This is a surgical procedure done to relieve compression of the nerves in cervical radiculopathy. The disc space is entered through a small incision in front of the neck and the disc material pressing on nerves is then completely removed under the operating microscope. The empty disc space is plugged with a bone graft or a metal cage filled with bone chips. Plates and screws can be used to provide stability and enhance fusion.



FAQs:

• How many days do I need to stay in Hospital?
  Patients are usually admitted to the hospital a day before the surgery. After the surgery, patients will be up walking around within the first day after surgery and throughout the rest of the hospital stay period. If surgery is being done for arm pain due to nerve root compression, this pain is usually significantly improves shortly after surgery. If weakness or numbness was present prior to surgery these symptoms may take longer to recover. Patients are usually observed for 2 days and discharged on the 3rd day. This allows us to make sure that your pain is well-controlled on oral medications prior to discharging home and to make sure that you are able to swallow regular food comfortably.
• How long does this surgery take?
  The length of surgery depends on each individual patient’s circumstances and diagnosis. Sometimes patients may need more than one level decompression and fusion.
• Are there risks involved in this surgery?
  There are risks and benefits of every medical and surgical intervention. These complications are very few and quiet rare. The risks of surgery include difficulty in swallowing, change of voice, infection, pain that persists after surgery, potential nerve or spinal cord damage and tear of the covering around the nerves. There is also a risk that the level above or below a fused level will have an accelerated rate of degeneration. Around 10% of patients will have some temporary complications most of which are treatable and improve in further course. Only 1% of patient will have permanent complications. The risks of anaesthesia are largely based on the patient’s general physical health which usually investigated by the anaesthetist prior to your surgery. The treating surgeon and anaesthetist will discuss these risks in further detail at your pre-operative visit.
• What is the follow up protocol?
  Follow up visit is scheduled at 1 month, 3 month, 1 year and 2 year. In each successive follow up, patient’s restriction is relaxed and he/she is encouraged to join his/her duties, do all active exercises and get back to normal life.
• Will I need a cervical collar after surgery?
  The style of brace and length a patient must wear it depends upon the specifics of surgery and various other factors. Most of the time for a standard single level anterior cervical Discectomy and Fusion, brace is not required. Instead patients are encouraged to do all neck exercises.
• How much pain will I have, and will I receive pain medications?
  Each patient has different pain tolerance. Before the discharge from hospital, the goal is to have your pain controlled on oral medications only.
• Do I need to take any other medications after the surgery?
  In addition to pain medications, oral antibiotics are prescribed for one week.
• How do I care for my surgical incision?
  Once the surgery is over, we cover the incision with a sterile dressing. After the discharge from hospital, patient is supposed to keep this dressing as dry as possible. If you notice any soakage of dressing then you should call to our helpline number to let us know. Since we do the subcuticular (below the skin) closure using dissolvable stitches there is no need of removal.
• Do I need to do the physical therapy after surgery?
  Patient is encouraged to do all exercises which he/she was taught during the hospital stay. Patient can coordinate with our dedicated spine physiotherapy team for other queries.

Like Anterior Cervical fusion the disc is completely removed under the microscope. However, instead of fusing the two adjacent vertebrae an artificial disc is inserted allowing near normal movements and almost replicating the normal spine. The major advantage of this procedure is that the preservation of motion decreases the chances of degeneration at the disc levels above and below the operated level. We are one of the few centres in the country doing this specialised procedure.



Cervical spondylotic myelopathy (CSM) refers to disturbances in the functioning of the spinal cord due to compression by bony outgrowths, ligaments becoming bony, or by large disc herniations. The normal wear-and-tear effects of aging can lead to a narrowing of the spinal canal squeezing the spinal cord. Patients may complain of neck pain, tingling-numbness and weakness of any or all of the limbs. Subtle symptoms like difficulty in buttoning shirts, dropping things, loss of balance while walking, changes in handwriting and urinary disturbances may be early warnings. These symptoms usually begin after the age of 50 and unless treated energetically, many people will have steady progression of their disease till they are completely crippled.

FAQs: Please see Anterior Cervical Discectomy and Fusion (ACDF) (above)....

Laminoplasty is a surgical procedure in which space available for the spinal cord and the nerve roots are increased by opening up the bony rear wall of the spinal canal (the laminae) like a door thereby reducing the pressure on the spinal cord. On one side of the vertebral column, the laminae are cut just deep enough to allow a hinge like movement, much like a door, and on the other side laminae are cut all the way through to, in effect, open the door. After gently opening the “door” of each vertebra to create more room for the spinal cord and nerve roots, very small metal plates are inserted to keep the door from totally closing resulting in an expanded canal for the spinal cord and nerves.



