Endoscopy and Minimally Invasive Surgery

Transcranial endoscopic surgery for hydrocephalu.
Endoscopic assisted surgery.
Endoscopic trans-nasal skull base surgery including surgery for pituitary tumors and other skull base tumors.
Trans-nasal endoscopic repair of CSF leaks.
Stereotactic surgery for brain tumors and intracranial catheter / electrode placement.

FAQ's

At Aster Hospitals we provide the highest quality of care and a transformative experience for all your healthcare needs. With our network of multi-speciality hospitals, specialised doctors, and world-class technology, we bring global standards of medical care to our patients.

What should I be asking before undergoing MISS?

Since MISS is technically challenging, enough care is taken on different aspects to ensure a safe and good outcome. It is important for you, as a patient considering MISS, that your surgeon is well-trained, and has enough experience of performing a wide range of spine key-hole surgeries. In addition, the hospital staff and infrastructure should also support performing these Minimally Invasive Procedures with accuracy, precision and safety. MISS is a way of life at Aster. More than 90% of the spinal surgeries here are done through minimally invasive techniques. Aster is probably the only hospital that ‘regularly’ does MISS for cervical pathologies and complex spine cases.

Clinical Expertise:

Dr. Umesh Srikantha, Head of Spine Services at Aster, has performed close to 2000 minimally invasive spine surgeries in the past seven years. His experience in MISS ranges from the most basic procedures like lumbar microdiscectomy, foraminotomy and decompression surgeries to the most complex spinal fusion procedures for advanced pathologies like tumors and high-grade spondylolisthesis. He is one of the top surgeon faculties in the country for MISS, having trained more than a hundred aspiring surgeons to adopt MISS through advanced training programs. The OR team at Aster has also been supporting MISS for the past seven years and is proficient with the use of complex MISS instrumentation and high-end technologies such as navigation and neuro-monitoring.

Technology:

We all know how the advent of data connectivity, GPS and Google Maps, has simplified road travel for the common man. We rarely feel the need to stop and to ask for directions. More importantly, we are able to reach the correct destination in the shortest possible time. Similarly, modern and state-of-the-art hospitals invest in and routinely use surgical navigation technologies. The use of surgical navigation systems along with advanced pre-surgery planning software has revolutionized a surgeon’s ability to visualize the anatomy in 3D and perform more accurate surgeries even through smaller skin incisions and narrow tubes. In addition, the use of intra-operative neuro monitoring ensures critical nerve structures are monitored and protected through the course of Spine surgery. At Aster, these advanced enabling technologies are used routinely to ensure MISS is performed with utmost accuracy, precision and safety.

Should I be worried?

A spine specialist may diagnose you as a candidate for surgery if they feel that your problem is advanced. The nature of the spine is such that degeneration or damage to one part can trigger a cascade which can start affecting other healthy parts as well. Therefore, a surgeon may suggest that in certain cases, surgery may be the right option for you. Spine surgery has been around for several decades and has evolved into a very safe procedure. Surgeons have the dual advantage of rigorous training and advanced technologies that ensure safe and satisfying outcomes. A large number of patients are known to have benefitted after spine surgery performed for conditions such as lumbar spinal stenosis, degenerative disc disease, disc herniation. Talk to your surgeon openly about your concerns!

What should I be doing?

Managing your back pain is all about taking timely action. See a trained physician about your condition if pain persists for more than a week of home treatment and rest. Depending upon their assessment of your condition, a physician may advise you one or more of the following:

  • Physical therapy including exercises and other treatments like heat, ultrasound, electrical stimulation to ease the pain and strengthen the back
  • Anti-inflammatory or pain medication
  • Epidural spinal injections to manage the pain supporting other treatment modalities
  • Lifestyle modification.

What can I do to maintain my spinal health?

A healthy back is a combination of healthy bones, mobile joints, and strong muscles. Unfortunately, a complex system like our back or spine is prone to issues arising from one or more malfunctioning elements. Any disturbance to the spine and it’s supporting structures due to aging, trauma, lifestyle stresses or other pathologies can lead to spinal complications, most commonly appearing as back or neck pain. Maintaining a healthy spine is almost non-negotiable to ensure a healthy, pain-free and active life. Simple activities such as maintaining healthy posture, regular exercise, good nutrition and regular exposure to the sun, go a long way in maintaining a healthy spine.

What are types of endoscopic surgery?

  • Intralaminar technique - performed from the back of the spine between two laminae
  • Transforaminal technique - performed from the / side of the spine (flank) into the neuroforamen(exit  passage for the nerve ).

