Dr. Himanshu Tyagi specializes in spine surgery in Noida, Delhi, Gurgaon and India. He performs orthopedic, knee replacement surgery and bone fracture.
Dr. Himanshu Tyagi: India’s Top Surgeon- Spine, Orthopedic, Bone fracture & Knee replacement
Dr. Himanshu Tyagi is a top reputed orthopedic doctor in Delhi specializing in ligament injury and spine surgery in Delhi, Noida, Gurgaon and India.
Dr. Himanshu Tyagi has a rich experience of treatment spine and orthopaedic related pathologies. He is presently working as senior consultant Spine, joint replacement and orthopedic surgeon at Artemis Hospital Gurgaon. He also runs his private clinic at Noida, sector-93, Uttar Pradesh.
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Do You Know
# 95% of slip discs can be treated without surgery.
# 3% of all slip disc can be treated by selective nerve root block injection
# 2% of slip discs require surgery.
Symptoms of Slip Disc Are
"Most Common Symptom of Slip Disc is Sciatica or Radicular Pain"
"Lumbar slip disc (PIVD) is more common than cervical slip disc."
# Medicines
- Analgesics (pain killers) with anti-inflammatory and muscle relaxant for few days. Other important class of medicine is nerve pain medicines for few weeks.# Physiotherapy
- Transcutaneous electrical nerve stimulation (TENS) and Laser therapy for first few days.# Exercises
- Exercises in the form of spinal Extension and core muscle strengthening exercises.
# Selective Nerve Root Block injection
- It is a 20 minute procedure done in operation theatre under x-ray guidance in local anaesthesia. Patient is kept drops ovation for one hour after procedure and then discharged home. Its a day care procedure. It has 95% success rate for treating sciatica & radicular pain.Endoscopic discectomy is a 40 minutes procedure and patient need to stay in the hospital for two hours only. It is a totally safe and effective procedure as it is done under local anaesthesia and there is a minimal risk for infection or blood loss. During this procedure the patient is totally awake and talks to the surgeon. In endoscopic discectomy we specifically target the disc fragment which is pressing the nerve and causing sciatica pain. In endoscopic discectomy we do not cut muscles (as in open discectomy) and the scar is smaller then the fingernail.
1) No anaesthesia required.
2) Less than 4 hours of hospital stay required.
3) No blood loss.
4) Stitch less surgery.
5) Less changes of infection (
<.1%)
6) Less than 1 cm scar.
7) Targeted procedure.
"Frequently asked questions about endoscopic discectomy-"
1) Herniated disc/slip disc/PIVD causing radicular pain.
2) Spinal stenosis (Enteraped nerves due to age related degeneration)
3) Discogenic Pain (lumbar/waist pain), Annular tear.
4) Disc space infections.
5) Facet joint syndrome with disc bulge.
1)endoscopic discectomy.
2)endoscopic laminectomy.
3)endoscopic decompression.
This technique is usually performed under local anesthesia and neuroleptic analgesia. For the safety of the patient’s nerve elements, the physician is in constant communication with the patient and thus can avoid the risk of injury to a nerve. Endoscopic surgery is a safe technique if performed without anesthesia. It is performed from the sides of the spine without injuring muscles, ligaments and bone structures, as in classical techniques. Therefore considered as atraumatic and bloodless.
It is radiographed with a special portable x-ray machine located in the operating room (c-arm) so that the surgeon can at any time check the position of the micro-instruments in relation to the patient’s spine, thereby ensuring accuracy and safety.
As mentioned, the endoscope transfers the image to a screen inside the operating room monitored by the surgeon. This image is enlarged, so the surgeon safely performs the surgery as the structures of the spine (nerves, intervertebral discs, ligaments, etc.) are clearly distinguished and the possibility of injury is minimized. Thus, the surgeon can remove an intervertebral disc, widen a spinal foramen, perform rhizotomy and generally all the endoscopic techniques depending on the patient’s condition, through a small incision with a diameter of 1 cm, that is, a regular surgery is performed with less risk, without destroying healthy structures. The special micro-tools that go through the endoscope are duplicates (miniatures) of all the tools used in the classic open spine surgeries except that they are thinner to go through the endoscope.
The average surgical time required is 40 minutes. The patient’s stay in the clinic is about 3-5 hours in total, that is, a “walk in – walk out” procedure (no overnight stay is required).
The patient walks immediately after being transferred to the ward, shortly after being transferred to bed. The patient can return to everyday activities on the same day or up to 3 weeks later and, depending on the type of work, the patient may return immediately for non-manual work or up to 3-6 weeks later (on average) for heavy manual work.
These techniques require training and special equipment. Surgeon training in specialized centers abroad on endoscopic spine surgery is deemed necessary. Another major factor that plays a key role in the success of the surgery is the equipment in the operating room. There should be a suitable surgical table, specially designed for spine surgery, a suitable X-ray machine that can be combined with the surgical table, appropriate monitors, the corresponding endoscopic equipment for spinal cord surgeries with the appropriate tools, as well as experienced personnel in the operating room, that is, an experienced radiologist and an experienced assistant nurse.
Compared to other transdermal methods (laser, radioablation, automated transdermal discectomy) it is superior, because the aforementioned are “blind” techniques. The endoscopic technique is performed with real-time vision and the previous techniques (laser, radiofrequency) can be used in a safer way. In addition, the range of diseases that can be treated endoscopically is broader than the one that can be treated by simple transdermal techniques.
With regard to microdiscectomy, that is, the discectomy performed under a microscope, the endoscopic discectomy is not clinically predominant, although the latter does not cause spinal instability, whereas in microdiscectomy this risk is non-negligible.
Most patients can go home on the same day or early on the next day.
Before leaving the hospital, a physiotherapist provides instructions on mobilization, that is, how to get out of bed and walk.
It is also recommended to avoid weight lifting, as well as bending and rotational movements for 2-4 weeks to avoid recurrence of the hernia.
Walking with gradually increased intensity is also beneficial, while seating for more than 45-60 minutes should be avoided.
It is usually not necessary in this operation
Most patients need no special care other than to keep the surgical trauma clean by covering it with small sterilized pad to prevent friction and irritation caused by the clothes.
The patient can bathe immediately after surgery as long as the incision is covered with waterproof gauze so that the trauma does not get wet. After the bath the gauze must be removed, the area should dry and a small sterile pad should be applied. A normal bath can be performed after 2 weeks post-operatively and provided that the surgical trauma is fully healed.
The patient can safely drive only when the postoperative pain has fully subsided, which is usually 3 to 10 days after surgery. The patient is not allowed to drive under the influence of opioid analgesics. However, it is not advisable to make long trips for up to 2 months.
The patient may return to office work in 1 week. In sports and manual work it is safe to return in 4-6 weeks, provided that the post-operative pain has completely subsided and muscle strength has returned.
The patient should be re-examined in 5 days after surgery.
The outcome of these surgeries is usually excellent with total pain relief immediately after surgery. The success rates are approximately 95%.
Most patients report immediate improvement and return to their work and daily life without any problems.
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