Swasthya Sambad had an exclusive conversation with one of the most eminent orthopedic surgeons in the state, Dr Paresh Chandra Dey, who is the pioneer in Endospine surgery in India. In this interview, he extensively talked about the causes and latest surgical treatment as far as back pain is concerned. Excerpts of the interview:
How Does The Spine Works?
The spine or vertebral column is made up with 33 vertebrae, (7 in neck, 12 in mid back, 5in lower back) and 24 discs. The disc is a cushion like thing lies in between two vertebrae and contains the nucleus pulposus at the centre surrounded by annulus fibrosus.
The extension of brain is called the spinal cord, which passes through a canal made up by spaces at the centre of vertebras and give rise to 25 pairs of nerves. The Upper 8 nerves supplies to both hand called brachial plexus and lower 5 nerves supplies to leg called sciatic nerve. The sensation like pain, touch, pressure is carried from different parts of body through nerves to spinal cord to brain.
What Causes Back Pain?
Back pain is almost the most common complaint heard in the present century. Apart from being common it is also quiet painful, distressing and causes limitations in day to day activities. It is estimated that 77% of the population goes through back pain and 35% with sciatica at least once during their lifetime. With the advent of MRI, the cause of back pain is diagnosed very early and almost 100% accurately.
It is mostly due to two causes. First being slipped disc, which is most commonly seen in young generation, while lifting heavy weight in forward bending posture.
The other one is spinal canal stenosis or sciatica in which the diameter of the spinal canal is decreased due to aging process. When age advances the canal dimension decreases due to weakness of the bone and side projection, ligamentumflavum hypertrophy and disc degeneration. In both slipped disc and sciatica, spinal cord or nerve roots are compressed. The pain radiates from back to legs and toes. Tingling and numbness starts in legs and toes. During walking, person feels tightness in legs and the walking distance reduces. Sometimes control over urine lost, is also called sciatica syndrome. At times negligence of petty symptoms leads to complete loss of sensation of toes and foot and loss of power of foot which is otherwise called footdrop.
What are the latest and the most efficient surgical treatment?
One of the most advanced and risk free surgical treatment is Endoscopic spine surgery or Endospine surgery. It was first started by a French neurosurgeon and only few doctors in India are skilled enough to conduct this complex-free surgery. Endospine surgery is the most advanced and successful technique for treatment of slipped disc and sciatica. A special localizing device is used to localize the disease site with the help of image intensifier. The operating tube is placed on the laminae through a small 16 to 18 mm incision. The surgeon’s eye is focused right inside the body close to the problem. The working insert mounted in the tube, of having 4 channels, for 4 mm telescope, 4 mm suction tube, 8 mm operating instruments channel and the last one for nerve root retractor.
The entire procedure is performed under video-endoscopic monitor through 3D high definition camera and the nerve is guarded by nerve root retractor, so almost nil chance of injuring the nerve. There will be minimal blood loss and no stitches required.
It can move from left to right below the spinous process and very easily decompress bilateral nerve roots at multiple levels. Endospine minimizes post operative discomfort and allow for rapid resumption of normal physical activities including sports.
How is Endospine different from traditional spine surgery?
Traditional spine surgery needs long incision. Huge amount of muscles and tissues are stripped from spine to visualize the deep structures.
With Endospine, patients gets similar and even better results with very less complications by using high definition image system and skin incision about the size of thumb breadth.
What are potential Benefits of Endospine Surgery?
-16 to 18 mm skin incision
-Minimal blood loss
-30 to 40 times magnified & well illuminated view
-Average surgery time is 25 to 30 minutes
-Endospine is mobile tube. So, it enables surgeon to illuminate and explore the hidden recesses
-Surgeon’s eye is practically inside the spine, so advantageous in obese patients
-Special nerve root retractors protect the nerve. So, remote chances to nerve root injury
-Less tissue damage
-Minimal post operative pain
-Rapid resumption of physical activities including sports
-No stitch
-Patient is mobilized on the same day
-Discharged in a day or two
-Multiple level canal stenosis and disc herniation can be treated easily
What is the percentage of nerve root injury or any other complication?
We have most advanced high end facilities to treat the patients with Endospine technique with almost nil complications.
What facilities are available in Modern Ortho Clinic?
We have the most advanced high end facilities of Endospine technique at Bhubaneswar. We have operated around 2400 cases successfully, which is the 3rd highest in the world.
At Modern Ortho, we have 3D Endospine system of Storz Company (Germany) which is one of the most sophisticated equipments as far as spine surgery is concerned.
It is first of its kind in Eastern India‚ that Modern Ortho Clinic, Bhubaneswar provides this painless, bloodless, stitchless procedure and maximum comfort at an affordable cost.
About Dr. PC Dey:
M.S –Orthopaedics
Fellow –Endospine –France
Fellow –Arthroscopy –Germany
Fellow—Arthroplasty—Singapore
Modern Ortho Clinic, Beside Kalinga Stadium, Beherasahi, Nayapalli, Bhubaneswar
Consultant Orthopaedics, AMRI Hospital, CARE Hospital, Utkal Hospital and Kalinga Hospital, Bhubaneswar
Honorary Secretary to WESS -World Endoscopic Spine Society
Founder President, OAS- Odisha Arthroscopy Society
Executive body Member – MISSAB ( Minimally Invasive Spine Surgeons Association of Bharat )
Mobile –9438800020, 9437928686, 9437069966, 9437113636, 06742421122
Email–[email protected]