Condition treated by Endoscopic Spine Surgery

  • Disc prolapse (slipped disc)
  • Spinal Canal Stenosis (Cervical and lumbar – narrowing of spinal canal)
  • Refractory back pain
  • Spinal infection – for biopsy and debridement.

What are my options? What will life be like post-surgery?

Traditional methods of spine surgery, or ‘open procedures’ require long incisions down the middle of the back and stripping of muscles and ligamentous attachments to the spine. Moreover, the muscles are pulled and held apart to grant a surgeon access to the spine for the surgery duration. This can range from one hour to several hours. The invasive and traumatic nature of open spine surgery, compromises the vital supporting structures of the spine that play an important role in maintaining the strength and flexibility of your back. This method of surgery will address a surgeon’s operative goal, i.e. relieving the pressed nerve or spinal cord. However, it compromises on the natural anatomy and exposes the patient to weakness of the back post-surgery leading to compromised muscle strength and flexibility, and pain.

How can a Spine Specialist help me?

Visiting a spine surgeon does not mean you will need spine surgery! A specialist can understand and interpret the root cause of your back pain through some simple tests like X-rays, MRI or CT Scans. Also a spine specialist has comprehensive training and experience to understand spinal anatomy, correlate symptoms to pathology, and recommend and offer surgical or non-surgical treatment options. This makes them much better-equipped to manage your spinal issues effectively.

What is causing my unresolved back pain?

Pain that just doesn’t go away can be frustrating and agonizing. If you have been suffering from unresolved back pain despite medication, physiotherapy, and other pain-relieving treatment, please be assured that you are not alone. Chronic back pain is more common than you would imagine. In fact, it has been noted that as many as 60% Indians cope with significant back pain, some or the other time in their lives. The most common cause of chronic back pain is age related degeneration of the spinal discs. Though aging is a natural process, in some individuals it may lead to unmanageable and incessant pain. The pain may or may not be accompanied by numbness, weakness and stiffness. Another common cause of severe back pain is stress or sports injury. For example, sudden surge in activity or lifting heavy loads can sometimes lead to spinal complications beyond a simple muscle spasm. In most cases, root cause of pain and weakness is some pressure or impingement on highly sensitive structures like spinal cord or nerves, due to:

  • excess bony growth (osteophytes)
  • damage to the disc leading to displacement of the inner core (herniated disc)
  • drying up of the discs leading to reduction in the opening between two adjacent vertebrae
  • dislocation of the spinal joints (spondylolisthesis)
  • fractures due to osteoporosis.

What constitutes a healthy back?

Our spine is nature’s extraordinary miracle. Several complex structures come together to provide the human body with a fine balance of protection, support, strength and movement. A healthy spine is not just the bony segments but a combination of several ‘supporting structures’ - protective discs, strong muscles and attached ligaments and tendons. The 24 bony segments or vertebral bodies or vertebrae in the spine are interspersed with a tough, yet soft gel-like cushion or shock-absorber, called intervertebral disc. The muscles surrounding the spine or ‘para-spinal muscles’ are attached to the bones through ligaments. Together these structures, called the ‘natural tension band’ provide mobility, strength and protection to the back. The core of our spine’s movement, structure and flexibility comes from complex biomechanics of the bony vertebrae and supporting structures. Often compared to a ‘crane’, it is said that for the spine to be stable, all elements must be intact and function in unison.

What are benefits of Endoscopic spine surgery?

  • Target oriented surgery - less trauma muscle and soft tissue
  • Minimal bone removal - Spinal stability is preserved
  • Less blood loss
  • Lesser infection rates
  • Reduced requirement of post - operative analgesia
  • Through this the patients are mobilised and can be discharge the same day with proper post-operative instructions.
  • ESS procedure can be performed using regional or local anaesthesia instead of general anaesthesia, decreasing the risk of general anaesthesia in elderly patients or patients with co-existing medical conditions.

What is Endoscopic spine surgery?

Endoscopic Spine Surgery (ESS) is a procedure performed through small incision with help of tubular system assisted with endoscope to visualize the surgical field. ESS is an advanced form of Minimal Invasive Surgery aimed at providing lesser recovery time, early return to work and less post-operative pain than traditional spine surgery methods with improved visualisation.

This procedure is performed with a fibre optic tube with light and lens. Through this the muscles are not cut but are pushed aside to permit small tube to enter the spine and a very small high-definition camera is used to see the spine anatomy.

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