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Overview

Discectomy: Procedure, Recovery, Cost, Risk & Complication

Discectomy refers to a surgical procedure that involves the removal of a damaged part of a herniated disk (also known as ruptured, slipped, bulging disk or disk prolapse) in the spine. A herniated disk is a condition where a portion of the soft material present in the disk pushes out from a crack in the tough exterior. The herniated disk may cause irritation or compression of the nerves located nearby, resulting in numbness, weakness and pain. These symptoms may affect the neck or the back and even radiate down to the arms and legs.

A doctor generally suggests discectomy to a patient if the symptoms have gradually worsened or the non-surgical treatments have not been effective. Though there are several ways for performing a discectomy, surgeons prefer minimally invasive discectomy, where small incisions are made and a small video camera is used for viewing purpose.

Indication

A patient may be recommended to undergo discectomy in the following circumstances:

  • If one has trouble in standing or walking due to a nerve weakness
  • When other conservative treatments such as physical therapy or medication does not bring any improvement in your condition
  • A disk fragment is lodged in the spinal canal, pressing on to a particular nerve
  • Extensive pain in the legs, arms, buttocks or chest that becomes difficult to tolerate

Pre Procedure

It is important to follow the following pre-procedure instructions before undergoing a discectomy:

  • There may be a few tests like an x-ray or EKG that you need to undergo before the surgery
  • Stop smoking a few days before the surgery. Non-smokers are found to have lesser bleeding problems compared to smokers during a surgery
  • Inform your doctor about the medications, supplements and vitamins that you take. You may have to stop taking medicines like aspirin, blood thinners and anti-inflammatory medicines for a few days before the surgery.
  • You may have to stop drinking and eating anything for a few hours prior to the surgery. Your doctor will provide you with proper instructions. Ensure that you follow them correctly. If you have to take any medicine during that time, take it with very sips of water.

During Procedure

The surgery is performed by administering the patient with general anaesthesia. It can be done by one of the following methods or a combination of both:

  • Sacral: The physician inserts an endoscopic fiber-optic scope through the help of a tiny incision into the sacrum, which is a natural opening at the base of your spine. With the help of direct visualization, the doctor examines the insides of the spinal canal and disc for identifying any ruptures, tears, bulges or other abnormalities. The damaged disc is then shrinked with the help of laser.
  • Posterior lateral: The surgeon inserts a hollow needle through the back side of the lateral spine, directly into your disc tissue. A laser is then passed from into the disc through the needle for shrinking the bulging or herniated disc. Fluoroscopy is used for watching and guiding the progress of the whole procedure.

Post Procedure

After the surgery has been successfully completed, you will be shifted to a general bed where the doctors will monitor you and look for any complications related to the surgery or anaesthesia. You can go home the same day, or you may to stay in the hospital for a few days if you had a pre-existing health condition.

You can get back to work in 4-6 weeks after the surgery. In case your profession involves lifting heavy objects or operating heavy machinery, you may have to wait for 8 weeks before you resume working. Limit activities that involve bending, lifting or stooping for 3-4 weeks after the surgery. Also, avoid sitting down for long hours during this time.

Ensure to take your medications in time. A physical therapist will be able to teach you exercise for improving the flexibility and strength of your muscles around the spine.

Risk & Complication

Discectomy is generally considered to be a safe procedure. However, as with every surgery, there may be some risks that are associated with it. These complications also depend on your age, your general health condition, and how your body reacts to the surgery and the medications. Some of the complications that may occur are:

  • Bleeding from the incision site
  • Infection at the incision site
  • Leaking of the spinal fluid
  • Build-up of fluid in the lungs, leading to pneumonia
  • Injury to the nerves or blood vessels in and around the spine while performing the surgery
  • Injury in the protective layer that surrounds the spine
  • Persistent pain even after the surgery

More Info

A discectomy reduces the symptoms of a herniated disc, but it does not cure the reason why the disc was actually herniated. To avoid injuring your spine once again, your doctor may recommend losing weight, go for low-impact exercises, and limit activities that involve repetitive or extensive twisting, bending or lifting. You can assume your normal diet, from the time you get back home. Fruits, vegetables and extra fluids must be added to avoid constipation.

