Minimally Invasive Spine Tumor Removal Surgery in India

Spine Tumor Removal Surgery

Spinal tumor, most back pain is associated with stress, strain and aging — not with a tumor. In most areas of your body, noncancerous tumors aren't particularly worrisome. That's not necessarily the case with your spinal cord, where a spinal tumor or a growth of any kind can impinge on your nerves, leading to pain, neurological problems and sometimes paralysis. A spinal tumor, whether cancerous or not, can threaten life and cause permanent disability. Yet advances in spinal tumor treatment offer more options than ever before.

Although back pain is the most common indication of a spinal tumor, most back pain is associated with stress, strain and aging — not with a tumor. In most areas of your body, noncancerous tumors aren't particularly worrisome. That's not necessarily the case with your spinal cord, where a spinal tumor or a growth of any kind can impinge on your nerves, leading to pain, neurological problems and sometimes paralysis. A spinal tumor, whether cancerous or not, can threaten life and cause permanent disability. Yet advances in spinal tumor treatment offer more options than ever before.

Following are different types of Spinal tumors based on their cancerous or non-cancerous behavior.

Benign bone tumors are of following types:

• Giant Cell Tumor: Usually found in the sacrum

• Hemangioma: Usually found in the thoracic spine

• Osteoid Osteoma: Usually found to affect the lumbar spine's posterior spinal column

• Osteoblastoma: Usually found to affect the spine's posterior spinal column Malignant bone tumors are classified as follows:

• Chordoma: Affects the sacrum and coccyx in the midline

• Osteosarcoma: affect the anterior vertebral body and it may also invade the Posterior spinal elements.

Malignant cartilage tumor:

• Chondrosarcoma; Found primarily in the thoracic, lumbar, and sacral spine

Malignant plasma cell tumors:

• Plasmacytoma is cancer of the white blood cells (plasma cells) which effects the thoracic spine and may also involve the spinal cord ot the nerve roots.

• Lymphomas are cancer of the body's lymphatic system that may spread to the spine .Usually the anterior part (front) of the spinal column is affected

• Ewing's Sarcoma: It affects the Sacrum or the nerves.

What are the Symptoms of Spinal Tumor?

There is a rapid increase in technology that allows the MIS physician to treat patients with minimally invasive spine surgery procedures. Some of these techniques are now well established, while others remain new and continue to evolve. The best MIS (Minimally Invasive Spine Surgery) technique will depend on the specific character of the problem. While the list of MIS (Minimally Invasive Spine Surgery) techniques continues to expand, the most commonly employed today include:

• Minimally Invasive Tubular Microdiscetomy

• Minimally Invasive Lumbar Laminectomy

• Cervical laminoforaminotomy

• Endoscopic Discectomy

• Minimally Invasive Transforaminal Interbody Lumbar Fusion (TILF)

• Minimally Invasive eXtreme Lateral Interbody Fusion (XLIF)

• Microsurgical Discectomy

• Posterior Lumbar Interbody Fusion (PLIF)

• Kyphoplasty

• Nucleoplasty or Percutaneous Discectomy

Comparing Minimal type of Invasive pine surgery to Invasive Spine Surgery:

Tumor may cause generalized symptoms in the body (like persistent low energy levels, unexplainable weight loss, lump formation, enlargement of lymph nodes, malaise, irregularities of menstruation in females etc) as well as symptoms pertaining to the affected organ in the body. In case of spinal tumor the patient may present with any of the following

• Back pain, often radiating to other parts of the body and worse at night

• Loss of sensation or muscle weakness, especially in the legs

• Difficulty walking, sometimes leading to falls

• Paralysis may occur in varying degrees and in different parts of the body, depending on which nerves are compressed.

• Scoliosis or other spinal deformity resulting from a large, but non cancerous tumor

• Erosion and Destruction of vertebral body

Objective of Spinal Tumor Surgery

The primary objective of the surgery is to reduce the pain caused by the spinal tumor, to restore and preserve neurological function and provide spinal stability. Spinal Tumor surgery is generally indicated in case there is a localized tumor which can be removed with minimum damage to nerve and spinal cord, or there is persistent neurological deficit and pain which is unresponsive to non operative treatment, or there is vertebral bone destruction affecting spinal stability. Surgery may include resection (partial removal) or excision (complete removal) of tumor. When the tumor is removed (partially or completely) pain and neurologic problems may clear up.

