactic Radiosurgery - Gamma Knife & Novalis TX
• Tumor Embolization using Neuro Interventional Radiology

1. Brain Suite - Intra-operative MR Navigation Microsurgery - Amongst very few such facilities worldwide

It is the most advanced Neuro-Surgical Operating Room with high field MR. This system permits the neurosurgeon to have an MRI study on the patient during surgery, and if tumour has remained which was hidden to the human eye, can be detected by special MRI sequences, and can be targeted using neuro navigation (which works on the same principle as the GPS system).

The Brain Suite has two main parts. There is a high-intensity MRI scanner integrated with an image-guided surgical system. The MRI scanner has a wide-bore opening allowing a patient to lie on his or her side. Previously, tumours that could only be accessed from the side of the skull were not easy to scan. This special MRI system lets doctors repeat scans during the operation to get more accurate information on the location, shape and size of the tumour. This minimizes problems associated with brain tumors shifting during excision.

2. Trans-Nasal Endoscopic Removal of Brain Tumor through the nose

The endoscopic trans-nasal approach is performed through the nostrils. A natural passage way exists at the backend of the nose leading into the sphenoid sinus( an air filled cavity in the depths of the skull) , which can be enlarged so that the endoscope so that the endoscope and instruments can pass into this air filled cavity.

From this region the sella turcica is easily accessed, which is the location of pituitary gland. Neurosurgeons use this route normally to remove the tumor from pituitray ( the master gland).

3. Stereotactic Radiosurgery - Gamma Knife & Novalis TX

Gamma Knife RadioSurgery : Advanced Non Surgical Treatment for Brain Tumors

There is a new ray of hope for patients diagnosed with brain tumor disorders for treatment by Gamma Knife radiosurgery. Although it's called Gamma Knife, there is no blade or blood. Instead, it's a stereotactic radiosurgical treatment that delivers a dose of gamma radiation to the target with surgical precision and is the most accepted and widely used radiosurgery treatment in the world.

Novalis Tx Radiosurgery : Advanced Non Surgical Treatment for Brain Tumors

Novalis Tx Radiosurgery is one of the most precise, non-invasive radiosurgery treatments available for cancerous and non-cancerous conditions of the entire body. It represents a new standard in radiosurgery treatment, featuring advanced technologies that deliver highly precise treatment while protecting surrounding healthy tissue and offers one of the fastest treatment times available-minutes, not hours-giving new hope to patients with tumors once considered untreatable

4. Tumor Embolization using Neuro Interventional Radiology

Neurointerventional radiology focuses on diagnosis and treatment of abnormalities of the nervous system, spine, head and neck. This rapidly advancing specialty provides imaging of and minimally invasive treatment for conditions, such as aneurysm or stroke, which previously may have required major surgery. Tumor embolization is used to close off the vessels supplying blood to a tumor, especially when the tumor is difficult or impossible to remove.

Minimally Invasive Spine Surgery for Herniated Disc

Cervical Disc Herniation

The vertebrae that form the spine are cushioned by round, flat intervertebral discs. Each disc contains a tire-like outer band (called the annulus fibrosus) that encases a gel-like substance (called the nucleus pulposus).When these discs are healthy, they act as shock absorbers for the spine and keep the spine flexible. If they become damaged, they may bulge abnormally or break open (rupture), in what is called a herniated or slipped disc. Herniated discs can occur in any part of the spine, but they are most common in the neck (cervical) and lower back (lumbar) spine. The seven vertebrae between the head and the chest make up the cervical spine. Pain develops when the damaged intervertebral disc pushes into the spinal canal or nerve roots. Terminology referred to are herniated disc, prolapsed disc, ruptured disc and slipped disc.

Causes of cervical disc herniation

A herniated disc usually is caused by wear and tear of the disc (also called disc degeneration). Due to age, the discs lose some of the fluid that helps them stay flexible.

Injuries to the spine might also cause a herniated disc, which may cause tiny tears or cracks in the outer layer (annulus or capsule) of the disc. The jellylike material (nucleus) inside the disc may be forced out through the tears or cracks in the capsule, which causes the disc to bulge, break open (rupture), or break into fragments.

Symptoms of Cervical Disc Herniation

Herniated discs in the neck or cervical spine can cause pain, numbness, or weakness in the neck, shoulders, chest, arms, and hands. In some cases a very large herniated disc in the neck may cause weakness or slight prickling which affects different body parts. The arm pain from a cervical herniated disc results because the herniated disc material presses on a cervical nerve, causing pain to radiate along the nerve pathway down the arm. Along with the arm pain, numbness can be present down the arm and fingertips.

