MINIMAL ACCESS SURGERY LUMBAR SPINE

DR. PARTHA P BISHNUMCh

Neurosurgeon

BACK PAIN

Survey

• 75 to 85 percent of all people will experience some form of back pain during their lifetime.

Back pain is: • the second most frequently reported reason for visiting a

doctor, • the fifth most frequent cause of hospitalization and

• the third most frequent reason for surgery.

Spinal or Radicular pain

+ Neurological deficit

1. Pain associated with fever & weight loss

Axial skeletal infection

2. Pain associated with recumbency and night

Neoplastic process

3. Pain associated with morning stiffness

Axial skeletal Inflammatory disorder

4. Mechanical pain

Degenerative spinal disorder

5. Acute localized pain

Axial skeletal fracture/ dislocation

MINIMAL ACCESS SURGERY LUMBAR SPINE

CASE SERIES:OPD :440 LBP patients- March,2011 to February,

2012. OPERATED CASES : 20/18 analyzed• PATIENTS AGE RANGE :19-70 YEARS• MALE PATIENTS : 8/18• FEMALE PATIENTS : 10/18• DURATION OF SYMPTOMS : 25 DAYS- 7 YEARS

Chronic Recurrent Problem

ASSESMENT OF DISABILITY IN PATIENTS OF LOW BACK PAIN

REVISED OSWESTRY DISABILITY INDEX (ODI)PAIN INTENSITYPERSONAL CARELIFTING OF WEIGHTSWALKINGSITTINGSTANDINGSLEEPING SOCIAL LIFETRAVELLINGCHANGING DEGREE OF PAIN

DISABILITY SCORING 0-50 ( 0-100%)

ASSESMENT OF DEGREE OF PAIN IN LOW BACK PATIENTS

QUADRUPLE VISUAL ANALOGUE SCALE 0 to 10

LOW BACK PAIN

Chronic Recurrent Problem

PSYCHOLOGICAL EVALUATION

ODI BEFORE SURGERYS.NO. ODI1 44.00%2 58.00%3 80.00%4 60.00%5 68.00%6 78.00%7 54.00%8 66.00%9 68.00%10 96.00%11 92.00%12 58.00%13 82.00%14 90.00%15 80.00%16 66.00%17 50.00%18 62.00%

RANGED FROM 44% TO 96%

MINIMAL ACCESS SURGERY LUMBAR SPINE

• MICRODISCOIDECTOMY

• MICROSURGICAL DECOMPRESSION OF LATERAL RECESS STENOSIS

• BILATERAL FENESTRATION FOR CANAL STENOSIS

LAMINECTOMY ×-no longer done

GOAL S OF SURGERY• Neural Decompression• Minimal / No destruction of Normal

structures• Minimal / No Scarring of Back Muscles

Lumbar Disc Prolapse Lumbar canal / Lateral Recess Stenosis

ODI PRE OP AND FOLLOW UP

S.NO. PRE OP FOLLOW UP1 44.00% 10.00%2 58.00% 12.00%3 80.00% 24.00%4 60.00% 08.00%5 68.00% 00.00%6 78.00% 14.00%7 54.00% 18.00%8 66.00% 38.00%9 68.00% 06.00%10 96.00% 00.00%11 92.00% 04.00%12 58.00% 18.00%13 82.00% 08.00%14 90.00% 24.00%15 80.00% 00.00%16 66.00% 14.00%17 50.00% 12.00%18 62.00% 12.00%

CHANGE IN THE ODI SCORE OVER TIME

ALL PATIENTS’ DISABILITY IMPROVED SIGNIFICANTLY

No new neurological deficits

No complications

Four Indications for Surgery

• Intractable Pain- Radicular > Back• Progressively worsening

Neurological Deficit• Recurrence of Pain• Cauda Equina Syndrome

Low Back Pain Disc Prolapse

MRI SCAN CORRELATES WITH THE NEUROLOGICAL SYMPTOMS AND SIGNS

MINIMAL ACCESS LUMBAR SPINE SURGERY

DISCUSSION FACTORS AFFECTING RESULTS OF SURGERY1.CASE SELECTION- CLINICAL FEATURES2.MRI CORRELATION3.MICROSURGICAL/MINIMAL ACCESS

TECHNIQUES4.POST OPERATIVE REHABILITATION5.PSYCHOLOGICAL ASSESMENT

Lumbar Disc Prolapse Minimally Access Surgery

RD,35Y FRADICULAR PAIN WITH L5RADICULOPATHY90% PRE OP DISABILITY(ODI)

POST OPCOMPLETE RECOVERYPOST OP ODI 4 %

• Pain free in 24-48 hrs• Minimal or No post operative Discomfort• Awake Surgery possible• Hospital Stay few hours to 02/03 days• Safe and Effective• Cost Effective

Minimal Access Lumbar Spine Surgery

Minimally Invasive Maximally Effective