Hydrodiscetomy: Cutting with Water

Hydrodiscetomy is solving unmet needs and improving outcomes in spine surgery by providing fluidjet-driven medical devices for use in ‘open’ and ‘minimally
invasive’ spine procedures.

The products empower neurosurgeons to simultaneously cut, ablate, and remove hard and soft tissue quickly, safely, and effectively— without the collateral thermal or mechanical trauma of other surgical modalities. Imagine being able to remove tissue during back
surgery via an opening the size of a straw—with the aid of a hair-thin, 600-miles-per-hour stream of water, instead of a one- to two-inch incision from an ‘open’ surgery with a
scalpel. Although high-pressure water jets have been employed for many years in
industrial cutting applications, this technology is not easily adapted for use in medicine
because of the unique technical requirements of surgery:

(1) the working fluid must be sterile;
(2) the tools must be tiny and easily maneuverable;
(3) the pump system must be small enough to fit in any operating room; and,
(4) the devices must be safe.

Hydrodiscetomy has overcome the major barriers to the transfer of fluidjet technology from industrial to surgical applications with significant technical innovations. As a result, a growing number of neurosurgeons are using Hydrodiscetomy to wash away patients’ pain in a variety of back procedures. Unique to Hydrodiscetomy’s devices is the use of a ‘collector’ tube, not only to capture the fluidjet stream, but also to create a powerful ‘Venturi’- and-morcellation effect at the active site—resulting in tissue being drawn into the collector tube and thus away from the operative site, without the need for an external suction connection. This also allows optimal visibility during operation of the device—particularly important in spine procedures, where the surgical site is surrounded by vital structures such as nerves and blood vessels. A further major advantage of Hydrodiscetomy is the ability to achieve ‘selective’ tissue excision. The tissue selectivity benefit allows spine surgeons to quickly and safely remove appropriate tissue, such as disc nucleus, without damaging the surrounding harder tissue or vertebral endplates. These advantages illustrate the power and versatility of Hydrodiscetomy to provide solutions to the spine surgeon, enabling efficient surgical procedures and optimal patient outcomes.

Reference: http://www.minimally-invasive-centrehk.com/english/resources/resources_neurosurgery.html
http://www.youtube.com/user/HKHealthConcern#p/u/5/pFLIV3UfQgg

The above information serves as educational reference only, you should consult your neurosurgeon for diagnosis, treatments and surgeries.

神經痛 - 坐骨神經痛 （neuropathic pain, Sciatica）

神經痛十分普遍，但一般人對它的認識卻不深。神經痛有多種成因，疹後神經痛, 三叉神經痛, 坐骨神經痛, 腦中風後疼痛, 周邊神經受損, 糖尿病引發的神經病變, 大部分都會使病人感到非常痛楚，不但引致日常工作大受影響，晚上也因痛楚而難以入睡。要減輕疼痛，第一步就是加深對神經痛的認識。本小冊子將為你介紹有關神經痛的常識及其中三種最常見的神經痛，並提供一些有效的治療建議。

坐骨神經是人體最長的神經線，從下腰一直延伸到腳掌。假如這束神經任何一處受損或受壓，都可引起坐骨神經痛。嚴格來說，坐骨神經痛是一種症狀，最常見的病因是椎間

盤脫位，壓住神經線所致。坐骨神經痛相當普遍，很多時只影響身體的一邊，疼痛

從臀部開始蔓延至大腿後面及小腿，並帶有麻痺感，如果情況嚴重，更會使下肢肌肉無力，影響病人行動。急性椎間盤脫位可引致小便失禁，必須立即施行手術。坐骨神經痛發作時，下半身就好像有一條橡筋被硬拉到腿部般，而當要坐下、咳嗽、打噴嚏、用力甚至笑的時候，痛楚還會加劇。

參考資料: www.brain-spine.com.hk

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向自己的醫生查詢，而不應單倚賴以上提供的資料。

Back Pain and Degenerative Disc Disease: Are Artificial Discs the Solution?

There has been considerable excitement among surgeons as well as patients following the recent FDA (Food and Drug Administration) release. The excitement among patients with degenerative disc disease stems from the impression that there is now a safe way to eliminate pain from degenerative discs while at the same time maintaining normal motion. Many of these patients have heard about others with similar problems undergoing fusion procedures in the past, who still continue with persistent pain or had more than one attempt at fusion without success or have developed additional levels of disc degeneration requiring an additional fusion procedure. They have also heard of the successful results following disc arthroplasty in Europe which has been highly publicized by the media in the United States. 

