Archive for September, 2012

Foraminotomy Surgery India: Taking Pressure off Spinal Nerves

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A foraminotomy is a surgical procedure that is performed to enlarge the passageway where a spinal nerve root exits the spinal canal. The term foraminotomy is derived from the medical term for a hollow passageway – foramen. The latter half of the term foraminotomy – otomy – means to remove.

During a foraminotomy, the spine surgeon removes bone or tissue that obstructs the passageway and compresses (‘pinches’) the spinal nerve root, which can cause inflammation and pain. Often the nerve (neuro) passageways are called neuroforamen.

Neuroforamen: Location in the Spine 

The neuroforamen are passageways that are naturally formed on either side (left, right) between an upper and lower vertebra. In between each upper and lower vertebra is an intervertebral disc. The height of the disc separates the two vertebrae and creates the size of the neuroforamen. The vertebral body and nerve structures of a single spinal segment are illustrated in Figure 1.

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There is 31-pair of spinal nerve roots that shoot off from the spinal cord and exit the spinal canal through the neuroforamen. (See Figure 2) Spinal nerve roots branch out to form an intricate network of nerves outside of the spinal canal called the peripheral nervous system.

 

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Nerve Compression : Symptoms and Causes 

When the size of a neuroforamen is reduced, there is less room for the spinal nerve, which may cause nerve compression. Symptoms of nerve compression include pain, stiffness, numbness, tingling sensations, and/or weakness. Since spinal nerves branch outward to form the peripheral nervous system, these symptoms may radiate into other parts of the body. For example, cervical nerve root compression can cause symptoms in the shoulders, arms, and hands. Lumbar symptoms may radiate into the low back, buttocks, legs, and feet.

Disorders that can cause nerve root compression include spinal stenosis, degenerative disc disease, a bulging or herniated intervertebral disc, bone spurs (osteophytes), or spondylosis (spinal osteoarthritis).

 

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Foraminotomy: The Procedure 

Depending on many factors such as the location of the compressed nerve or severity of the patient’s symptoms, a foraminotomy may be combined with other procedures such as a laminotomy or Laminectomy. A laminotomy removes a portion of the lamina whereas a laminectomy is the complete removal of the lamina. The lamina is a small bony plate that covers the spinal canal. Sometimes removing the lamina (or a portion of it) provides greater access to the neuroforamen

A foraminotomy involves an incision through the skin and muscle to reach the spine. The muscles may be dissected (cut apart) or retracted using an endoscope or tubular retractor. Special cutting instruments and/or a drill is used to remove bone spurs, thickened ligaments, and debris (e.g. a    Herniated Disc). Removing these tissues from the neuroforamen increases the space for the nerve root. This process is called nerve root decompression.

When the spine surgeon is satisfied that ample space has been created around the nerve root, the muscles and interior tissues are closed in layers using absorbable sutures. The skin incision may be closed using absorbable sutures, Steri-Strips®, or surgical staples. Steri-Strips® fall off from the wound as it heals and surgical staples are removed after the wound is well-healed.

Risks

All surgical procedures carry some risk. The risks from a foraminotomy include the risks inherent to every operation (i.e. a small risk of infection, bleeding etc.). In addition to this there is a small risk of injury to the nerve or spinal cord and this should be discussed specifically with the surgeon.

Recovery

The length of the patient’s hospital stay depends on the extent of the surgery. Some patients may be discharged home the same day as surgery. Most patients require a day or two of hospital care.

Pain at the operative site is normal and should be expected. This pain resolves over time and can be controlled with oral pain medication. Many patients notice an immediate improvement in some or all of their pre-surgery symptoms. For some patients, symptoms diminish gradually.

Patients with a positive outlook and reasonable expectations who comply with their spine surgeon’s recommendations do well. Most patients find they are able to return to regular activities within several weeks

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Cervical Corpectomy Surgery India

What Is An Anterior Cervical Corpectomy with Fusion?
The term corpectomy is derived from the Latin words corpus (body) and -ectomy (removal). The procedure typically involves accessing the cervical spine through an anterior approach, or from the front. Spinal fusion is usually necessary because of the amount of vertebral bone and/or disc material that must be removed to achieve sufficient decompression of the neural structures.

