Most Advanced Minimally invasive Cervical Discectomy Spine Treatment in India

What is Cervical Discectomy?

Cervical discetomy is a medical procedure to treat the problems associated with the discs. When the disc bulge and disc herniation are occurring, they lead to the neck problems. And these neck problems could eventually be managed by performing such medical treatments. When the intervertebral disc is prolapsed the spinal nerves as well as the spinal cord will be compressed in the region of the neck. The result will be tingling, numbness and pain that is radiated along the arms in one or both the arms. This nerve compression can be relieved by the removal of the entire disc or only offending fragments of the disc. The cord will be restored into the normal and original size and shape.

Human spine consists of cervical segment. This segment has 7 cervical vertebrae and is separated by intervertebral discs, which are soft. These discs absorb the shocks and neck movements are well facilitated. The problems start when the water in these discs gets lost. The loss of water in these discs generally happens because of the wear and tear of these bones. Eventually the intervertebral height will be reduced and the discs will get disintegrated. Sometimes there can be formation of the bony spurs and degeneration of the body of the vertebra occurring under the vertebral body’s surface and at the same time the facet joints will be thickened. Eventually the nerve roots will be compressed because of the osteophytes encroach and disc fragments into the foramen. When these nerves are compressed, it would result in the pain.

The disc generally herniated either in the backward direction or sometimes may bulge towards the sideways. When it herniated backwards, it compresses the cord. When it bulges in the sideways, it may compress the nerve. The cord compression generally leads both the arms to become weak and experience numb. If this condition becomes sever, it affects the function of the bladder and bowel. So, the compression can be relieved either by removing either the fragments of the disc or the entire disc.

Pediatric Cardiac Surgery often deals with heart problems in children, the cause of congenital heart diseases which are common heart ailments among new born children and involves deficiencies like structural defects, congenital arrythmias and cardiomyopathies, which result in different kinds of abnormalities related to the heart. Congenital heart disease is a cause of improper growth of the heart or blood vessels before birth.

Who may require Cervical Discectomy ?

Those patients who suffer from persistent neck pain, one or both arm pain and weakness, instability while walking and lack of bowel and bladder control in spite of taking conservative treatment methods such as rest, medication, physical therapy are ideal candidates for this procedure.

The disc may herniate backwards to compress upon the cord or it may bulge sideways to compress upon the nerve. Cord compression may lead to numbness and weakness of both arms and in severe case may affect the bowel and bladder function. This procedure aims to remove the complete disc or its fragments in order to relieve compression of the cord or nerve and restore their function.

In Cervical discectomy, disc can be accessed via anterior or posterior approach. Anterior Approach

The patient is made to lie down on his back under general anesthesia. A horizontal incision is made just 2 inches above the clavicle on either left or right side. The thin muscle layer is cut and the trachea and esophagus are shifted to one side along with the nerves and vessels. The surgeon has a clear view of the cervical vertebrae. An X-ray is done to confirm the involved disc. An operating microscope can also be used to get a better picture of the operating field. The anterior longitudinal ligament is gently removed to reach the osteophytes and the disc fragments. The osteophytes are scraped off and the intervertebral disc is dissected.

Once the disc is removed the vertebral bodies are gently distracted to their original distance to fill the space with bone graft. This helps to relieve the compression from the nerves as the diameter of the intervertebral foramen is enlarged. Sometimes cervical discectomy is followed by spinal stabilization using screws and plates.

Posterior Approach

The patient is sedated under general anaesthesia and made to lie on his abdomen. The neck is slightly bent and head is supported on the head rest. An incision is made on the back of the neck in the midline. The skin, fascia and muscles are retraced to reach the vertebrae. An X-ray is done to confirm the level of affected disc. Edges of the lamina are shaved off to give a clearer vision. In case of central herniation, both lamina may have to be removed in order to get full view of the fragmented disc.

Minimally invasive cervical discectomy surgery in India

Cervical discectomy is a surgical procedure which relieves compression on the nerve roots and/or the spinal cord because of a herniated disc or a bone spur. This procedure involves making an incision on the front side of the neck (anterior cervical spine), followed by the removal of disc material and/or a portion of the bone around the nerve roots and/or spinal cord to relieve the compression on neural structures and provide them with additional space.

