Dubai: A 67-year-old Emirati man with a degenerative curve in spine underwent a successful minimally invasive, recently introduced surgery at a hospital in Dubai to relieve his intense back pain in just one day, after it had been worsening over the last 10 years.
The surgery was performed by Dr Sameh Abolfotouh, orthopaedic surgeon and specialist in spine surgery at Medcare Orthopaedic and Spine Hospital in Dubai, who used the recently-introduced Oblique Lumbar Interbody Fusion (OLIF) technique to correct a 36-degree lumbar spine scoliosis due to arthritis in the patient, Abdalla Mohamed Mahmoud Sulaiman Al Ali.
Scoliosis is a condition in which the spine curves on one side more than the other.
According to Dr Abolfotouh, the OLIF surgery approach accesses the lower spine from the side of the patient’s belly and preserves spinal muscles. It corrects scoliosis by removing disc spaces and applying large spacers without cutting into bones or breaking the spine. This results in minimal blood loss, less postoperative pain, and faster recovery compared to conventional surgeries that enter from the back, said Dr Abolfotouh.
Al Ali told Gulf News: “I have been suffering from this pain in my lower back since the last 10 years. However, over the years the intensity of this pain increased to a degree that I was not able to sleep at night.”
He had intense pain in the back when walking and even when sleeping. Al Ali had undergone a couple of spine surgeries which were not successful.
Scoliosis due to arthritis
Dr Abolfotouh said Al Ali’s was a common type of scoliosis in adults which was caused by arthritis.
“When we talk about scoliosis in general, people tend to think that it’s a problem that affects children and they are not entirely wrong because the most common type of scoliosis is the type that affects children and it’s called adolescent idiopathic scoliosis. However, we have several types of scoliosis and one of them is degenerative scoliosis which affects the elderly,” he pointed out.
In Al Ali’s case, it was a significant deformity of more than 36 degrees of the lumbar spine with severe foraminal stenosis, he explained.
“Degenerative scoliosis is pretty common in the adult population. However, the degree of the curve differs from person to person. It depends on the amount of arthritis that the person goes through and depends on the magnitude of the problem. Still, it’s a common pathology in the adult population as a result of the normal wear and tear of the human body,” said Dr Abolfotouh.
Such deformity happens as a result of arthritis. “Patients tend to think that arthritis is a disease that affects only the knees and hips but as a matter-of-fact arthritis is a disease that affects all joints in the body and the back is no different in that regard. Small joints between the vertebrae in the spine get arthritic over time and the arthritis is not equal on both sides and that’s why the spine tends to go into scoliosis or curve on one side more than the other.”
OLIF vs classic surgeries
He said the problem with the elderly is that they are not just presenting with the pathology at the spine clinic. “They are usually frail patients and have lots of comorbidities and we need to optimise them before we decide to enter any surgical decision. In this particular patient, he had a couple of unsuccessful spine surgeries.”
The surgeon said he decided to achieve correction of the deformity and relief for Al Ali’s symptoms with the most minimal intervention possible.
“Usually, for such surgeries, they are done with major incisions in the back, with multiple cuts in the bone, which are called osteotomies, to correct the spinal column, to break it and put it back together in a straight fashion.”
The problem with those classic surgeries is, Dr Abolfotouh said, that they are time-consuming, associated with a lot of complications, and the postoperative recovery is very long, particularly in the older population.
“What’s unique about this patient is that we used one of the latest techniques in spine surgery which has actually been revolutionised over the past seven or eight years,” he added.
Minimal blood loss
The Oblique Lumbar Interbody Fusion or OLIF surgery has several advantages, he said.
“Basically, we went in directly from the side of his belly and addressed his disc pathology, placing big spacers between the bony blocks of his back and correcting it through a minimally invasive approach through very small incisions in the side of his belly and his back.
“The beauty of this is that the average blood loss in scoliosis surgeries ranges from 500cc to two litres of blood. In his case, we lost less than 100cc of blood.”
That also allowed us to preserve his back muscles which allowed for less post-operative pain and a very fast recovery. He was out of his bed and walking on the same night of the surgery and was discharged from the hospital on the second postoperative day with minimal painkillers.”
Al Ali said he now leads a normal life with no back pain.
“Thankfully, after the surgery, thanks to God and thanks to the doctor, I am no longer in pain. Thanks to Dr Sameh, I am not suffering from any problems currently and I am feeling totally comfortable right now,” added.