XLIF® Minimally Disruptive Procedure for Spine Surgery

The procedure, called XLIF® (eXtreme Lateral Interbody Fusion), involves a lateral, or side, approach to the patient, rather than from the back or front. This approach provides direct access to the disc space, allowing for complete disc removal and implant insertion. An estimated 10 million adults suffer from chronic back and leg pain, which often limits their activities. It is estimated that more than one million patients undergo spine surgery each year in the US Until recently, adults with back or leg pain have undergone traditional, or 'open', spine surgery, requiring large incisions, significant recovery time and a delay in return to normal activity. Juan Uribe, MD, Assistant Professor, Department of Neurosurgery, University of South Florida College of Medicine will perform the procedure using NeuroVision®, a technologically advanced EMG system. This technology allows surgeons to have accurate, reproducible, real-time feedback about nerve health and function, reducing the incidence of nerve injury during surgery. Fernando Vale, MD, Associate Professor, University of South Florida College of Medicine, and Vice Chief of the Neurosciences Department at Tampa General Hospital will provide commentary and answer email questions from viewers during the procedure.

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Low Back Pain & Spine Surgery FAQ

Dr. Milan Herceg, fellowship trained & board certified spine surgeon, of the Ohio Orthopedic Center of Excellence discusses common causes of low back pain and frequently asked questions regarding treatment including spine surgery.

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External Hemorrhoids Surgery

Many patients suffering from hemorrhoids are not aware about treatment they can go for after being diagnosed with hemorrhoids. Hemorrhoids mostly are life style related and can be cured if proper and timely medical help is sought after. What happens is blood vessels in the rectum and the anus swell and enlarges beyond their normal size and is embedded in cushion of tissue. The hemorrhoids do not hurt very much initially but in due course they pain very much. The initial indication of occurrence of hemorrhoids is itching sensation in the anal area along with irritation. These symptoms persist even after that only to become more and more severe if attention is not paid. Blood pressure if it's high can increase the irritation and itching along with pain.

Hemorrhoids are of two types: external hemorrhoid placed outside the anal opening and the internal one inside the anal opening. The external hemorrhoid is easily diagnosable because it always itches, irritates and hurts during defecation. There are many reasons for the formation of hemorrhoids including high blood pressure and hyper tension, obesity, bad food habits, bad sleeping habits and at times it may be genetic. Hemorrhoids can also happen to pregnant women and children as well.

There are various methods with which the disorder can be treated. Some are effective and some are not but have been persisting in the market since a long time. Non surgical treatments chiefly focus on smoothening and softening the stool which leads to less irritation and hence less swelling of the hemorrhoids. They also strengthen the mucosal lining of the inner side of the anus and the rectum to avoid anal fissures. Non surgical methods are good only till the initial stages of this disorder. For advanced stages surgery is recommendable.

One must consult a specialist before going for surgical treatment. There are various surgeries developed depending on the severity of the external hemorrhoids. One of the surgeries involves passing an electric current to the hemorrhoids. This current removes the hemorrhoid completely. Another surgery known as sclerotherapy or injection therapy allows injecting chemicals inside the hemorrhoids. The chemicals injected inside the hemorrhoids dissolve their walls thus removing them completely. One more surgery which is out of use these days due to its side effects is cryosurgery. In this surgery a cryo probe is used which is frozen first at sub zero temperature and then used to remove hemorrhoidal tissues. The advancement of laser technology has also contributed to the field of external hemorrhoids surgery.

The most painful and the most effective method is surgically removing the hemorrhoids by a specialist. Patients who have undergone the surgery say that it pains a lot even after the operation is successful and continues till the patient recovers completely. However, due to great intensity of pain this surgery is recommendable only for last stage hemorrhoids which could not be treated with any other method.

There are various other surgeries available these days. Proper guidance is extremely necessary before undergoing these types of operations.

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How to Get Rid of Hemroids - Surgery is the Best Option?

Increasingly, as the pace of modern life quickens, it is tempting to believe that advances in modern medicine provides an instant solution to all our problems. It is even more so with age old problems like how to get rid of hemroids. The desire for a quick fix is intensified by the embarrassing nature of hemroids, also known as hemorrhoids or piles. Surgery immediately springs to mind, sometimes encouraged by an overly enthusiastic medical specialist.

