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MBBS, MS(Gen Surg), Dip Ortho, MCh (Ortho)<br>PDF(Trauma Surgery)<br><br>#Fellowship in Keyhole Spine Surgery-Singapore<br>#Fellowship in Motion Preserving Surgery-Germany<br>#Fellowship in Spinal Deformity Correction Surgery-Korea<br>http://www.shishirspine.com/<br>
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Spine Diseases:Current Trends in Management MBBS, MS(Gen Surg), Dip Ortho, MCh (Ortho) PDF(Trauma Surgery) Fellowship in Keyhole Spine Surgery-Singapore Fellowship in Motion Preserving Surgery-Germany Fellowship in Spinal Deformity Correction Surgery-Korea
Degenerative Spine disease • Age related process • Starts affecting all beyond 30 years of age • It is as certain as ‘Death’ and ‘Taxes’ • Not all become symptomatic • Great dichotomy between MRI and clinical findings
Prolapsed disc Bulge Prolapse Extruded
Disc Disease • Back Pain • Radicular pain • Claudications • Cauda Equina Syndrome
Canal Stenosis • Initial leg pain • Pain both legs-on walking—on rest • Severe back pain • Numbness both legs • Neurological deficits
Conservative Management • Rest • Analgesics • Muscle Relaxants • Spinal flexion exercises • Lumbar support ???? • IFT—good in elderly • Local heat—SWD, TENS
Which patients to ref to ‘Spine Surgeon’? • Acute onset radicular pain • Long standing radicular pain ---no response to treatment • Radicular pain with neuro deficit • Any bowel bladder involvement • Neurogenic claudications • Backache with deformity • Any spinal deformity
Epidural steroids • Severe leg pain due to degenerative disc disease, spinal stenosis, and post-laminectomy syndrome • 70% of patients may get relief
Selective nerve root block • More effective for disc herniations. • Can identify the cause of root pain • Inject steroids or hyaluronidase—chemical neurolysis
Dr(Lt Col) Shishir Kumar MBBS, MS(Gen Surg), Dip Ortho, MCh (Ortho) PDF(Trauma Surgery) Fellowship in Keyhole Spine Surgery-Singapore Fellowship in Motion Preserving Surgery-Germany Fellowship in Spinal Deformity Correction Surgery-Korea
Intra-discal Electrothermal Therapy(IDET Annuplasty) • Catheter introduced • Annulus heated with a probe to burn the nerve endings • Only for pure discogenic backpain
Nucleoplasty • Needle introduced into the disc • Radiofrequency heat ablation of the disc • Wand causing the radio-ablation costly • Only for contained disc bulges
Surgery for Spinal Stenosis • Micro-decompression • Transforaminal Lumabar Interbody Fusion