Spinal fusion involves placing bone graft or bone graft substitute between two or more affected vertebrae to promote bone growth between the vertebral bodies. The graft material acts as a binding medium and also helps maintain normal disc height – as the body heals, the vertebral bone and bone graft eventually grow together to join the vertebrae and stabilize the spine.

Why Do I Need This Procedure?
Nerve compression in the cervical can cause neck pain and/or pain, numbness and weakness that extends into the shoulders, arms and hands.

Degenerative spinal conditions, including herniated discs and bone spurs, are common causes of spinal nerve compression. Spinal fracture, tumor or infection also may result in pressure on the spinal nerves.

To determine whether your condition requires treatment with an anterior cervical corpectomy and fusion, your doctor will examine your spine and take your medical history, and may order an x-ray, computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of your cervical vertebrae. An anterior cervical corpectomy and fusion is typically recommended only after conservative treatment methods fail. Your surgeon will take a number of factors into consideration before making this recommendation, including the condition to be treated, your age, health and lifestyle and your anticipated level of activity following surgery. Please discuss this treatment option thoroughly with your spinal care provider.

How Is A Cervical Corpectomy Performed?
Through an incision either to the right or left of the midline of your neck, your surgeon will:
  • Gently retract the muscles and tissues of the neck to expose the anterior vertebral column.
  • Remove a portion of the vertebral body(ies) and intervertebral disc(s) to access the compressed neural structures
  • Relieve the pressure by removing the source of the compression
  • Place a bone graft or bone graft substitute between the adjacent vertebrae at the decompression site
  • Attach instrumentation, such as plating and screws, along the treated vertebra(e) to provide extra support and stability while fusion and healing occurs.
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Anterior Cervical Discectomy Surgery in India

Anterior Cervical Discectomy is surgery to remove one or more discs from the neck. The disc is the pad that separates the neck vertebrae; ectomy means to take out. Usually a discectomy is combined with a fusion of the two vertebrae that are separated by the disc. In some cases, this procedure is done without a fusion. A cervical discectomy without a fusion may be suggested for younger patients between 20 and 45 years old who have symptoms due to a herniated disc.
Anterior cervical spinal fusion surgeries are commonly done in conjunction with an anterior cervical discectomy. For many patients, cervical spinal fusion surgery (fusing one vertebra to another) is often done to eliminate motion at a vertebral segment. Decreasing the motion at a painful motion segment should decrease the pain at that segment. Achieving the fusion also serves to maintain adequate space for the decompressed spinal cord and/or nerve roots. The fusion may also prevent the spine from falling into a collapsed deformity (kyphosis).
Risks
There are always risks with surgery. You may bleed more than usual or get an infection (in-fek-shun). You could have trouble breathing or get blood clots.You may have hoarseness after surgery because the surgery is done near a nerve that controls your voice box. Caregivers will watch you closely for these problems. Without surgery, your neck problems may get worse and not better.
Why Do I Need This Procedure?
If you have a herniated disc, this means that the nucleus pulposus – the soft, gel-like center of the disc – has pushed through the annulus fibrosus, the disc’s tough, outer ring. Bone spurs, also called osteophytes, can form when the joints of the spine calcify. Anterior Cervical Discectomy w/ FusionPressure placed on nerve roots, ligaments or the spinal cord by a herniated disc or bone spur may cause: –

– Pain in the neck and/or arms
– Lack of coordination
– Numbness or weakness in the arms, forearms or fingers.

Pressure placed on the spinal cord as it passes through the cervical spine can be serious, since most of the nerves for rest of the body (e.g., arms, chest, abdomen, legs) must pass through the neck from the brain. A cervical discectomy can ease pressure on the nerves, ultimately providing pain relief.

An anterior cervical discectomy with spinal fusion is typically recommended only after non-surgical treatment methods fail. Your surgeon will take a number of factors into consideration before making this recommendation, including the condition to be treated, your age, health and lifestyle and your anticipated level of activity following surgery. Please discuss this treatment option thoroughly with your spinal care provider.

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For more information, medical assessment and medical quote
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Email : info@sanitbahri.in, info@spinesurgeriesindia.com