MINIMAL ACCESS SURGERY
LUMBAR SPINE
DR. PARTHA P BISHNU
MCh
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
2. Pain associated
with recumbency
and night
1. Pain associated
with fever & weight
loss
Axial skeletal
infection
4. Mechanical
pain
3. Pain associated with
morning stiffness
Neoplastic process
Degenerative spinal
disorder
5. Acute localized
pain
Axial skeletal
Inflammatory disorder
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 INTENSITY
PERSONAL CARE
LIFTING OF WEIGHTS
WALKING
SITTING
STANDING
SLEEPING
SOCIAL LIFE
TRAVELLING
CHANGING 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
S.NO.
ODI BEFORE SURGERY
RANGED FROM 44% TO 96%
ODI
1
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%
MINIMAL ACCESS SURGERY
LUMBAR SPINE
• MICRODISCOIDECTOMY
• MICROSURGICAL DECOMPRESSION OF
LATERAL RECESS STENOSIS
• BILATERAL FENESTRATION FOR CANAL
STENOSIS
LAMINECTOMY ×-no longer done
Lumbar Disc Prolapse
Lumbar canal / Lateral Recess Stenosis
GOAL S OF SURGERY
• Neural Decompression
• Minimal / No destruction of Normal
structures
• Minimal / No Scarring of Back Muscles
ODI PRE OP AND
FOLLOW UP
CHANGE IN THE ODI SCORE
OVER TIME
ALL PATIENTS’ DISABILITY
IMPROVED SIGNIFICANTLY
 No new neurological deficits
 No complications
S.NO.
PRE OP
FOLLOW UP
1
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%
Low Back Pain
Disc Prolapse
Four Indications for Surgery
•
•
•
•
Intractable Pain- Radicular > Back
Progressively worsening
Neurological Deficit
Recurrence of Pain
Cauda Equina Syndrome
MRI SCAN CORRELATES WITH THE
NEUROLOGICAL SYMPTOMS AND SIGNS
MINIMAL ACCESS
LUMBAR SPINE SURGERY
DISCUSSION
FACTORS AFFECTING RESULTS OF SURGERY
1. CASE SELECTION- CLINICAL FEATURES
2. MRI CORRELATION
3. MICROSURGICAL/MINIMAL ACCESS
TECHNIQUES
4. POST OPERATIVE REHABILITATION
5. PSYCHOLOGICAL ASSESMENT
Lumbar Disc Prolapse
Minimally Access Surgery
RD,35Y F
RADICULAR PAIN WITH L5
RADICULOPATHY
90% PRE OP DISABILITY(ODI)
POST OP
COMPLETE RECOVERY
POST OP ODI 4 %
Minimal Access Lumbar Spine Surgery
•
•
•
•
•
•
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
Minimally Invasive
Maximally Effective