Minimally invasive spine surgery procedures
Dr Rajesh Garg takes pride in offering unique and effective minimally invasive spine surgery procedures (or “spine interventions”). These procedures are quick to perform, dramatically effective, and require little to no recovery time. All of these procedures are performed in our modern facility located at HMS Al Garhoud hospital, Dubai.
All of the spine procedures are performed on an outpatient basis or day case admissions, with most patients walking out of our office on their own within 2 hours. Most of our patients report a full recovery from the pain symptoms that brought them to us in a matter of days.
We will approach your condition by treating it at the source. By precisely injecting low doses of medication directly at the nerve using fluoroscopic guidance, pain can typically be stopped or minimized almost entirely. Our innovative procedures will help you to get back to the life that you want and help you avoid invasive and costly surgery. These procedures are all medically proven, highly effective, and very safe.
- Spinal injections: Epidural steroid injections, Selective nerve root blocks, Facet joint blocks, Medial branch blocks, Sacroiliac joint blocks Percutaneous disc decompression: Nucleoplasty, Intradiscal electrothermal therapy (IDET) Kyphoplasty, Vertebroplasty
- Percutaneous discectomy: DISKOM
Dr. Rajesh Garg is an expert in minimally invasive spine surgery procedures and spine interventions. He is especially trained for minimally invasive spine surgery at Keil, Germany. He has performed successfully over 700 minimally invasive spine surgery procedures.
1) Spinal injections
Epidural steroid injections, Selective nerve root blocks, Facet joint blocks, Medial branch blocks and Sacroiliac joint injections provide diagnostic data and pain relief by delivering local anesthetic (numbing medication) and anti-inflammatory steroid medications into the spinal area on the surface of the spinal column. This procedure may reduce inflammation, resulting in long-term pain relief, and it can provide valuable information on the source of your pain.
Procedure Preparation
Epidural steroid injections, Selective nerve root blocks, Facet joint blocks, Medial branch blocks and Sacroiliac joint injections provide diagnostic data and pain relief by delivering local anesthetic (numbing medication) and anti-inflammatory steroid medications into the spinal area on the surface of the spinal column. This procedure may reduce inflammation, resulting in long-term pain relief, and it can provide valuable information on the source of your pain.
Please bring any previous imaging study results (MRI, CT, X-rays) such as films, reports, or CD-ROMs to your initial appointment. If you do not have current images, we may refer you to have them done prior to the procedure.
If you come by car, you will need a driver to take you home after your appointment. You will be able to go home unaccompanied via subway or taxi.
Please notify our physician if you are nursing or if there is a chance you may be pregnant.
Please be prepared to discuss any medications that you are currently on with our physician, or bring your medication bottles with you to your appointment.
During the Procedure
Using a thin needle and X-ray-guidance (fluoroscopy), a physician will inject contrast (X-ray dye) into or adjacent to the epidural space thought to be causing your pain. This will ensure correct placement of the needle for the procedure. Our minimally invasive spine surgery procedures are very effective.
Additional x-rays will be taken to ensure the accurate delivery of a combination of an anti-inflammatory and anesthetic medication injected for pain relief.
You will remain awake during the 10-20 minute procedure, and you may experience some slight pressure or discomfort during the injection.
Please inform your physician of any feeling that differs from your usual symptoms.
You will be asked to wait 30-40 minutes after your procedure before leaving.
After the Procedure
There is very little recovery time after this procedure. Many patients return to work the same day.
You may experience numbness from your symptoms for up to six hours after the injection.
Your usual symptoms may then return and may possibly be worse than usual for a day or two.
The beneficial effects of the steroids usually require 2-3 days to be effective; in some cases it may take as long as 5-7 days. If there is no change in your symptoms after a week, consult with your doctor to investigate other possible causes of your pain.
If an initial injection provided a certain amount of relief, a second injection might strengthen the pain relief effect (known as “stacking”). Some patients have relief in the first few weeks, but if the pain returns in the following weeks and months, additional injections will increase your pain relief.
Keep track of how long your relief lasts and report it to your physician. If there is no change in the pain, then we can investigate other possible sources of your pain. The effects of the treatment are an important part of determining the problem and planning future treatment programs.