A cervical herniated disc will typically cause pain patterns as follows:

• C4 - C5 (C5 nerve root) - Can cause weakness in the deltoid muscle in the upper arm. Can cause shoulder pain.
• C5 - C6 (C6 nerve root) - Can cause weakness in the biceps (front upper arms muscles) and wrist extensor muscles. Numbness and tingling along with pain can radiate to the thumb side of the hand. This is one of the most common levels for a cervical disc herniation to occur.
• C6 - C7 (C7 nerve root) - Can cause weakness in the triceps (back upper arm muscles and extending to the forearm) and the finger extensor muscles. Numbness and tingling along with pain can radiate down the triceps and into the middle finger. This is also one of the most common levels for a cervical disc herniation .
• C7 - T1 (C8 nerve root) - Can cause weakness with handgrip. Numbness and tingling and pain can radiate down the arm to the little finger side of hand.
  

Stages of a Cervical Herniated Disc

The 4 stages to a cervical herniated disc are:

1. Disc Degeneration: Due to chemical changes associated with aging, intervertebral discs weaken. As part of the aging process, it can cause the disc to dry out, making it less able to absorb the shock. Disc can also become thinner in this stage.
2. Prolapse: The position of the disc changes with some slight impingement into the spinal canal or spinal nerves. This stage is also called a bulging disc or protruding disc.
3. Extrusion: The gel-like nucleus pulposus (inner part of the intervertebral disc) breaks through the tire-like wall (annulus fibrosus) but remains within the disc.
4. Sequestration or Sequestered Disc: The nucleus pulposus breaks through the annulus fibrosus and can move outside the interverterbral disc and into the spinal canal.

Low Cost Kyphoplasty at Best Spine Surgery Hospitals in India

What is Kyphoplasty

Pain caused by vertebral compression fractures in the spine is treated by a procedure called Kyphoplasty. Each year thousands of people suffer from Vertebral fractures osteoporosis being the main cause of these fractures. Bone looses its strength and becomes more susceptible to fractures with Osteoporosis. For the maximum probability of restoring the spinal bone to its standard height Kyphoplasty should be completed within eight weeks of when the fracture occurs. 

Following tests needs to be done after a physical examination to confirm the presence of a compression fracture

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

When is Kyphoplasty recommended?

Patients who experience painful symptoms or spinal deformities due to vertebral compression fractures resulting from osteoporosis opt for this procedure. Kyphoplasty is also performed on patients who:

• Inability to tolerate open spinal surgery due to age or poor health.
• bones too frail for surgical spinal repair
• cancerous tumor leading to vertebral damage
• Are younger and have osteoporosis caused by a long-term steroid management or a metabolic disorder.

How does the procedure work?

In Kyphoplasty, procedures x-ray equipment, a hollow needle/tube called a trocar, orthopedic cement, barium powder and a solvent are used. balloon tamp is a special device used on these procedures. 

Firstly through the trocar into the fractured vertebra, a balloon is inserted. it is inflated to create a cavity once the balloon reaches there, and also helps in pushing the bone back to its standard height and shape. Thereafter the balloon is removed to insert cement into the cavity created by the balloon. The vertebra is stabilized by the hardenening of the cement. 

Cervical Disc Replacement Surgery Cost in India - Top Spine Hospital India

Cervical Disc Replacement Surgery

An artificial disc is a device that is implanted into the spine to replace a degenerative disc, whose regular function is to carry weight and allow motion. A disc is the soft cushioning structure between the individual bones of the spine, (called vertebra). Artificial discs are usually made of metal and plastic-like (biopolymer) materials, or a combination of the two. These materials have been used in the body for many years.

Why is Cervical Disc Replacement Surgery required?

A large number of people nowadays face neck, shoulder and/ or pain in the arms mainly because of the abnormalities in the neck. These complaints can be signs of disc herniations or disc degeneration, and/or arthritis of the neck.

The cervical spine is composed of vertebral bodies and intervertebral discs. These discs wear out with time causing pain and other symptoms and are referred to as degenerative disc disease, a subgroup of which includes cervical disc herniations. This means the disc becomes compressed, frayed, and/or herniates into the adjacent spinal canal where it can press on nerves or the spinal cord.

