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.
Image 3 (above and below) shows areas of active spine degeneration/spondylosis (depicted brightly in yellow/orange here) on a CT-SPECT “bone” scan. The “bone scan” is a very helpful and sensitive scan using a combination of low-dose CT scanning and a safe, dilute radio-tracer to find “hot spots” in the bones and joints. Such “hot spots” could be inflammation, deposits of tumour/cancer, infection, trauma, or sites of active degeneration. They “light up like a bulb”.
In the CT SPECT/bone scan shown below, there is a wedge fracture at L2 of little clinical relevance. The patient’s discs at L4/5 and L5/S1 were very worn/degenerative, and the are lighting up on the bone scan images. The discs were successfully replaced by me shortly after the scan was done, and the patient has gone on to resume a very active and independent life again.
Facet joint stress/inflammation and degeneration shown below
Shown below: degenerative scoliosis and previous lumbar laminectomy; discovertebral stress on bone scan at curvature/inflection points
Images 3b-g (above)
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’ or ‘fibro-mucinous’ 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 as they often form in association with some form of local (facet) joint movement/instability.
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. The image immediately below (Image 7b) shows cauda equina compression (1) from a synovial cyst and its mucinous content (red arrow)!
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.
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.
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!
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.
Image 11 (above) shows an acutely herniated cervical disc (C6/7; red arrow heads and circle) causing neurological symptoms and signs.
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].
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.
Images 19 (below) shows a spinal “slip”, where one vertebral bone is out of alignment with its neighbouring vertebral bone (blue arrows, blue line). This can be due to congenital/developmental reasons [“pars defect”, “isthmic spondylolisthesis” (I.S.) – a missing bony bridge – red arrow] as shown in the CT image below, or less commonly due to trauma. The I.S. may not be so symptomatic as a younger person, but is likely to be more symptomatic as one reaches 30s to 40s.
Image 19 (below) shows an even worse “slip” (Meyerding Grade 2 of 4) from a congenital pars defect.
Image 20 (below) shows a normal “cervical spine series” set of x-rays from a young healthy and active adult.