Posterior Lumbar Discectomy: An Overview

A surgery on the lower spine to remove a damaged or herniated disc is referred to as posterior lumbar discectomy. In this process, an incision is made posterior, through the back muscles, for reaching and removing the disc that presses the nerve. Physicians recommend discectomy in those situations where physical therapy or medication fails to relieve leg or back pain caused by spinal nerves pinching. The surgery done to solve this problem can be performed open or through minimally invasive techniques.

The literal meaning of the term discectomy is “cutting out the disc.” A discectomy can be done at any spot near the spine from the neck (cervical) to the low back (lumbar). The surgeon accesses the damaged disc from the back of the spine-through the muscles and bone. To reach the disc, the surgeon removes a portion of the lamina. The lamina forms the backside of the spinal canal and creates a roof-like appearance over the spinal cord. After this, the spinal nerve is retracted to one side. Next, depending on the need of the case, one or more than one disc is removed.

To perform a discectomy, multiple varieties of surgical tools and instruments are used. If it is an open technique, it involves a large skin incision and muscle retraction to give access to the surgeon for an open view. On the other hand, a minimally invasive surgery uses an incision of a small area of skin. To make this process easier, multiple progressively larger tubes are inserted through the muscles. In case of minimally invasive incision the chances of the disruption of the back muscles get limited. It may also require less time to recover.

Lumbar Discectomy is performed on people when their diagnostic tests show a herniated disc. It is also suggested to people who have significant pain, numbness, weakness in their leg or foot.

Robotic Spinal Surgery and its Benefits

One of the latest advancements in the field of spinal and neurosurgery, robotic spinal surgery is available to the patients who rely only on leading edge technology in the operating theatre. In the traditional method of spinal surgery, surgeons place screws in the spinal bones either using their feel and judgement or take help of many X-rays taken during the procedure. If these X-rays are taken in large numbers, they expose the patient to significant amounts of radiation, which may be harmful for the patients. In this technique, there is a high risk of placing the screws in the wrong place. As a result, your patient may face paralysis or a less effective operation.

To get rid of these problems, robotic spinal surgery was conceived. It reduces the risk of screw misplacement. When Mazor Renaissance Robot is used, the surgeon remains in control of the surgery and places the screws with their hands. However, here the robot provides a guidance system, on the basis of computerized pre-operative plan. This process increases the degree of precision, which results in an accuracy of 1mm.

The robotic guidance system involved with the robot spine surgery allows surgeons to perform even the most complex types of spine surgery safely, accurately and efficiently. It limits radiation exposure, postoperative pain and the time of recovery.

Benefits of robotic spinal surgery

Spinal surgery is definitely the most challenging and risky surgery that people require. Variations in the anatomy of the patients, possibility of human error, combined with the complex nature of the spinal cord and nerves on which the operation is performed means that even a very minor mistake can cause a lot of havoc.

Hence, neurosurgeons are in constant search of ways to minimize the risk of surgery. Taking help of Renaissance Spinal Robot these risks can be reduced.

An Overview of Artificial Disc Surgery

An artificial disc is a device which is implanted into the spine to mimic the functions of a normal disc. The entire range of disc design is primarily divided into two general types: total disc replacement and disc nucleus replacement. In case of total disc replacement, almost all the disc tissues are removed and a replacement device is implanted into the space between the vertebra. In case of a disc nucleus replacement, only the nucleus or the disc center is removed to replace it with an implant. In this type of disc replacement, the outer part of the disc (the annulus) is not removed.

Usually artificial discs are made with a combination of metal or plastic-like (biopolymer) materials or either of the two. The materials used to make the artificial discs have been used in the human body for several years. The process of Total disc replacement has been performed since the late 1980s.

Who needs an Artificial Disc?

The indications for disc replacement may vary from instance to instance. Some general indications include pain arising from the disc that could not be reduced with non-operative care, like medication, injections, physical therapy or chiropractic care.

In an ideal situation, an MRI is done to show the disc degeneration. Often discography is performed to verify which disc (s) is related to your pain. To check if the person in question is fit for disc replacement or not, the surgeon may require a few tests, including:

  • X-rays
  • Discography
  • Computed tomography (CT) scans
  • Magnetic resonance imaging (MRI) scans

There are some circumstances where you can’t opt for an artificial disc surgery. For example, allergy to the device materials, spondylolisthesis, osteoporosis, vertebral body fracture, spinal tumor, spinal infection, morbid obesity, pregnancy, chronic steroid use or autoimmune problems.

Cavernous Malformation: An Overview

Vascular malformations refer to the localized collections of blood vessels that are not cancerous (nonneoplastic), abnormal in structure or number and lead to altered blood flow. While originally it was believed that the most vascular malformations are present at birth (congential), the lesions of cavernous malformation may develop throughout the lifetime of the affected individual. Other types of vascular malformations are not congential, but are caused by radiation, trauma or other injury to the spinal cord. The classifications of vascular malformations are done by size, location and type of change.

The four most common vascular malformations are capillary telangiectasias, cavernous malformations, venous malformations, and arteriovenous malformations.

