“Endoscopic Spine Surgery : Hliam Na lo leh darh zau lo thei ang bera enkawlna lama hmasawnna rahbi thar”

Hnung na hi khawvel puma hriselna kawnga buaina tam tak zinga a langsar ber pawl a ni a, thliar bik nei lovin eng hna thawk tan pawh, a pui a pang; a lian a tein an nei thei vek a. Tunlai khawsak leh hnathawh danin a ken tel – hun rei tak tak ṭhut ngai te, body posture chhia leh kum upatnain a ken tel ve hrim hrim avangte hian spine (hnung) lama buainate hi a tam em em a ni. Kum tam tak chhung chu he buaina enkawlna atan hian open spine surgery an lo hmang tawh ṭhin a, he surgery ah hian taksa zai ngai lai hmunhma a lianin, hei vang hian damdawiina hun rei tak awm a ngaih phah a, nunphung pangngaia let leh nghal mai a harsa ṭhin. He surgery hi hlawkpui viau ṭhin bawk mah se, awm a tinuam loin dam leh hun chhung a duh rei em em a ni. Amaherawhchu, tun hnaiah endoscopic spine surgery hian a lo luahlan ta a, a ṭhat dan inang rengah open spine surgery aiin taksaa nghawng a neih dan te a tlem zawk a, chu vang chuan mi pawhin an duh zawk tlangpui ṭhin.

Endoscopic spine surgery hi minimally invasive surgery zinga pakhat niin endoscope tih hmanrua hman a ni a. He hmanrua hi tube tereuhte, a chhunga camera ṭha tak leh enna keng tel a ni a, hemi hmang hian doctor-te’n monitor-ah hnungzang awm dan vel chu chiang takin an thlithlai thei ta ṭhin a. Incision tereuhte - 1.5 cm aia thuk lo chhungah surgeon chuan endoscope chu thun lutin hmanraw dang tlem nen belhbawmin, buaina bulpui ber chu an zuk enkawl ta ṭhin a ni. Hetia an tih hian an tum bulpui ber chu nerve compression tih ziaawm a, mihring taksa awm dan leh ruangam pangngai khawih danglam lo thei ang ber tura tih a ni. Damlo dinhmun leh case a harsat dan azirin, he procedure tih lai hian kah hitna leh inchiu mutnate hman ṭhin a ni.

Kum zabi 20-na hma lama medical lama hmasawnna thar tam tak a rawn awm chhoh lai khan he technique pawh hi a rawn lar thar ve a, taksa chhung awm dan enfiah nana zuk zai thler chiam a ngaih loh nana tih a ni. Chutih rual chuan, an duh ang thálin kum tam tak chhung chu he technique hi an la hmang thiam/ngam mai bik lo a. Kum 1970 vel bawra fiber optic technology a lo chhuah hnuah chiah an hmang tam ngam chho ta a, he technology hian an taksa chhung zuk enna kawngah nasa takin a pui a ni. Kum 1980 velah percutaneous discectomy technique a lo lar chhuak leh ta a, hetah hian surgeon te’n taksa chhungah kua/puncture tereuh te te zuk siamin hemi hmang hian herniated discs an la chhuak ta ṭhin a, mahse he an thil tih hi chiang fek fawka zuk hmuh a harsat avangin an duh angin an tidik tawk ṭhin lo a ni.

Kum 1990 a lo inher meuh chuan damdawi/medical lama hmasawnna a lo pung chho ve zel a, endoscopic camera te pawh spine procedure tihnaah an lo seng lut ta a. He hmasawnna hmang hian surgeon-te chuan taksa chhung an duh lai tak kha chiang takin an zuk hmu thei ta a, hei hi damlo tan a him lehzual a ni. Technique/tihdan chi dang deuh “Transforaminal leh interlaminar approach-te” pawh heng hunlai hian an lo chhuak a, tunlaia kan lo hriat lar tak endoscopic surgery bul ṭanna tak an ni nghe nghe.

Kum 2000 chho velah chuan image quality, hmanrua design, leh inzaina technique-ah te hmasawnna tam tak hmuh tur a rawn awm ve ta a. High definition camera, optics ṭha zawk leh irrigation system changtlung zawk te hmangin heng te hian procedure tihna kawngah nasa takin an pui a, surgeon te tan an thil khawih lai an hmuh chian theih avangin an duhdan thlapin procedure an kalpui theih phah ṭhin a ni. Tunah chuan endoscopic spine surgery hi khawvel pumah uar lehzuala hman a lo ni ta a, tin tunlai thiamna chi dang leh - heng robotic assistance, navigation system leh artificial intelligence kan tih te nen hian ṭangrualin damlo enkawlna chi khat hlawhtlinna chance sang tak nei a lo ni ta ni.

