THIRUVANANTHAPURAM : Do you feel a sharp or severe pain in the back or legs? Or do you feel weakness, tingling or numbness in your legs? Chances are that you need treatment for damaged spinal disc or unstable spine. When all other treatment options fail, doctors recommend a procedure to stabilise the spine, also called spinal fusion, which may involve removing bone fragments from the spine and connecting two or more vertebraes to eliminate movement between them. The procedure can treat conditions such as spinal instability, scoliosis, traumatic spine fractures, and degenerative disc disease.
One common method to treat spinal problems was fusing painful vertebrae, but the challenge was accessing the area for fusion surgeries, owing to the intricate nature of the spine. Open surgery had the disadvantage of larger incisions, more tissue damage, riskier infection chances, higher morbidity, etc. But now, endoscopic TLIF (Transforaminal Lumbar Interbody Fusion), the latest advancement in this realm, offers improved access for doctors during surgery, which benefits patients in the form of reduced tissue trauma, quicker recovery times, and decreased postoperative pain. The advent of minimally invasive techniques has also changed the way surgeons perform spine surgery.
“Endoscopic TLIF is the future of spine surgery. It is at a nascent stage now and a lot of refinement is happening in this procedure. More doctors are getting trained in it these days. It will be part of robotic surgeries in the next phase,” said Dr Shiju Majeed, professor of orthopaedics surgery, Government Medical College, Thiruvananthapuram. In Endoscopic TLIF, the surgeon uses an endoscope, a slender instrument equipped with a camera and light source, to visualise and access the spine through small incisions in the back. This contrasts with traditional open TLIF procedures, which involve larger incisions and more extensive tissue dissection.
The procedure typically begins with the patient under general anaesthesia. The surgeon makes small incisions near the affected area of the spine, through which specialised instruments and the endoscope are inserted. With the guidance of the endoscope’s camera, the surgeon navigates to the target vertebrae and removes any damaged or diseased disc material. Next, the surgeon prepares the disc space for fusion. This may involve removing additional disc material, preparing the endplates of the adjacent vertebrae, and inserting a bone graft or synthetic material into the disc space to promote fusion. In some cases, screws or rods may be used to stabilise the spine. The biggest advantage, according to Dr Majeed, is that this technique can be used to correct problems associated with open surgeries, with minimal trauma. This is particularly useful when the patient is not medically fit for another open surgery.
Dr Ajith R, senior consultant and coordinator, department of neurosurgery, KIMS Health, performed endoscopic TLIF on a 52-year-old patient who suffered from severe lumbar canal stenosis with listhesis – a condition where the narrowed spinal canal pinches the spinal cord and nerves resulting in an unstable spine. She had undergone back surgery 15 years ago with only temporary relief.
“Considering the complexities, the patient underwent endoscopic TLIF to stabilise the spine. This advanced surgery, which was conducted in two stages, involved the precise removal of the narrowed spinal segment and the placement of an expandable artificial disc to restore its optimal height through incisions less than 1cm in length with no collateral muscle damage. The patient started walking from the next day onwards and was discharged three days after the surgery,” said Dr Ajith.
“Endoscopic spine surgery is increasingly preferred as it allows individuals return to work sooner than with traditional open surgeries. It is suitable for treating various lumbar and cervical disc diseases, spinal stenosis and listhesis,” Dr Ajith added.
Traditional open and invasive spinal fusion requires dissection of the normal muscles and ligaments with a large incision, which can lead to significant operative blood loss, and post-surgery pain, limiting functional recovery.
While endoscopic TLIF offers many potential benefits, it may not be suitable for all patients or all types of spinal conditions. “Factors such as the location and severity of the spinal pathology, as well as the patient’s overall health and medical history, must be carefully considered when determining the most appropriate treatment approach. It is important to check the correct indication before choosing endoscopic TLIF. At this stage, the surgeons opt for this when they see it can tackle the condition. The costs for the endoscopic TLIF are on the higher side,” said Dr Shiju Majeed.
When this treatment may be considered
Degenerative disc disease: Changes in the lumbar discs, such as disc herniation, disc bulge and loss of disc height
Lumbar disc herniation: Nerve compression causing symptoms such as back pain, leg pain (sciatica), numbness and weakness
Lumbar spinal stenosis: Compressing nerve roots causing symptoms such as back pain, leg pain, and difficulty walking
Failed back surgery syndrome: Persistent or recurrent back or leg pain following one or more failed spinal surgeries
Other spinal instabilities: isthmic and degenerative spondylolisthesis, segmental instability, and spinal deformities like scoliosis or kyphosis
Pseudoarthrosis: The lack of a solid fusion from a prior fusion surgery