Cervical discectomy is also referred to as decompressive spinal procedure as the surgeon removes compression on nerve roots by removing the total or a part of the disc and/or bony material that is causing pain. Your surgeon may choose a minimally invasive approach based on your condition and the specific surgical goals.

Minimally invasive cervical discectomy involves a small incision(s) and muscle dilation to separate the muscle fibers surrounding the spine, unlike conventional open spine surgery which requires muscles to be cut or stripped.

The advantages of Minimally invasive cervical discectomy surgery :

• Maintaining normal neck motion

• Reducing degeneration of adjacent segments of the cervical spine

• Eliminating the need for a bone graft

• Early postoperative neck motion

• Faster return to normal activity

What is Stroke?

A stroke occurs when the blood supply to a part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients. Within a few minutes, brain cells begin to die.

Stroke is a medical emergency, and prompt treatment of a stroke is crucial. Early treatment can minimize damage to your brain and potential stroke complications. The good news is that strokes can be treated, and many fewer Americans now die of strokes than was the case 20 or 30 years ago. Improvement in the control of major risk factors for stroke - high blood pressure, smoking and high cholesterol - is likely responsible for the declin

What are the symptoms of Brain Stroke?

The warning signs of stroke are:

- Numbness, weakness, or paralysis of the face, arm, or leg (on one or both sides of the body)

- Vision that suddenly blurs or decreases (in one or both eyes)

- Trouble speaking or understanding

- Dizziness, loss of balance, or a fall that is unexplained

- Difficulty swallowing

- Sudden, severe, unexplained headache

- Sudden confusion

Types of Brain Stroke

Ischemic stroke

About 80 percent of strokes are ischemic strokes. They occur when the arteries to your brain are narrowed or blocked, causing severely reduced blood flow (ischemia). This deprives your brain cells of oxygen and nutrients, and cells may begin to die within minutes.

The most common ischemic strokes are : -

Thrombotic stroke : - This type of stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain. A clot usually forms in areas damaged by atherosclerosis - a disease in which the arteries are clogged by fatty deposits (plaques). This process can occur within one of the two carotid (kuh-ROT-id) arteries of your neck that carry blood to your brain, as well as in other arteries of the neck or brain.

Embolic stroke : - An embolic stroke occurs when a blood clot or other particle forms in a blood vessel away from your brain - commonly in your heart - and is swept through your bloodstream to lodge in narrower brain arteries. This type of blood clot is called an embolus. It's often caused by irregular beating in the heart's two upper chambers (atrial fibrillation). This abnormal heart rhythm can lead to poor blood flow and the formation of a blood clot.

Essential Tremor: DBS is a highly effective therapy for patients with essential tremor, often resulting in an 80% decrease in tremor that lasts for several years. Patients with a tremor secondary to stroke, traumatic brain injury or multiple sclerosis are less likely to benefit from DBS.

Hemorrhagic stroke

"Hemorrhage" is the medical word for bleeding. Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Hemorrhages can result from a number of conditions that affect your blood vessels, including uncontrolled high blood pressure (hypertension) and weak spots in your blood vessel walls (aneurysms). A less common cause of hemorrhage is the rupture of an arteriovenous malformation (AVM) - an abnormal tangle of thin-walled blood vessels, present at birth.

There are two types of hemorrhagic stroke : -

Intracerebral hemorrhage : - In this type of stroke, a blood vessel in the brain bursts and spills into the surrounding brain tissue, damaging cells. Brain cells beyond the leak are deprived of blood and are also damaged. High blood pressure is the most common cause of this type of hemorrhagic stroke. Over time, high blood pressure can cause small arteries inside your brain to become brittle and susceptible to cracking and rupture.

Subarachnoid hemorrhage : - In this type of stroke, bleeding starts in a large artery on or near the surface of the brain and spills into the space between the surfaces of your brain and your skull. This type of hemorrhage is often signaled by a sudden, severe "thunderclap" headache. This type of stroke is commonly caused by the rupture of an aneurysm, which can develop with age or be genetically inherited. After the hemorrhage, the blood vessels in your brain may widen and narrow erratically (vasospasm), causing brain cell damage by further limiting blood flow to parts of your brain.

