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.

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.