Most patients with these types of symptoms do not need surgery and improve with conservative like anti-inflammatory medications, physical therapy, or cold/heat therapy. However, if a person continues to have significant neck pain and/or radicular arm pain, he or she may be a candidate for cervical spine surgery. An anterior discectomy and fusion is the most common operation for treating patients with symptoms related to a degenerative or herniated disc in the neck.

Cervical Disc Replacement Surgery- The Procedure

Artificial disc replacement surgery takes place under a general anesthesia, which means the patient is put to sleep. The procedure takes between one and two hours, followed by a three to four-day hospital stay. The artificial disc is designed as two metal end plates, between which may be found medical grade polyethylene or plastic or gel-like substances, much like a sandwich. After a general anesthesia the first step, is to remove the diseased disc before installing the replacement. For a total disc replacement in the lower back, a type of disc prosthesis may be used which consists of two metal plates surrounding a mobile core made of plastic.

Spikes protruding from the metal pieces fix them into the bone, which eventually grows and fuses with the plates. The plastic core allows gliding movements to occur. A different type of spine arthroplasty device, where two metal pieces articulate by way of a ball and trough, is sometimes used to replace a cervical disc in the neck. An alternative to a total disc replacement is what is known as a disc nucleus replacement, which may be carried out if the outer part of the disc is still quite healthy. In this procedure, only the center, or nucleus, of the original disc is removed. It is replaced by a type of plastic which absorbs water and swells to fill the nucleus cavity.

As the material is soft and can be compressed, it allows the disc to continue to function in a relatively It may take up to eight weeks for people to return to normal everyday activities after an artificial disc replacement has been carried out, although it could be longer before more vigorous exercises, such as sports, can be pursued. Artificial disc prosthesis, usually made of a gelatinous or plastic substance, is inserted into the vertebral space to approximate the normal height of the original disc.

Benefits of Cervical Disc Replacement

• Artificial disc surgery has lesser chances of requiring a revision surgery, compared to spinal fusion surgery

• Normal neck motion can be maintained

• Unlike the spinal fusion surgery the adjacent spinal discs in case of cervical disc replacement don’t have to bear the extra stress .

• Eliminates the need for a painful bone graft

• Recovery time is quicker compared to the fusion surgery.

How long is the recovery after artificial disc replacement surgery?

Most people spend one or two nights in the hospital. You may require an extra day or two if for some reason you're having extra pain or unexpected difficulty. Patients generally recover quickly after an artificial disc replacement. You should be able to get out of bed and walk within a few days. Some people wear a corset or brace for support. As you recover in the hospital, a physical therapist may see you to start you on a few gentle exercises.

You'll also start a walking program that you are encouraged to continue when you get back home. When you leave the hospital, you should be safe to sit, and walk. Your surgeon will see you within a month to do an X-ray to make sure the disc is in place and holding steady. However, you should avoid lifting things for at least four weeks. You can often return to work after your surgeon has evaluated you, as long as your job does not include heavy lifting. It should be noted that a successful result of the disc replacement means that back symptoms are better but not necessarily perfect. Most studies show that 70 to 80 percent of patients have significantly less back pain and greatly improved function with the operation.

Balloon Kyphoplasty at Best Spine Surgery Hospitals in India

Minimally Invasive Spine Surgery in India- Balloon Kyphoplasty at Best Spine Surgery Hospitals in India

Kyphoplasty in India

Kyphoplasty spine surgery is a minimally invasive procedure which supports fractured or compressed vertebrae and also helps in reducing back pain and as well as helps in restoring the height and spinal alignment. During the fracture of vertebrae, the bone which is shaped rectangular gets compressed causing terrible pain. During such cases of compression fractures, there could be a high possibility of collapse of the vertebrae in the spine and becomes a common symptom resulting in osteoporosis. This is a disease that results in loss of bone density, mass and strength leading to weak bones having a lot of pores and which are vulnerable for breaking.

In this Kyphoplasty procedure, balloons are used to elevate the fractured vertebrae to bring it back to its original and correct position. This balloon creates a cavity that is filled with cement which protects from future damages.

When is Kyphoplasty recommended ?

Kyphoplasty is done on patients who experience painful symptoms or spinal deformities due to vertebral compression fractures resulting from osteoporosis. Kyphoplasty is also performed on patients who:

• Are aged or are in poor health to tolerate open spinal surgery.

