Spinal Fusion or Artificial Disc Replacement: Which Option Is Better For You?

When a patient is suffering from continuous low back pain and if six months of aggressive conventional (non-surgical) treatment has failed to help and especially if other symptoms, including pain, is making it hard to complete everyday activities, then back surgery is an option to bring about pain relief and restore ones’ potential to function. For patients in this condition, this article will give the patient a summary of about the two types of back surgery currently available:

1. Spinal Fusion
2. Artificial Disc Replacement (ADR or Total Disc Replacement or TDR)

Lumbar Spinal Fusion 

Normal approach to treat pain and/or disability from lumbar degenerative disc disease is spinal fusion. This surgery involves making a direct bony connection between the vertebrae surrounding the painful discs; by stopping motion of the painful discs & which can give the patient relief from pain. There are plenty of options available with spinal fusion, each one having its own advantages and disadvantages. Surgical methods include fusion approached from the front, back or both. Spinal instrumentation in the form of pedicle screws and/or intervertebral cages provide internal structural help while bones fuse, and bone graft can either be harvested or one of a number of synthetic bone graft surrogate or extenders can be used from the patient themselves.

Lumbar Artificial Disc Replacement 

With artificial disc replacement, pain relief is brought by removal of the painful disc and motion is maintained by using a prosthetic implant made of metal, without or with a plastic bearing surface. This is somewhat more similar in theory to the artificial hip, knee and the shoulder joints that the Orthopaedic surgeons have been using it for more than 35 years to maintain the range of motion and to get relief from the pain of arthritic extremity joints. But there is a significant difference that only one of the three joints is present at each vertebral level is being replaced, whereas in a knee or hip joint the total joint is replaced.

Fusion Surgery is Most Prevalent

By far till now, fusion surgery is still the most prevalent surgery, and patients should be aware that most of them won’t be eligible for disk replacement as it can treat only limited types of disc pathology. Some are considered same for certain types of artificial disc replacement and fusion. Like, for example, an anterior approach is used for both artificial disc replacement and for an anterior lumbar interbody fusion, which means that risks and potential complications are similar for both the surgeries. Well, for most of the part, there are unique considerations for every type of surgery, and the patients are well advised to get as much educated as possible when considering these two surgeries and analyze their options thoroughly with their treating or consulting physicians.

Determining the Right Treatment for Back Pain

Prior to, considering any type of surgery, patients with chronic low back pain should remember that not all pain are treatable by surgery. The collapse of non-operative treatment doesn’t mean that surgery is necessary to be the next step. Estimation with X-rays and MRI scan may be enough for the surgeon to give an opinion, but other tests including provocative discography and CT scan may be required to determine if surgery is suitable and if both artificial disc replacement and spinal fusion are options.

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Avail Customized Knee Joint Implants for Snug Fit Replacement

Knee joint is a very complex arrangement as this important joint not only differs in size, but also in the shape which is required. Traditional total knee replacement surgery utilizes knee implants which are generally available in an assortment of 6 to 10 sizes which are standardized according to requirement. Orthopedic surgeons normally select the knee implant which closely matches with the shape & size of the patients’ knee, while minor adjustments are made during the knee replacement surgery so as to best fit the knee implant as near to the patient’s natural knee joint. Moreover, the knee replacement surgical technique sometimes compromises on how precisely the knee implant is able to fit the patients’ associated bone structures. Therefore, there is a narrow range of tolerance which improper knee implant fit can cause residual issues which may result in problems following knee replacement surgery.

Breaking New Ground

Requirement of precise knee implant fits has driven newer trends among knee replacement implant companies towards customizing tailor-fit & personalized gender specific knee implants. Research conducted has suggested that such implants are very helpful in reducing compromising with sizing during knee replacement surgery. Customized implants are more closely able to replicate curvature of the original knee joint, thus providing the patient with a more natural feeling after knee replacement surgery.

Personalized Patient-Specific Knee Implants

There are some knee replacement implant manufacturers who are now offering customized or patient specific knee implants which are created from CT scan or MRI data & which closely matches the natural curve & shape of the patient’s knee. These companies are utilizing specialized technology in order to convert scans of the patient’s knee into 3D models which are then utilized to construct knee implants which closely match that of the patient. By using the scanned data, the orthopedic surgeon utilizes computer-assisted surgical instrumentation during the knee replacement surgery procedure. This in fact, simplifies several alignment & sizing issues which are typically associated with the traditional knee implants & knee replacement surgery.

