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MINIMAL ACCESS SURGERY LUMBAR SPINE

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,

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MINIMAL ACCESS SURGERY LUMBAR SPINE

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  1. MINIMAL ACCESS SURGERY LUMBAR SPINE DR. PARTHA P BISHNU MCh Neurosurgeon

  2. BACK PAIN Survey • 75 to 85 percent of all people will experience some form of back pain during their lifetime. Back pain is: • the secondmost frequently reported reason for visiting a doctor, • the fifth most frequent cause of hospitalization and • the third most frequent reason for surgery.

  3. Spinal or Radicular pain + Neurological deficit • Pain associated with recumbency and night • Mechanical pain • Pain associated with fever & weight loss • Pain associated with morning stiffness Degenerative spinal disorder • Acute localized pain Neoplastic process Axial skeletal infection Axial skeletal Inflammatory disorder Axial skeletal fracture/ dislocation

  4. 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

  5. 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%)

  6. ASSESMENT OF DEGREE OF PAIN IN LOW BACK PATIENTS QUADRUPLE VISUAL ANALOGUE SCALE 0 to 10

  7. LOW BACK PAIN Chronic Recurrent Problem PSYCHOLOGICAL EVALUATION

  8. ODI BEFORE SURGERY RANGED FROM 44% TO 96%

  9. MINIMAL ACCESS SURGERY LUMBAR SPINE • MICRODISCOIDECTOMY • MICROSURGICAL DECOMPRESSION OF LATERAL RECESS STENOSIS • BILATERAL FENESTRATION FOR CANAL STENOSIS LAMINECTOMY ×-no longer done

  10. 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

  11. ODI PRE OP AND FOLLOW UP • CHANGE IN THE ODI SCORE • OVER TIME • ALL PATIENTS’ DISABILITY IMPROVED SIGNIFICANTLY • No new neurological deficits • No complications

  12. Low Back Pain Disc Prolapse Four Indications for Surgery • Intractable Pain- Radicular > Back • Progressively worsening Neurological Deficit • Recurrence of Pain • CaudaEquina Syndrome MRI SCAN CORRELATES WITH THE NEUROLOGICAL SYMPTOMS AND SIGNS

  13. MINIMAL ACCESS LUMBAR SPINE SURGERY DISCUSSION FACTORS AFFECTING RESULTS OF SURGERY • CASE SELECTION- CLINICAL FEATURES • MRI CORRELATION • MICROSURGICAL/MINIMAL ACCESS TECHNIQUES • POST OPERATIVE REHABILITATION • PSYCHOLOGICAL ASSESMENT

  14. 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 %

  15. 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

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