your pain is within our scopePosted: June 15, 2012
by Rafael C. Bundoc, MD
Professor of Anatomy, UP College of Medicine
Spine Specialist, Department of Orthopedics,
Philippine General Hospital
Ten Outstanding Young Men Award for Medicine, 1996
Most Outstanding Young Scientist Award, 2000
Percutaneous Lumbar Endoscopic Discectomy (PLED) and Transforaminal Lumbar Interbody Fusion (TLIF) are surgical procedures that treat spinal problems such as herniated discs, bulging discs, degenerative disc disease and pinched nerve or nerve root compression. Symptoms range from leg pain usually felt as “ngalay”- heaviness, “kinukuryente”- radiating, “hinihilat”- tense, “pinupulikat”- claudication. This is oftentimes also related to weakness of the legs and inability to walk. This is medically called “sciatica”. PLED and TLIF are minimally-invasive surgical techniques that provide an alternative to the traditional “open” surgery.
The open surgery technique requires a big incision at the middle of the back where the surgeon cuts the back ligaments, strips the muscle from the spine and cuts bones from the spine. This invariably destroys too many normal tissues just to correct the problem deep inside the spine. Patients are then faced with a long recovery period of several weeks or months. High hospitalization cost and loss of income due to longer hospital confinement are indirect consequences to them.
Many patients also develop weakness of thin trunk muscle because the back musculature fails to regenerate or heal properly due to the big incision.
On the other hand, minimally-invasive surgical techniques require only “small incisions” on the back. PLED involves localizing the herniated disc by MRI and placing a very small diameter scope precisely to where the problem is. Very small instruments are passed thru the scope to safely remove the disc herniation with the aid of high definition video and intra-operative image intensifiers. The herniated disc is practically removed without damaging any normal tissues.
While in the TLIF procedure, a part of the degenerative bone and disc are removed and replaced with composite grafts and reinforced with titanium screws and rods to connect nerve impingement and even spine deformities.
These minimally-invasive procedures greatly minimize blood loss, muscle and tissue trauma. Patients are benefitted with reduced postoperative narcotic use and faster recovery time of 2-3 hours. This in turn indirectly cuts medical cost not only for hospital confinement, but also allows the patients to get back to their work and normal routine faster.
UPMC in its Ambulatory Surgical Center at the UP-PGH FMAB established the first “Center for Minimally-Invasive Spine Surgery” in the country. UPMC likewise performs arthroscopic, endoscopic, and laparoscopic surgeries and other minimally-invasive procedures like cataract extraction .
Recently, UPMC-FMAB shared in bringing 2 surgical milestones in the Philippines for performing the very first PLED surgery and for performing the very first TLIF surgery on an out-patient basis.
Together with Dr. Bundoc, the other members of the team are Drs. Dave Dizon and Samuel Gozman (Spine Surgeons) and Dr. Dominic Villa (Anesthesiologist).*
*The members of the team hold clinic at the UPM-PGH Faculty Medical Arts Building (FMAB), PGH Compound, Taft Avenue, Manila.
Spine surgery is one of the services offered by the Orthopedics Practice Group at FMAB.