Life Fourways Hospital is pioneering a minimally invasive/percutaneous surgical procedure that offers a welcome alternative to sufferers of herniated (slipped) discs who would otherwise be facing potential open spinal surgery.
The procedure is performed by specialist neurosurgeon, Dr Avinash Kolloori, who is based at the hospital. Dr Kolloori was first introduced to the technique by Vivid Surgicals in 2017, when he travelled to Seoul, South Korea, to train with the spinal surgeons there. (Vivid Surgicals is the sole distributor on the African continent of the INTO-LB/CB, a disposable medical catheter developed by IntoCare in Korea, where it is now a well-established surgical procedure for herniated discs).
The technique, referred to as a Percutaneous Plasma Disc Decompression (PPDD), requires minimally invasive surgery through a small incision under local anaesthesia. The procedure takes approximately 30-45 minutes theatre time, requires no prosthesis, and the patient is usually discharged the same day. Patients are usually booked off-work for a day or two after the procedure, but can usually return to their normal daily/work activities within a few days.
It is also a fraction of the cost of open spinal fusion surgery. The all-inclusive price of a single or dual-level PPDD procedure is around 80% less than that of a single-level cervical disc replacement or cervical fusion.
Excellent Clinical Outcomes
“Although minimally invasive procedures for this purpose have been around for many years using technology such as laser or radiofrequency, PPDD has been developed to be much safer for the patient and has delivered very promising clinical outcomes for patients thus far” says Dr Kolloori. To date, over 50,000 PPDD cases have been performed in South Korea since 2008, and it is now the primary surgical technique utilized when attempting to treat cervical and lumbar disc disease.
During the procedure, a specialized catheter is inserted into the disc through a needle. Heat is introduced through the plasma tip, which coagulates the tissue in the disc. This aids in reducing pressure within the disc and allows for the retraction of the herniated disc fragment away from the nearby compromised nerve root, thus reducing/eliminating the pain symptom. The entire procedure is performed in theatre and under X-ray guidance to ensure sterility, optimal catheter tip placement, and to reduce the overall risk to the patient.
According to Dr Kolloori, the tip of the catheter is not only safer because it uses far lower temperatures than previous technologies, but due to its curved shape and ease of manipulation, it dramatically enhances accuracy when localising the lesion.
Dr Kolloori explains that among his patient population, there are many patients who do not fulfil the absolute criteria for open surgery, but who also do not respond to conservative treatment such as pharmacotherapy or physiotherapy. These patients are left to endure chronic pain with no guarantee of recovery using conventional modalities. He hopes that the PPDD procedure could potentially give these patients some improvement in their quality of life by reducing their pain and improving their functional capacity.
Dr Kolloori points out that not every patient will meet the criteria for the PPDD procedure, and there are inclusion/exclusion criteria based on MRI findings and clinical symptomology.
“But, what it does offer is one more therapeutic modality to the neurosurgeon’s arsenal, which I am convinced will help many patients avoid open surgery, or at least postpone it until they are much older”.
From the cases performed at Life Healthcare Fourways Hospital to date, the results have been very promising, with some patients showing almost complete recovery in the first few weeks post procedure.
Collaborative effort to address patient pain
PPD is but one treatment plan available to patients with back pain. A number of variables contribute to back pain and Dr Kolloori is in the process of forming the Neuro-Pain institute, together with a multi-disciplinary team of pain specialists, psychotherapists, psychiatrists and physiotherapists, as well as the use of cryotherapy to try and ensure better clinical outcomes for patients with chronic, complex pain syndromes.
Despite the small number of PPDD procedures performed to date in South Africa, some medical schemes have already agreed to pay for the procedure and he is confident that as patient outcomes speak for themselves, more will follow.
Ian Robertson, MD of Vivid Surgicals, says that after years of continuous development of the IntoCare PPDD product, it finally received CE marking late in 2016 and has started rolling out across the EMEA region. “The visionary approach to pain management at Life Healthcare Fourways hospital, places it at the forefront of the drive to assist the many people suffering from back and neck pain, and I’m confident that the availability of PPDD will enable it to bring further relief to thousands of sufferers in the coming years”.
Please contact Dr Avinash Kolloori on 011 875 1730 for additional information or to book an appointment