Possible side effects
Although side effects from this procedure are rare, our physician will review any possibilities with you before your procedure. Possible side effects include facial flushing, occasional low-grade fevers, hiccups, insomnia, headaches, water retention, increased appetite, increased heart rate, and abdominal cramping or bloating. These side effects occur in less than 5% of patients and usually disappear within 1-3 days after the injection. If you experience any side effects, please feel free to contact us at any time.
2) Percutaneous disc decompression: Nucleoplasty, Intradiscal electrothermal therapy (IDET)
Percutaneous disc decompression is a treatment option for people suffering prolonged and severe back pain resulting from a disc herniation (bulge) that did not respond to conventional treatment. Nucleoplasty is a minimally invasive alternative for treating the disc bulge. Performed in an outpatient setting, this procedure uses a needle that emits radio waves to shrink a disc bulge by dissolving excess tissue. This relieves the pressure inside the disc and on the nerves responsible for causing pain. The procedure should take less than one hour.
Procedure Preparation
This procedure will be done in a hospital setting. After your initial consultation in our office, you will set up an appointment with our staff for day case admission.
Please bring any previous imaging study results (MRI, CT, x-rays) such as films, reports, or CD-ROMs to your initial visit. If you do not have current images, we may refer you to have studies done prior to the procedure.
You will receive specific instructions to follow prior to the procedure with regard to eating and drinking.
You will need someone to drive you home and stay with you for 12 hours post-procedure due to the effects of sedation medications. Please make any necessary arrangements.
Please notify our physician if you are nursing or if there is a chance you may be pregnant.
Please be prepared to discuss any medications that you are currently on with our physician, or bring your medication bottles with you to your initial appointment.
During the Procedure
Nucleoplasty is an advanced injection procedure that is performed in a local hospital with our staff.
You will be awake during the procedure to provide important feedback to the physician, but you will be under a sedative to diminish your anxiety and any discomfort.
After you are in position on the table, your lower back will be numbed with a local anesthetic.
Under x-ray guidance (fluoroscopy), a small, tube-like needle is placed into the center of your bulged disc.
A small, specialized wand is inserted through the needle, where it is heated to create a series of channels within the disc by dissolving tissue.
By reducing the amount of excess tissue within the disc, this treatment can reduce the size of the bulge and also relieve pressure inside the disc, as well as on the adjacent nerves.
The wand will then be slowly withdrawn to its original position while thermally sealing the new channel.
You will be closely monitored during your procedure.
The number of channels created is dependent on the disc size. At the end of the procedure, the wand and needle will be removed.
After the Procedure
A small bandage will be placed over the needle insertion site and you will be taken to the recovery area until you are ready to go home.
Adult supervision is necessary for the remainder of the day due to the effects of sedation.
You will receive general activity and rehabilitation guidelines.
You may experience increased symptoms for 7-10 days until the disc begins to heal.
Prescription medications may be given to relieve these symptoms.
Possible side effects
Complications are rare, but we encourage you to keep track of any symptoms you experience after the procedure and report them to your physician at your follow up visit 7-14 days after the procedure.
A full course of physical therapy will help you to fully recover, strengthen your back and core muscles, and maximize your recovery.
3) Kyphoplasty, Vertebroplasty
Kyphoplasty is a procedure designed to relieve back pain caused by compression fractures of the thoracic (mid-back) and lumbar (low-back) spine that have failed to heal normally. These fractures of the vertebrae are most often seen in the elderly population and are usually the result of severe weakening of the bone from osteoporosis. The underlying osteoporosis often results in delayed healing or lack of healing of the fracture.
Osteoporosis can also be seen in younger individuals, typically as a result of long-term use of steroids used to treat diseases such as asthma, lupus, and rheumatoid arthritis. Compression fractures may also occur in vertebra weakened by cancer.
Percutaneous vertebroplasty (percutaneous means 'through the skin') is a minimally invasive spine surgery procedure designed to relieve back pain caused by osteoporotic compression fractures of the thoracic (mid-back) and lumbar (low-back) spine that have failed to heal normally. By injecting bone cement into the compressed vertebra, the fracture is stabilized, significantly improving or alleviating back pain.