Attending follow-up session with your doctor is important after undergoing a discectomy. You may also have to undergo an x-ray so that your doctor can analyse your progress.

The cost of discectomy would be approximately Rs. 2,25,000 – Rs. 2,75,000.

Popular Health Tips

Sciatica - When Do You Have To Go For Surgery?

Dr. Dhruv Chaturvedi 88% (10 ratings)
MCh - Neurosurgery, MS-General Surgery, MBBS
Neurosurgeon, Delhi
Sciatica - When Do You Have To Go For Surgery?
Sciatica pain can be mild to intense. Many with lumbar herniated disc and sciatica often wonder whether or not they require a surgery. Needless to say, it is never an easy decision. But the good news is that micro discectomy surgery has a higher rate of success when it comes to relieving sciatica pain. When compared to many other options, this one is relatively minimally invasive. It doesn t alter the structure of the spine permanently since it works by removing a small portion of the disc, which has herniated or extruded out of the disc. When your sciatica pain stems from lumbar disc herniation, a small open surgery with the help of magnification is the prevalently opted surgical approach. On the other hand, a laminectomy is done when the bone or disc pinching the nerve root is required to be removed. When should you consider undergoing surgery for sciatica? Typically, neurosurgeons recommend considering surgery for sciatica in a host of situations which include the following: Severe pain in the leg lingering for more than six weeks, which mainly affects one side of the leg or buttock Intense pain in the low back and buttock, which continues through the course of the sciatic nerve andextends to the lower leg and even foot. This pain can be described as sharp and searing rather than a dull thud. When pain has not alleviated even after non-surgical treatments that may include non-steroidal anti-inflammatory drugs (NSAIDs),oral steroids, injections, manual manipulations, and physical therapy When the patient is not able to take part in the day to day activities due to intense lower back pain and the symptoms tend to become severe during movements like sneeze and cough. When the symptoms are continuing to worsen, thereby indicating nerve damage, particularly when the progressive signs have their root in neurological issues It is important to note here that surgical intervention may only be needed when the patient experiences progressive weakness in the lower portion of the body or sudden loss of bladder or bowel movement, which may stem from cauda equina syndrome. Two surgeries, namely lumbar laminectomy and microdiscectomy are performed on the basis of the cause as well as the duration of the sciatica pain. In some cases, the symptoms are unique on the basis of the underlying causes of sciatica. For instance, trying to bend the body backward or walking a longer distance than normal may trigger unbearable symptoms. On the other hand, when the affected individual tries to bend the body forward, it can lead to symptoms stemming from the lumbar herniated disc. In case sciatica occurs after an accident, injury or trauma, or if it happens in tandem with other symptoms, then it requires an immediate medical attention. Thus, choosing to go for a surgery depends on several factors that only your doctor can assess and decide upon.

