Prolapsed Intervertebral disc causing Low back pain & Leg pain
If back and leg pain does not respond to nonsurgical treatment and continues for four to six weeks or longer, the physician may prescribe diagnostic tests, such as X-ray imaging, MRI or a CT scan, to verify the source of the pain. If a diagnosis of herniated disc is confirmed, open discectomy may be recommended.
Open discectomy is the most common surgical treatment for ruptured or herniated discs of the lumbar spine. When the outer wall of a disc, the annulus fibrosus, becomes weakened, it may tear allowing the soft inner part of the disc, the nucleus pulposus, to push its way out. This is called disc herniation, disc proplapse or a slipped or bulging disc. Once the inner disc material extends out past the regular margin of the outer disc wall, it can press against very sensitive nerve tissue in the spine. The disc material can compress or even damage the nerve tissue, and this can cause weakness, tingling or pain in the back area and into one or both legs. Open discectomy uses surgery to remove part of the damaged disc and thus to relieve the pressure on the nerve tissue and alleviate the pain. The surgery involves a small incision in the skin over the spine, removal of some ligament and bone material to access the disc and the removal of some of the disc material.
Microdiscectomy, also called microlumbar discectomy (MLD), is a very common MIS decompression procedure performed in patients with a symptomatic lumbar herniated disc. A 1- to 2-cm longitudinal incision is made in the midline of the lower back, directly over the area of the herniated disc. Special retractors and an operating microscope are used to visualize the region of the spine, with minimal or no cutting of the adjacent muscles and soft tissues. After the retractor is in place, an x-ray is used to confirm that the appropriate disc is identified. A small amount of bone of the superior lamina may be removed first to expose the disc herniation. The nerve root and neurologic structures are protected and carefully retracted so that the herniated disc can be removed. Surrounding areas are checked to ensure that no additional disc fragments are remaining. This procedure typically takes about 1 hour to perform.
Minimally invasive discectomy
Microsurgical discectomy is a procedure to remove a herniated disc and bone spurs in the spine. A 1-inch incision is made into one side of your back. The muscles are gradually dilated with increasingly larger tubes to form a tunnel to the spine. Through this tunnel, the ruptured portion of the disc is removed along with any bone spurs pinching the nerve. The entire disc is not removed. Your doctor may recommend a discectomy if physical therapy or medications fail to relieve your leg, arm or back pain. Patients go home the next day.
Spinal decompression (laminectomy)
Spinal decompression (laminectomy) is a surgery to remove the bony overgrowth caused by spinal stenosis. The incision is made in the back of the spine. The arched portion of the bone (lamina) is removed to expose the spinal cord. Thickened ligaments and bone spurs are also removed. The overgrown facet joints may be trimmed to give more room for the spinal nerves. One lamina (single-level) or more (multi-level) may be removed. Decompression does not cure spinal stenosis nor eliminate arthritis; it only relieves the symptoms. The surgery can be performed in an open or minimally invasive technique.
Preparing for spinal fusion
Spinal fusion is a surgical procedure performed to permanently join together one or more bony vertebrae. It will stop the motion in the painful area of your spine allowing you to return to a more normal lifestyle—though one that may not be totally pain-free. Because back pain responds well to physical therapy and exercise, make sure you have done your part toward a successful rehabilitation before considering surgery. What you do before and after surgery can help get you back on your feet sooner. It’s important to have realistic expectations and prepare properly for your recovery.
Transforaminal Lumbar Interbody Fusion
Transforaminal Lumbar Interbody Fusion (TLIF) is a minimally invasive surgery to permanently join together one or more bony vertebrae of the spine. A 1-inch incision is made in the lower back. The muscles are gradually dilated (widened) with increasingly larger tubes to form a tunnel to the spine. Through this tube, the damaged disc is removed and a bone graft is inserted into the empty disc space. Over time, new bone growth will fuse the two vertebrae together. The surgery is done without splitting the back muscles, takes 1 to 2 hours, and patients often go home the in two days.
Dynamic Interlaminar stabilization
The DIAM™ (Device for Intervertebral Assisted Motion) Spinal Stabilization System provides flexible support of the lumbar spine while treating spinal degeneration.
Potential benefits of the DIAM™ Spinal Stabilization System:
- Provides an alternative to spinal fusion
- Fits between the interspinous processes and functions as a shock absorber that reduces loads on the surrounding vertebrae
- Only requires a small incision to implant, which can reduce scarring, shorten surgery time and decrease recovery time
COMPLEX SPINE CASES IN KOLKATA – 2014
Read about the complex spine cases in Kolkata – 2014, treated by Dr Debnath and team.