INDIA: 38-year-old Mrs. Parvati Dhonde (Name Changed) is a housewife & part-time maid. One day she suddenly started feeling pain in her neck going through her left hand with burning sensations and loss of grip. Pain was so much that things started falling from her hand. She approached Saishree hospital and was in urgent medical attention. Neck-collar gave her some temporary pain relief. Patient could barely sleep on her back & sleeping in sitting position only was the comfortable position for her.
Giving the patient Powerful doses of steroids, painkillers, physiotherapy and traction did not help to stop her agony. Patient was subjected to an MRI Scan which showed that one of the Nerves in her cervical spine (neck region) was compressed; this resulted in severe pain in her neck and left hand. She was given a Root Block injection, which involves temporarily blocking the root at the site of its origin, this usually gives good pain relief and allows the body to heal, without any surgical intervention.
As expected, the patient had good pain relief and was discharged the following day. Unfortunately, the pain relief didn’t last long and the patient was again brought to the Opd with same agonising pain. At this, point of time the doctors new that some form of surgical intervention needs to be done to permanently fix this problem.
One of an expert surgeon who was involved in this Surgery Dr. Ketan Deshpande, renowned Endoscopic Spine Surgeon, at Saishree Hospital said, “Previously in 2018 Mrs. Sakhubai came to Saishree hospital & was diagnosed with slip disc in lower spine & was successfully operated. This time she again started suffering with sudden pain in the neck & left hand., and was diagnosed with Cervical slip disc. Anterior Cervical discectomy & fusion is a routine surgery done for this type of patient but it involves removal of the disc via an anterior approach and replacing it with artificial cage & plate. But considering this patients age and the type of disc herniation we decided to do something novel, applying biportal endoscopic approach in Cervical spine, possibly the first of its kind cervical biportal endoscopy to be performed in India.”
The nerves in the neck region are very delicate and manipulating during surgery isn’t permissible. This is where the role of Endoscopy comes into play, since this procedure is done under complete endoscopic visualisation, the magnified view under camera provide crisp, clear images and clear identification of neural elements. Also, this approach involves approaching the spinal nerves from back of neck which avoids manipulating critical front sided structures like the oesophagus (food pipe), trachea (windpipe), and also major blood vessels reducing approach related complications. Anterior approach involves removal of the entire disc and replacing it with metalling cage-plate construct, whereas, this posterior endoscopic approach involves removal of only the damaged part of the disc and rest (>90%) of the normal disc is untouched negating the need for any metallic implant placement.
This is a completely stitch less surgery. The wound on the incision is quickly healed up because there is a rich amount of blood flow. Cervical Biportal Endoscopy consists of 2 small incisions, a 4mm incision that carries the Endoscope and 1cm incision that allows passage of instruments needed to perform the decompression procedure. There is a camera and light at the tip of the endoscope along with a couple of water irrigation channels. Surgery is done under endoscopic vision, with good illumination, clear picture with a magnified view and continuous irrigation allows a blood-less field for operation. The whole procedure was completed in 75 minutes and the patient was mobilized on the very next day and discharged on the 3rd day walking freely and pain-free. Patient is advised to wear a neck support for a month or so but can regain all activities within a week.
“These types of surgeries are regularly done in foreign countries but this was possibly the first incidence in India.The results are very encouraging and will benefit the patients by providing early recovery, and early return to function” quoted Dr. Ketan Deshpande.
At the time of the surgery, Dr. Ketan Deshpande, Spine Surgeon, Dr. Trupti Pare, Anaesthesiologist at Sai Shree Hospital, were present.
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