ADVANCED MINIMALLY INVASIVE SPINE SURGERY-MISS AND AMISS

There are many people who need back and neck surgery but are afraid of it. Many have heard horror stories of severe pain, long recovery periods and even those who have become paralysed. There is however technology currently available that addresses these concerns. It is true however that these methods are available from some neurosurgeons/spine surgeons worldwide; those who have listened to  patients and understood their needs have been working hard to find solutions that are minimally painful, allow quick recovery and are effective treatments.

These solutions include but are not limited to several of the following:

1.Percutaneous Plasma Energy Discoplasty
2.Percutaneous Endoscopic Laser Disectomy-PELD
3.MicroDisectomy
4.Endoscopic Disectomy
5.Microsurgical Discetomy with Dynamic Implants
6.MicroEndoscopic Discectomy-MED
7.Microsurgical Spinal Decompression
8MicroEndoscopic Spine Microsurgery- MESM
9.Percutaneous Disc Regeneration Technology
10.Endoscopic Disc Replacement
11.Microsurgical Disectomy and disc replacement
12.Minimally Invasive Spine Fusion and Instrumentation

Some of these options allow the patient to arrive at a day surgery center, have the procedure under iv sedation and local anesthesia (no general anesthesia) and leave within a few hours of a fairly short procedure. Most patients walk out of the center themselves and can return to work in a few days.

Unlike taking pain medications or pain injections; these procedures do address the root of the problem. They allow reduction in nerve pressure and therefore can prevent ongoing or future nerve damage. Spinal nerves especially the spinal cord, cannot be effectively replaced at this point in time. Stem cell treatment is still experimental and not consistently successful. Taking away spine nerve pressure to reduce the risk of spine nerve injury is still the best strategy.

These procedures are also evolving and becoming more successful with experience, technology and the passage of time. Many of us who are Minimally Invasive Spine Surgeons believe that more spine doctors need to know and be trained to do these procedures. An informed patient can also help to accelerate these changes worldwide by insisting on the latest and least invasive spine treatments.

References

Dr Prem Pillay, Singapore Spine Specialist and Neurosurgeon

Neuro Spine and Pain Center Singapore

Leg Pain can occur from Back Problems!

Leg Pain can come from Back problems that may start as

back pain and then spread to the legs. This is also called
Sciatica or psuedo claudiation leg pain.

Back Pain used to be seen mainly in those who worked
 in physically demanding jobs like builders, bricklayers,
 plantation workers, heavy industry workers , construction
 workers and miners. However, nowdays Dr Prem Pillay 
 has noticed that there are more executives who come

 to him for back pain. He has identified prolonged sitting,
 a poor posture, overuse of computers , frequent business
 travel and a unhealthy  executive lifestyle as major reasons
 for this problem. When you sit too long, he explains, there
 is increased pressure in the spine discs. The spine is not
 one bone but about 33 bones with a soft gel like substance
 called the disc in between. The disc allows flexibility and

 movement in the spine.  An Executive Lifestyle with 
computer work and  a lack of movement can cause the
 spine discs to break down and come  out or slip out.
 These slipped discs can pressure on the nerves  and cause
 back pain, leg pain, numbness, tingling, and as the problem 

 gets worse even weakness in the legs. The worse case
 scenario is becoming unable to walk, unable to pass urine
 or pass motion. This  can happen gradually or in some people
 it can happen suddenly even  from a small accident or injury 
once the pressure on the spine nerves is already present.

People who have back pain and leg pain often go for 
massages or manupilation  to therapists and chiropractors.
If the pain does not get  better  after three visits to the 
therapist , or gets worse after the first visit, or comes back
after the therapy  , its best that you see a real spine specialist.
Dr Prem Pillay does warn that massage therapy or 
physical therapy done in the wrong way by unqualified people
can  make the problem worse.  A proper spine and nerve 
examination followed  by an MRI of the spine can reveal
and confirm the problem. X rays alone cannot show the
nerves or pressure on the nerves from  a slipped disc.

In some older people, the back pain with leg pain is 
caused by spine stenosis. This is a narrowing in the spine 
canal which squeezes the spine  nerves. A common story
that Dr Prem hears is that the person cannot  walk far
without the legs feeling uncomfortable. He or she has 
to stop  and rest first before walking further. This is called
spinal claudication pain  or psuedo-claudication leg pain.

