Spine2019 calls for greater focus on minimally invasive surgery

Spine2019 calls for greater focus on minimally invasive surgery

Mastery over minimally invasive techniques has become an unavoidable requirement for spine surgeons to decrease morbidity and maintain spinal stability, concluded the 19th annual national conference of Neuro Spinal Surgeons Association (NSSA) held in Kochi from Aug 30 to Sep 1.

Conducted by Cochin Spine Society under NSSA, the 3-day convention — themed ‘Minimally Invasive Technology-Driven Spine Surgery’– discussed the latest diagnostic and surgical advancements in minimally invasive spine surgery (MISS).

“Surgery itself is evolving so much that it is moving from open surgery to minimally invasive endoscopy,” says Dr P S Ramani, Senior Neuro Spinal Surgeon at Lilavati Hospital, Mumbai.

With the ability to perform operations through a pencil-sized incision without disturbing muscle plains, these procedures have the potential benefits of decreased postoperative infections and hospitalization times. They lead to less time off work, and have minimal chances of developing instability that require future fusion.

“We have started with big incisions and we have reached micro-incisions. The advent of advanced, minimally invasive techniques drastically reduced the stay of the patient in the hospital,” he adds.

Dr Ramani noted that in earlier days, spinal surgeons used to give a lot of instructions to patients post-surgery. If the patient was a hard labourer, there was no chance of him going back to the same job. Today, the scenario has changed dramatically, enabling such patients resume the same work that he was doing before the surgery. This is primarily due to the evolution that has been happening in the field of minimally invasive spine surgery.

Moreover, these days, the patient does not suffer from any of the morbidities associated with surgery. Many a time, the patients are operated in the morning and sent home by the evening.

Even though surgeons have been using endoscopy in spine surgery for over two decades, with  recent improvements in surgical instruments and imaging, this field is poised for a big leap in coming years.

“Now we do endoscopic surgery, endoscope-assisted microsurgery and full endoscopic surgery. The incision size is gradually going down from 2cm to 1.4cm. This is how technology advances, technical skill advances. Overall, it contributes to improving the patient experience,” comments Dr R Selvan, Consultant Neuro Spinal Surgeon, Subiksha Neurocure Brain and Spine Centre, Nagercoil, Tamil Nadu.

While it is true that the advances in minimally invasive surgery (MIS) technology provide a lot of tools, the surgeon should have full control over their use without going overboard, experts alerted.

“A spinal surgeon of today should be in a position to offer MIS to the patient in order to decrease morbidity, preserve motion and maintain spinal stability. However, the choice of the procedure and management strategy should be tailored as per the patient’s requirement and the disease process,” opines Dr Vernan Velho, Professor & HOD, Neurosurgery, Grant Medical College, Mumbai.

Not all neurosurgeons will take up minimally invasive spine surgery, because its application is very minimal such as the early disc disease, early listhesis etc.. This restricts the number of patients, said Dr Selvan.

“Introduction of newer techniques requires a long learning curve, and we need to supplement this with more workshops, seminars and updates. This is exactly what Cochin Spine Society (CSS) has been striving for,” says Dr Paul Manjooran, Neurosurgeon at Pushpagiri Medical College Hospital at Thiruvalla, Kerala and the organizing chairman of the conference,

There has been an explosion in the field of surgery in the last 70 years and many state of the art techniques have faded and given way to newer technologies. They serve as stepping stones for more complex procedures. The anatomy of the body remains the same and it is only the approaches that are being redefined, he adds. 

India reports over 15,000 new cases of spinal cord injury every year. The disability caused even by the slightest injury to the spine is higher than that in other types of injuries. Besides, the cost involved in the treatment of spinal cord-related ailments is enormously high.

“In Kerala, the population above 60 constitutes about 12% and it may cross 25% by 2050. It is time to address the neurological health issues of elderly population,” Justice P. Sathasivam, former Governor of Kerala, said, while inaugurating the conference.