Options for Stroke Treatment in India | Best hospital for Brain Stroke Treatment in India

Carotid Endarterectomy:

Carotid endarterectomies are performed to prevent and reduce the risk of stroke. This surgery has been proven to be highly beneficial for patients who have already had a stroke or experienced the warning signs of a stroke and have a severe stenosis of 70 percent to 99 percent. During this procedure, a surgeon removes fatty deposits (plaques) from carotid arteries that run along each side of neck to brain.

Carotid angioplasty and Stenting Stroke Treatment in India

Carotid angioplasty is an endovascular surgery procedure that opens clogged arteries to prevent or treat stroke.Carotid angioplasty is often combined with the placement of a small metal coil called a stent in the clogged artery and this procedure is suggested when traditional carotid surgery isn’t feasible or is too risky.

Craniotomy & Surgical Clipping for Stroke Treatment in India

A craniotomy is surgical procedure performed in the brain itself to remove blood clots or repair bleeding in the brain. The neurosurgeon first must perform a craniotomy and then Surgical clipping by placing a tiny clamp at the base of the aneurysm, to stop blood flow to it. This can keep the aneurysm from bursting, or it can prevent re-bleeding of an aneurysm that has recently hemorrhaged.

Surgical AVM (Arteriovenous Malformations) Removal for Stroke Treatment in India

This surgical procedure is performed by endovascular specialists, to help prevent a stroke from occurring. Smaller AVM can be removed through an opening drilled into the skull; if it is located in an accessible (peripheral) part of the brain, to eliminate the risk of rupture and lower the risk of hemorrhagic stroke. However, it’s not always possible to remove an AVM if its removal would cause too large a reduction in brain function or if it’s large or located deep within your brain, Less invasive radiosurgery works best for deep, hard-to-reach AVMs; the procedure involves directing radiation to the affected area.

Rehabilitation

A rehabilitation program is an important part of treatment for stroke survivors. It starts in the hospital as soon as patient is stable following a stroke. The program is done with an objective to help the patient relearn the skills he/she lost when stroke affected the part of brain. This program helps to regain independence and improve quality of life. A multidisciplinary team of health professionals will work out in a rehabilitation program.

Minimally Invasive Spine Laminotomy Surgery in India - Laminotomy Surgery at Best Spine Surgery Hospitals in India

Laminotomy

The word laminotomy originates from the Latin terms lamina - the bony plate covering the posterior arch of the vertebra and otomy - the act of cutting or making an incision. A Laminotomy is a minimally invasive endoscopic approach to opening the spinal canal. A laminotomy does not require the use of general anesthesia and it can be performed in a surgical outpatient setting.

A laminotomy is performed to relieve pressure from the spinal canal for exiting nerve roots and the spinal cord. The procedure is performed with an end goal of increasing the amount of available space for neural tissues, and releasing entrapped nerves. A laminotomy can be used to treat bone spurs, pinched nerve, spinal stenosis, disc problems such as a herniated or bulging disc, excessive

Types of Laminotomy:

• Cervical - Removal of part of lamina in the neck portion.

• Lumbar – Removing the part of the lamina in the lower back

• Sacral – Abstracting part of the lamina in the back between your hipbones.

• Thoracic – Removing the portion of lamina in the middle part of the back.

Laminectomy is recommended when:

• Traditional treatment like physical therapy, or medication fails to improve or alleviate symptoms

• Suffering from muscle weakness or numbness making standing or walking difficult

• Experiencing loss of bowel or bladder control

In certain cases, laminectomy may be necessary as part of surgery to treat a spinal disc herniation. The surgeon may need to remove part of the lamina to gain access to the damaged disk.

Laminotomy - The Procedure

After the patient receives a local anesthetic, a small incision is made in the back and a round Depuy tube is inserted into it. Gradually, a small series of tubes are placed over the initial tube slowly increasing in size to make an opening for access to the spine. The final working tube will be about 18 millimeters in diameter which the surgeon will use to insert the laser, camera, suction, irrigation and other surgical instruments. With this minimally invasive method, the muscles are pushed aside instead of being cut or torn.

