Brain & Spine Specialist Clinic

Hi,

I am Dr. Nitin Jagdhane (Jain), Neurosurgeon, Brain & Spine Specialists, Mumbai. Today I will talk about spinal fusion surgery. Many times people are scared of back pain. They go to orthopedics or a neurosurgeon, they are told that they need spinal fusion surgery.

What is exactly spinal fusion surgery? It is nothing but connecting the broken parts of the 2 vertebrae and later on utilized for many causes and many problems which lead to back pain and degenerative spondylosis and also for the tumors which are invading, the vertebral wounds which cause the instability. So, the most common reasons why spinal surgery is done these days is the degenerative spondylotic changes which affect the entire spine. The most affected either cervical spine than in the neck area and the lumbar spine.

What happens in the ages, there is wear and tear and because of this, the disc between the 2 vertebrae degenerates and sometimes it slips out and it causes the narrowing of the spinal canal. The neuro structure is compressed. Because of compression, the patient finds various symptoms like pain, especially in the lower back, pain in the neck which is associated with tingling and numbness of the particular limb. The upper and the lower limbs and sometimes in all 4 limbs. Sometimes, it is associated with the weakness of the particular limb. The weakness of the particular action. The procedure is decided by our neurosurgeon. There are various techniques like in the neck, the cervical region the most common fusion is done from the anterior.

Sometimes, depending on the pathology, the fusion is also done posteriorly. In the lumbar region and the lower back, there are various techniques for spinal fusion. Most commonly done techniques are from the posterior or from the backside, in the lumbar region. Sometimes the structure which replaces the disc is used but after seeing whether the artificial discs can be used or not. But since a long time, the support is kept between 2 vertebrae which gives the support to the adjacent vertebrae. And they help in realignment of the vertebrae. So that the neural structure which gets compressed is relieved and the pain which the patient is suffering from is also relieved. Many times, fusion alone releases a patient's pain because the pain is not only caused by the compression of the neural structure of the nerve but sometimes it is caused by the friction of the opposing vertebrae because of the degenerative slip disc also.

Once the motion segments are fixed, the pain also automatically gets relieved because of the fixation of the particular segment. So, this was about the various techniques that are used. But spinal fusion technique is not a very simple procedure. It is a very demanding procedure. Sufficiently qualified spinal or a neurosurgeon can do this procedure. But they also carry substantial risks. The main risks are like a failure of the procedure in the first and foremost. There can be a deterioration of the current neurological. There can be paralysis of the surgery which is contemplated. There can be other various problems such as infections, If the patient is older, then there can be an infection on the suture lines. So, based on all these things, these are the early complications. Ther are late complications as well as the adjacent segment disease.

What should you expect from the spinal fusion? Usually, the procedure is done for pain relief, giving stability to the spine. Fixation of the bone is not enough because muscles in the body are the main structure which holds the entire spine and the body. So, muscles rehabilitation is something which is required more. If you need any kind of help regarding spinal fusion procedures, you can visit any of the neurosurgeon and trained spinal surgeons. They will guide you what kind of surgery is suitable for you and what can you expect from the surgery. If you want to see our other videos, you can login to Lybrate.

Thank You.

Hello,

This is doctor Nitin Jagdhane. I am a consultant neurosurgeon, brain and spine surgeon. Today we are going to discuss about brain tumors, to start with what exactly causes Brain tumor actually scientists have not found any exact reason as of now that what causes brain tumors, but some patients usually children if they get some radiation dose during their childhood, excessive radiations, they may have brain tumors. Some tumors are caused by hereditary inheritance like neurofibromatosis which run in families and many people more than 65 years of age, they get kind of brain cancer which is called as Glioma, so the reasons for such cancers are usually not known, but they usually affect people who are elderly, more than 60-65 years of age. So to start to know what are the types of brain tumor, basically as anywhere in the body there are two types of brain tumors. Few tumors are called as benign brain tumors, benign means which are not harmful and the other type is a malignant brain tumor or cancer what we can call it as. All the burning brain tumors are not harmful as such by definition, but if they are in a part of the brain which is critical or the part of brain which is controlling the left side of the body or left side of the brain rather are more difficult to exercise and sometimes carry equal or even more risk than the so called malignant brain tumors.

These are the primary brain tumors which we discussed but there are some Brain tumors which are secondary also, like if there is anywhere cancer or tumor inside the body and that may also spread to the brain which are called secondary brain tumors, so depending on the part of the brain involved these tumors can be either in the larger part of the brain which is called cerebral hemisphere or the supratentorial what we call it and there are few tumors which affect the small brain or the cerebellum or the posterior fossa tumor or the infratentorial part of the brain, so usually the location that can also be divided based on the surface location of the tumor like which lobe of the brain they are involved like frontal lobe, parietal lobe on the sides, then posteriorly in the occipital lobe or maybe in the subtentorial region like in posterior fossa involving the cerebellum or the brain stem. They can be classified whether they are skull base that is affecting the part of the brain which is very close to the base of the skull which are more difficult to exercise. Now to come to the usual symptoms of brain tumors. Usually the patients of Brain tumor are present with excessive headache especially in the morning, whenever they get up in the morning they get headache associated with vomiting, sometimes we call it projectile vomiting.

