5 dr daya-thirumala-rao-ambulatory-spine-surgery_ncas_2011

Nova Medical Centers

Ambulatory Spine Surgery

(Day Care Spine Surgery)

Dr V.Daya Thirumala Rao Endoscopic Spine Surgeon

Bangalore, Delhi, Mumbai

My Mentor

Dr P.S.Ramani

THE MOTTO

“Never cease to be a student.”

Chairman, WFNS Spine Committee

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.

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

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.

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

Slipped disc

Different Surgical Options For

Treatment of Slipped Disc

• Laminectomy : A traditional treatment

procedure

• Microdisectomy: This is referred to as

Gold standard

• PELD: Latest advancement

procedural milestones in spine surgery

Laminectomy

Laminectomy

Microdisectomy

PELD (Percutaneous Endoscopic Lumbar Disectomy)

What is PELD?

• It is the technique used for decompression

of the nerve roots by removal of bulged

soft tissue via the posterolateral approach.

PELD-anatomical consideration

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

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.

Various Instruments for PELD

Various types of lumbar disc herniation

treated by PELD

Far lateral type

Para central type

Inferior Migration

Central type Foraminal type

Superior Migration

Extended use of PELD

PELD is also suitable for

• elderly patients,

• patients with cardiovascular problems,

• patients who are afraid of surgery and

general anesthesia.

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

Nucleoplasty

• Contained herniated disc.

• Safe and controlled

method of removing the

bulged tissue.

• Performed on outpatient

basis.

• Rapid recovery of patients

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

Pe-TLIF (Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion)

Indication:

Degenerative Lumbar Disc

Disease with more than 50%

disc height loss

Pe-TLIF (Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion)

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.

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

MOVE A HEAD WITH TECHNOLOGY

Avicenna’s (980–1037 AD)

principal method of

treating spinal disorders

Modern Operative Room

Thank You

Day care Spine Surgery

Day Care surgeries. 24 hours.

No more. Maybe less.