From Major Surgery To Tiny Portals: Nims Advances Endoscopic Spine Treatment
A 45-year-old man with severe neck pain underwent spine surgery without metal implants: Reports
HYDERABAD: A 45-year-old man with severe neck pain underwent spine surgery without metal implants and was discharged the next day. In another case, a patient who underwent endoscopic removal of a tumour from the spinal cord was able to walk on the day of surgery. These cases illustrate how advances in endoscopic spine surgery are changing treatment and recovery for selected patients at the Nizam’s Institute of Medical Sciences (Nims).
Ahead of World Spine Day on October 16, Dr Thirumal Yerragunta, associate professor of Neurosurgery at Nims, told Deccan Chronicle that endoscopic techniques allowed surgeons to operate through tiny access points instead of the larger incisions used in conventional open surgery. The approach can reduce muscle damage and postoperative pain and help eligible patients return to normal activities sooner. “From a large incision to a small incision, and from a small incision to a tiny portal this is the journey of spine surgery,” he said.
In the first case, the 45-year-old man underwent an endoscopic cervical laminoforaminotomy to relieve pressure on a nerve. Conventionally, the condition could require open surgery and, in some cases, fusion using metal implants. The endoscopic procedure avoided implants, and the patient recovered sufficiently to be discharged the following day. The surgery was performed free of cost. Nims has performed 25 such cervical laminoforaminotomy procedures, according to the institute.
In another case, doctors removed a tumour located within the spinal cord using an endoscopic approach. Such tumours are generally treated through open surgery, which can involve removing bone and disrupting surrounding muscles, followed by a longer recovery period. The patient in this case was able to walk on the day of surgery. NIMS has performed four spinal cord tumour removal procedures using this technique.
Dr Yerragunta said endoscopy was no longer limited to treating slipped discs. In appropriately selected patients, it can be used for conditions such as nerve compression, spinal canal narrowing and certain spinal tumours. The choice of procedure depends on the location and nature of the problem, the degree of nerve compression, spinal stability and the surgeon’s experience.
He cautioned that endoscopic surgery is not suitable for every patient. Extensive spinal deformities, severe instability, complex conditions and certain large tumours may still require conventional or microscopic surgery. “The correct principle is to choose the right technique, at the right time, for the right patient,” he said.
Dr Yerragunta said persistent back pain, pain radiating into the legs, weakness in the limbs or changes in walking should be assessed by a specialist. Not every patient with an abnormality on an MRI scan requires surgery; treatment decisions must also consider symptoms and clinical examination.
These advanced surgical procedures are being performed through the collaborative efforts of Dr Vamsi Krishna, head of the department of neurosurgery; Dr Suchanda, senior professor; and Dr Ram Nath. The advanced endoscopic surgical equipment was generously donated to Nims by BHEL-GE through the concerted efforts of the Rotary Club.