• Have too frail bones for surgical spinal repair

• Have a vertebral damage due to a cancerous tumor

• Are younger and have osteoporosis caused by a long-term steroid management or a metabolic disorder

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 (to be seen using image guidance x-rays) 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.

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

How Does Kyphoplasty Compare to Non-surgical Treatment?

Kyphoplasty was shown to be more effective than non-surgical care for the treatment of acute vertebral compression fractures.

Patients treated with kyphoplasty had faster and greater improvement in back pain relief, back function and quality of life at one month after surgery. The benefits of kyphoplasty were sustained on average through 12 months. The overall frequency of patients with adverse events did not differ between the kyphoplasty and the non-surgical groups.1

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

• Minimally Invasive, Scarless , Minimal Pain & discomfort to the patient

• Quick recovery and return back to active work life

• Minimal Tissue trauma and no risk of complications that may result from open surgery

• Quick Symptom relief within two weeks of undergoing the Nucleoplasty Surgery.

Percutaneous Endoscopic Lumbar Discectomy (PELD) Surgery in India

Percutaneous Endoscopic Lumbar Discectomy (PELD) is quite a unique approach which is quickly getting popular amongst patients and surgeons in the treatment of nonsequestrated disc herniation (disc prolapse) as it reduces the post operative hospitalization and recovery time.

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.

Candidates for Percutaneous Endoscopic Lumbar Discectomy

Individuals suffering from chronic low back pain and disability may benefit from a PELD procedure. It is often used to treat patients suffering from degenerated discs, bulging discs or herniated discs that compress upon the surrounding structures within the spinal canal causing nerve compression, sciatica and low back pain. It can also be used if the patient fails to respond to conventional management therapies including direct injection therapies for three months or more. The surgery is also found to be successful in resection of spinal tumors, fusion and structural deformities of the spinal cord.

How is a PELD procedure performed?

Percutaneous Endoscopic Lumbar Discectomy is a minimally invasive day care procedure which is performed under local anaesthesia and mild sedation. The patient is made to lie on his front on the operation table and through an image intensifier X-ray system the entry point on patient’s body is mapped. There are two ways by which inter-vertebral disc is removed which could be manual or using laser.

A manual procedure, also known as automated percutaneous discectomy, entails inserting a long spinal needle from side of back directly into the disc bypassing other bone and ligament structures. A guide wire is made to pass through the spinal needle and after making an incision of 5 mm an endoscope is inserted. To the endoscope is attached a camera and monitor which provide visual help in removing the prolapsed part of disc.

The laser surgery or percutaneous laser discectomy uses an external imager or fluoroscope to direct the probe. Through this probe laser energy is passed which vaporizes a part of inter-vertebral disc material which helps in decompression of the nerve root. Holmium yttrium- aluminum-garnet (Ho:YAG) laser is the most frequently used laser for this treatment. Following the procedure, the wound is closed and single stitched. With this procedure the pain relief is immediate and the patient can soon resume work.

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.

How much does Percutaneous Endoscopic Lumbar Discectomy cost?

Our world class spine hospitals in India are fully equipped with state of art diagnostic centres with advanced Digital X-ray, MRI and CT scan facilities and fully-equipped operating room with specialized equipment like endoscope and laser, to undertake such specialized procedures. The surgery is performed by experienced orthopedicians or neurosurgeons, who have specialized in spine surgeries and who have undergone specialized training in the world’s best spine surgery hospitals in USA, UK and Australia. Our hospitals also provide excellent patient care at extremely affordable costs which is just around 20-30% of the surgery cost in countries like US.

Minimally Invasive Spinal Fusion Surgery in India

Minimally Invasive Spinal Fusion Surgery at India Best Spine Surgery Hospital 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.

What is Spinal Fusion Surgery?

Spinal fusion (spondylodesis or spondylosyndesis) is the surgical method of joining two or more verebrae. It is done most commonly in the lumbar region of the spine, but it is also used to treat cervical and thoracic problems. In this procedure, the damaged and painful vertebrae are fused into a solid stable bone. Fusion of the spine is used primarily to eliminate the pain caused by abnormal motion of the vertebrae by immobilizing the faulty vertebrae themselves, which is usually caused by degenerative conditions. However, spinal fusion is also the preferred way to treat most spinal deformities, specifically scoliosis and kyphosis. But, the results may vary according to the individual. Some may not feel any improvement in their back pain even after the surgery.