Back Pain Management

Dr. Mukesh Vyas 90% (436 ratings)
BPTh/BPT
Physiotherapist, Pune
Back Pain Management
Spondylitis includes swelling of the vertebra. It happens because of wear and tear of the ligament and bones found in your cervical spine, which is in your neck. While it is to a great extent because of age, it can be brought on by other reasons too. Side effects incorporate pain and stiffness starting from the neck to the lower back. The spine's bones (vertebrae) get fused, bringing about an unbending spine. These changes might be mellow or extreme, and may prompt a stooped-over posture. Some of the non-surgical methods to treat spondylitis are as follows- Exercise based recovery/physiotherapy: your specialist may send you to a physiotherapist for treatment. Non-intrusive treatment helps you extend your neck and shoulder muscles. This makes them more grounded and at last, relieves pain. You may neck traction, which includes using weights to build the space between the cervical joints and decreasing pressure on the cervical disc and nerve roots. Medications: your specialist may prescribe you certain medicines if over-the-counter medications do not work. These include: Muscle relaxants, for example, cyclobenzaprine, to treat muscle fits Opiates, for example, hydrocodone, for pain relief Epileptic medications, for example, gabapentin, to ease pain created by nerve damage Steroid infusions, for example, prednisone, to decrease tissue irritation and diminish pain Home treatment: in case your condition is less severe, you can attempt a couple of things at home to treat it: Take an over-the-ounter pain reliever, for example, acetaminophen or a calming medication, for example, advil or aleve. Use a warming cushion or an ice pack on your neck to give pain alleviation to sore muscles. Exercise routinely to help you recover quickly. Wear a delicate neck prop or neckline to get transitory help. In any case, you shouldn't wear a neck brace for temporary pain relief. Acupuncture: acupuncture is a highly effective treatment used to mitigate back and neck pain. Little needles, about the extent of a human hair, are embedded into particular points on the back. Every needle might be whirled electrically or warmed to improve the impact of the treatment. Acupuncture works by prompting the body to deliver chemicals that decrease pain. Bed rest: severe instances of spondylitis may require bed rest for close to 1-3 days. Long-term bed rest is avoided as it puts the patient at danger for profound vein thrombosis (dvt, blood clots in the legs). Support/brace use: temporary bracing (1 week) may help get rid of the symptoms, however, long-term use is not encouraged. Supports worn for a long time weaken the spinal muscles and can increase pain if not continually worn. Exercise based recovery is more beneficial as it reinforces the muscles. Lifestyle: losing weight and eating nutritious food with consistent workouts can help. Quitting smoking is essential healthy habits to help the spine function properly at any age. Once the conservative treatment fails: Early aggressive treatment plan of back leg pain has to be implemented to prevent peripherally induced cns changes that may intensify or prolong pain making it a complex pain syndrome. Only approx 5% of total lbp patients would need surgery approx 20% of discal rupture or herniation with neurologically impending damage like cauda equina syndrome would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then. Depending upon the diagnosis one can perform combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon patient`s pathology response to treatment. Using precision diagnostic therapeutic blocks in chronic lbp, isolated facet joint pain in 40%, discogenic pain in 25% (95% in l4-5 l5-s1), segmental dural or nerve root pain in 14% sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of lbp after conservative treatment has failed. Need for non-surgical options: outcome studies of lumber disc surgeries documents, a success rate between 49% to 95% and re-operation after lumber disc surgeries ranging from 4% to 15%, have been noted. in case of surgery, the chance of recurrence of pain is nearly 15%. In fbss or failed back surgery the subsequent open surgeries are unlikely to succeed. Reasons for the failures of conventional surgeries are: Dural fibrosis Arachnoidal adhesions Muscles and fascial fibrosis Mechanical instability resulting from the partial removal of bony ligamentous structures required for surgical exposure decompression Presence of neuropathy. Multifactorial aetiologies of back leg pain, some left unaddressed surgically. Epidural adenolysis or percutaneous decompressive neuroplasty is done for epidural fibrosis or adhesions in failed back surgery syndromes (fbss). A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ l. A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with epiduroscope sciatica gets complicated by pivd with disco-radicular conflict causing radicular pain sometimes disabling. In this era of minimally invasive surgery lot many interventional techniques have evolved to address the disc pathology. We are still working for the ideal, safe effective technique to tackle disco- radicular interphase. Here now we have devised a mechanical neuroplasty or foraminoplasty technique using an inflatable balloon tip catheter with guide wire via targeted transforaminal or interlaminar route aided by drugs instillation. Selected patients are procedured fluoroscopic guided with local anesthesia under prescribed sedation aseptically via preselected route depending upon location type of pivd causing root insult. First a suitable size