Endoscopic spine surgery (ESS) hi nerve/hnung lam nerve sawng te lama buaina enkawlna atana hman deuh ber a ni a. He natna lo lanchhuah dan ber chu Herniated disc emaw slipped disc niin, hetah hian spinal disc chhung lam material te chu a rawn pawrh/pawng chhuak a, a bulhnaia nerve dangte tan buaina lian tham tak thlenin, hei hian taksa natna leh chak lohna te a thlen ta ṭhin a ni. ESS hian spinal stenosis te thlengin a enkawl thei a, spinal stenosis neite chu an spinal canal lo sâwng téin hei hian spinal cord leh nerve root te a nghawng a, an ke te lo nain han kal/veivah te thlengin an harsat ṭhin. Sciatica natna neih vanga taksa hnung aṭanga ke lam thlenga zuk na thla ṭhinte thleng pawhin he surgery hi an hlawkpui a. Tin, natna chi dang heng – degenerative disc disease, foraminal stenosis leh facet joint cyst te pawh hi case ṭhenkhatah chuan an enkawl theih ve a ni.

Endoscopic spine surgery (ESS)-ah hian approach (tih dan) pahnih an hmang a, spinal pathology hrang hrangte’n an mil zawk zawk an hmang ṭhin. Approach pakhat zawk Transforaminal approach ah chuan nerve root chhuahna lam hmang ṭangkaiin a sir lam aṭangin spine an zuk lut a. Hei hi Lumbar disc herniation enkawl nan bik a ṭha ber a, an tih lai hian damlo chu kah hiknain an chiu a, na a hriat theih miau loh avangin hemi treatment an pek lai hian damlo chuan a duh duh a sawi thei a ni. Interlaminar approach ve thungah chuan ruh leh ruh inkara laminae hmangin hnung lam aṭangin spine kha an zuk lut ṭhin. He technique hi Central disc herniations leh spinal stenosis ṭhenkhatah te hman tṭhin a ni. Hemi approach pahnihte hi an taksa zai lai tak tuamtu tissue te tichhe lo thei ang ber tura ruahman an ni.

ESS hi a ṭhatna lai ber chu taksa tan ná/hliam a siam tlem hi a ni. Open surgery anga muscle leh tissue tam tak zai thler a ngaih loh avangin, damlote tan inzaina avanga natna a tlem a, damdawi pawh ei hnem lutuk a ngai lem lo. Taksa an zuk zai thler nasat loh avangin, a hmuamhma pawh a dam chakin ser te a tlem a, an zaina lai pawh an enkawl uluk phei chuan a pun mai mai thei lo. Tin, inzai laia thisen chhuak pawh a tlem angreng a, hei hi kum upa lam leh taksa bawrhsawm deuh te tan thil lawmawm tak a ni. A tam zawkah chuan inzai aṭanga darkar 24 chhungin damlote an kal nghal theih bakah damdawiin aṭanga chhuahtir theih an ni. Heti khawpa dam leh hun chhung pawh a rei loh avang hian he surgery lo paltlang tawh te chuan nunphung pangngai an zawh leh nghal vat thei ṭhin a ni.

Taksa tana a ṭhatna bakah hian, rilru lam leh sum leh pai lam thlengin ESS hi damlo hian an hlawkpui zawk a. Hei hi a chhan bulpui ber chu damdawiin awm rei te a lo ngai lo va, tin, dam zung zungna a nih bawk avangin inenkawlna sensote a tlem phah a, damlo tan buaina a thlen tlem a ni. Hnathawk lai tan phei chuan an hnaah an let leh vat thei ṭhin. Tichuan, he procedure hian hun leh tha leh sum tam tak damlo tan a “save” a ni.

