CNS Neurosurgery    |    Spine Without Instrumentation

Spine Without Instrumentation

Welcome to Dr Khurana’s Spondylosis page.

Images shown here are with the permission of Dr Khurana’s patients, for educational purposes.

Click any image for a larger view

Images 1 and 2 (above left and right) show basic spinal structure/anatomy.

Spondylosis imaging_instrumentation

Image 3a

Image 3 (above and below) shows areas of active spine degeneration/spondylosis (depicted brightly in yellow/orange here) on a CT-SPECT “bone” scan.

Screen Shot 2017-03-03 at 12.20.17 pm Screen Shot 2017-03-08 at 11.06.06 am Images 3b-d

Image 4 (above left) shows a herniated lumbar disc (HLD) and the small opening (laminotomy, L, depicted in red) required to be made in the overlying bone in order to access and remove the herniated disc fragment(s) and any associated loose disc tissue (discectomy).

Image 5 (above right) shows the difference between a normal spinal canal (left slice) and one that is moderate-to-severely compromised (right slice) by a combination of a broad-based intervertebral disc (IVD) bulge and overgrown local ligament and facet joint (FJ) tissue (this is central spinal stenosis).

Image 6 (above left) shows a small but symptomatic synovial cyst (S.C.) arising from a degenerative facet joint (F.J.) in the lumbar spine. These ‘pearly’ synovial cysts in the spine arise from the facet joints just to the side of midline, which may be degenerative, injured, mechanically unstable, and/or inflamed. The synovial cysts can enlarge and compress nerve tissue and if so need to be removed. They can stick to local nerve tissue coverings (dura). They can also recur.

Image 7’s (above right) radiology images show severe compression of the leash of nerve roots (cauda equina) in the half of the lumbar spine. Here, a herniated lumbar disc is causing this patient to have “cauda equina syndrome”. This is a neurosurgical emergency as the patient is at risk of permanent and severe leg weakness and numbness with loss of bowel and bladder control. Laminectomy and discectomy were carried out, the multiple disc fragments are shown in the bottom right of Image 7, above. The patient made an excellent recovery.

 

Image 6b Image 6c

The intra-operative colour-picture immediately above (Image 6b, left) shows part of another patient’s complex synovial cyst being removed. A posterolateral non-instrumented fusion (e.g., using iFACTOR bone-forming matrix; Image 6c, above right) can be carried out at the end of a synovial cyst excision surgery, to aid the mechanical stability of the joint from which the cyst arose and was removed. In combination with temporary back bracing, the fusion material should form a solid bone bridge in time, increasing local bone stability. During this time of “fusion” which can take up to 12 months to occur, Dr Khurana recommends oral supplementation of Calcium and Vitamin D, and permanently not smoking.

Image 8 Image 8

Compression of nerve tissue can also occur over time in the cervical spine. Examples of patients who presented with cervical myelopathy from cervical spondylosis (left panel of MRI, Image 8, above) and ossification of the posterior longitudinal ligament (OPLL, right panel of MRI, Image 8, above) are shown here.

9.cervical-stenosis-pre 10.Cervical-stenosis-post

 

 

 

 

 

 

 

Images 9a and b

Images 9a (before) and b (after) shown here are intraoperative from a patient undergoing cervical decompressive laminectomy and rhizolysis (C3-6 inclusive in this patient). No more compression of the spinal cord!

Microdiscectomy and rhizolysis - Dr Khurana - Intraoperative

Image 10 (above) is an intraoperative image of a surgically decompressed lumbar nerve root which had previously been compressed by a combination of disc bulge and overgrown ligament and facet joint tissue. The surgical incision required to do this surgery is quite tiny using minimally invasive techniques.

cervical disc C6-7

Image 11 (above)

Image 11 (above) shows an acutely herniated cervical disc (C6/7; red arrow heads and circle) causing neurological symptoms and signs.

cervical discectomy, disc

Image 12

Image 12 (above) shows a herniated cervical disc (left panel) removed surgically and replaced with a a state-of-the-art artificial disc device (Mobi-C; right panel) used by Dr Khurana. The risk of “adjacent segment disease” is reduced by the fact that the patient has preservation of normal cervical mobility as a result of this excellent device with which Dr Khurana and his patients have had an excellent experience. For images of ADVANCED SPINAL INSTRUMENTATION, click here [you can use your browser back-arrow to return to this page].

Lumbar Spondylosis Intra-op

Image 13

Image 13 (above) shows intraoperative photos of symptomatic lumbar stenosis being relieved by surgical decompression.

Images 14-17 (above) show a large herniated lumbar disc being removed by a minimally invasive microdiscectomy.