Spine Diseases:Current Trends in Management

1. 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

2. 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

3. Basic Spinal anatomy

4. Prolapsed disc Bulge Prolapse Extruded

5. Disc Disease • Back Pain • Radicular pain • Claudications • Cauda Equina Syndrome

8. Facet Joint Hypertrophy

9. Canal Stenosis • Initial leg pain • Pain both legs-on walking—on rest • Severe back pain • Numbness both legs • Neurological deficits

10. Conservative Management • Rest • Analgesics • Muscle Relaxants • Spinal flexion exercises • Lumbar support ???? • IFT—good in elderly • Local heat—SWD, TENS

11. 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

12. Treatment options available with ‘Spinal Surgeon’

13. Epidural steroids • Severe leg pain due to degenerative disc disease, spinal stenosis, and post-laminectomy syndrome • 70% of patients may get relief

14. Selective nerve root block • More effective for disc herniations. • Can identify the cause of root pain • Inject steroids or hyaluronidase—chemical neurolysis

15. 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

16. Facet Joint Injections

17. Surgical Interventions

18. Selective endoscopic discectomies

19. Intra-discal Electrothermal Therapy(IDET Annuplasty) • Catheter introduced • Annulus heated with a probe to burn the nerve endings • Only for pure discogenic backpain

20. Nucleoplasty • Needle introduced into the disc • Radiofrequency heat ablation of the disc • Wand causing the radio-ablation costly • Only for contained disc bulges

21. Gold StandardMicro-discectomy

24. Surgery for Spinal Stenosis • Micro-decompression • Transforaminal Lumabar Interbody Fusion

25. Micro-decomprssion

26. Transformainal Interbody Fusion

27. Keyhole TLIF

28. Dorsal Scoliosis

29. Post Operative

31. Lumbar Scoliosis

32. Tuberculosis

33. Pars Defect

35. Complex Spinal Deformity

36. Navigation

37. Robotics