Back pain and leg pain can often be treated without
 surgery. The proper  medications and  therapy organized
 by a spine specialist can help the  person recover faster 
and return to his normal lifestyle. Some people require
 spine injections including nerve blocks,  Neuroplasty, 
facet injections, Annuloplasty, Biacuplasty, and RF to the 

medial branch nerves to reduce pain. The better and 
more advanced  type of spine injections such as Discoplasty
treat the root of the problem.  This involves a laser like spine
njection to the disc to reduce the disc pressure on the nerves. 
This can be done as a day procedure  without any surgery.

In some people the problem has become too serious
and requires surgery.  Fortunately modern surgery including
microsurgery and keyhole type spine  surgery has advanced
to a stage that the risks are low and the recovery  can be  
quick. These are minimally invasive spine procedures with
a keyhole  like approach.  Dr Prem gives the example of a
 patient who came to see him because of back pain with leg pains 

 that was worse on sitting for  too long and on walking a short distance.

The test showed that he had  spinal nerve pressure from 
slipped discs and spine narrowing. A minimally  invasive 
advanced microsurgery was done without any metal screws
but  using modern gel implants. He has now recovered
well after a short hospital stay and is walking and working
with a good quality of life.

In conclusion, more people including home and  office
 workers are suffering  from back pain. If this back pain 
is frequent or spreads to the legs, Dr Prem Pillay recommends
 that you see a spine and nerve specialist  for a proper check
 up to find out the root of the problem. Once the causes

 for the back and leg p[ains are found and treated at the source;
 a healthy lifestyle with less sitting, the right exercises and a good
 diet can also work together  lessen or solve frequent back pain 
and leg pain. 

Furthur information is available at 

http://www.spine-neuro.org/
 and http://www.singaporespine.org/
or by contacting clinicsg@yahoo.com or calling +6568354325 for assistance.

Motivation Can Enhance Recovery from Spinal Cord Injury

Motivation can promote recovery after spinal cord injury

Researchers  confirm that motivation can facilitate recovery after spinal damage.
Clinicians have known for a long time that motivation can enhance a patient’s recovery from spinal cord injury or stroke, and that depressive symptoms resulting from brain injury can delay functional recovery. To date, however, the mechanism has remained elusive and there has been no neuroscientific evidence as to how motivation affects recovery of motor function in rehabilitation.
A research team led by Yukio Nishimura and Hirotaka Onoe has found that the nucleus accumbens, which controls motivation in the brain, stimulates the activity of the motor cortex of the brain, and then promotes recovery of motor function during the early stage of recovery after spinal cord injury. This result was published in Science.
The research team focused on the relationship between the neuronal activity of the nucleus accumbens and that of the motor cortex, which controls motor function, in a monkey suffering from spinal cord injury. When the researchers temporally blocked the activity of the nucleus accumbens of the monkey one month after spinal cord injury, they observed that motor cortex activity was suppressed and a transient deficit of amelioration in finger dexterity was obtained by rehabilitation. In the intact monkey, and also in the fully recovered stage (three months after spinal cord injury), such deficit in hand movement by blocking the activity of the nucleus accumbens was not observed. This suggests that the nucleus accumbens makes a causal contribution to the functional reinstatement of hand control during early stage recovery, and the activity of the nucleus accumbens successfully promotes functional recovery.
“Our result suggests that in the early stage after brain injury including spinal cord injury, it is important to motivate the patients for promoting functional recovery in rehabilitation. Psychological support may also be important,” said Nishimura. "My experioence in treating Spine injuries is quite similar in finding that depressed and poorly motivated spinal injury patients don't recover as well or as fast as those with a positive attitude" states Dr Prem Pillay, a Neurosurgeon and Spine Specialist from the Neuro Spine and Pain Center in Singapore."its clear that this evidence gives us good reason to pursue furthur research into medications and even brain stimulation to specific nuclei to promote motor recovery after brain and spinal cord injury" said Dr Prem Pillay. "In the meantime, it is important for the whole treating team and the patient's family to provide psychological support for a positive attitude to rehab and recovery" states  Dr Prem Pillay.



Reference: M. Sawada, K. Kato, T. Kunieda, N. Mikuni, S. Miyamoto, H. Onoe, T. Isa, Y. Nishimura. Function of the nucleus accumbens in motor control during recovery after spinal cord injury. Science, 2015; 350 (6256): 98 DOI: 10.1126/science.aab3825

Eureka Alert

Spinal Surgery News Dec 2015

 Neuro Spine and Pain Center Singapore