Gender-Specific Knee Replacement Surgery for Women

Regular sized knee implants are found to overhang on bone at the side of the knee & eventually lead to soft tissue interference or mid-flexion instability. Moreover, in many cases this has been found to cause pain & discomfort even long after the person has fully recovered. For this purpose, relatively new knee implants are designed to accommodate the knee which may be smaller from side-to-side than a knee from front-to-back. This is meant to reduce knee pain & knee implant misfit after knee replacement surgery. Experts believe that a woman’s knee differs from that of men not just in size but also in shape. Due to this difference in knees of men & women, orthopedic surgeons have been making tedious adjustments to the conventional standardized knee implant so as to size them & make them fit properly for women.

Gender Specific Knee Implants are Based Upon Research

Basic design of gender-specific knee implants is based upon research which illustrates three distinct differences between men’s & women’s knee joints. Women’s knees generally feature a thinner profile at front of the knee. It has a distinct shape which accommodates the difference in angle between the hip & knee alongside a different contour in order to allow for a more precise fit. Some knee replacement surgery patients, orthopedic surgeons & manufacturers also strongly feel that gender specific options are absolutely necessary, while others are skeptical about customized knee implants since there are a wide variety of stock options that are available. 

Determining the Best Fit Knee Implant

On the flip side, some experts feel that differences in knee shape & size have very less to do with gender & more with the patient’s stature in general & possibly few ethnic influences which go on to determine the differences in size. Irrespective of these factors, there are a number of knee implants which are available nowadays & which closely match the patient’s knee shape & size, with a wide spectrum of knee implant designs offering a variety of benefits. However, it is in the best interest of the patient that he discusses these options with the operating orthopedic surgeon who will eventually be determining as to which knee implant will most suit the patient’s lifestyle.

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Radiation therapy: An Option for Brain Tumor Surgery

Radiation therapy for brain cancer

Radiation therapy is one of the methods used to eradicate brain tumor cells and to relieve symptoms, like discomfort and pain, caused by a tumor. The highly targeted radiation therapy delivers the dose and the radiation with great precision to the brain tumor while reducing damage to the neighbouring healthy brain tissue.
For brain cancer patients, radiation therapy is mostly used after biopsy or following surgical resection of a tumor, to destroy any tumor cells left behind. It might also be an option for metastatic brain tumors (tumors spreading to the brain from another part of the body) or unresectable brain tumors.
The specifics of the brain cancer radiation therapy plan is based on several factors, including the size and type of the brain tumor and the extent of the disease. External beam radiations are used for brain cancer treatment. The area that is targeted by radiation includes the tumor and the area surrounding the tumor. Sometimes, the radiation is given to the entire brain, in case of metastatic brain tumors.
Since lung cancer mostly spreads to the brain, some people with lung cancer receive radiation therapy as a prevention from metastatic tumors developing in the brain.

Addressing Side Effects of Brain Cancer Radiation Therapy

Depending upon the radiation dose, site, and other factors, radiation therapy for brain cancer can cause certain side effects. Edema (brain swelling), skin irritation, hair loss, and fatigue are common side effects of radiation for brain tumors.
When a patient receives brain tumour radiation therapy, the medical team will work proactively to manage any of the side effects. For example, the doctor may prescribe steroids to help reduce the swelling, or blood thinners to dissolve the blood clots and help prevent them from traveling into the lungs.
The patients will also receive integrated oncology services, like medicine, nutrition therapy, and naturopathic medicine, management of pain, oncology rehabilitation and mind and body medicine, to help fight the radiations’ side effect or other treatments the patient receives. These therapies will keep one strong so that they can continue the treatment while maintaining a quality of life.

What Is Radiation Therapy?

