5 dr daya-thirumala-rao-ambulatory-spine-surgery_ncas_2011
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TRANSCRIPT
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Nova Medical Centers
Ambulatory Spine Surgery
(Day Care Spine Surgery)
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Dr V.Daya Thirumala Rao Endoscopic Spine Surgeon
Bangalore, Delhi, Mumbai
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My Mentor
Dr P.S.Ramani
THE MOTTO
“Never cease to be a student.”
Chairman, WFNS Spine Committee
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Ambulatory Spine Surgery
Include those surgical procedures more
complex than office-based procedures but
less complex than major procedures
requiring less than 24 hours admission for
post anesthetic and patient monitoring.
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Ambulatory Spine Surgery
• progress in diagnosis with MRI
• progress with surgical tools: Better Endoscopic tools with minimal fiber optics diameter , a large
working channel , a flow integrated system keeping the surgical field
clear
• progress with anaesthesiology pain
prevention, patient comfort and security
• more people requirement against pain
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Ambulatory Spine Surgery
• Advances in surgical technique and
technology have a profound effect on
shifting many surgical procedures
previously require long-term in-patient
hospitalization are now routinely
performed on an out-patient basis.
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Day Spine Surgery procedures
at
Nova Medical Centers
Ambulatory spine
surgery
Percutaneous Endoscopic
Lumbar Disectomy
(PELD)
Percutaneous Endoscopic
Lumbar Foraminoplasty
Fully Endoscopic
Lumbar Disectomy
Percutaneous Transforaminal
Lumbar Interbody
fusion
(Pe-TLIF)
Nucleoplasty
Kyphoplasty
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Slipped disc
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Different Surgical Options For
Treatment of Slipped Disc
• Laminectomy : A traditional treatment
procedure
• Microdisectomy: This is referred to as
Gold standard
• PELD: Latest advancement
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procedural milestones in spine surgery
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Laminectomy
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Laminectomy
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Microdisectomy
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PELD (Percutaneous Endoscopic Lumbar Disectomy)
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What is PELD?
• It is the technique used for decompression
of the nerve roots by removal of bulged
soft tissue via the posterolateral approach.
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PELD-anatomical consideration
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Historical Review of PELD
Primary Intradiscal Aproach
– 1977 - Hijikata : Percutaneous manual discecotmy (non-selective, not concurrent with surgical identification)
– 1983 - Kambin & Gellman : Non-visualized posterolateral percutaneous nucleotomy
– 1984 - Ascher : Percutaneous laser discectomy(nonspecific depressurization)
Modification of intradiscal approach : Visualized
– 1987 - Schreiber : transdiscoscopic percutaneous nucleotomy
– 1988 - Kambin : arthroscopic microdiscectomy : Published the first intraoperative discoscopic view of a HNP.
– 1989 - Mayer : percutaneous endoscopic lumbar discectomy
– 1991 - Davis : percutaneous endoscopic laser disc decompression
– 1991 - Kambin : Described & illustrated the triangular working zone
Transforaminal approach
– 1996 - Kambin : Foraminal arthroscopic decompression of lateral recess stenosis : annulectomy & osteophtectomy
– 1996 - Mathews : transforaminal endoscopic microdiscectomy
– 1996 - Siebert : endoscopic laser disc surgery : the foraminal app.
– 1996 - Lew : percutaneous foraminoscopy
– 1996 - Casper : foraminal laser endoscopic disc ablation
Foraminoplasty approach
– 1996 - Knigh : endoscopic laser foraminoplasty
– 1997 - Yeung : YESS : Introduced a rigid rod-lens, integrated, multichannel, wide-angle operating spinal endoscope.
– 1997 - Hoogland : percutaneous endoscopic discectomy
– 1998 - Yeung : selective endoscopic discectomy
– 1999 - chiu : microdecompressive percutaneous discectomy with laser thermodiskoplasty
– 2005 : Ruetten : Extreme lateral access : full-endoscopic uniportal transforaminal approach
– 2006 : Lee : Percutaneous endoscopic lumbar discectomy for migrated disc herniation
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Photograph taken during the First International Symposium held at the Graduate Hospital in Philadelphia
in 1983. From left to right: Dr. Hijikata, Professor Adam Schreiber,Dr. Parviz Kambin.
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Various Instruments for PELD
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Various types of lumbar disc herniation
treated by PELD
Far lateral type
Para central type
Inferior Migration
Central type Foraminal type
Superior Migration
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Extended use of PELD
PELD is also suitable for
• elderly patients,
• patients with cardiovascular problems,
• patients who are afraid of surgery and
general anesthesia.
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Advantages of PELD
• Immediate pain-relieve in 95 % of the cases
• Eliminating the possibility of resection of bone and
ligament
• Performing selective Disectomy
• No need for general anesthesia
• Outpatient treatment
• Faster rehabilitation
• Earlier return to work or sports
• Higher patient satisfaction
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Nucleoplasty
• Contained herniated disc.
• Safe and controlled
method of removing the
bulged tissue.
• Performed on outpatient
basis.
• Rapid recovery of patients
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Kyphoplasty (Balloon Kyphoplasty)
• Kyphoplasty is a used to
repair osteoporotic
fracture vertebrae.
• Restores the vertebral
body height.
• Reduces or eliminates the
back pain.
• Performed as an
outpatient basis.
• Allows in performing daily
activities
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Pe-TLIF (Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion)
Indication:
Degenerative Lumbar Disc
Disease with more than 50%
disc height loss
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Pe-TLIF (Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion)
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SUMMARY
• Percutaneous Endoscopic Lumbar Disectomy (PELD) is
a safe and sparing excision of herniated disc material for
disc prolapse.
• Nucleoplasty is a safe procedure for Contained Disc
Herniation.
• Kyphoplasty is a safe procedure for Osteoporotic
Vertebral Compression fractures.
• Pe-TLIF (Percutaneous Endoscopic Transforaminal
Lumbar Interbody Fusion) is the advanced technique in
Lumbar Interbody Fusion for severe Degenerative
Lumbar Disc Disease.
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Take Home Message
Ambulatory Spine Surgery
or
Day Care Spine Surgery
Safe method
for all types of
Lumbar Disc Prolapse
Osteoporotic Vertebral Fractures
Lumbar Degenerative Disc Disease
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MOVE A HEAD WITH TECHNOLOGY
Avicenna’s (980–1037 AD)
principal method of
treating spinal disorders
Modern Operative Room
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Thank You
Day care Spine Surgery
Day Care surgeries. 24 hours.
No more. Maybe less.