Vertebroplasty also prevents further vertebral collapse, which is associated with height loss and spine curvature commonly seen with osteoporosis. With non-surgical therapies like vertebroplasty, you will experience less pain and risk, and you will return quickly to previous activity levels.
Procedure Preparation
If you are a candidate for this procedure we will discuss this option with you at your initial visit in our office. When you make the decision to have the procedure, you will schedule an appointment with our staff for admission.
Please bring any previous imaging study results (MRI, CT, x-rays) such as films, reports, or CD-ROMs to your initial appointment, if you do not have current images, we may refer you to have them done prior to the procedure.
Usually patients are admitted to the hospital for this procedure. Plan on staying overnight. You will need an adult to take you home the next day.
Please notify our physician if you are nursing or if there is a chance you may be pregnant.
Please be prepared to discuss any medications that you are currently on with our physician, or bring your medication bottles with you to your initial appointment.
During the Procedure
You will be admitted to the hospital or surgery center the morning of the procedure for preparation and preoperative nursing assessment.
Laboratory tests to ensure proper blood clotting may be necessary at this time.
Kyphoplasty is generally performed using a local anesthetic (numbing medication) in conjunction with heavy sedation, administered by an anesthesiologist or nurse anesthetist.
Using x-ray-guidance (fluoroscopy), the physician inserts a specialized needle through the skin into the damaged vertebra on each side. The x-ray assures accurate placement of the needle.
Through the outer needle, channels are drilled within the bone. KyphX balloons, or bone tamps, are then placed into each channel.
The balloons are slowly inflated, moving the collapsed vertebra to try and restore the bone to its original shape.
Once the desired result is achieved, the balloons are deflated and the cavities that have been created within the bone are filled with bone cement, which has the consistency of toothpaste.
The bone cement hardens over 10-20 minutes, stabilizing the fractured vertebra. It is possible to treat more than one fractured vertebra during the same operation, if necessary.
After the Procedure
Kyphoplasty generally requires admission to the hospital, although the actual hospital stay is usually around 24 hours, depending on the patient's condition and the number of fractures that are treated.
Most patients experience marked pain relief within 24 to 48 hours after the procedure, and they may resume activities soon after the procedure.
Possible Side Effects
Complications are rare, but you are encouraged to keep a record of any symptoms you experience following the procedure and report them to the physician at the time of the follow-up visit, usually 7 to 14 days after the procedure.
A full course of physical therapy will help you to fully recover, strengthen your back and core muscles, and maximize your recovery.
4) Percutaneous discectomy: DISKOM
Procedure Preparation
There is very little preparation needed for this procedure. In fact, you may decide to go ahead with this procedure during your initial consultation in our outpatient clinic. The procedure will be fully explained to you before you decide to proceed.
Please bring any previous imaging study results (MRI, CT, x-rays) such as films, reports, or CD-ROMs to your initial appointment. If you do not have current images, we may refer you to have them done prior to the procedure.
If you come by car, you will need a driver to take you home after your appointment. You will be able to go home unaccompanied via subway or taxi.
Please notify our physician if you are nursing or if there is a chance you may be pregnant.
During the Procedure
Once you arrive, you will be given an IV and a light sedative, if desired and appropriate.
Your physician will review all current prescriptions, MRIs, x-rays and reports.
The procedure will be performed under x-ray-guidance (fluoroscopy) to verify accurate positioning of the discectomy probe.
The discectomy probe (DISKOM) removes disc tissue, which may relieve painful pressure on the surrounding nerves.
The procedure generally takes 15 minutes to an hour.
Throughout the procedure, we will monitor your condition and comfort level closely.
You will be asked to rest in our recovery area until you are ready to go home.
After the Procedure
We will provide patients with activity and physician rehabilitation guidelines.
Adult supervision is necessary for the remainder of the day due to the effects of sedation.
Apply ice to the area for 1-2 hours per day for 3 days.
Prescription medications may be given to relieve any pain symptoms.
With appropriate follow-up care, pain will be reduced.
Physical therapy and home exercise is optimal for your speedy recovery.
If you want to learn more about our minimally invasive spine surgery procedures, feel free to contact us.