Abstract: Introduction: Surgery has made tremendous advances in the fields of joint Arthroplasty & Spine. Major advances in both these fields have made patient care more nature friendly & less morbid, thus allowing smaller incisions, day care procedures like endoscopic spine surgeries, minimally invasive joint replacement and so on. However, both these specialties have remained diverse and separate. Thus, in the typical modern-day specialty-based practice era, a patient consulting an Arthroplasty surgeon will seldom have a detailed spine examination or vice versa. This may lead to scenarios where the pain generator is from for example radiculopathy to the knee and below & the recommended procedure is a joint replacement due to incidental wear of the joints seen on the X ray. (1) The international data shows that there are 20% dissatisfied arthroplasty patients worldwide. (2) We have found concomitant knee & spine pathologies in more than 90% of our patients& published our research on the same topic. (1, 3, 4, 5) Thus the need arises for taking care of both pain generators i.e. from the spinal stenosis (central & or lateral) & knee arthritis for complete pain relief to the lower limbs. The developed protocol is the first of its kind for a more Holistic diagnosis & treatment of lower limb pain. It also saves interval dissatisfaction of the patient, healthcare costs & is a step towards a more team based surgical care between specialized spine & arthroplasty surgeons. Specialization should no more be a cause of separation between treating surgical teams & continued pain for the patient. A more Holistic clinical & surgical approach is hereby proposed.
Methods: In this pilot study, twenty two patients were selected who underwent simultaneous & single sitting surgical treatment for leg pain, unilateral or bilateral. After detailed clinical examination & imaging studies, Simultaneous, Single stage Surgery was carried out in needy patients. Step one was Transforaminal Endoscopic Lumbar discectomy of the L4-5 disc in 17 patients, 2 level L3-4 & L4-5 in 3 patients & L5-S1 in 2 patients under local anesthesia in an awake & aware patient. After completion of the Percutaneous Endoscopic Lumbar Discectomy, an epidural catheter was inserted through the endoscope under vision in the epidural space by the spine surgeon (Dr. Sunil Nadkarni) & patient turned supine after checking the position of the catheter with radiolucent dye & securing the catheter. The anesthetist pushed the drug, patient was turned supine and painting & draping was done to begin the second part of the procedure i.e. single side or bilateral unicondylar joint replacement.
Results: Results were classified by VAS, ODI, Oxford knee score, SF 12 before & after the procedure.
Conclusion: The proposed “Dervan Simultaneous Surgical protocol “for Lower Limb pain, is a satisfying procedure with good to excellent outcomes in more than 90% patients. It provides the way for a holistic patient centered approach to treating all the main pain generators of the lower limb in one sitting. It is time saving & cost effective. Rehabilitation can start for the entire physiological neuromuscular unit and provide more holistic therapy.