Minimally Invasive Spinal Tumor Removal Surgery at World's Best Spine Surgery Hospitals in India

Depending on the type of spinal tumor and its location, surgery may include one or more of the following procedures: -

Decompression : - Remove the tumor, bone, and other tissues compressing the spinal cord and or spinal nerve roots.

Spinal Stabilization : - Your spine can become unstable after part of the bone or other tissues (e.g., intervertebral discs) are taken out. An unstable spine can move in abnormal ways, putting you more at risk for serious neurological injury. In this case, the surgeon will want to stabilize your spine by using instrumentation and fusion.

In spine stabilization by fusion, the surgeon creates an environment where the bones in your spine will fuse together over time (usually over several months or longer). The surgeon uses a bone graft (usually using bone from your own body, but it's possible to use donor bone as well) or a biological substance (which will stimulate bone growth). Your surgeon may use spinal instrumentation-wires, cables, screws, rods, and plates-to increase stability as the bones fuse. The fusion will stop movement between the vertebrae, providing long-term stability.

Combination : - You may need to have both a decompression and spinal stabilization. Decompression and stabilization spine surgeries may be performed as a minimally invasive procedure or by using a more traditional open approach (longer incision, longer recovery time).

Kyphoplasty or Vertebroplasty : - These are similar minimally invasive surgical procedures performed to stabilize a fractured vertebra. Spinal tumors that invade vertebrae may cause it to break and can cause severe pain.

Kyphoplasty uses a special orthopaedic balloon. It's inserted into the fractured vertebra. Then, the balloon is inflated in an effort to return the vertebra to the correct height and position. The balloon creates a void-a hole-in your vertebra, and it's then removed. The void is filled in with a surgical cement that should support the vertebra and keep it from fracturing again.

Vertebroplasty does not use a balloon, but it does involve injecting surgical cement into the vertebral body. Both procedures provide immediate fracture stabilization.

Why surgery for Spine Tumor Removal?

• When the tumor is removed (partially or completely) pain and neurologic problems may clear up.

• To restore and preserve neurological function and provide spinal stability.

• Spinal Tumor surgery is generally indicated in case there is a localized tumor which can be removed with minimum damage to nerve and spinal cord,

• There is persistent neurological deficit and pain which is unresponsive to non operative treatment

• Surgery may include resection (partial removal) or excision (complete removal) of tumor.

Recovery post Spinal Tumor Surgery

Recovery post Spinal Tumor surgery depends on patient’s health before surgery. The patient’s care is monitored by periodical office visits and re-evaluation by the treating physician. This is important because some tumors, benign or malignant, may reoccur. Usually when the treatment period has ended, the symptoms clear up.

Analgesics are given to control post-operative pain and cancer pain. Cancer pain may be difficult to control (e.g. ‘break through pain’). A pain management specialist may provide assistance if conventional drugs (e.g. pill, skin patch) do not provide relief. Any surgery, radiation treatment or chemotherapy can drain the patient nutritionally. Therefore, a proper diet is important to regain strength, lost weight, and a measure of health. A professional nutritionist can provide guidance. Depending on the extent of the surgery and the patient’s medical status, a course of physical therapy may be prescribed. Through exercise and modalities the patient can build strength, endurance and flexibility.

Percutaneous Endoscopic Lumbar Discectomy (PELD) Surgery for Slipped Disc, Disc Herniation and Chronic Lower Back pain at World Best Hospital in India

Percutaneous Endoscopic Lumbar Discectomy (PELD)

Surgery in India Percutaneous Endoscopic Lumbar Discectomy (PELD) is quite a unique approach which is quickly getting popular amongst patients and surgeons in the treatment of nonsequestrated disc herniation (disc prolapse) as it reduces the post operative hospitalization and recovery time.

PELD or Percutaneous Endoscopic Lumbar Discectomy is an advanced minimally invasive spine surgery done for the decompression of the lumbar disc space and removal of nucleus pulposus via a posterolateral approach. PELD is also a good treatment option in management of spinal tumors and structural deformities also in patients whose pain threshold is low or who are not responding well to conservative treatments like pain killers, anti inflammatory drugs and rehabilitation.

