Non Invasive Spine Surgery

Non Invasive Or Minimmally Invasive Spine Surgery :

Minimally invasive spine surgery uses very small surgical incisions (often less than one inch) and specially designed surgical tools to treat spinal disorders. Because minimally invasive surgery is performed through small tubes, there is little disruption of normal structures. This reduces postoperative pain, speeds recovery, and leads to shortened hospital stays. Many minimally invasive spine procedures can be performed on an outpatient basis.

Nucleoplasty

Nucleoplasty is a minimally invasive procedure developed to treat patients with contained, or mildly herniated discs. Nucleoplasty literally means removal of the nucleus (nucleus pulposis is the center gel-like substance of the disc.) The outer band-like substance of the disc is the annulus fibrosis. Typically when a disc herniates, the annulus fibrosis opens and allows the nucleus pulposis to protrude and compress structures such as nerves. Nucleoplasty does not involve an incision. A special access needle is placed into the disc under x-ray guidance. A wand-like device is then inserted through the needle and into the disc. The device uses heat to remove disc material and seal the channel made by the needle. Several channels are made depending on how much disc material needs to be removed.

Pre Pocedure Preaparation :This procedure is done under local anesthesia (“novacaine.”) Most of the patients also receive intravenous sedation and analgesia, to help them relax and make the procedure easier to tolerate. The amount of sedation given depends upon the patient. You need to be awake enough to tell the doctor what you are feeling.

Procedure : The procedure is performed in a surgical center with fluoroscopic (x-ray) guidance. Nucleoplasty is done with the patient lying on the stomach. Intravenous sedation is given to help with comfort and relaxation. The skin is cleaned with an antiseptic solution and the back is numbed with a local anesthetic before the procedure is performed. The patient is monitored with an electrocardiogram, blood pressure cuff and blood oxygen-monitoring device. The surgeon uses a needle, guided by fluoroscopic x-ray, to introduce a special instrument into the nucleus. The surgeon’s goal is to pull leaking nuclear material back into the center of the nucleus. This procedure is performed using a special “wand” The wand is moved back and forth in the nucleus creating destroyed nuclear channels, thereby decreasing volume of the nucleus.

Advantages of Nucleoplasty
The operation is extremely precise and does not remove more tissue than is necessary to shrink the disc. If too much nucleus tissue is removed, the disc will shrink more than necessary. In this case the disc will suffer fromdegenerative disc disease, instead of being herniated. This procedure offers good results with little risk taken by the patient. A more involved surgery can always be performed if results are poor. The procedure is relatively comfortable and leaves no scar tissue or physical limitations.

Post Operation Care :Patients to take it easy the day of the procedure. You may need to apply ice to the affected area for 20-30 minutes at a time for the next 48 hours. Your doctor will provide specific activity restrictions if indicated. Typically driving, lifting, bending/twisting at the waist are restricted in the first few weeks. Formal physical therapy may begin at 2 weeks post-procedure.

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Side Effect & Other : RiskGenerally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is discomfort, which is temporary. Sometimes, the access needle brushes past a nerve root and the nerve root is irritated. This pain gets better quickly. Other risks include infection, bleeding, and worsening of symptoms. Fortunately, because the procedure is performed with x-ray in a controlled environment, serious side effects and complications are rare.

IntraDiscal Electrothermal Therapy or IDET :

Is also called Intradiscal Electrothermal Annuloplasty (IDEA). The procedure is minimmallly invasive and usually done under local anesthetic. This surgery is generally recommended for patients with contained disc herniations. The procedure is not recommended for ruptured discs.

Procedure : Intradiscal thermocoagulation (IDET) is a technique that uses heat to destroy part of the nucleus and inner annulus of the disc. This can decrease the size of the nucleus, which allows for the nuclear material that has leaked to re-form in the center of the disc. This decreases an individual’s pain. It also destroys pain sensitive receptors in the fibrous annulus, thereby reducing pain in the back. Figure 16 shows a cartoon of an IDET heating coil inThis drawing the IDET heating coil within the nucleus of the intervertebral disc, placed through a needle under fluoroscopic guidance. The red depicts a burn or thermal lesion

Risk & Side Effect : The possible risks of the IDET procedure include infection of the disc, epidural infection, or burn of the nerve root, which can result in weakness or paralysis of the legs as a result. In general, however, this procedure is safe and these complications are very rare.

Recovery From IDET :

The patient is advised to avoid sitting and only have restricted physical activity for a period of about 6 to 8 weeks. The patient can expect full healing in about 4 months on average. The procedure is not always permanent, as the disc can degenerate, herniate again, or rupture, requiring additional treatment. the nucleus of the disc that was placed there through a needle under fluoroscopic guidance.

Ozonucleolysis Or Ozone Discetomy People suffering from spinal injuries like low back pain and disc disorder now have a reason to smile as injections of ozone gas could bring better results than conventional surgery.

Ozonucleolysis or Ozone Discectomy for curing spinal injury is a better option than surgery. This new form of treatment is less painful as well as cost effective.Ozonucleolysis has emerged as an affordable, least invasive approach and costs two-thirds the price of a conventional surgery.In case of surgery, the chance of recurrence of pain is nearly 15 percent as against less than three percent in ozone treatment. In the new treatment, patients don’t have to stay in the hospital for a week. Only six sittings of one hour each spread over three weeks can cure the problem.

Ozone Discectomy is the injection of ozone inside the affected intervertebral disc. When injected, Ozone (O3) breaks down into O2 and O (single oxygen) and rapidly dissolves in the water in the disc.As per the new technique, ozone is injected in the spine with 22G needle under the fluoroscopic guidance, with 4ml of a mixture of ozone and oxygen at a concentration of 30 micrograms per millilitre. It causes shrinkage of the disc, thus reducing its volume and lessening pressure on the nerves. The treatment relieves pain substantially and, after two sittings, people can go back to work under medical guidance.

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