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

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

  1. 1. Nova Medical Centers Ambulatory Spine Surgery (Day Care Spine Surgery)
  2. 2. Dr V.Daya Thirumala Rao Endoscopic Spine Surgeon Bangalore, Delhi, Mumbai
  3. 3. My Mentor Dr P.S.Ramani THE MOTTO “Never cease to be a student.” Chairman, WFNS Spine Committee
  4. 4. 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.
  5. 5. 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
  6. 6. 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.
  7. 7. 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
  8. 8. Slipped disc
  9. 9. Different Surgical Options For Treatment of Slipped Disc • Laminectomy : A traditional treatment procedure • Microdisectomy: This is referred to as Gold standard • PELD: Latest advancement
  10. 10. procedural milestones in spine surgery
  11. 11. Laminectomy
  12. 12. Laminectomy
  13. 13. Microdisectomy
  14. 14. PELD (Percutaneous Endoscopic Lumbar Disectomy)
  15. 15. What is PELD? • It is the technique used for decompression of the nerve roots by removal of bulged soft tissue via the posterolateral approach.
  16. 16. PELD-anatomical consideration
  17. 17. 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
  18. 18. 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.
  19. 19. Various Instruments for PELD
  20. 20. Various types of lumbar disc herniation treated by PELD Far lateral type Para central type Inferior Migration Central type Foraminal type Superior Migration
  21. 21. Extended use of PELD PELD is also suitable for • elderly patients, • patients with cardiovascular problems, • patients who are afraid of surgery and general anesthesia.
  22. 22. 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
  23. 23. Nucleoplasty • Contained herniated disc. • Safe and controlled method of removing the bulged tissue. • Performed on outpatient basis. • Rapid recovery of patients
  24. 24. 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
  25. 25. Pe-TLIF (Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion) Indication: Degenerative Lumbar Disc Disease with more than 50% disc height loss
  26. 26. Pe-TLIF (Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion)
  27. 27. 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.
  28. 28. 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
  29. 29. MOVE A HEAD WITH TECHNOLOGY Avicenna’s (980–1037 AD) principal method of treating spinal disorders Modern Operative Room
  30. 30. Thank You Day care Spine Surgery Day Care surgeries. 24 hours. No more. Maybe less.

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