Backache is the main cause of absence from work in working population. It is also the main presenting complaint of almost 60% of patients in any busy orthopedic surgeon’s practice. Commonest cause of backache is “prolapsed inter-vertebral disc” which is commonly known as slipped disc.
Between two vertebras there is fibro-cartilagenous structure known as disc. Inter-vertebral disc is composed of outer tough fibrous structure called annulus fibrosus, which encloses jelly like structure called nucleus pulposus. Tear of annulus forces nucleus out side, this nucleus material which has come out presses on the neural structures lying behind disc and causes backache, leg pain(sciatica).
Conventional treatment of slipped disc involves rest, physiotherapy and analgesics for adequate period of time. However, failure of conservative treatment, all progressive neurological deficit, and intractable pain, surgery is required.
Conventional Spine surgery involves taking long incisions, forceful muscle retraction for prolonged time, removal of normal tissues like ligaments and bone to approach area of pathology. Most of the times these surgeries are done under prolonged general anesthesia.
This long incisions and injury to normal structures results in
- Increased blood loss
- Increased scar tissue formation
- Increased chance of neural injury
- Epidural scarring
- Denervation of paraspinal muscles
All these cause increased morbidity and failed surgery syndrome. Since many times patients require to stay in bed for long duration of time, and there is also loss of work, earning , patients tend to avoid surgery and prefer to suffer pain and disability. Now there is hope for all these suffering population, in the form of minimal invasive spine surgery.
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