needle is placed at desired site confirming with radiolucent dye through which hyaluronidase with saline or la was injected. A flexible guide wire is passed at selected location direction on which the inflatable balloon is threaded to the area of interest. Adhesiolysis is achieved mechanically with inflating balloon for 10 seconds at a time location. We inflated the balloon with contrast agent to have visualization of adhesiolysis opening up of adhesions or root route. Here the balloon pressure time has to be kept in minimum to avoid neurological damage, for which we inflate balloon for 10 seconds at a time. Close observation is made to balloon shape, pressure patient`s response. Once dilatation is done the drug mixture of steroid with la or hynidase/ hypertonic saline is instilled over nerve in epidural space. We have logically used same approach for our balloon neuroplasty foraminoplasty as it is safe targets exactly the area of disco-radicular interphase or conflict. We can manage to address both the exiting and traversing nerve roots with single entry just by manipulating our guide wire to the place of offence. The procedure can be done via transforaminal route at level or level above or below, especially via s1 foramen. Now we are employing this technique for fresh cases coupling with intradiscal decompression aided by instant disc retrieval by epidural balloon inflation with good results. The idd is done by coblation/ laser/ dekompressor or rf biacuplasty. There is scope of coupling this technique with endoscopic spine surgery. By adding balloon neuroplasty to the armamentarium of the interventional pain management many patients can be benefited relieved of previously interventionally unmanageable disco-radicular pain including fbss sufferers. Intradiscal procedures: Provocative discography: coupled with ct a diagnostic procedure prognostic indicator for surgical outcome is necessary in the evaluation of patients with suspected discogenic pain, its ability to reproduce pain (even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options in assessing previously operated spines. Percutaneous disc decompression (pdd): after diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed. Ozone-chemoneucleoplasty: ozone discectomy a least invasive safe effective alternative to spine surgery is the treatment of choice for prolapsed disc (pivd) done under local anaesthesia in a day care setting. This procedure is ideally suited for cervical and lumbar disc herniation with radiculopathy. Total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at european countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no post operative discomfort or morbidity and low cost. If despite the ozone therapy the symptoms persist, percutaneous intradiscal decompression can be done via transforaminal route with drill discectomy/ laser or coblation nucleoplasty/ biacuplasty/ disc-fx / endoscopic discectomy are good alternatives before opting for open surgerical discectomy; which has to be contemplated in those true emergencies, as mentioned above as the first choice. In biacuplasty radiofrequency energy is used in bipolar manner heating shrinking the disc making it harder as well for weight bearing. It also seals the annular defect ablates annular nerves relievingback pain. In laser or coblation nucleoplasty energy is used to evaporate the disc thereby debulking it to create space for disc to remodel itself assisted by exercises. Dekompressor: a mechanical percutaneous nucleotome cuts drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression. A mechanical device cuts drills out the disc material debulking the disc reducing nerve compression curing sciatica brachialgia. It comes in needle size of 17g for lumbar discs 19 g for cervical discs. In lumbar region postero-lateral approach is used in cervical discs anterolateral approach is used. Disc-fx : endoscopic discectomy: in this novel technique a wide bore needle is inserted placed sub-annular in post disc just under the disc protrusion. Disc is then mechanically extracted with biopsy forceps to empty the annular defect. This painful sensitive annular defect supplied be sinuvertebral nerve is thermo-ablated with radiofrequency which also seals the defect to prevent decrease recurrences. Next higher procedure, endoscopic discectomy is done with endoscope put through sheath inserted via posterolateral transforaminal or posterior interlaminar approach. Mostly done under local anaesthesia its fast becoming standard of care for disc protrusion extrusions causing spinal canal stenosis with root or cord compression with leg pain. Laser discectomy done for closed bulging discs is an outpatient procedure with one-step insertion of a needle into the disc space. Disc material is not removed; instead, nucleus pulposus is debulked by evaporating it by the laser energy. Laser discectomy is minimally invasive, cost-effective, and free of postoperative pain syndromes, and it is starting to be more widely used at various centers. Seld: epiduroscopic laser neural decompression is considered an effective treatment alternative for chronic refractory low back and/or lower extremity pain, including lumbar disc herniation, lumbar spinal stenosis, failed back surgery syndrome with morbid adhesion neuritis that cannot be alleviated with existing noninvasive conservative treatment. This procedure is done under vision via an epiduroscope inserted via caudal canal or transforaminally employing front or side firing laser fibers /or fine instruments. If you wish to discuss about any specific problem, you can consult a pain management specialist.
2 people found this helpful

