Vice Chairman & Head - Ortho Spine, MIS & Robotic Spine Surgery, BLK-Max Super Speciality Hospital, New Delhi
Part 4 of 8 in Advances in Spinal Surgery Technology
Minimally Invasive Surgery for Disc Herniation and Spinal Stenosis
May 26, 2024
Two of the most common spine conditions, disc herniation and spinal stenosis, illustrate how dramatically minimally invasive and endoscopic techniques have changed recovery times.
Spinal stenosis and disc herniation
In spinal stenosis, narrowing around the nerves means patients typically cannot walk more than a few minutes before needing to sit down due to pain and numbness in the legs. In disc herniation, a portion of the disc presses on a nerve, causing sciatica, shooting pain into the arm or leg.
Same-day relief through keyhole surgery
For lumbar canal stenosis, endoscopic surgery through a small hole can free all the compressed nerves in around 40 minutes, with the patient walking a kilometre and going home the same evening. For a large disc herniation pressing on a nerve, a small-cut procedure removes the offending disc material, giving the patient immediate relief from pain and numbness. Treatment generally follows a ladder: medicine and physiotherapy first, then a spinal injection if that fails, and surgery, usually keyhole endoscopic surgery, only if both of those fail.
This article is based on a Jivo Masterclass session conducted by Dr. Puneet Girdhar, Principal Director & Head, Ortho Spine, MIS & Robotic Spine Surgery, BLK-Max Super Speciality Hospital, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr. Puneet Girdhar taught doctors across Africa on May 26, 2024.
FROM THE LIVE Q&A
Moderator
What are the new advancements for conditions like quadriplegia in the cervical spine?
Dr. Puneet Girdhar
The first step with quadriplegia is always to find out the underlying cause. Once the cause is identified, it can potentially be addressed and removed.
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Frequently Asked Questions
What would someone need to do to become your assistant?▼
Rather than becoming an assistant, doctors can partner through Jivo's training programmes, which bring fellows from Africa to train directly - the framing is colleague and partner, not assistant.
Does nutrition play any role in spine health, and is a nutritional deficiency a risk factor for developing spine problems?▼
The spine is made up of three main components, each with its own nutritional needs: bones need calcium, vitamin D and sunlight; muscles and tissues need exercise and good protein in the diet; nerves need exercise and vitamin B12. Altogether, a good lifestyle, diet and exercise are what keep the spine healthy.
At what point can we say scoliosis bracing has failed and surgery is indicated? Also, for the interbody cage, can long plates not be used instead?▼
For idiopathic scoliosis, once the curve goes beyond 40 to 45 degrees, bracing has failed and surgery is indicated. On plates: long plates such as Steffee plating are no longer used - for the last 15 to 20 years, the standard has been transpedicular screws with a titanium or PEEK cage instead.
What are the possible obstacles to performing minimally invasive spine surgery in tropical, resource-limited areas?▼
There is no real obstacle - the obstacle is in the mind. As an example, three minimally invasive spine surgeries (two of them revisions of prior laminectomies) were performed in Abuja, Nigeria over the last two months, and all three patients were walking the next day; this has already led to inquiries from ten different hospitals wanting to start similar programmes. It is a matter of local doctors taking the initiative, supported by training and partnership.
What would be the medical method for the management and support of individuals with discopathy (disc disease)?▼
The first line is medicine and physiotherapy. If that doesn't help, a nerve block injection is the next step. If that also fails, endoscopic surgery is used.
How is spinal stenosis treated with minimally invasive surgery?▼
Endoscopic surgery through a small hole can free all compressed nerves in about 40 minutes, with the patient walking a kilometre and going home the same evening.
What is the treatment ladder for disc problems?▼
Medicine and physiotherapy first, then a spinal injection if that fails, and keyhole endoscopic surgery only if both of those fail.
In This Series: Advances in Spinal Surgery Technology
- 1.Advances in Spinal Surgery Technology
- 2.The Technology Behind Modern Spine Surgery
- 3.Robotic Spine Surgery: Accuracy and Outcomes
- 4.Minimally Invasive Surgery for Disc Herniation and Spinal Stenosis
- 5.Scoliosis: Warning Signs and When to Brace or Operate
- 6.Complex Spine Reconstruction: TB Spine, Revisions and Delayed Referral
- 7.Bringing Minimally Invasive Spine Surgery to Resource-Limited Settings
- 8.Spinal Fusion, Symptom-Based Surgery Decisions, and Spine Nutrition