In the face of temptation, it is often wise to take a step back to gain a better perspective. Consider, is the medical practitioner serving your interest? What is the percentage of hemroid patients who are recommended surgery and what proportion actually opt for it? What are the various surgical methods available? Is it painful, during and after? Will general anesthesia be applicable? Will there be side effects? Is it a permanent solution? Should a second opinion be sought from another doctor? Quite clearly, the answer to how to get rid of hemroids is not a quick one.

On the premise that modern medicine has made great advancements, a review of what the medical community says of hemroid surgery may be instructive.

The Center for Minimally Invasive Surgery of Ohio State University estimates that 95% of hemroid patients can be treated WITHOUT surgery. Without commenting on external hemroids, the Center goes on to say that minimally invasive techniques are good for treating internal hemroids as the affected area does not have pain nerve endings.

Statistical data presented by the US National Library of Medicines in conjunction with the National Institutes of Health substantiate the 95% Ohio estimate. In a 2004 US study, there were 2,036,000 hemroid sufferers who sought outpatient medical care in hospitals compared with 38,000 who were admitted for surgery. That's 98% who were treated, on doctor's advice, WITHOUT surgery. Perhaps, surgery is not the clear-cut solution to how to get rid of hemroids?

Useful perspective as to whether to opt for surgery can be gleaned from assertions made by medical specialists who perform hemroid surgery.

Renowned colorectal surgeon Dr. Goh Hak-Su states that "piles surgery traditionally is reported to be one of the most painful procedures". This is because conventional piles surgery involves cutting of piles from areas of the body that are rich in sensory nerve endings. A key risk highlighted by Dr. Goh is that improper excision of hemorrhoidal tissue can result in 20% loss of anal sphincter control! Imagine the havoc wreaked when we sit on the toilet bowl.

Dr. Goh specializes in a "painless" piles surgery known as Longo stapled haemorrhoidopexy. Even with this state-of-the-art technique, he concedes that like every surgical operation, complications may arise, ranging from minor bleeding and urine retention to major haemorrhage and rectal injuries. Thus, in deciding how to get rid of hemroids, be aware that there is no such thing as risk-free surgery.

What about the so-called minimally invasive surgery which do not require hospitalisation? Again, let's hear from the medical practitioners who know best. The Center for Colorectal Health which offers a disposable banding system criticizes conventional rubber banding as resulting in up to 29% of hemroid patients who complain of pain after the procedure. The use of a metal-toothed clamp to grasp the hemorrhoidal tissue is blamed for the pain and also increased risk of bleeding. Pain and long post-procedural downtime (average time off work) is attributed to other minimally invasive procedures like infrared coagulation. The Center also criticizes the more invasive techniques like stapled hemorrhoidectomy and conventional hemorrhoidectomy as requiring pain medication and downtime of up to 14 days.

From the above, the question of how to get rid of hemroids by surgery appears to depend a lot on which medical specialist we speak to. Once again, there is reason to pause and not rush into hemroid surgery of any kind.

Are we saying there is no need to see a doctor for hemroids? NOT AT ALL. In fact the very first thing to do when there is persistent anal bleeding is to consult a doctor. The primary purpose is to confirm that the bleeding is not caused by a more serious condition like colorectal or anal cancer. Once hemroids are diagnosed, we can then decide on the multiple options that are available for treatment. Surgery may be the solution. But more often than not, our findings above imply otherwise.

It will be enlightening to know how the 2,036,000 patients dealt with the problem of how to get rid of hemroids. Well, the same 2004 report revealed that nearly 2 million prescriptions for hemroids were filled at retail pharmacies. Topical (i.e. those applied on the body surface) medications such as pramoxine and hydrocortisone and stool softeners such as psyllium were most often prescribed. The amount spent was a staggering US$43m.

But the most interesting comment in the 2004 report was that most people with hemroids do not seek medical care and are self-treated using non-prescription medications. These medications bought from retail pharmacies were similar in nature to pramoxine and hydrocortisones. The total cost of hemroid medications is believed to be a huge multiple of US$43m.

Indeed, there are many other possibilities on how to get rid of hemroids. Many of these alternatives are non-surgical and well worth considering.

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