My Mentor Dr P.S.RamaniChairman, WFNS Spine Committee THE MOTTO “Never cease to be a student.”
Ambulatory Spine SurgeryInclude those surgical procedures morecomplex than office-based procedures butless complex than major proceduresrequiring less than 24 hours admission forpost 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 Percutaneous Endoscopic Lumbar Disectomy (PELD) PercutaneousKyphoplasty Endoscopic Lumbar Foraminoplasty Ambulatory spine surgery Fully EndoscopicNucleoplasty Lumbar Disectomy Percutaneous Transforaminal Lumbar Interbody fusion (Pe-TLIF)
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
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.
Photograph taken during the First International Symposium held at the Graduate Hospital in Philadelphiain 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 Superior Migration Far lateral type Central type Foraminal type Para central type Inferior Migration
Extended use of PELDPELD 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 DiscDisease with more than 50%disc height loss
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 TECHNOLOGYAvicenna’s (980–1037 AD)principal method of Modern Operative Roomtreating spinal disorders
Day care Spine SurgeryDay Care surgeries. 24 hours. No more. Maybe less. Thank You