Cavernous malformations are abnormal clusters of blood vessels that are characterized by multiple clusters of blood vessels with small bubbles or caverns through which the blood flows very slowly. Cavernous malformation vessels have a tendency to leak because of their thin wall. Due to this Leakage (bleeding) from these vascular lesions, the clinical symptoms associated with the illness appear. Though cavernous malformations are primarily found in the brain, sometimes they can be found on the skin, in the spinal cord, and in some rare cases in the retina as well.

Usually, cerebral cavernous malformations (CCMs) or  cavernous malformations brain is found in the cortex or white matter of the brain. Unlike other lesions such as arteriovenous malformations, CCMs do not have brain tissue within the malformation. Also CCMs usually are not encapsulated. CCMs are changing in size, dynamic in structures, and number over time.  The size of CCMs ranges from a few millimeters to several centimeters.

CCMs are found in up to 0.5% of the general population, and they constitute for a large proportion (8-15%) of all brain and spinal vascular malformations. The prevalence of people with at least one CCM lesion is high, while at least 40% of affected individuals may not have ever experienced symptoms of CCM or become diagnosed with cavernous malformation.

Cavernoma: Symptoms and Treatments

Cavernomas, also known as cavernous angiomas or cavernous malformations are abnormal clusters of blood vessels with small bubbles or caverns filled with blood give them the look of a berry. These berry like substances range from microscopic to several inches in diameter. Unlike AVMs or  arteriovenous malformations, the flow of blood is very low in cavernomas. Since the cavernomas wall are very weak, chances of blood leaking out are high. Cavernomas can occur in the brain and in the spinal cord. While a cavernous may not cause to affect function, it can cause stroke symptoms, seizures, headache and hemorrhages.

The risk factors of Cavernoma

It is estimated that around one in every 200 people have a  cavernous angioma. Anyone may be a patient of cavernoma and majority of diagnosed people do not report a family history. However, people with more than one cavernoma are suspected to have an inherited factor.

Symptoms of Cavernoma

Usually Cavernomas are diagnosed with after a loss of function, a seizure or from a surprise finding when an MRI is done for some other reason. Cavernomas may have no symptoms, but more than 30 percent people with cavernoma angiomas eventually develop symptoms. In most of the cases, these symptoms occur when patients are 20 to 40 years old. The frequency, type and severity of the symptoms mostly depend on the locations of the angioma. Some of the typical symptoms include

  • Headache
  • Epileptic seizure
  • Neurological loss, such as limb weakness, vision or balance problems, or problems with memory and attention
  • Brain hemorrhage, which can be small, but sometimes massive, leading to stroke-like symptoms
  • Spinal cord injury

Treatment of Cavernoma

Physicians evaluate how to treat cavernomas depending on – How the cavernomas are bleeding, Where the cavernomas are located, If there are multiple cavernomas, The presence of other endovascular abnormalities.

Depending on the detailed assessment of the aforesaid factors, following treatments are offered:

  • Watching and waiting: A lot of cavernomas are observed for changes, recent hemorrhage, or worsening symptoms.
  • Medications: Medicines can not directly treat cavernomas, but they can effectively treat symptoms like seizures and headaches.

Surgery: Cavenoma surgery is the only curative approach to cavernomas and is suggested for cavernous angiomas with latest hemorrhage and those expanding in size causing seizures.

Brain Tumor: Risk Factors and Diagnosis

A collection or mass of abnormal cells in your brain is called brain tumor. Your skull, which encloses your brain is very rigid. Any unusual growth in such a restricted space can cause disturbances. Brain tumors can be cancerous (malignant) or non-cancerous (benign) and when any of these tumors grow, they cause in increasing pressure inside the skull. This can cause brain damage which can be life threatening.

Brain cancers are mainly categorized as primary or secondary. Primary brain tumors originate in your brain and many of them are benign. On the other hand, secondary brain tumor, which is also known as metastatic brain tumor occurs when cancer cells spread to the brain from some other organs in the body such as lung or breast.

Risk Factors for a Brain Tumor

Family History: Only around 5 to 10 percent of all cancers is reported to be hereditary or genetically inherited. In case several people in your family have been diagnosed with a brain tumor, you are advised to consult your doctor. They can recommend a genetic counselor for you.

Age: Risk of maximum brain tumors increases with the age.

Chemical Exposure: If you are exposed to certain cancer causing chemicals in the workplace, the risk of brain cancers increases. The National Institute for Occupational Safety and Health has released a list of potential cancer-causing chemicals found in workplaces.

Exposure to Radiation: People exposed to ionizing radiation are more prone to the risk of brain tumors. You can be exposed to ionizing radiation through high radiation cancer therapies.

No History of Chicken Pox: According to the American Brain Tumor Association people who have a history of childhood chicken pox are less likely to get brain tumors.

Diagnosis of Brain Tumor

A physical examination and a thorough analysis of your medical history are the first steps in diagnosis. The physical exam involves a very detailed examination. Doctors test to see if your cranial nerves are intact. Cranial nerves originate in your brain. CT Scan, MRI, Angiography, Brain Scan, Skull X-Rays and last but not the least, Biopsy are various techniques used to diagnose brain tumors.

Australia hosts some of the best brain tumor surgeons who are using the most advanced techniques to remove and cure the tumors. The latest developments in this field include various laser techniques that are less painful and get cured in less time.