This therapy uses targeted energy (i.e. X-rays and other radioactive substances) to destroy the cancer cells, shrink tumors, and/or alleviate confirmed cancer-related symptoms. It is used as:

• A primary treatment to eradicate cancer cells
• To relieve symptoms of advanced cancer
• Before another treatment to shrink a tumor
• In combination with the other treatments to stop the growth of cancer cells
• After another treatment to pause the growth of remaining cancer cells, if any

Types of Radiation Therapy

Radiation therapy has three delivery methods or types. They include:

• External Beam Radiation Therapy: In this therapy, a radiation is directed from a machine outside the body onto the cancerous cells present within the body. (E.g.: IMRT, IGRT, 3D Conformal Radiation Therapy, tomotherapy, stereotactic radiosurgery)
• Internal Radiation Therapy: In this therapy, a radioactive material is placed (via a catheter or some other carrier) directly into or near the tumor. (E.g.: High dosage rate brachytherapy)
• Systemic Radiation Therapy: In this therapy, a radioactive substance which is either swallowed or injected travels through the blood to locate and destroy the cancerous cells. (E.g.: Radioactive Iodine Therapy)

Managing Radiation Side Effects

A typical radiation therapy may be damaging to the human body and may also cause unpleasant side effects, like nausea, fatigue, skin changes and other side effects, depending upon the part of the body being treated. During the radiation treatment, the team of physicians from a variety of integrated oncology services work with the patients to reduce the side effects and improve the patient’s quality of life.

Brain Tumor Surgery Cost

The cost of brain tumor surgery across different countries varies from $50,000 - $700,000. Stereotactic radiosurgery performed on brain tumors costs from $12,000 - $55,000. In case of additional treatments, the total cost can rise up to $100,000. For treating brain cancer like Glioblastoma, the cost goes up to $450,000 and the treatment for lifetime reaches $700,000. When comparing these costs with other countries like UK, USA the average cost for brain tumor surgery in India starts around $8000 - $9000.

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How to Save Your Money by Undergoing Partial Knee Replacement Surgery in India ?

Partial knee replacement surgery is also known as Unicompartmental Knee Replacement Surgery. This surgery is recommended to patients who have severe arthritis in knees and all other treatments gave failed to provide them with relief.

Traditionally, patients who are suffering from advanced arthritis of the joint undergo total knee replacement in which all the cartilage is removed from the knee joint are replaced with an artificial implant.  Whereas in partial knee replacement surgery only the damaged areas of the cartilage from the joint is removed without disturbing the healthy parts of the joints. Partial knee replacement surgery is performed by making a small incision and involves faster recovery. This surgery use implants which are placed between the end of the thigh bone and the top of the shin bone. This surgery can also be performed to replace the part of the joint under the kneecap.

Partial knee replacement can be considered at any age. This surgery offers an opportunity for younger people to preserve more bone whereas in the case of older people partial knee replacement is a less stressful surgery as it involves less pain and less risk of bleeding.

Who Are The Candidates For Partial Knee Replacement Surgery?

Partial knee replacement surgery is recommended to patients who are suffering from severe arthritis in knees and all other conservative treatments have failed to provide them with relief. Conservative treatments include medicines, injection, exercises and physical therapy. Partial knee surgery is possible if arthritis in the knee is confined to a limited area. In case if arthritis is more widespread than partial knee replacement is not an appropriate option. The ideal candidate for partial knee surgery are:-

•    Not overweight.

•    Older than 55 years.

•    People who are not laborers or athletes.

•    People who have intact ligaments.

•    All treatments have failed.

Surgical Procedure of Partial Knee Replacement

Partial Knee Replacement surgery requires resurfacing of the damaged surfaces of the knee joint. The artificial knee joint used in the surgery is designed in such way that it fits over the edges of the damaged joint to replace the damaged areas with one that can be used pain-free.

The surgery takes around 4-6 hours and is performed under general anaesthesia. To perform this surgery the surgeon makes an incision of 10 cms in the middle of the knee over the top of the kneecap which provides the surgeon with access of the entire knee. The surgeon then removes the damaged bone and tissue. An artificial implant which is made of plastic and metal is placed into the knee. Once the artificial implant is placed it is attached with the help of bone cement. The surgeon then closes the wound with stitches. There are two main techniques to perform partial knee replacement surgery Repicci method and oxford method. The method used for the surgery varies from patient to patient.

Risks Associated With Partial Knee Replacement Surgery

Following are some of the risks and complications can arise while performing the surgery:-

•    Blood clots.

•    Buildup of fluid in the knee joint

•    Failure of implants.

•    Damage to the nerves.

•    Loosening of Implants.

•    Damage to blood vessels.

•    Pain with kneeling.