Sciatica Pain - What Are The Causes Behind?

Dr. Gautam Das 92% (941 ratings)
MD, FIPP
Pain Management Specialist, Kolkata
Sciatica Pain - What Are The Causes Behind?
Sciatica pain arises from the sciatic nerve which is the single largest nerve in our body. It consists of individual nerve roots, which branching out from the lower back of the spine to the back of each leg and combining together forms the sciatic nerve. The origination of the sciatic pain lies in the lower back of the body and radiates down the buttock to the sciatic nerve. Causes of the sciatica pain Arthritis: If an individual is diagnosed with arthritis, then he or she can expect a throbbing pain or numbness down till the leg. Herniated disc: Another cause could be a herniated disc in the lower back of the body. Spondylosis: Spondylosis in the lower back would also be a reason for the development of the sciatica pain. PIVD/DISC bulge Other causes are a spinal injury, diseased degenerative disc, infection on and around the lower back. The pain would worsen, if an individual is in an occupation where he or she has to stand or sit for hours at length. The lifting of heavy things would strain the sciatic nerves as well. How to identify sciatica pain? Sciatica pain varies from infrequent to a constant throbbing down the lower back. So initially it is difficult to detect whether it is sciatic pain or not. But when the constant pain in the lower back leads right down till the toes and foot, it is really time for an individual to get in touch with a doctor. The pain can give a burning sensation almost searing making it difficult for the person to stand up or walk properly. Along with the pain, one can feel fatigued. An involvement of the spinal cord is rare in the sciatic pain but is possible. Treatment for sciatica pain Sciatica can be treated in both surgical and non-surgical way. Surgical treatment is rare as sciatica tends to respond well with non-surgical treatments. If the pain continues for over a month despite treatment, surgical treatment will be considered. The non-surgical pain treatment would include physical exercises and oral medications along with natural treatment. Medications: Painkiller medications prescribed by the doctor can be used to reduce sciatica. Medicines like aspirin, non-steroidal or oral steroids can help reduce the pain. Steroid injection: Epidural steroid injection acts faster as it is injected in the affected area, thus providing relief from the pain quickly. Exercise: Early morning exercises can be quite helpful. Percutaneous Endoscopic Discectomy: The surgical treatment of Percutaneous endoscopic disc dissectomy constitutes a large part of interventional pain physicians and it has evolved considerably in terms of surgical technique and instrumentation. Percutaneous endoscopic discectomy is a relatively new technique for removing lumbar disc herniation. It involves using an endoscope to visualize the disc removal. The discectomy is performed through a posterolateral approach using specially developed instruments. The advantage of percutaneous endoscopic discectomy is that the disc is approached posterolaterally through the triangle of Kambin without the need for bone or facet resection thus preserving spinal stability. The procedure is day care and is done under local anaesthesia.
4815 people found this helpful

Non-surgical Treatment for Cervical Spondylosis - Tips!