Candidates for Percutaneous Endoscopic Lumbar Discectomy

Individuals suffering from chronic low back pain and disability may benefit from a PELD procedure. It is often used to treat patients suffering from degenerated discs, bulging discs or herniated discs that compress upon the surrounding structures within the spinal canal causing nerve compression, sciatica and low back pain. It can also be used if the patient fails to respond to conventional management therapies including direct injection therapies for three months or more. The surgery is also found to be successful in resection of spinal tumors, fusion and structural deformities of the spinal cord.

How is a PELD procedure performed?

Percutaneous Endoscopic Lumbar Discectomy is a minimally invasive day care procedure which is performed under local anaesthesia and mild sedation. The patient is made to lie on his front on the operation table and through an image intensifier X-ray system the entry point on patient’s body is mapped. There are two ways by which inter-vertebral disc is removed which could be manual or using laser.

A manual procedure, also known as automated percutaneous discectomy, entails inserting a long spinal needle from side of back directly into the disc bypassing other bone and ligament structures. A guide wire is made to pass through the spinal needle and after making an incision of 5 mm an endoscope is inserted. To the endoscope is attached a camera and monitor which provide visual help in removing the prolapsed part of disc.

The laser surgery or percutaneous laser discectomy uses an external imager or fluoroscope to direct the probe. Through this probe laser energy is passed which vaporizes a part of inter-vertebral disc material which helps in decompression of the nerve root. Holmium yttrium- aluminum-garnet (Ho:YAG) laser is the most frequently used laser for this treatment. Following the procedure, the wound is closed and single stitched. With this procedure the pain relief is immediate and the patient can soon resume work.

Advantaages of PELD (Percutaneous Endoscopic Lumbar Discectomy)

• Surgery done under local anesthesia with conscious sedation

• Very good technique for old and medically compromised patients.

• No muscle, ligament or normal tissue damage

• It saves the time and the costs. 75% of the patients discharged on the same.

• Due to rapid recovery, comparing to open surgeries, it is recommendable for the workers or students with the desire of early return-to-work.

• Even prolapsed, migrated, extra-foraminal, recurrent discs can be removed.

• Very good technique for old and medically compromised patients.

• Even prolapsed, migrated, extra-foraminal, recurrent discs can be removed.

How much does Percutaneous Endoscopic Lumbar Discectomy cost?

Our world class spine hospitals in India are fully equipped with state of art diagnostic centres with advanced Digital X-ray, MRI and CT scan facilities and fully-equipped operating room with specialized equipment like endoscope and laser, to undertake such specialized procedures. The surgery is performed by experienced orthopedicians or neurosurgeons, who have specialized in spine surgeries and who have undergone specialized training in the world’s best spine surgery hospitals in USA, UK and Australia. Our hospitals also provide excellent patient care at extremely affordable costs which is just around 20-30% of the surgery cost in countries like US.

Most Advanced Minimally Invasive Spinal Fusion Surgery in India

Minimally Invasive Spinal Fusion Surgery at India Best Spine Surgery Hospital in India

A person’s spine is subjected to a lot of forces throughout its lifetime. It may be subjected to age related wear and tear or infections like tuberculosis. As a result it undergoes degeneration which gives rise to a variety of problems like spinal osteoarthritis, disc prolapse, spondylolisthesis, osteoporotic fractures, vertebral collapse etc. All these conditions manifest as severe pain in the back and radiating pain, numbness, tingling in the upper or lower extremities (lower leg or arm) due to compression of spinal nerves, spinal cord and spinal instability. When these symptoms become debilitating enough to preclude the patient’s day to day activity, a Spinal Fusion Surgery is advised.

What is Spinal Fusion Surgery?

Spinal fusion (spondylodesis or spondylosyndesis) is the surgical method of joining two or more verebrae. It is done most commonly in the lumbar region of the spine, but it is also used to treat cervical and thoracic problems. In this procedure, the damaged and painful vertebrae are fused into a solid stable bone. Fusion of the spine is used primarily to eliminate the pain caused by abnormal motion of the vertebrae by immobilizing the faulty vertebrae themselves, which is usually caused by degenerative conditions. However, spinal fusion is also the preferred way to treat most spinal deformities, specifically scoliosis and kyphosis. But, the results may vary according to the individual. Some may not feel any improvement in their back pain even after the surgery.