Early Detection and Lumbar Fusions
This is definitely an exciting new addition to our armamentarium for the treatment of degenerative disc disease. When we look at how the evaluation and treatment for degenerative disc disease has developed over the past few years an almost unbelievable amount of progress has been made. We now are better able to identify disc disease early on with MRI and pain generators with discography and facet blocks. Where only a decade ago, lumbar fusions were being performed through large posterior incisions, now they can be performed percutaneously through incisions that are barely visible either anteriorly through the abdomen or through the back. With the use of presently available instrumentation, success rates for one level fusions approach 90-95%. Unfortunately, not every patient who has degenerative disc disease and has a successful fusion has a successful clinical result. There is still a group of patients for whom fusion does not effectively alleviate pain.

Disc Replacement: Risks
Disc replacement arthroplasty has the potential for the treatment of many of the spinal motion segment disorders that are currently being treated both successfully and not so successfully by one of the many fusion techniques. At this relatively early stage of disc replacement development, we do not know all of the problems that may be encountered following these procedures. Because the surgical approach is through the abdomen either retroperitoneal or transperitoneal (around/through the stomach), there are some predictable complications including vascular injury, thrombophlebitis (vein inflammation accompanied by blood clot formation), nerve root injuries, injury to the ureter, and retrograde ejaculation in males.

We also know that a number of disc replacements have failed and have been converted to a fusion with variable clinical outcomes. The removal of artificial discs, especially at the L4-5 level, is fraught with a significant risk of vascular injury because of scarring around the prosthesis. We do not know at the present time how long these prostheses will last and how well they will function. Will they provide enough motion to prevent adjacent segment degeneration, and will the patient with multilevel disease be a candidate for this procedure? Certainly we know that artificial joints produce wear debris and an inflammatory response which escalates over time where this is obviously not a problem with fusion. 

Optimism and Early Results
Spine surgeons in general are very optimistic and excited about total disc arthroplasty and appropriately so. There also will be a learning curve by both the spine surgeon as well as the access surgeons who provide the exposure. Appropriate training via courses and cadaveric labs will help to minimize the learning curve and potential complications. There will no doubt be many improvements and modifications in the prosthetic designs.

Early results are certainly encouraging in the hands of the investigational surgeons but are fraught with the many problems common to the development of a new procedure. Total disc arthroplasty is likely to be a better solution than fusion for many degenerative disorders of the lumbar spine as design improvements continue to be made and as further experience defines the indications for its use.

Reference source: http://www.spineuniverse.com/treatments/emerging/artificial-discs/back-pain-degenerative-disc-disease-artificial

The above information is for educations only, if you have any related disease, plese consult your neurosurgeon for more information.

Hong Kong Pain review – Visceral pain and neuropathic pain

Visceral Pain

Visceral pain is caused by obstruction, infiltration or compression of visceral structures and supporting

connective tissues.3 Lung, liver and kidney parenchyma are insensitive to pain, but tumours associated with these organs may cause pain when the capsule or adjacent structures are affected.4 Visceral pain is often diffuse and sometimes referred to other nonvisceral structures, making the source of pain difficult to localize.

Neuropathic Pain

Studies indicate approximately 30% to 55% of cancer patients have neuropathic pain, which is due to involvement of neural structures (eg, nerves, plexi or roots), usually by tumour infiltration or compression. Sympathetic activity also plays a role in spontaneous neuropathic pain. This type of pain is characterized as aching, burning, stabbing or lancinating.3,4 It may also present as paraesthesia, dysaesthesia, hyperalgesia or allodynia. Relative to somatic and visceral pain, neuropathic pain responds poorly to systemic opioids, hence other treatments are often utilized. Most post-treatment pain syndromes (eg, postsurgical, postradiotherapy or postchemotherapy pain) are neuropathic.3 Injury to the intercostobrachial nerve during mastectomy causes a tight, burning sensation in the axilla, the medial aspect of the upper arm and the upper aspect of the anterior chest wall. Radiation-induced fibrosis can cause peripheral nerve injury. Vincristine, cisplatin and paclitaxel are neurotoxic and can cause dysaesthesia, paraesthesia, cramps and restless legs associated with weakness, sensory loss or autonomic dysfunction. This set of recommendations aims to provide a logical approach to

effectively manage cancer pain, with a particular focus on neuropathic pain. Patients may have several cancer pain syndromes that respond differently to pharmacological and nonpharmacological interventions. Therefore, a pain management programme should be devised on an individual basis depending upon patient characteristics and responses. Multiple medications may be used, with each agent adjusted according to the specific pain syndrome for which it is used.7 Pain management should be guided by a detailed patient assessment.