•    Reflex sympathetic dystrophy which occurs in very rare condition.

Successful Partial Knee Replacement Surgeries in India

The knee replacement surgery success rate in India is very high. India has a large pool of highly skilled and qualified orthopaedic surgeons who add to the success rate. Hospitals in India are equipped with the latest techniques, technology and uses most modern equipment. Partial knee replacement surgery cost in India is very less as compared to any other country. Undergoing partial knee replacement surgery in India can be quite beneficial for patients can save a huge amount on the surgery.

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PRL-Secreting Pituitary Tumors

PRL-secreting pituitary tumors are those adenomas found growing in the pituitary gland which affects the production of Prolactin in the body. PRL-secreting (Prolactin-secreting) tumors are benign and non-cancerous abnormal growth seen in the pituitary tumors at times. This tumor affects the production of the Prolactin hormone in the body as well as several other complications.

Prolactin is a naturally-occurring hormone which is mainly responsible for the production of breast milk in women after pregnancy (lactation process). Prolactinoma is the tumor which affects the production of Prolactin in the patient.

Signs and Symptoms of PRL-Secreting Pituitary Tumors

As the pituitary tumor causing Prolactinoma in a person is a normally slow-growing type of tumor its signs and symptoms might not be noticed even after years into its development in the pituitary gland.

Signs and symptoms are mostly noticed as the pituitary tumor starts to affect the production of Prolactin in the body, leading to hyperprolactinemia as well as from the pressure being put by the tumor on the surrounding soft tissue structure such as the nerves.

As higher than normal levels of Prolactin cause problems with the reproductive system (hypogonadism) several signs and symptoms are exclusive to men and women separately.

In women, PRL-secreting pituitary tumors can result in:

• Abnormal menstrual cycle
• Irregular periods
• Milky discharge from breast without pregnancy or breast-feeding
• Vaginal dryness during sexual activities
• Acne
• Excessive body hair growth

In men, PRL-secreting pituitary tumors can lead to:

• Reduced facial and body hair
• Erectile dysfunction
• Gynecomastia (abnormally large breast in men) 

The common signs and symptoms of PRL-secreting pituitary tumors are:

• Decreased bone density
• Hypopituitarism  - decreased hormone production
• Fatigue
• Headaches
• Infertility
• Impotence
• Loss of libido (sex drive)
• Vision problems

As the tumor affects the menstrual cycle in women, they tend to notice the signs earlier as compared to men. In men, the symptoms are mostly noticed when the large tumor begins to cause headaches and problems with the vision.

Diagnosing PRL-Secreting Pituitary Tumors

In case the signs and symptoms of PRL-secreting pituitary tumors are noticed it is advisable to consult a doctor/physician at the earliest for better and effective diagnosis.

The patient might be required to undergo any of the following tests for effective and precise diagnosis of PRL-secreting pituitary tumors:

Blood test – Testing the blood helps to determine the level of Prolactin in the body as well as the level of the other hormones regulated by the pituitary gland. Pregnancy test will also be performed for women belonging to the child-bearing age (pre-menopausal).

Brain imaging – Brain imaging techniques such as MRI (magnetic resonance imaging) and CT (computerized tomography) can help to detect the location and size of the pituitary tumor precisely.

Vision test – Testing the vision can help determine of the pituitary tumor is causing pressure and affects the optic nerve which is located very close to the pituitary gland inside the skull.

Treating PRL-Secreting Pituitary Tumors

PRL-secreting pituitary tumors (Prolactinoma) is ideally treated using advanced minimally invasive surgical treatment methods today.

The main aims of the surgery are to:

• Restore normal levels of Prolactin in the body
• Restore normal function of the pituitary gland
• Decrease size of pituitary tumor
• Treat complications caused by pressure from the pituitary tumor on surrounding neural and vascular structure.

The surgical treatment of PRL-secreting pituitary tumors requires the surgeon to use advanced minimally invasive endoscopic surgical method to perform this pituitary tumor surgery. The surgeon will not make large incision instead the natural passage created by the nasal cavity is used to gain access to the tumor in the pituitary gland situated just behind the nose at the base of the skull.

PRL-secreting pituitary tumors need prompt diagnosis and effective treatment in order to restore normal hormonal functions in the body as well as to improve the quality of life of the patient.

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