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Microdiscectomy

A microdiscectomy is generally considered as the gold standard for removing the herniated portion of a disc that is pressing on a nerve, as the procedure has a long history and many spine surgeons have extensive expertise in this approach. This approach is a workhorse for spinal deformity correction surgery in conditions like scoliosis,kyphosisand spinal reconstructions

Most of the patients with Lumbar disc herniation can be treated with non-operative treatments like rest, pain medications, pain blocks and physiotherapy. Some patients require surgery to remove the herniated disc and free the compressed nerve roots. Microdiscectomy (Microscope assisted discectomy), is also called a microdecompression is usually more effective for relieving leg pain than back pain. Leg pain is also known as radiculopathy, or sciatica. In case of leg pain patient normally gets pain relief immediately after the procedure. While for the syptoms such as numbness, weakness, or other neurological symptoms in the leg and foot, it may take weeks or months for the nerve root to heal completely and to subside numbness or weakness.

Anterior Lumbar Interbody Fusion (ALIF)

When fusion surgery is needed for the lower lumbar spine especially at L4-5 and L5-S1 level, it is best done through the anterior approach. In this surgery, the incision is on the belly and a bloodless tissue plane is developed to reach the lumbar spine. In this procedure surgeon chooses the access to lumber spine from the front (ALIF).

ALIF surgery can restore normal spine alignment and lumbar lordosis. This procedure is minimally invasive and does not damage any muscles or structures of the spine. It achieves indirect nerve decompression without even touching the nerves (extremely useful in revision or second-time spine surgery wherein the nerves are already scarred.)

In order to prevent nerve damage, electromyography or EMG is used for nerve monitoring, which provides surgeons the information about the the postion of nervs and surgical instruments durign the surgery.

Oblique Lumbar Interbody Fusion (OLIF)

Due to modern lifestyle lower back pain is a common problem of health. Traditional treatment of interbody fusion is an invasive procedure that requires the peeling of muscles and soft tissue causing surgical morbidity. OLIF is a minimally invasive technique of Lumbar fusion. Surgery is done through very small incisions on the side of the belly. In a single operative position, the surgeon can access disc spaces from L2 to S1. This is a useful approach in cases of adult spinal deformity surgery. In this procedure surgeon chooses the access to lumber spine from the front, at an angle (OLIF).

In order to prevent nerve damage, electromyography or EMG is used for nerve monitoring, which provides surgeons the information about the the postion of nervs and surgical instruments durign the surgery.

Lateral Lumbar Interbody Fusion (XLIF)

XLIF surgery is a surgical treatment of adult degenerative scoliosis (DS). It is a complex multilevel surgery by traditional approach. It can become more complex since the patients may have serveral comorbitities with age. Hence, It is important to take safety measures. It is done through a small incision on the side of the belly. In this procedure surgeon chooses the access to lumber spine directly from the side (XLIF).

It is another minimally invasive lumbar fusion technique. L2-3 and L3-4 are the lumbar levels most easily accessed by this technique, which is close to nerves on the spinal column. In order to prevent nerve damage, electromyography or EMG is used for nerve monitoring, which provides surgeons the information about the the postion of nervs and surgical instruments durign the surgery.

Transforaminal Lumbar Interbody Fusion (TLIF)

Lumbar Fusion can also be done through an incision on the back. Space between the two vertebrae is cleared through a channel created to remove the disc material. Bone graft and cage are inserted to achieve solid fusion. This is supported by Pedicle screw instrumentation. In this procedure surgeon chooses the access to lumber spine from the back (TLIF).

Though TLIF is a good technique for lumbar fusion, it involves more muscle dissection as compared to the ALIF and OLIF technique and it is difficult to restore the normal lumbar lordosis and spine alignment through this approach.

Anterior Cervical Discectomy/ Corpectomy and Fusion

Lumbar Fusion can also be done through an incision on the back. Space between the two vertebrae is cleared through a channel created to remove the disc material. Bone graft and cage are inserted to achieve solid fusion. This is supported by Pedicle screw instrumentation. In this procedure surgeon chooses the access to lumber spine from the back (TLIF).

Though TLIF is a good technique for lumbar fusion, it involves more muscle dissection as compared to the ALIF and OLIF technique and it is difficult to restore the normal lumbar lordosis and spine alignment through this approach.

Posterior Cervical Foraminotomy

This procedure is a minimally invasive, designed to enlarge to space through which the nerve root exits from the spinal cord and simultaneously try to remove any piece of disc which is pushing on the nerve. The procedure is suitable which avoids limitations of other disc operations and gives excellent outcome in terms of pain relief in a minimally invasive manner.

In some cases, only foraminotomy can ease the symptoms without discectomy. In these case the whole disc is not removed, just the fragment that presses the nerve root, only that portions is removed. Fusion is not required and patients may not even neck collar after the surgery.

Cervical Laminoplasty

This is a surgical procedure to widen the space available for the cervical spinal cord. It is a useful procedure for patients with compressive cervical myelopathy wherein the spinal cord gets squeezed due to the degenerative changes in the cervical spine.

This procedure involves the use of plates and screws to widen the space for the spinal cord. Lamina is section of bone that cause a roof over the spinal canal. In the procedure, a hinge is created on one side of the lamina, and the other side is wedged to open by a small metallic plate or a bone strut.

Posterior Cervical Instrumentation and Fusion

The procedure Posterior Cervical Instrumentation and Fusion which uses spinal fusion technique may be recommended when the spine is unstable or the natural disc space has decreased. The technique is used for stabilizing the spinal bones or vertebrae. The goal of lumbar fusion is to create a firm bridge of bone between two or more vertebrae. In such cases the cervical spine needs to be fixed with screws, rods and bone graft to achieve fusion. This can be done with a wide variety of implants like Lateral Mass Screws, Pedicle screws, Translaminar screws, Occipito-Cervical Plate.

The use of individual implants depends on the disease-specific condition of the patient Cervical Laminoplasty and Lateral Mass Fusion. This is the best surgery for posterior cervical fusion and decompression. The goal of this procedure is to decrease pain, correct spinal deformity and improve stability.

Posterior Spinal Fusion

This surgery involves pedicle screw instrumentation through incision at the back. Bone graft is used to achieve spinal fusion. Depending on the goal of the surgery, series of deformity correction manoeuvres or spinal osteotomes can be done through this approach.

This approach is a work horse for spinal deformity correction surgery in conditions like scoliosis, kyphosis and spinal reconstructions

Minimally invasive SI joint fusion

This surgery is done in selective patients with Sacroiliac joint dysfunction and pain. The procedure involves decortication and putting 2 large screws across the SI joint and achieving a fusion of the joint. All this is done through a 3 cm incision on the buttock area with minimal blood loss. In properly selected patients, this technique can yield gratifying results.

Thes procedure Minimally Invasive SI Joint Fusion is a surgical procedure performed under general or spinal anesthesia. A minimally invasive surgical (MIS) procedure, requires a small incision of the size about one to two inches long, along the side of the buttock.