IJOCP | Volume – 2015| Issue – 2015| Article ID – 2015:54
Conference: Poona Orthopaedic Society Annual Conference POSAC-2015,      India [Click for Full details]  

Authors: Sunil Nadkarni, Satishchandra Gore

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Abstract                                                                                                                 

Disabling claudicant symptoms from dynamic stenosis is not an uncommon problem. In these patients there is usually a clear-cut forward translation of the lumbar vertebrae from supine to erect position on x-ray. TLIF is a successful procedure for treating such patients.

We propose a new method which merges two proven techniques, to improve the safety and accuracy of the intervention, namely transforaminal percutaneous endoscopic discectomy with percutaneous pedicle screws and cage. We have called this new procedure “hybrid”.

We share the experience of 45 patients treated using this technique at Walawalkar hospital in Derwan (a state of the art charitable hospital functioning since 1996 midway between Mumbai and Goa in an economically and geographically deprived part of rural India erected with a humanitarian spirit).and in pune at prime surgical centre.

Results tested using Oswestry disability index have proved satisfactory. There was one slippage of the cage through inadvertent use of the Indian toilet.  This was revised with satisfactory result.

 Discussion:

There are several advantages in combining the two procedures. It is done in an awake state considerably adding to the safety of the procedure. The correct level is identified and marked with a sturdy dilator. This also facilitates the insertion of the cage into the disc space without damaging the endplate adjacent, which is sometimes a real problem in elderly osteoporotic bones. Visualization of the foramen for any disc or bone fragments that may have been inadvertently pushed on the opposite side is possible. In fact it is possible to visualize the positioning of the cage in the disc space from the opposite side while it is being inserted or after insertion. The irrigating fluid at the time of endoscopy causes a certain amount of dissection of the anatomical planes in the overlying soft tissues. This facilitates an easy intramuscular entry to the facet. Because the dilator is in the disc space already, targeting the disc space by chasing the dilator becomes a simple matter. Moreover the dilator in the foramen protects the exiting nerve from injury while using the osteotome to remove the lateral part of the facet

 

How to Cite this Abstract
Nadkarni S, Gore S. Hybrid Surgery for Stabilisation in Lumbar Spine Combining Stitchless Surgery under Local Anaesthesia and Percutaneous StabilisationInternational Journal of Conference Proceedings 2015;(2015):54