Projectile vomiting means vomiting which is not preceded by the nauseating symptoms usually which many people have it. 2nd symptoms are, along with the headache patients find blurring of vision, some patients may even get convergence or we call it as seizures or fits, some people also present with paralysis of any side of the body, paralysis of the face or what we call as facial paralysis or maybe hemiplegia which affects either part of the body. Some patients if they have tumors in the frontal part of the brain or in front part of the brain they even present with behavioral disturbances, some patients which have benign brain tumors like which are not malignant but they grow into a very big size and then they create a Mass effect which affects the entire brain and which causes a rise in intracranial pressure, so such patients can sometimes directly come with unconscious state also because of the rise in intracranial pressure, so any of the symptoms if any of your relative and you find in someone you have to consult a neuro specialist so that they can guide you further regarding what can be done in such cases. So usually whenever anyone gets such kind of symptoms you have to see a neuroscientist, either a neuro physician or a neurosurgeon, neurosurgeons are better because they operate these kind of tumors and once you go to a neurosurgeon he will usually evaluate with either a CT scan or maybe MRI scan of the brain and based on the MRI scan or CT Scan findings he will discuss with you what kind of tumor it is, whether it is a benign tumor or whether it is a brain cancer and based on that the next line of treatment is usually devised.

So the usual line of treatment for any kind of Brain tumor is surgery unfortunately because none of the brain tumors can be cured with medicines alone and even if there are some tumors or tumor-like lesions like sometimes tuberculosis also can present with some lesions which sometimes are very similar to brain tumors, but whatever is the case the neurosurgeon has to find what it is exactly and to find what it is exactly, we have to do the surgery. The surgery can vary from minimally invasive right from the stereotactic biopsy what we call it by just putting a hole in the skull bone and putting needle through it and taking a piece of the tumor and then sending it for histopathological examination and based on that we take further decisions, but many a times surgery is contemplated for such cases. Surgery for brain tumors is basically based on the nature of the tumor rather than anything, like the location of the tumor where is it? is it in the areas which are easily accessible or whether it is close to the areas which are very important part of the brain, so in such places sometimes it is difficult to excise or to remove the tumor completely, even if it is a benign tumor or even if it is a malignant tumor, so as I said earlier that even if the tumor is benign or not malignant or it is just a simple tumor it also can be dangerous depending on its location so the usual surgery which is done is either complete surgical removal, if it is accessible either a partial removal in which part of the tumor is excised and remaining part is left behind that is we called as the maximum safe resection of the tumor and many a times if the tumor is very deeply located or situated in the part of the brain which is very delicate or where tumor cannot be reached in such cases most of the times the stereotactic biopsy option is used, in which the exact location of the tumor is navigated through the computer program and based on that only a single hole is made and needle is past and the part of the tumor is taken out and send it for the biopsy.

The usual procedure which is done for either partial or complete removal of the tumors is by doing the craniotomy. Craniotomy means opening up a part of the skull, the skull bone which is drilled and which is cut out and the brain is accessed and through that access we usually reach the brain tumor we take it out and send it for histopathological examination and then close it with sutures. Many a times we replace it with bone flap and fix it with sutures or maybe the screws and plates and then suture the skin and the fascia above that or the skull with regular sutures or maybe staplers, so that is the routine commonly done operation called craniotomy. So based on the patient’s condition. Patients are directly shifted to ICU or maybe if they are good enough, their tumor was accessible and easily taken out, sometimes they are shifted to the wards, so during 7 days time we get histopathological examination and based on this the further course of action is devised.

If the patient has a benign tumor and if it is completely excised then no more treatment is usually required just a follow up every 6 months or maybe yearly is sufficient but if the tumor is malignant one like Glioma or grade IV glioblastoma multiforme, which is usually seen in patients who are 65 years and more so in cases where the tumor is a malignant tumor like a glioblastoma multiforme usually seen in people of more than 65 years of age, such patients they require additional forms of treatment like chemotherapy and/or radiotherapy sessions. So based on this histopathological examination the treatment is given and the neurosurgeon will be able to tell you based on the histopathological diagnosis that what is the prognosis in such kind of tumors and what kind of humour it is and what kind of case we are dealing with. So this was in short about the brain tumors whenever you have any patient who has got these kinds of symptoms like as I told you earlier, you can visit your neurosurgeon and he will further guide you regarding the best possible treatment for your patient, thank you. So this was in short about brain tumors if you would like to go through any of the other videos regarding any neurosurgical problems you can login to the lybrate.com and go through the rest of the available videos.

Thank you.