Reference source: http://www.neuroPAINhk.org, www.brain-spine.com.hk

The above information is for educations only, if you have any related disease, please consult your neurosurgeon for more information.

Prevalence, Pathophysiology and Symptoms of Neuropathic Cancer PAIN – Hong Kong review

PAIN can be a persistent and incapacitating symptom of cancer. Although reports indicate only 15% of patients with nonmetastatic disease experience tumour-associated PAIN at the time of diagnosis, PAIN becomes more pervasive as disease progresses.1 In patients with recurrent or metastatic cancer, 67% complain of PAIN and 41% experience PAIN directly attributable to the disease. PAIN may be

chronic or acute, and patients with chronic PAIN commonly experience acute flares of PAIN. One half to two thirds of patients with well-controlled chronic PAIN experience transitory ‘breakthrough’ PAIN. Cancer-associated PAIN may be secondary to antineoplastic therapy or an unrelated comorbid condition, but is commonly due to direct tumor involvement (ie, infiltration or compression of adjacent local structures, such as bone, soft tissue, nerves or the gastrointestinal tract).1,4 Hence, cancer PAIN syndromes can be somatic, visceral or neuropathic in origin.3 Understanding and recognizing these

syndromes can help identify PAIN etiology and the need for additional evaluation, and target therapy

more appropriately.

Reference source: http://www.neuroPAINhk.org, www.brain-spine.com.hk

The above information is for educations only, if you have any related disease, please consult your neurosurgeon for more information.

Migraine headache

Migraine headache is a common and often undertreated condition in the Asia-Pacific region.

Migraine is a recurrent, often debilitating headache disorder that causes significant impairment to the patient’s quality of life.1 The International Headache Society (IHS) has classified migraine into six subtypes2:

1.          migraine without aura

2.          migraine with aura

3.          childhood periodic syndromes that are

4.          commonly precursors of migraine

5.          retinal migraine

6.          complications of migraine

7.          probable migraine

Each of these subtypes is characterized by specific features and associated symptoms. These recommendations focus on the first two subtypes: migraine with and without aura. The

main difference between these two subtypes is the presence of focal neurological symptoms in

migraine with aura.2 These symptoms generally precede or accompany the headache.

The prevalence of migraine in females (12%–17%) is about twice that in males (6%–8%); while migraine attacks may commence at any age, the highest incidence is between 35 and 45 years.1,3-6 In some studies,

the lifetime prevalence in females has been estimated to be as high as 24%. Epidemiological studies have estimated the median frequency of migraine attacks to be 1–1.5 a month.1,3 A survey in Hong Kong in 1998 revealed that the estimated prevalence of migraine is 12.5%, similar to that reported in Western populations, with a greater preponderance in females. More patients have migraine without aura than migraine with

aura. Migraine sufferers often have lower health-related quality of life than non-migraineurs. The impact of

migraine extends beyond the patient’s personal life, affecting work, family and social activities.9 In the United States, costs attributed to migraine amount to US $13 million annually due to missed workdays and impaired work function. A number of clinical and community-based studies have demonstrated that patients with migraine are also likely to suffer from certain comorbid psychiatric disorders, such as depression, generalized anxiety.

Reference source: http://www.neuropainhk.org, www.brain-spine.com.hk

The above information is for educations only, if you have any related disease, plese consult your neurosurgeon for more information.

常見的頭痛種類有哪些？

約六成以上的人每個月會經歷至少一次頭痛，雖然沒有伴隨其他異狀，但卻不可忽略，這可能是一些嚴重疾病的表徵，像是腫瘤、血腫或腦膜炎就會因為在顱內敏感的組織中擴張或發炎而引發疼痛。你知道日常發生的頭痛種類有哪些嗎？

張力性頭痛

約所有頭痛者的90%，發生原因目前無法明確掌握，一般來說，患者會因為壓力增加而加重疼痛感，可能會有慢性壓抑、焦躁或者服用止痛藥過量的現象。張力性頭痛沒有明顯的前驅症狀、頭痛主要沿著兩側擴散。發作時間可能是每天或間歇性，也可能持續數小時到數天時間。