Emphasizing the need to utilise the latest medical tools and technology to ensure an equitable treatment and safety to patients, he noted that neurological problems, especially those related to the spine, constitute a large part of ailments faced by elderly people.

Justice Sadasivam conferred the Prof. P.S. Ramani Lifetime Achievement Award to Dr. Kanak Kanti Barua of Bangladesh and honorary membership of NSSA to Dr Krishna Sharma of Nepal. Dr P.S Ramani, the founder of NSSA, was also honoured on the occasion.

A pre-conference cadaveric workshop, in alliance with AO Spine, was conducted on 29th August at Amrita Institute of Medical Sciences and Research Centre. About 30 participants were given specific hands-on training at the workshop.

“The conference is organised with multiple modalities to make training sessions more effective. Besides a live cadaver demo for youngsters to get hands-on training, we have a second way of teaching and learning — by sharing of experience via a platform presentation. We also have speakers from higher levels, who present new technology and even the older technology in a much better way, in a minimally invasive way,” said Dr. Satish Rudrappa, Senior Consultant Neurosurgeon, Director of Skull Base Surgery & Head – Spine Surgery at Sakra Hospital in Bangalore and the President of NSSA.

Stem cell therapy for spinal cord injury and robotic-assisted spinal fusion was discussed by Dr. Sekhar N Kurpad of Medical College Wisconsin. Early recovery, improved arm and hand function and greater independence in self-care should be the goals of all meaningful treatments, they observed.

Various spinal deformities like scoliosis, stenosis and kyphotic deformities of the spine and paediatric spinal disorders were deliberated at the conference sessions.

Over 300 participants, including faculty from Korea, Thailand and Japan, convened at the event. The sessions were offered by APCSS (Asia Pacific Cervical Spine Society) and MISSCOT (Minimally Invasive Spine Surgery Club of Thailand) and IASA (Indo American Spine Alliance).

Stem cell therapy for spinal cord injury and robotic-assisted spinal fusion was discussed by Dr. Sekhar N Kurpad of Medical College Wisconsin. Early recovery, improved arm and hand function and greater independence in self-care should be the goals of all meaningful treatments, they observed.

Various spinal deformities like scoliosis, stenosis and kyphotic deformities of the spine and paediatric spinal disorders were deliberated at the conference sessions.

Over 300 participants, including faculty from Korea, Thailand and Japan, convened at the event. The sessions were offered by APCSS (Asia Pacific Cervical Spine Society) and MISSCOT (Minimally Invasive Spine Surgery Club of Thailand) and IASA (Indo American Spine Alliance).


About Cochin Spine Society

Cochin Spine Society (CSS) started around 5 years ago when a motley group of neurosurgeons and orthopedicians dedicated to spine surgery came together to discuss various pathologies related to spine, challenges and solutions once every two months.

CSS’ first workshop on cervical spine was held in April 2016 at Pushpagiri Medical College with the support of Dr P S Ramani, Founder of Neuro-Spinal Surgeons Association of India (NSSA) and Dr Sushel Patkar. 

“The encouragement truly emboldened us to venture further in this field. The need to form a registered society, as a forum to increase our academic activities in addition to our regular clinical meetings, was proposed at a scheduled meeting of the neuro and ortho spine surgeons conducted at IMA House at Kochi in December 2017, which resulted in the birth of CSS,” said Dr Paul Manjooran, Neurosurgeon at Pushpagiri Medical College Hospital, Thiruvalla, Kerala.

Dr Manjooran, along with Dr Sajesh Menon, Professor and Head of the Department of Neurosurgery, Amrita School of Medicine, Kochi, were instrumental in the formation of the society. Amrita Spine Course 2018 was conducted in association with the departments of neurosurgery and anatomy and Surgical Skill Enhancement Centre at Amrita Institute of Medical Sciences. 

Spinal Deformity course was conducted May 2018 in association with the departments of neurosurgery and orthopaedics.

In October of the same year, the NEUROCRITICON2018, a two-day CME programme, was organized in association with the departments of neurosurgery and anaesthesia.

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