When is Fusion Recommended

• Fracture

• Tumor

• Infection

• Spondylolisthesis

• Degenerative disc disease

• Scoliosis

• Spinal Stenosis

Types of Spinal Fusion Surgery

Lumbar spinal fusion can be divided into two categories|

• Posterolateral Fusion : In the back of the spine, the bone graft is placed in amid the transverse processes. With the help of wires and screws, the vertebrae is carefully fixed throughout the particles of every vertebrae. A rod is made up of metal which is attached on the side of vertebrae.

• Interbody Fusion : In this, the graft of the bone is placed in between the vertebrae and the area is generally engaged by the intervertebral disc. The disc is entirely removed in preparing for the spinal fusion. In order to maintain the disc height and spine alignment, a device can be placed in between the vertebrae. This device (intervertebral device) can either be prepared from titanium or plastic.

Then the fusion starts in between the vertebrae’s endplates. Interbody fusion is of 3 types-

o Posterior Lumbar Interbody Fusion (PLIF)

o Transforaminal Lumbar Interbody Fusion (TLIF)

o Anterior Lumbar Interbody Fusion (ALIF)

o Transpsoas Interbody Fusion (XLIF or DLIF)

Posterior Lumbar Interbody Fusion (PLIF)

In Posterior lumbar interbody fusion, the spinal fusion is achieved through a surgical incision made on the posterior (back) aspect of spine. It aims at fusion of two adjacent vertebrae in cases of spinal instability and associated back pain. It is a popular procedure as it gives excellent results. The procedure provides almost complete relief of symptoms in 90-95% of the cases and the patients are able to return to their daily activities within a few weeks. The patients can also return to most of their recreational activities.

Procedure for Posterior Lumbar Interbody Fusion (PLIF)

PLIF surgery aims at achieving spinal stability through bony fusion by two ways:

The Open PLIF is the traditional technique which is performed using general anesthesia. The patient is made to lie down on his front side on the table with the low back exposed. A 3-6 inch long incision is made on the skin overlying the affected vertebrae. The skin and the fascia are cut open. The underlying muscles are retracted and the affected vertebrae are identified. Fluoroscopic X-ray is used to confirm the exact location of the affected vertebrae. Then a complete laminectomy (removal of the lamina of the vertebrae) followed by bilateral foraminotomy (enlargement of the foramen by removing the bony spurs) and/or discectomy (removal of offending disc) are performed.

This relieves the compression off the spinal nerves, allowing them to come to their normal size and shape. The area is checked for any remaining bony outgrowth or disc fragments that may compress the nerves. Autogenic bone grafts or Metal or plastic implants are fitted in the empty disc space for initiating bone growth.

Minimally Invasive Posterior Lumbar Interbody Fusion (PLIF) in India

The other method is the Minimally Invasive PLIF procedure which is performed using x-ray guidance. 2.5-cm incisions are made on either side of the lower back The muscles are gradually dilated and tubular retractors inserted to allow access to the affected area of the lumbar spine. The lamina is removed to allow visualization of the nerve roots. The offending disc material is removed from the spine and replaced with a bone graft and structural support from a cage made of bone, titanium, carbon-fiber, or a polymer, followed by placement of rod and screws. The tubular retractors are removed, allowing the dilated muscles to come back together, and the incisions are closed.

This procedure typically takes about 3 to 3 ½ hours to perform. There was less blood loss,tissue trauma, operative time, and quick recovery in this procedure as compared to the traditional one.Generally the patients can go home within 3-5 days after traditional PLIF and within 1-2 days after a minimally invasive PLIF

What are the Advantages of Spinal Fusion Surgery?

In most cases, spinal fusion can eliminate the pain and other symptoms. It is important for a surgeon to explain the options, and benefits of spinal fusion surgery. There are many advantages of Spinal fusion surgery such as:

• By fusing the level, there is less concern that the patient will need surgery again at that level. If the discs and/or facets are pain generators, as is often the case, a fusion will ensure that motion at the level is stopped, potentially eliminating the low back pain.

• A second advantage of spinal fusion surgery is that it reduces post-decompressive deformity. Some patients develop post-laminectomy kyphosis, which is an abnormal alignment of the spine. This too can often lead to additional surgery. Similarly, a fusion can correct any deformity the patient had before surgery and ensure that the normal alignment of the spine is restored. This may reduce wear and tear (and need for future surgery) on the neighboring levels.