Hello everyone,

I am Dr. Nitin Jagdhane, consultant neurosurgeon and minimally invasive spine surgeon. Today we are going to talk about minimally invasive spine surgery. So basically everybody knows about the human spine, still to brief it, there are many vertebrae, right from the head up to the tailbone, which constitutes the spine and amongst these vertebraes between each vertebrae there are disc, which is the cushioning mechanism and there are such 7 vertebrae in the neck, around 12 vertebrae in the back and around 5 vertebrae in the lower back and then there are tailbone and its fine bones. So amongst these bones vertebrae or the disc their runs the nervous system that is a spinal cord and then its branches, we call it as nerves or roots. So as age advances and with many other factors, several times there are issues related to either the bones or maybe because of the disc or maybe sometimes inherent to the neural elements as well which lead to problems such as tingling or numbness in the limbs, weakness of the limbs, then paralysis of the limbs, sometimes urinary disturbances and main symptoms which they represent is the low back ache, backache or neck pain.

So these all conditions when they come at say after 40-50 years of age, they are mainly related to the degenerative pathology, so degenerative pathology means the age-related changes that reason that are causing wear and tear of the various vertebrae and its discs and the other elements of the spine because spine is something which holds entire body and it has the maximum wear and tear. So to know what are all other aspects or all other disease of the spine we will probably have another session on the various spine disorders. Today we are going to talk about what are the options when we get such spine problems? So traditionally spine surgery is known since ages and it has been done as an open procedure in which many vertebrae are exposed to reach the neural elements and then they are decompressed so that there is no pain, no tingling or there are no other symptoms which are because of the spine pathology.

Minimally invasive spine surgery is a relatively new advance and it can be done by various ways, but to know whether you are right candidate of minimally invasive spine surgery, you will have to get evaluated by a spine surgeon or by a neurospine surgeon or a neurosurgeon, who would be able to guide you whether you are the right candidate for the minimally invasive, some say endoscopic spine surgery, some say microscopic spine surgery etc. So basically minimally invasive spine surgery deals with the same approach for decompressing the neural elements which are compressed because of degenerative pathology in the bones or of the discs, other neural elementary itself by minimal invasive way that means in traditional spine surgery the muscles are cut and the tendons are cut and then we reach the vertebral bones and then after the surgery we approximate them by taking multiple sutures but whenever we do such extensive operations although we try to approximate these muscular structures, they do not actually come into the same place as they were before surgery, minimally invasive spine surgery techniques basically, they avoid cutting of these muscles and the incision is also not like a traditional midline incision, it is a little lateral and this is basically a muscle splitting approach so that muscles are not cut and basically tubes or endoscopes or there are multiple types of endoscopic instruments available these days, which are used to gain access to the vertebra and the neural structures and for the decompression.

So because the muscles are not cut, approximation is better as well as the incisions are very small because they are done through very small incision through which the tubes or endoscopes can enter and with various neuronavigation or other techniques, the exact location is guided to the surgeon and then the particular part of the spine is decompressed or is treated. Now as I said that whether you are a candidate for minimally invasive spine surgery is decided by spine surgeon and in general if there are multiple level problems in your spine, there are chances that you may not be a candidate but yes if you are having a problem at one or two levels or even three levels that can be managed with minimally invasive spine techniques and with the recent advances going on in the field of illumination as well as the endoscopes the field is quickly developing.

So in this procedure, there are three basic approaches. One is, a little lateral to the midline that is paraspinal approach or interlaminar approach, then there are other approaches which are called as transforaminal techniques, which are done with far lateral technique, which is used with the longer endoscope and then there are techniques which differ basically in the kind of endoscope that is used, so we will not go into much detail of these endoscopic instruments and equipment but the basic thing as I told you is that we take the minimally invasive approach to reach the pathology and we decompress it. Now the advantages of these techniques is that as there is a small incision, the healing time is faster, many cases can be done under local anaesthesia, which will traditionally be done under general anaesthesia in the traditional open spine surgery and this can be done even in cases in the elderly patients, who are not suitable candidates for general anaesthesia because of their comorbid conditions and this can be done as daycare procedure as well. Patient admitted in the morning, it is done under local anaesthesia and the patient can go home.

So these are in short the various techniques or as we can see in this image, basically this is a kind of tubular approach for tubular endoscopic system, which is used to decompress the neural elements. This is the endoscope to image the instruments and endoscope and nerves and the neural elements, which are getting compressed because of the disc and other pathologies are decompressed. So in traditional spine surgery as you can see in this image there is a bigger incision compare two minimally invasive spine surgery in which you can hardly see any incision and even after the surgery if you see the transection of that level in MRI, there are hardly any changes in the muscles and which shows very good recovery and good healing. I hope this was useful for all of you to at least know what are the basics regarding the minimally invasive spine surgery and what are the various techniques of it. Probably in the next video, we can discuss more the details of each surgery and the indications and right candidate for such kind of surgeries.

Thank you very much