張力性頭痛的治療法

必須採取保守性的治療方法，以冷敷先降低壓力，同時採用規律的運動及放鬆治療法。如果是藥物治療，必須先判斷病症屬於偶發性還是慢性，可以採用不易上癮的止痛藥劑與肌肉鬆弛劑治療。而慢性、張力性頭痛比偶發性頭痛更難治療，可能還需要加上抗憂鬱劑甚至手術才行。

偏頭痛

約有6% 的頭痛是屬於偏頭，偏頭痛發病的原因目前無法完全掌握。一般說來，女性比較常出現偏頭痛的毛病，約多出男性3倍的機率，這可能跟女性荷爾蒙動情素有關，尤其是30歲左右的女性更容易有這類毛病。偏頭痛的特點是搏動性疼痛，而且常常伴隨著噁心及嘔吐症狀。每個月可能發作1-10次不等，每次發作時間可能持續4-24小時。

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向自己的神經外科醫生查詢，而不應單倚賴以上提供的資料。

Spinal neuropathic pain conditions treated with minimally invasive spine surgery by neurosurgeron

If you have back pain and non-surgical treatments aren't working for you, then you may be a candidate for minimally invasive spine surgery.

Minimally invasive spine surgery is different from standard open spine surgery because it combines technology with innovative techniques so you can have smaller incisions, and a shorter hospital stay. In fact, minimally invasive spine surgery can often be performed on an outpatient basis.

Although minimally invasive spine surgery accomplishes what traditional open spine surgery accomplishes, it's an attractive option if you need spine surgery for a certain spine conditions because there are fewer risks involved than in open spine surgery.

Numerous spine conditions can be treated using minimally invasive spine surgery like degenerative disc disease, Herniated discs, Sciatica, Spinal stenosis, Scoliosis or other spinal deformities, Spondylolisthesis, Spinal fractures, Spinal infections Spinal tumors. 

It's important to note that not all spine conditions can be treated using minimally invasive surgery. In rare cases, if you have a certain spinal infection, sometimes it cannot be treated minimally invasively.

If minimally invasive spine surgery is an option for you, your neurosurgeon will explain the types of surgery he or she recommends. In most cases, minimally invasive spine surgery can effectively and safely treat your pain.

Because of rapid advances in technology, many spine disorders now can be treated with minimally invasive surgery, so talk to your doctor about any questions or concerns you have regarding MISS

Reference source: spineuniverse.com

The above information is for educations only, if you have any related disease, plese consult your neurosurgeon for more information.

神經外科醫生治療椎間盤突出 (Hong Kong neurosurgery, scoliosis)

很多人都有腰背痛，問題其中一個成因是椎間盤突出，長遠更可能形成骨刺，治療方法包括椎間盤切除手術但復發率較高，藍明權醫生指，新的微創手術可以解決這個問題. 

蔡太以前從事服裝批發經常要搬貨，背部近腰的位置七年前已開始痛，痛到不能再工作，在街市下車，我下不了車，痛到突然起身，痛得下不了車，那種痛苦痛到好像條腰不是自己.

蔡太是椎間盤突出，椎間盤是脊椎骨之間的軟組織，它像是一條中間充滿啫喱的車胎，車胎老化或意外撕裂，中間的啫喱就會流出，壓著神經線，這種情況通常出現於腰椎第四至五節之間，痛楚由這裡延伸至臀部，大小腿及腳掌，嚴重更可以引致肌肉萎縮，當影響到坐骨神經時，腳會麻木，可能甚至沒有感覺，有些嚴重的可能影響力度，開始行不到，有些持續很久，肌肉會萎縮，如果啫喱狀的椎間盤核心長時間或大量流失，脊椎骨之間失去緩衝，互相磨擦，最終形成骨刺.

神經外科藍明權醫生表示不少病人是搬重物時姿勢不正確，突發出硫椎間盤撕裂，但長時間坐著工作而坐姿不對，都會令椎間盤突出，如情況不嚴重可用推拿、物理治療等方法治療，但嚴重便要做手術. 傳統手術是將突出的椎間盤切除，但手術後有三至五成病人於半年至十年間復發，因椎間盤核心容易透過手術的傷口再次流出，新手術就是將啫喱完全抽出，放進一顆珠子，珠子代替原本椎間盤核心的功能，包括保持關節的活動保持骨與骨之間的距離及防避震. 但椎骨本身位置異常的人不適宜做這個手術.

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向自己的神經外科醫生面對面查詢，而不應單倚賴以上提供的資料。