Dr. Neeraj Jain 82% (10 ratings)
MBBS, MD, FIMSA, FIPP
Pain Management Specialist, Delhi
Non-surgical Treatment for Cervical Spondylosis - Tips!
Spondylitis includes swelling of the vertebra. It happens because of wear and tear of the ligament and bones found in your cervical spine, which is in your neck. While it is to a great extent because of age, it can be brought on by other reasons too. Side effects incorporate pain and stiffness starting from the neck to the lower back. The spine's bones (vertebrae) get fused, bringing about an unbending spine. These changes might be mellow or extreme, and may prompt a stooped-over posture. Some of the non-surgical methods to treat spondylitis are as follows- Exercise based recovery/physiotherapy: Your specialist may send you to a physiotherapist for treatment. Non-intrusive treatment helps you extend your neck and shoulder muscles. This makes them more grounded and at last, relieves pain. You may neck traction, which includes using weights to build the space between the cervical joints and decreasing pressure on the cervical disc and nerve roots. Medications: Your specialist may prescribe you certain medicines if over-the-counter medications do not work. These include: Muscle relaxants, for example, cyclobenzaprine, to treat muscle fits Opiates, for example, hydrocodone, for pain relief Epileptic medications, for example, gabapentin, to ease pain created by nerve damage Steroid infusions, for example, prednisone, to decrease tissue irritation and diminish pain Home treatment: In case your condition is less severe, you can attempt a couple of things at home to treat it: Take an over-the-counter pain reliever, for example, acetaminophen or a calming medication, for example, Advil or Aleve. Use a warming cushion or an ice pack on your neck to give pain alleviation to sore muscles. Exercise routinely to help you recover quickly. Wear a delicate neck prop or neckline to get transitory help. In any case, you shouldn't wear a neck brace for temporary pain relief. Acupuncture: Acupuncture is a highly effective treatment used to mitigate back and neck pain. Little needles, about the extent of a human hair, are embedded into particular points on the back. Every needle might be whirled electrically or warmed to improve the impact of the treatment. Acupuncture works by prompting the body to deliver chemicals that decrease pain. Bed Rest: Severe instances of spondylitis may require bed rest for close to 1-3 days. Long-term bed rest is avoided as it puts the patient at danger for profound vein thrombosis (DVT, blood clots in the legs). Support/brace use: Temporary bracing (1 week) may help get rid of the symptoms, however, long-term use is not encouraged. Supports worn for a long time weaken the spinal muscles and can increase pain if not continually worn. Exercise based recovery is more beneficial as it reinforces the muscles. Lifestyle: Losing weight and eating nutritious food with consistent workouts can help. Quitting smoking is essential healthy habits to help the spine function properly at any age. ONCE THE CONSERVATIVE TREATMENT FAILS: Early aggressive treatment plan of back & leg pain has to be implemented to prevent peripherally induced CNS changes that may intensify or prolong pain making it a complex pain syndrome. Only approx 5% of total LBP patients would need surgery & approx 20% of discal rupture or herniation with Neurologically impending damage like cauda equina syndrome would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then. Depending upon the diagnosis one can perform & combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon patient`s pathology & response to treatment. Using precision diagnostic & therapeutic blocks in chronic LBP , isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5-S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of LBP after conservative treatment has failed. NEED FOR NON-SURGICAL OPTIONS: Outcome studies of lumber disc surgeries documents, a success rate between 49% to 95% and re-operation after lumber disc surgeries ranging from 4% to 15%, have been noted. In case of surgery, the chance of recurrence of pain is nearly 15%. In FBSS or failed back surgery the subsequent open surgeries are unlikely to succeed. Reasons for the failures of conventional surgeries are: Dural fibrosis Arachnoidal adhesions Muscles and fascial fibrosis Mechanical instability resulting from the partial removal of bony & ligamentous structures required for surgical exposure & decompression Presence of Neuropathy. Multifactorial aetiologies of back & leg pain, some left unaddressed surgically. EPIDURAL ADENOLYSIS OR PERCUTANEOUS DECOMPRESSIVE NEUROPLASTY is done for epidural fibrosis or adhesions in failed back surgery syndromes (FBSS). A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ L.A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with EPIDUROSCOPE Sciatica gets complicated by PIVD with disco-radicular conflict causing radicular pain sometimes disabling. In this era of minimally invasive surgery lot many interventional techniques have evolved to address the disc pathology. We are still working for the ideal, safe & effective technique to tackle disco- radicular interphase. Here now we have devised a mechanical neuroplasty or foraminoplasty technique using an inflatable balloon tip catheter with guide wire via targeted transforaminal or interlaminar route aided by drugs instillation. Selected patients are procedured fluoroscopic guided with local anesthesia under prescribed