1. MINIMAL ACCESS SURGERY LUMBAR SPINE DR. PARTHA P BISHNU MCh Neurosurgeon

2. BACK PAIN Survey 75 to 85 percent of all people will experience some form of back pain during their lifetime. Back pain is: the second most frequently reported reason for visiting a doctor, the fifth most frequent cause of hospitalization and the third most frequent reason for surgery.

3. Spinal or Radicular pain + Neurological deficit 1.Pain associated with fever & weight loss Axial skeletal infection 2.Pain associated with recumbency and night Neoplastic process 3.Pain associated with morning stiffness Axial skeletal Inflammatory disorder 4.Mechanical pain Degenerative spinal disorder 5.Acute localized pain Axial skeletal fracture/ dislocation

4. MINIMAL ACCESS SURGERY LUMBAR SPINE CASE SERIES: OPD :440 LBP patients- March,2011 to February, 2012. OPERATED CASES : 20/18 analyzed PATIENTS AGE RANGE :19-70 YEARS MALE PATIENTS : 8/18 FEMALE PATIENTS : 10/18 DURATION OF SYMPTOMS : 25 DAYS- 7 YEARS Chronic Recurrent Problem

5. ASSESMENT OF DISABILITY IN PATIENTS OF LOW BACK PAIN REVISED OSWESTRY DISABILITY INDEX (ODI) PAIN INTENSITY PERSONAL CARE LIFTING OF WEIGHTS WALKING SITTING STANDING SLEEPING SOCIAL LIFE TRAVELLING CHANGING DEGREE OF PAIN DISABILITY SCORING 0-50 ( 0-100%)

6. ASSESMENT OF DEGREE OF PAIN IN LOW BACK PATIENTS QUADRUPLE VISUAL ANALOGUE SCALE 0 to 10

7. LOW BACK PAIN Chronic Recurrent Problem PSYCHOLOGICAL EVALUATION

8. ODI BEFORE SURGERY S.NO. ODI 1 44.00% 2 58.00% 3 80.00% 4 60.00% 5 68.00% 6 78.00% 7 54.00% 8 66.00% 9 68.00% 10 96.00% 11 92.00% 12 58.00% 13 82.00% 14 90.00% 15 80.00% 16 66.00% 17 50.00% 18 62.00% RANGED FROM 44% TO 96%

9. MINIMAL ACCESS SURGERY LUMBAR SPINE MICRODISCOIDECTOMY MICROSURGICAL DECOMPRESSION OF LATERAL RECESS STENOSIS BILATERAL FENESTRATION FOR CANAL STENOSIS LAMINECTOMY ×-no longer done

10. GOAL S OF SURGERY Neural Decompression Minimal / No destruction of Normal structures Minimal / No Scarring of Back Muscles Lumbar Disc Prolapse Lumbar canal / Lateral Recess Stenosis

11. ODI PRE OP AND FOLLOW UP S.NO. PRE OPFOLLOW UP 1 44.00% 10.00% 2 58.00% 12.00% 3 80.00%24.00% 4 60.00%08.00% 5 68.00%00.00% 6 78.00%14.00% 7 54.00% 18.00% 8 66.00%38.00% 9 68.00%06.00% 10 96.00%00.00% 11 92.00%04.00% 12 58.00%18.00% 13 82.00%08.00% 14 90.00%24.00% 15 80.00%00.00% 16 66.00%14.00% 17 50.00%12.00% 18 62.00%12.00%  CHANGE IN THE ODI SCORE OVER TIME  ALL PATIENTS’ DISABILITY IMPROVED SIGNIFICANTLY  No new neurological deficits  No complications

12. Four Indications for Surgery Intractable Pain- Radicular > Back Progressively worsening Neurological Deficit Recurrence of Pain Cauda Equina Syndrome Low Back Pain Disc Prolapse MRI SCAN CORRELATES WITH THE NEUROLOGICAL SYMPTOMS AND SIGNS

13. MINIMAL ACCESS LUMBAR SPINE SURGERY DISCUSSION FACTORS AFFECTING RESULTS OF SURGERY 1.CASE SELECTION- CLINICAL FEATURES 2.MRI CORRELATION 3.MICROSURGICAL/MINIMAL ACCESS TECHNIQUES 4.POST OPERATIVE REHABILITATION 5.PSYCHOLOGICAL ASSESMENT

14. Lumbar Disc Prolapse Minimally Access Surgery RD,35Y F RADICULAR PAIN WITH L5 RADICULOPATHY 90% PRE OP DISABILITY(ODI) POST OP COMPLETE RECOVERY POST OP ODI 4 %

15. Pain free in 24-48 hrs Minimal or No post operative Discomfort Awake Surgery possible Hospital Stay few hours to 02/03 days Safe and Effective Cost Effective Minimal Access Lumbar Spine Surgery Minimally Invasive Maximally Effective