1. Nova Medical Centers
Ambulatory Spine Surgery
(Day Care Spine Surgery)

2. Dr V.Daya Thirumala Rao
Endoscopic Spine Surgeon
Bangalore, Delhi, Mumbai

3. My Mentor
Dr P.S.Ramani
THE MOTTO
“Never cease to be a student.”
Chairman, WFNS Spine Committee

4. Ambulatory Spine Surgery
Include those surgical procedures more
complex than office-based procedures but
less complex than major procedures
requiring less than 24 hours admission for
post anesthetic and patient monitoring.

5. Ambulatory Spine Surgery
• progress in diagnosis with MRI
• progress with surgical tools:
Better Endoscopic tools with minimal fiber optics diameter , a large
working channel , a flow integrated system keeping the surgical field
clear
• progress with anaesthesiology pain
prevention, patient comfort and security
• more people requirement against pain

6. Ambulatory Spine Surgery
• Advances in surgical technique and
technology have a profound effect on
shifting many surgical procedures
previously require long-term in-patient
hospitalization are now routinely
performed on an out-patient basis.

7. Day Spine Surgery procedures
at
Nova Medical Centers
Ambulatory
spine
surgery
Percutaneous
Endoscopic
Lumbar
Disectomy
(PELD)
Percutaneous
Endoscopic
Lumbar
Foraminoplasty
Fully
Endoscopic
Lumbar
Disectomy
Percutaneous
Transforaminal
Lumbar
Interbody
fusion
(Pe-TLIF)
Nucleoplasty
Kyphoplasty

8. Slipped disc

9. Different Surgical Options For
Treatment of Slipped Disc
• Laminectomy : A traditional treatment
procedure
• Microdisectomy: This is referred to as
Gold standard
• PELD: Latest advancement

10. procedural milestones in spine surgery

11. Laminectomy

12. Laminectomy

13. Microdisectomy

14. PELD
(Percutaneous Endoscopic Lumbar Disectomy)

15. What is PELD?
• It is the technique used for decompression
of the nerve roots by removal of bulged
soft tissue via the posterolateral approach.

16. PELD-anatomical consideration

17. Historical Review of PELD
 Primary Intradiscal Aproach
– 1977 - Hijikata : Percutaneous manual discecotmy (non-selective, not concurrent with surgical identification)
– 1983 - Kambin & Gellman : Non-visualized posterolateral percutaneous nucleotomy
– 1984 - Ascher : Percutaneous laser discectomy(nonspecific depressurization)
 Modification of intradiscal approach : Visualized
– 1987 - Schreiber : transdiscoscopic percutaneous nucleotomy
– 1988 - Kambin : arthroscopic microdiscectomy : Published the first intraoperative discoscopic view of a HNP.
– 1989 - Mayer : percutaneous endoscopic lumbar discectomy
– 1991 - Davis : percutaneous endoscopic laser disc decompression
– 1991 - Kambin : Described & illustrated the triangular working zone
 Transforaminal approach
– 1996 - Kambin : Foraminal arthroscopic decompression of lateral recess stenosis : annulectomy & osteophtectomy
– 1996 - Mathews : transforaminal endoscopic microdiscectomy
– 1996 - Siebert : endoscopic laser disc surgery : the foraminal app.
– 1996 - Lew : percutaneous foraminoscopy
– 1996 - Casper : foraminal laser endoscopic disc ablation
 Foraminoplasty approach
– 1996 - Knigh : endoscopic laser foraminoplasty
– 1997 - Yeung : YESS : Introduced a rigid rod-lens, integrated, multichannel, wide-angle operating spinal endoscope.
– 1997 - Hoogland : percutaneous endoscopic discectomy
– 1998 - Yeung : selective endoscopic discectomy
– 1999 - chiu : microdecompressive percutaneous discectomy with laser thermodiskoplasty
– 2005 : Ruetten : Extreme lateral access : full-endoscopic uniportal transforaminal approach
– 2006 : Lee : Percutaneous endoscopic lumbar discectomy for migrated disc herniation

18. Photograph taken during the First International Symposium held at the Graduate Hospital in Philadelphia
in 1983. From left to right: Dr. Hijikata, Professor Adam Schreiber,Dr. Parviz Kambin.

19. Various Instruments for PELD

20. Various types of lumbar disc herniation
treated by PELD
Far lateral type
Para central type
Inferior Migration
Central type Foraminal type
Superior Migration

27. Extended use of PELD
PELD is also suitable for
• elderly patients,
• patients with cardiovascular problems,
• patients who are afraid of surgery and
general anesthesia.

28. Advantages of PELD
• Immediate pain-relieve in 95 % of the cases
• Eliminating the possibility of resection of bone and
ligament
• Performing selective Disectomy
• No need for general anesthesia
• Outpatient treatment
• Faster rehabilitation
• Earlier return to work or sports
• Higher patient satisfaction

29. Nucleoplasty
• Contained herniated disc.
• Safe and controlled
method of removing the
bulged tissue.
• Performed on outpatient
basis.
• Rapid recovery of patients

32. Kyphoplasty (Balloon Kyphoplasty)
• Kyphoplasty is a used to
repair osteoporotic
fracture vertebrae.
• Restores the vertebral
body height.
• Reduces or eliminates the
back pain.
• Performed as an
outpatient basis.
• Allows in performing daily
activities

36. Pe-TLIF
(Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion)
Indication:
Degenerative Lumbar Disc
Disease with more than 50%
disc height loss

37. Pe-TLIF
(Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion)

38. SUMMARY
• Percutaneous Endoscopic Lumbar Disectomy (PELD) is
a safe and sparing excision of herniated disc material for
disc prolapse.
• Nucleoplasty is a safe procedure for Contained Disc
Herniation.
• Kyphoplasty is a safe procedure for Osteoporotic
Vertebral Compression fractures.
• Pe-TLIF (Percutaneous Endoscopic Transforaminal
Lumbar Interbody Fusion) is the advanced technique in
Lumbar Interbody Fusion for severe Degenerative
Lumbar Disc Disease.

39. Take Home Message
Ambulatory Spine Surgery
or
Day Care Spine Surgery
Safe method
for all types of
Lumbar Disc Prolapse
Osteoporotic Vertebral Fractures
Lumbar Degenerative Disc Disease

40. MOVE A HEAD WITH TECHNOLOGY
Avicenna’s (980–1037 AD)
principal method of
treating spinal disorders
Modern Operative Room

41. Thank You
Day care Spine Surgery
Day Care surgeries. 24 hours.
No more. Maybe less.