When is Fusion Recommended

• Fracture

• Tumor

• Infection

• Spondylolisthesis

• Degenerative disc disease

• Scoliosis

• Spinal Stenosis

Types of Spinal Fusion Surgery

Lumbar spinal fusion can be divided into two categories|

• Posterolateral Fusion : In the back of the spine, the bone graft is placed in amid the transverse processes. With the help of wires and screws, the vertebrae is carefully fixed throughout the particles of every vertebrae. A rod is made up of metal which is attached on the side of vertebrae.

• Interbody Fusion : In this, the graft of the bone is placed in between the vertebrae and the area is generally engaged by the intervertebral disc. The disc is entirely removed in preparing for the spinal fusion. In order to maintain the disc height and spine alignment, a device can be placed in between the vertebrae. This device (intervertebral device) can either be prepared from titanium or plastic.

Then the fusion starts in between the vertebrae’s endplates. Interbody fusion is of 3 types-

o Posterior Lumbar Interbody Fusion (PLIF)

o Transforaminal Lumbar Interbody Fusion (TLIF)

o Anterior Lumbar Interbody Fusion (ALIF)

o Transpsoas Interbody Fusion (XLIF or DLIF)

Posterior Lumbar Interbody Fusion (PLIF)

In Posterior lumbar interbody fusion, the spinal fusion is achieved through a surgical incision made on the posterior (back) aspect of spine. It aims at fusion of two adjacent vertebrae in cases of spinal instability and associated back pain. It is a popular procedure as it gives excellent results. The procedure provides almost complete relief of symptoms in 90-95% of the cases and the patients are able to return to their daily activities within a few weeks. The patients can also return to most of their recreational activities.

Procedure for Posterior Lumbar Interbody Fusion (PLIF)

PLIF surgery aims at achieving spinal stability through bony fusion by two ways:

The Open PLIF is the traditional technique which is performed using general anesthesia. The patient is made to lie down on his front side on the table with the low back exposed. A 3-6 inch long incision is made on the skin overlying the affected vertebrae. The skin and the fascia are cut open. The underlying muscles are retracted and the affected vertebrae are identified. Fluoroscopic X-ray is used to confirm the exact location of the affected vertebrae. Then a complete laminectomy (removal of the lamina of the vertebrae) followed by bilateral foraminotomy (enlargement of the foramen by removing the bony spurs) and/or discectomy (removal of offending disc) are performed.

This relieves the compression off the spinal nerves, allowing them to come to their normal size and shape. The area is checked for any remaining bony outgrowth or disc fragments that may compress the nerves. Autogenic bone grafts or Metal or plastic implants are fitted in the empty disc space for initiating bone growth.

Minimally Invasive Posterior Lumbar Interbody Fusion (PLIF) in India

The other method is the Minimally Invasive PLIF procedure which is performed using x-ray guidance. 2.5-cm incisions are made on either side of the lower back The muscles are gradually dilated and tubular retractors inserted to allow access to the affected area of the lumbar spine. The lamina is removed to allow visualization of the nerve roots. The offending disc material is removed from the spine and replaced with a bone graft and structural support from a cage made of bone, titanium, carbon-fiber, or a polymer, followed by placement of rod and screws. The tubular retractors are removed, allowing the dilated muscles to come back together, and the incisions are closed.

This procedure typically takes about 3 to 3 ½ hours to perform. There was less blood loss,tissue trauma, operative time, and quick recovery in this procedure as compared to the traditional one.Generally the patients can go home within 3-5 days after traditional PLIF and within 1-2 days after a minimally invasive PLIF

What are the Advantages of Spinal Fusion Surgery?

In most cases, spinal fusion can eliminate the pain and other symptoms. It is important for a surgeon to explain the options, and benefits of spinal fusion surgery. There are many advantages of Spinal fusion surgery such as:

• By fusing the level, there is less concern that the patient will need surgery again at that level. If the discs and/or facets are pain generators, as is often the case, a fusion will ensure that motion at the level is stopped, potentially eliminating the low back pain.

• A second advantage of spinal fusion surgery is that it reduces post-decompressive deformity. Some patients develop post-laminectomy kyphosis, which is an abnormal alignment of the spine. This too can often lead to additional surgery. Similarly, a fusion can correct any deformity the patient had before surgery and ensure that the normal alignment of the spine is restored. This may reduce wear and tear (and need for future surgery) on the neighboring levels.