The High Commission for Pakistan in United Kingdom

Pakistani Neurosurgeon’s Achievement

Dr Irfan Malik, a Consultant Neurosurgeon from Pakistan, who works at King’s College Hospital London, has recently pioneered an innovative operation at his institute. Daily Mail of 15 ^th November carried following article on his innovative achievement in the field of neurosurgery.

Operation that banishes back pain in an hour - and doesn't leave a scratch

By Rachel Ellis

A slipped disc is a common cause of back pain and around 10 per cent of patients end up having surgery.

Vic Hall, 52, a financial adviser from Selsdon, Surrey, was one of the first to have a minimally-invasive procedure to treat the problem.

THE PATIENT

Back pain affects almost everybody at some point in their lives and is the most common reason for long-term sickness from work

When I started getting pain down the front of my legs last Christmas, initially I didn’t pay too much attention to it.

But when it hadn’t cleared up by April, I went to my GP who suggested it was referred pain caused by a trapped nerve in my back, and he sent me for physiotherapy.

Immediately, alarm bells started ringing as I have a history of back problems — 23 years ago I underwent surgery for a slipped disc in my lower spine, which I blamed on the squash and karate I’d done in my 20s.

The operation wasn’t very successful — I was in hospital strapped up from the chest down to the buttocks for four days after the surgery, had an enormous seven-inch scar and suffered pain and complications over the next year.

Fortunately, the problems settled down and after a couple of years my back was normal again — until earlier this year.

By the time I saw a physiotherapist in May, my lower back had now started to hurt and I couldn’t stand up straight because of the pain.

On top of that, as well as needing painkillers every day, I started to develop pins and needles and numbness in my left leg and down to my toes.

My physiotherapist sent me to King’s College Hospital, London, the nearest specialist back centre — here X-rays and an MRI scan in early September revealed a slipped disc in my lower spine.

The centre of the disc, which contains a jelly-like substance, had ruptured out of its capsule and was putting pressure on the nerves in my spine, causing the pain.

The problem was so bad the doctors were concerned that if it wasn’t treated quickly, the nerves would be damaged, causing irreversible paralysis of my lower body functions. Surgery was the only option.

Naturally, I was extremely worried but within just a few days I saw back surgeon Mr Malik, who told me about a new technique now available on the NHS. This involves removing the protruding bit of the disc through a tiny incision in the back and is carried out while the patient is awake.

This sounded so much better than the open surgery I’d had 20 years before, but I was slightly spooked at the idea of being awake.

In fact during the operation, on September 19, I was given a sedative to keep me calm and then a local anaesthetic was put into my back.

Although most patients stay awake during the 60-minute operation, I was so tired I fell asleep (I had been anxious the night before and hadn’t slept) — the next thing I knew I was being woken up in the recovery room.

When I came round from the operation, I had none of the sickness I’d suffered after having a general anaesthetic and felt like I’d woken up from a really good sleep.

The first thing I did was to wiggle my toes just to make sure I still had feeling in my legs and it soon became clear the operation had been a success — I no longer had any pain in my back or legs, it was fantastic.

There was no strapping around my body, just a small incision the size of a small finger nail, covered by a dressing and a 10 cm plaster on my left side.

After a few hours on the ward, I was allowed to go home with my wife around 8pm. I was given painkillers and a surgical belt to wear for about a month to give my back support when I stood up.

Within a week I was back at work and, after less than two months, you couldn’t even see the scar any more. Compared with the open surgery, this was truly amazing.

THE SURGEON

Irfan Malik is a consultant spinal neurosurgeon at King’s College Hospital Foundation Trust, London.

For one in 20 people with back pain, a slipped disc is the cause

Back pain affects almost everybody at some point in their lives and is the most common reason for long-term sickness from work.

For one in 20 people with back pain, a slipped disc is the cause (most commonly affecting people between the ages of 30 and 50), and one in ten will require surgery.

Discs sit between the vertebrae — the bones of the spine — and are made up of an outer coat of tough fibrous tissue with a jelly-like substance inside. They act as shock-absorbers, cushioning the spine when you jump or run.

If the outer part of the disc tears — which can occur if you move awkwardly, carry a heavy weight or simply because of the ageing process — the cushioning gel leaks out, putting pressure on the nerves which pass between the vertebrae and cause pain, generally in the lower back and down the legs.

While painkillers and physiotherapy can help relieve the pain until the gel shrinks back — which happens in most cases — for a significant number of patients surgery is the only option.

This involves a big incision — the length varies but it can be 15 to 18 cm — as well as cutting the muscle and tissues and opening up the spinal canal (which contains the spinal cord and nerve roots) to remove the damaged part of the disc.

However, a new option called key-hole endoscopic spine surgery is now available.

This procedure can be used in a wide spectrum of back problems including disc prolapse, chronic back pain and sciatica (to shave bits off a problematic disc or sever problematic nerve roots in the spinal cord) and has been available in the UK since the start of this year.

Mr Hall is one of 20 patients who have undergone the procedure so far at King’s College Hospital in London, where I work.

First a 5 mm incision is made in the back, 10 cm to the side of the spine, and a small specially designed endoscope — a thin tube with a camera on the end of it — is guided through the skin with the help of X-rays to the damaged disc.

Tiny surgical instruments are sent down the hollow centre of the tube to cut away the bulging part of the disc. Graspers then pull the piece of dissected disc back down the endoscope.

The procedure takes about an hour and there aren’t any stitches — after the endoscope is removed a plaster is simply put over the cut.

Patients may feel a little pain or discomfort afterwards and are given paracetamol to take if they need it for the first 24 hours. Most can walk straight away and go home within two hours.

While the success rate of this procedure is about the same as open conventional back surgery — around 95 per cent — there are huge advantages for patients and the NHS.

Because it is not open surgery there are fewer complications; there is a lower risk of blood clots forming, scarring, blood loss and infection, no danger of spinal fluid leaking or injury to the nerves, and none of the side-effects associated with a general anaesthetic.

With conventional surgery, about 20 per cent of patients develop scar tissue around the nerves which can cause recurrence of symptoms, while with keyhole surgery there is no risk of scarring.

Recovery is quicker and less painful because the muscles in the back are not cut during the operation.

It is also cheaper as it can be carried out as a day case and patients require less follow-up care.

Despite these advantages, few surgeons offer this technique because it requires specialist training — my hospital is the only NHS unit I am aware of offering this surgery for slipped discs in England, although it will soon be available at London’s private Harley Street Clinic.

However, in the future, I am sure this will become the standard way of treating patients with back pain problems

Courtesy: www.dailymail.co.uk

Last updated: 29 December 2011