Amaherawhchu hetih mek lai hian, a ṭhatna tam tak karah ESS tih buaithlak na kawng ṭhenkhat a awm ve tho a. Thil har ve tak a nih avang hian doctor te tan pawh han zir chhuaha han thiam nghal zung zung chi a ni bik lo va. Uluk taka training te an paltlang a, experience ṭhahnem tawk tak an neih ve phawt a ngai a ni. ESS chungchang hi hre bel ve viau tawh mah ila, open surgery nen danglamna tam tak a la awm avangin la zir belh ve fe a ngai a ni. Tin, ESS tih nana hmanraw mamawh te hi an tlawm zawk zawk lem lo va, clinic/hmun ṭhenkhatah chuan an hmang pha lo ve thei a. Spine lama harsatna zawng zawng a ching fel thei vek bik lo bawk a, damlo ṭhenkhatah chuan surgery pangngai tih mai kha a hlawk zawk ve fo bawk a ni.

ESS ti tur hian damlote hi a thlana thlan an ni ve ṭhin a, damlo nazawngin an paltlang thei bik lo tihna a nih chu. Clinical evaluation leh MRI emaw CT scan-te an tih vek hnuah, damlo khan ESS a mamawh chiah em tih an chian fak hnuah chiah hma an la zui ṭhin. Nerve lama chiang taka harsatna neite’n an hlawkpui ber a. Surgery neih hmaa titipui/counseling neihpui thlap tur an ni a, hei hian damlote tan thlamuanna a thlen bakah an dinhmunte an hriat chian phah a, an dam leh theihna kawngah anmahniin hmalak belh ve an ngai tih an hriatthiam phah bawk.

Kan hriat tur chu ESS tih hnua dam leh hun (recovery time) hi a rei em em hran lo va. Surgery an tih zawh veleh hian damlote chu dim te tea insawizawitirin, thui lo te te kal zir nghal turin an hrilh thlap ṭhin. Hei hian blood clotting te vengin an damna kawngah nasa takin a pui a ni. Inzaina avanga na tawrh tur pawh tlem a, damdawi nachhawknate hmanga chhawk mai theih an ni. Ni eng emaw zat ral hnuah anmahni enkawltute puihna hmangin an ni tin nun pangngaiin an nung leh thei mai ṭhin. Hemi hun chhung hian Physiotherapy pawh tih a pawimawh hle a, hnungzang ruh te, taksa tihrawl dang te tih chak nan leh natna lo chhuak leh tur inven nan tea hman ṭhin a ni. Nundan ṭha leh hriselna ngaih pawimawh, exer lak taimak leh an taksa rihna thununte hian khuareia an dam hlen nan nasa takin a pui a ni.

Hun lo kal zel tur han en pawhin endoscopic spine surgery hi a ṭha chho telh telh tura ngaih a ni a. Robotic system, artificial intelligence leh imaging technology-te chuan he procedure hlawhtlinna chance hi an tihsân belh hle a, khawl thiamna hmangin damlo taksaa zuk enkawl lai tur takte kha chiang takin an zuk hriat chat chat theih tawh a, hei hi mihring tihsual/chetsual palh lak aṭanga invenna ṭha tak a ni bawk. Procedure harsa lehzual entirnan “spinal fusion” tih angreng te pawh endoscopic thiamna hmanga tih chhoh Doctor te’n an cho tawh hle.

Tin, ESS lama awareness te pawh a lo pung ve zel a, mi te pawhin hemi chungchang an hriat lar chhoh zel takah chuan, a hmang duhtu te pawh an pung chho zel tura beisei a ni. Surgeons te pawh an thiamna belhchhah turin training program leh workshop ṭha tak takte chhimtir an ni a. Spinal disorder vanga buaina tamna India ram angah te pawh, damlote tan senso a tih ziaawm bawk avangin a lar chho hle tura rin a ni.

A hmawr bawkna atan chuan, endoscopic spine surgery hi hnungzang/ruh enkawlna leh a natna tihdam kawngah hmasawnna lian tak a ni a. Tunlai thiamna sang tak, damlo tana na leh hrehawm em em bawk si lo hmanga mi tihdam theihna hmanraw ṭha tak a ni a. Damlo zawng zawng tan ṭha vek kher lo mah se, case tam zawkah chuan an hlawkpui tih hmuhchhuah a ni. Khawvel hmasawnna kal zelah technology leh damdawi lama thiamna/skills te an pung chho zel a, hemi mil hian ESS pawh hi hnung na leh spinal disorder enkawl nan te an her rem ve zel a, a pawimawh telh telh a ni. Damlo na benvawn tuarte leh nunphung pangngaia nun leh vat chak te tan chuan, he damna kawng thar tluka ṭha hi tun dinhmunah chuan a awm lo a tih theih hial awm e.

- Dr. Hriday Haloi, MCH, NEUROSURGERY