Spine Surgery

Spine services in INK deals with the whole spectrum of spinal disorders. The unit performs surgeries ranging from microdecompression to the most complex spinal deformity correction and excision of intradural tumours. The spine unit comprises of two full time experienced Spinal surgeons , a Junior Consultant in Spine surgery supported by 3 trainees . Over 1100 spine surgeries are being performed in INK per year. In our endeavour to make spine surgery safe, newer technologies like intraoperative spinal neuromonitoring , intraoperative imaging and computerised navigation system and high quality operating microscopes and endoscopes are being used . Minimally invasive spine surgeries for different spinal pathological conditions are being routinely performed. The unit is well supported by spinal rehabilitation team comprising of spinal physiotherapists and occupational therapists who work under the supervision of full time rehabilitation physicians. INK is accredited by National Board of Examinations (New Delhi) for Fellowship programme (FNB) in spine surgery.

Spinal Surgeries performed

  • Scoliosis correction surgery
  • Kyphosis correction surgery
  • Surgeries for spinal infections including tuberculosis
  • Spinal Baclofen pump placement
  • Spinal cord stimulator placement
  • Vertebroplasty and Kyphoplasty
  • Anterior thoracic and Lumbar surgeries
  • Surgeries for congenital spinal anomalies like tethered cord
  • Surgeries for spinal injuries
  • Transforaminal Spinal endoscopy

Spinal Pain procedures performed

  • Nerve root block
  • Transforaminal epidural injections
  • Facet joint and Sacroiliac joint injections
  • Rhizolysis / Radiofrequency lesioning for facet joint pain

Specialised Spine Services

Newer technologies and techniques used in spine surgery

Spinal Neuromonitoring

Intraoperative neuromonitoring allows us better and safer correction of spinal deformities and also helps to ensure safety during complex procedures involving the spinal cord including surgeries for spinal intradural tumors. We have the latest Medtronic NIM-ECLIPSE™ Spinal Neuromonitoring System. During spinal surgery, the NIM-Eclipse allow physicians to monitor critical neural pathways with the help of electrodes placed in different locations of the patient’s body. This helps to identify any imminent damage to the nerves and spinal cord during surgery and prevent post-operative neurological deficits. NIM-ECLIPSE™ Spinal System also provides for automatic pedicle screw monitoring with direct nerve and screw stimulation.

Spinal cord monitoring system in use for complex spine surgery

Minimally invasive spine surgeries

Most complex spinal surgeries can be performed through very small skin cuts and use of newer technologies like operating microscopes, endoscopes and intraoperative xray imaging as well as Xray based intraoperative computerised navigation systems. Minimally invasive surgeries can be done for lumbar or cervical disc prolapse, spondylolisthesis, spinal tumors, spinal fractures and spinal infections.

Minimally invasive spinal fixation being performed

Spinal navigation

We have the Medtronic StealthStation® surgical navigation imaging system which enable surgeons to visualize the anatomy of a patient’s spine during surgery and to precisely track the location of their surgical instruments in relation to the anatomy. Using these technologies during delicate and complex procedures, surgeons may navigate more precisely, may perform less-invasive procedures, can possibly reduce radiation for surgeons, staff and patients and potentially help improve clinical outcomes.

Spinal Fixation being performed using Computerised Spinal Navigation System

Spinal injections

Spinal epidural steroid injection is a minimally invasive procedure that can help relieve neck, arm, back, and leg pain caused by inflamed spinal nerves due to spinal stenosis or disc herniation. Under Xray guidance ,medicines (corticosteroid and an anaesthetic agent) are delivered to the epidural space, which is a fat-filled area between the bone and the protective covering of the spinal nerves. Pain relief may last for several days / months or even years. The goal is to reduce pain so that patients may resume normal activities and a physical therapy program. Injections for sacroiliac joints or facet joints and radiofrequency ablation for facet joint pain are also useful procedures in treatment of low back pain and are routinely performed in INK

Fluroscopic views of spinal nerve root block injections

Spine microsurgery

In microsurgery, a surgeon uses an operating microscope and specialized instruments to perform surgery on small or delicate structures. Operating microscopes are designed to provide bright focussed light and greatly magnify the surgical field. This allows the spinal surgeon to be more precise and effective in operating the delicate structures around and in the spinal cord and nerve roots. Many operating microscopes also display a high-resolution image on a screen in the operating room. Microsurgery may be used to remove a tumour or tangle of blood vessels in the spinal cord, a procedure called microsurgical spinal cord tumor resection. It may be used to remove part of a pathological disc, as in a cervical microdiscectomy or a lumbar microdiscectomy and as part of many surgeries, including minimally invasive spine surgery.

Modern high end operating microscopes used for spine surgery in INK

Intraoperative Xray using Digital Carms

Plasma Coagulator for Endoscopic Spinal procedures

Ultrasonic Bone Scalpel and CUSA for Spinal Decompression

Biportal Endoscopic spine surgery in progress

Spine microsurgery in progress

Scoliosis and spinal deformity correction surgeries

Scoliosis and kyphosis are curvatures of the spine. Although most common in young teenagers, these deformities affect children as well as adults. In most patients these deformities of the spine are non-progressive; however in some patients, scoliosis and kyphosis continue to slowly progress throughout life, resulting in cosmetic as well as functional issues. Surgery may be required for fast growing significant curves. The goals of treating any deformity of the spine are to stop progression, normalise spinal function, minimise any associated painful problems. Scoliosis and kyphosis correction surgeries are performed in INK by a team of trained surgeons. Use of technologies like intraoperative spinal neuromonitoring and spinal navigation make the surgeries more safe and less time consuming. Post operative rehabilitation under the supervision of specialised spinal physiotherapists help the patients return to normal activities much faster.

Scoliosis in a 17 year old girl corrected by surgery

Spinal Tumor Services

INK spinal team deals with all kinds of spinal tumors starting from intradural ones to the metastatic lesions. Microsurgical excision and biopsy of intradural tumors under spinal cord monitoring to ensure safe and complete excision is a standard practice. The metastatic tumors are often dealt with as a multidisciplinary approach involving the Oncologist, Interventional Radiologist , the Spine surgeons and of course the rehab team to provide best outcome. The unit also deals with primary bone tumors of the spine like Giant Cell Tumors, Aneurysmal Bone Cysts , vertebral hemangiomas, Sacrococcygeal chordomas and also haematological malignancies affecting the spine.

Sacral tumor -Chordoma surgically excised

24x7 Spinal emergency services

Spinal emergencies like spinal injuries , cauda equina syndrome and acute spinal cord compression are dealt with utmost priority and urgency in our hospital to provide best possible outcome to the patient. Timing of surgery in certain spinal conditions can be life changing for the patient.

Emergency spinal fixation done for fracture in a Bamboo spine

Endoscopic spine surgery

Endoscopic Spine Surgery is a type of state-of-the-art surgery that uses small tubular system or micro incisions, assisted with an endoscope for visualization. This type of Minimally-Invasive Spine Surgery (MISS) provides patients with quicker recovery and less pain than traditional spine surgery. We perform Transforaminal and Unilateral Biportal Endoscopic (UBE) procedures for selected patients with appropriate indications

Transforaminal Endoscopic discectomy performed under local Anaesthesia for prolapsed intervertebral disc making a 8mm small hole in the skin

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