sedation aseptically via preselected route depending upon location & type of PIVD causing root insult. First a suitable size needle is placed at desired site confirming with radiolucent dye through which hyaluronidase with saline or LA was injected. A flexible guide wire is passed at selected location & direction on which the inflatable balloon is threaded to the area of interest. Adhesiolysis is achieved mechanically with inflating balloon for 10 seconds at a time & location. We inflated the balloon with contrast agent to have visualization of adhesiolysis & opening up of adhesions or root route. Here the balloon pressure & time has to be kept in minimum to avoid neurological damage, for which we inflate balloon for 10 seconds at a time. Close observation is made to balloon shape, pressure & patient`s response. Once dilatation is done the drug mixture of steroid with LA & or hynidase/ hypertonic saline is instilled over nerve in epidural space. We have logically used same approach for our Balloon Neuroplasty & foraminoplasty as it is safe & targets exactly the area of disco-radicular interphase or conflict. We can manage to address both the exiting and traversing nerve roots with single entry just by manipulating our guide wire to the place of offence. The procedure can be done via transforaminal route at level or level above or below, especially via S1 foramen. Now we are employing this technique for fresh cases coupling with Intradiscal decompression aided by instant disc retrieval by epidural balloon inflation with good results. The IDD is done by Coblation/ Laser/ DeKompressor or RF Biacuplasty. There is scope of coupling this technique with endoscopic spine surgery. By adding Balloon Neuroplasty to the armamentarium of the interventional pain management many patients can be benefited & relieved of previously interventionally unmanageable disco-radicular pain including FBSS sufferers. INTRADISCAL PROCEDURES: PROVOCATIVE DISCOGRAPHY: coupled with CT A diagnostic procedure & prognostic indicator for surgical outcome is necessary in the evaluation of patients with suspected discogenic pain, its ability to reproduce pain(even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options & in assessing previously operated spines. PERCUTANEOUS DISC DECOMPRESSION (PDD): After diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed. OZONE-CHEMONEUCLEOPLASTY: Ozone Discectomy a least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a day care setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. Total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no post operative discomfort or morbidity and low cost. If despite the ozone therapy the symptoms persist, Percutaneous intradiscal decompression can be done via Transforaminal route with Drill Discectomy/ Laser or Coblation Nucleoplasty/ Biacuplasty/ Disc-FX / Endoscopic Discectomy are good alternatives before opting for open surgerical Discectomy; which has to be contemplated in those true emergencies, as mentioned above as the first choice. In Biacuplasty radiofrequency energy is used in bipolar manner heating & shrinking the disc & making it harder as well for weight bearing. It also seals the annular defect & ablates annular nerves relieving back pain. In Laser or Coblation Nucleoplasty energy is used to evaporate the disc thereby debulking it to create space for disc to remodel itself assisted by exercises. DEKOMPRESSOR: A mechanical percutaneous nucleotome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression. A mechanical device cuts & drills out the disc material debulking the disc reducing nerve compression curing Sciatica & Brachialgia. It comes in needle size of 17G for lumbar discs & 19 G for cervical discs. In lumbar region postero-lateral approach is used & in cervical discs anterolateral approach is used. DISC-FX & ENDOSCOPIC DISCECTOMY: In this novel technique A wide bore needle is inserted & placed sub-annular in post disc just under the disc protrusion. Disc is then mechanically extracted with biopsy forceps to empty the annular defect. This painful & sensitive annular defect supplied be sinuvertebral nerve is thermo-ablated with radiofrequency which also seals the defect to prevent & decrease recurrences. Next Higher procedure, Endoscopic Discectomy is done with endoscope put through sheath inserted via posterolateral transforaminal or posterior interlaminar approach. Mostly done under local anaesthesia its fast becoming standard of care for disc protrusion & extrusions causing spinal canal stenosis with root or cord compression with leg pain. LASER DISCECTOMY done for closed bulging discs is an outpatient procedure with one-step insertion of a needle into the disc space. Disc material is not removed; instead, nucleus pulposus is debulked by evaporating it by the laser energy. Laser discectomy is minimally invasive, cost-effective, and free of postoperative pain syndromes, and it is starting to be more widely used at various centers. SELD: Epiduroscopic laser neural decompression is considered an effective treatment alternative for chronic refractory low back and/or lower extremity pain, including lumbar disc herniation, lumbar spinal stenosis, failed back surgery syndrome with morbid adhesion neuritis that cannot be alleviated with existing noninvasive conservative treatment. This Procedure is done under vision via an epiduroscope inserted via Caudal canal or Transforaminally employing front or side firing Laser fibers &/or fine instruments.
3719 people found this helpful