A laminotomy is an endoscopic procedure and not arthroscopic. The difference being that arthroscopic surgery requires inserting the tubular instrument into the joint, where endoscopic covers surgery with the same instrument being placed anywhere outside of the joint.

After the working tube is in place the surgeon can begin the procedure. Many patients that undergo a laminotomy will feel instant relief as the surgeon releases the entrapped nerves. Symptoms of back and leg pain are resolved by decompressing the spinal canal.

When the surgeon is finished with the procedure the tube is slowly removed, allowing for muscles to naturally shift back to normal positions.

Laminotomy and Laminectomy differences

A laminotomy is a procedure that can be used to remove the ligamentum flavum. Spinal stenosis has been attributed to this ligament located in the spinal canal. It can naturally thicken to the point that it begins to compress the spinal cord. When a laminotomy is performed the ligament can be removed, freeing or releasing the affected nerve(s).

A laminectomy is classed as traditional open back surgery that requires the patient to be placed under general anesthesia. In a laminectomy the lamina is removed to increase the amount of space available for neural tissue.

Advanced Minimally Invasive Spinal Fusion Surgery at World Class Hospitals in India

Minimally Invasive Spinal Fusion Surgery for  Disc herniation and Degenerative Disc Disease at World Class Hospital in India

Spinal fusion is a surgical procedure in which two or more vertebrae are joined or fused together. Fusion surgeries typically require the use of bone graft to facilitate fusion. This involves taking small amounts of bone from the patient’s pelvic bone (autograft), or from a donor (allograft), and then packing it between the vertebrae in order to “fuse” them together. This can be accomplished either posteriorly or between the vertebral bodies. When it is done between vertebral bodies, bone graft, along with a biomechanical spacer implant, will take the place of the intervertebral disc, which is entirely removed in the process.

Spinal fusion surgery is a common treatment for such spinal disorders as spondylolisthesis, scoliosis, severe disc degeneration, or spinal fractures. Fusion surgery is usually considered only after extensive non-operative therapies have failed. Two common fusion surgeries available at World Class Neurosurgery Hospitals in India for Spinal Disorders include posterior fusion and interbody fusion such as PLIF, TLIF.

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What is 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. Major medical journals document that 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.

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How is Posterior Lumbar Interbody Fusion done?

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. Finally, pedicle screws are placed into the upper and lower vertebrae and connected with rods or plates. New bone is allowed to grow over these rods, helping to bridge the adjacent vertebrae and achieving interbody fusion. The total surgery time is approximately 3 to 6 hours, depending on the number of spinal levels involved.

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.

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What is Transforaminal Lumbar Interbody Fusion (TLIF)?

A transforaminal lumbar interbody fusion (TLIF) is a type of spine surgery that involves approaching the spine from the back, or posterior, of the body to place bone graft between two vertebrae. The procedure may be performed using minimally invasive surgical techniques.

How is a Minimally Invasive TLIF Performed?

Spinal Access and Bone Removal

First, your surgeon will make a small incision in the skin of your back over the vertebra(e) to be treated. Depending on the instrumentation to be used, the incision could be as small as approximately 3 centimeters. In a traditional open TLIF, a 3- to 6-inch incision is typically required.

The muscles surrounding the spine will then be dilated to allow access to the section of spine to be stabilized. After the spine is accessed, the lamina (the “roof” of the vertebra) is removed to allow visualization of the nerve roots. The facet joints, which are directly over the nerve roots, may be trimmed to give the nerve roots more room.

Bone Graft Material Placement

The nerve roots are then moved to one side and the disc material removed from the front (anterior) of the spine. A bone graft is then inserted into the disc space. The bone graft material acts as a bridge, or scaffold, on which new bone can grow. Screws and rods are inserted to stabilize the spine while the treated area heals and fusion occurs, and the ultimate goal of the procedure is to restore spinal stability.

Your surgeon will then close the incision, which typically leaves behind only a small scar or scars.