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

  • Nova Medical CentersAmbulatory Spine Surgery (Day Care Spine Surgery)
  • Bangalore, Delhi, MumbaiDr V.Daya Thirumala Rao Endoscopic Spine Surgeon
  • 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)
  • 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 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
  • 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 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