Awake Endoscopic Lumbar Discectomy

Dr. T.Shiva Prasad Tummarakoti 91% (907 ratings)
MBBS ,MD
Pain Management Specialist, Hyderabad
our work on awake endoscopic lumbar discectomy was presented and well appreciated at state neuro conference 2017. American spine and pain center banjara hills road 12 hyd

Popular Questions & Answers

Slipped disc L4-L5 Dr. Suggest me epidural treatment, can you tell me best alternative way to heal my disc as like before. I had took PT but It works only for some days but after some days pain comes back

Dr. T.Shiva Prasad Tummarakoti 91% (907 ratings)
MBBS ,MD
Pain Management Specialist, Hyderabad
Root block is better if severe, do endoscopic discectomy under local anesthesia for permanent relief Hyderabad.
1 person found this helpful

I am suffering from pack pain called sciatica. Wht will be the treatment available for this? And also having diabetes. Please suggest best treatment available.

Dr. Virendra Rastogi 88% (122 ratings)
MBBS, MD (Anaesthesiology)
Pain Management Specialist, Varanasi
You may be having disc prolapse L5/S1. I need to look your MRI Spine lumbo sacral region and the investigation like TLC, DLC, CRP, to know if the disc is protruded, extruded with or without foraminal compression. Maybe the slip disc is compressing your nerve resulting numbness. Medicine may be of some help. Non operative treatment include TFSI, Disc Fix and Percutaneous Endoscopic Lumbar discectomy (PLED) are now available. PLED is one the latest alternative to surgery which is performed percutaneous through a small hole in skin less than 1/2 inch, no blood loss, using local anaesthesia and you will be ambulatory on next day ,need hospitalization for max. 3 days.

I'm Harmeet Singh Chhabra Male 21 years old sir Im having pain in back since 3 months actually I use to do exercise normal exercise at my home using gym dumbles and suddenly I realize pain and from the side of bone till foot it pains badly please advise me regarding this problem. Thank you.

Dr. Virendra Rastogi 88% (122 ratings)
MBBS, MD (Anaesthesiology)
Pain Management Specialist, Varanasi
You may be having disc prolapse L4/5or L5/S1. I need to look your MRI Spine lumbosacral region and investigation like TLC, DLC, CRP, to know if the disc is protruded, extruded with or without foramin compression. Maybe the slip disc is compressing your nerve resulting numbness. Medicine may be of some help. Non operative treatment include TFSI, Disc Fix and Percutaneous Endoscopic Lumbar discectomy (PLED) are now available. PLED is one the latest alternative to surgery which is performed percutaneous through a small hole in skin less than 1/2 inch, no blood loss, using local anaesthesia and you will be ambulatory on next day ,need hospitalization for max. 3 days.

I am yogesh 25 years old, I have disc bulge in L4 L5 I had taken physio therapy as well but no benefit Doctor suggested me epidural but I don't have believe in it, please suggest me good way

Dr. Chandrakant Lawale 85% (22 ratings)
Bachelor Of Physiotherapist
Physiotherapist, Mumbai
There are various modes of treatment for this condition but exercise s in proper direction will definitely help you out. Electrotherapy like Heating modalities, I.F.T, TENS would not resolve your problems completely. I have treated such patient with better results ONLY with d help of exercises.

Is there any natural healing treatment for herniated disk in lower back. The disk imposses pressure on my right leg veins.

Dr. Sanyam Malhotra 92% (1487 ratings)
BPTh/BPT
Physiotherapist, Delhi
1. No natural healing possible. 2. Start with Physiotherapy treatment 3. Learn spinal exercises 4. Share your MRI REPORT for further consultation. 5. Don't sit on floor.
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