Dr. Ankur Gupta

Endoscopic Spine Surgery-Surgical treatment of the degenerative disc disease has evolved from traditional open spine surgery to minimally invasive spine surgery including endoscopic spine surgery. Constant improvement in the imaging modality especially with introduction of the magnetic resonance imaging, it is possible to identify culprit degenerated disc segment and again with the discography it is possible to diagnose the pain generator and pathological degenerated disc very precisely and its treatment with minimally invasive approach. With improvements in the optics, high resolution camera, light source, high speed burr, irrigation pump etc, minimally invasive spine surgeries can be performed with various endoscopic techniques for lumbar, cervical and thoracic regions. Advantages of endoscopic spine surgeries are less tissue dissection and muscle trauma, reduced blood loss, less damage to the epidural blood supply and consequent epidural fibrosis and scarring, reduced hospital stay, early functional recovery and improvement in the quality of life & better cosmesis. With precise indication, proper diagnosis and good training, the endoscopic spine surgery can give equally good result as open spine surgery. Initially, endoscopic technique was restricted to the lumbar region but now it also can be used for cervical and thoracic disc herniations.Previously endoscopy was used for disc herniations which were contained without migration but now days it is used for highly up and down migrated disc herniations as well. Use of endoscopic technique in lumbar region was restricted to disc herniations but gradually it is also used for spinal canal stenosis and endoscopic assisted fusion surgeries. Endoscopic spine surgery can play important role in the treatment of adolescent disc herniations especially for the persons who engage in the competitive sports and the athletes where less tissue trauma, cosmesis and early functional recovery is desirable. From simple chemonucleolysis to current day endoscopic procedures the history of minimally invasive spine surgery is interesting. Appropriate indications, clear imaging prior to surgery and preplanning are keys to successful outcome. In this article basic procedures of percutaneous endoscopic lumbar discectomy through transforaminal and interlaminar routes, percutaneous endoscopic cervical discectomy, percutaneous endoscopic posterior cervical foraminotomy and percutaneous endoscopic thoracic discectomy are discussed.

Minimally Invasive Spine SurgeryMinimally invasive spine surgery (MISS) is a type of surgery on the bones of your spine (backbone). This type of surgery uses smaller incisions than standard surgery. This often causes less harm to nearby muscles and other tissues. It can lead to less pain and faster recovery after surgery.The standard method of spine surgery is called open surgery. This uses a long incision down the back. The muscles and soft tissue around the spine would need to be moved away. In some cases, tissue would need to be removed.During MISS, the healthcare provider makes a smaller incision. He or she then inserts a device called a tubular retractor. This is a stiff, tube-shaped tool. It creates a tunnel to the problem area of the spine. It gently pushes aside the muscle and soft tissue around the area. The surgeon can then put small tools through the tunnel to work on the spine. The surgeon also uses a special operating microscope and views real-time X-ray images of the spine.Surgeons can use MISS for some types of spine surgery. These include lumbar discectomy, laminectomy, and spinal fusion.

As a major tertiary center for Multi-speciality Clinic, Udaayan Multi-speciality Clinic is able to correct even the most severe spinal deformities. Procedures on complex deformities are undertaken in children and adults, and are available at all Udaayan Multi-speciality Clinic. Surgical correction of a double major curve in a woman with scoliosis Surgical correction of a double major curve in a woman with scoliosis Open pop-up dialog box Recently, neurosurgeons at Udaayan Multi-speciality Clinic in Jaipur, Rajasthan, performed a complex surgical correction of a double major curve in a young woman with scoliosis, with excellent results. The patient was diagnosed in childhood with scoliosis, which remained stable through adolescence. However, the scoliosis worsened in early adulthood, resulting in an increasingly noticeable hump on her back, pain that interfered with her functioning and quality of life, and shortness of breath. Her condition hindered her ability to work and to care for her young child. The patient was evaluated by Dr. Ankur Gupta , both consultants in Neurosurgery at Udaayan Multi-speciality Clinic in Jaipur, Rajasthan. The surgical team included both of the neurosurgeons as well as a neuroanesthesiologist, an intensive care specialist and nursing staff with experience in complex spinal surgeries. The surgery was performed in two stages: a fusion of the anterior lumbar spine between L5 and S1, followed a few days later by a posterior decompression and fusion of the spine from T3 to the pelvis, including insertion of rods and screws, and bone grafting. "We were able to completely straighten the patient's back, significantly relieve her back pain and help her breathing capacity as well," Dr. Ankur Gupta says. "Our patients can have an excellent result, even with very complex surgery, because of our team approach. For a complex problem, it's important to have a team of experts helping to take care of the patient." The procedures for the double major curve correction utilized intraoperative monitoring of the spinal cord to enhance the patient's safety as well as intraoperative CT image guidance. The enhanced image guidance available at Udaayan Multi-speciality Clinic facilitates placement of more-robust implants with novel trajectories to better stabilize complex spinal deformities.