FAQs:

• How many days do I need to stay back in Hopsital?
  Patients are usually admitted to the hospital a day before the surgery. After the surgery, mobile and ambulatory patients will be up and about in a day or two after operation. If weakness or numbness was present prior to surgery these symptoms may take longer to recover. Most patients will be fit to go home in a week after a course of intensive physiotherapy.
• How long does this surgery take?
  The time taken for surgery depends on each individual patient’s physical structure (e.g. height and weight) and diagnosis. The actual time needed for operation also depends on the number of levels to be decompressed and fused.
• Are there risks involved in this surgery?
  There are risks and benefits in every medical or surgical intervention. Complications are rare, and, if they occur, usually mild. The risks of surgery include difficulty in swallowing, hoarseness of voice, infection, and persistent pain after surgery. Relatively serious complications like nerve or spinal cord damage leading to weakness of hands and feet, and tear of the covering around the nerves leading to leakage of fluid with wound healing problems are very infrequent. The levels above and/or below the operated level may have an accelerated rate of degeneration. Around 10% of patients will have some complication most of which are treatable and improve with time. Less than 1% will have permanent complications. The risks of anaesthesia are largely based on the patient’s general health which will be investigated and managed by the anaesthesiology team. The treating surgeon and anaesthesiologist will discuss these risks in the fullest detail prior to surgery.
• What is the follow up protocol?
  Follow up is usually scheduled at 1 month, 3 months, 1 year and 2 years post-surgery. In each successive visit restrictions are progressively relaxed and the patient is encouraged and guided to return to his/her normal life-style and activities.
• Will I need a collar after surgery?
  The type of collar and how long a patient must wear it depends upon the specifics of surgery and various other factors. This is decided by the surgeon and full guidance and training in the proper use of the collar are provided by the physiotherapy team.
• How much pain will I have, and will I receive pain medications?
  Every person has a different level of pain tolerance. Pain medications are, therefore, individualised for each patient and prescribed by our Anaesthesiology team. Full pain control is achieved with oral medications before discharge from hospital.
• Do I need to take any other medications after the surgery?
  In addition to pain medications, oral antibiotics are prescribed for one week.
• How do I care for my surgical incision?
  Once the surgery is over, we cover the incision with a sterile dressing. After discharge from hospital, this dressing must be kept clean and dry. Any soakage of the dressing should be reported through our Helpline number. Stitch removal is done by trained OT technicians at the patient’s residence.
• Do I need to do the physical therapy after surgery?
  Our specialised physiotherapy team will advise and train every patient during the hospital stay. The regimen of exercises and manoeuvres are individually planned for the patient’s specific needs and need to be followed rigorously for the best results.

Laminectomy is the surgical procedure in which the laminae or the rear bony wall of the spinal canal is removed in order to decompress the spinal cord and nerve roots. Laminectomy alone may lead to instability which in turn may give rise to pain and deformity. In order to prevent such complications the spine is stabilized with screws and rods to maintain alignment and to allow the bones to fuse.

The thoracic spine is the central part of the spine and is formed by 12 vertebrae. Thoracic spine decompression is a surgical procedure to relieve pressure on the spinal cord and nerves in the middle portion of the back. It is indicated in treating various spinal pathologies like spinal trauma, spinal infection, spinal tuberculosis and thickening of ligaments leading to spinal stenosis. Spinal decompression surgery removes the compressive structures, including thickened ligament flavum, bony overgrowth, collection of pus, tumour etc. The goals of surgical treatment are to alleviate neural compression (decompression) and, in selected patients with a deformity or instability, to stabilize the spine (fusion).Thoracic spine fusion is done by placing screws and rods in the bone. Bone grafts or bone graft substitutes are added to promotes bone growth and which eventually fuses the vertebrae into a single, solid bone.

A Laminectomy is a surgical procedure that removes the laminae which form the rear wall of the spinal canal. This procedure is performed to decompress the thoracic spinal canal and increase the space available for the spinal cord and the nerve roots. It is performed from the back of the spine, which also provides access for screw-rod fixation. En Bloc Laminectomy procedure is done in various conditions like spinal cord compression due to bony/ligament overgrowth, evacuation of pus, removal of tumours and some traumatic spine injuries.

The disc space is entered through a very small incision in midline of the back under the guidance of intra-operative X-Rays. Using a high precision microscope the herniated disc material compressing the nerve root/s is removed thereby relieving the pressure. Usually patient is able to walk the same day and is discharged from the hospital on the 3rd post-operative day.



FAQs:

• How many days do I need to stay in Hospital?
  Patients are usually admitted to the hospital a day before surgery. After operation patients will be up and walking within the first day. If surgery is being done for leg pain due to nerve root compression, the pain improves significantly immediately following operation. Weakness or numbness, however, may take longer to improve. Patients are usually discharged on the 3rd day, allowing us to make sure that pain is well-controlled on oral medications and that the patient can move around indoors freely and without support prior to going home.
• How long does this surgery take?
  The time taken for surgery depends on each individual patient’s physical structure (e.g. height and weight) and diagnosis. The actual time needed for operation also depends on the number of levels to be decompressed and fused.
• Are there risks involved in this surgery?
  There are risks and benefits of every medical and surgical intervention. Complications are rare, and, if they occur, usually mild. The risks of surgery include foot weakness, foot drop, infection, persistent pain after surgery, spinal nerve damage and tear of the sac around the nerves and problems in passing/holding urine and stool. There is also a risk that the level above or below the operated level will have an accelerated rate of degeneration. Around 10% of patients will have some temporary complications most of which are treatable and improve with time. Only 1% of patients may have some permanent deficits most of which will be of a trivial or minor nature. The risks of anaesthesia are largely dependent on the patient’s general physical health which will be investigated by the anaesthesiology team prior to surgery. The treating surgeon and anaesthesiologist will discuss these risks in the fullest detail during the pre-operative visit.
• What is the follow up protocol?
  Follow up visits are usually scheduled at 1 month, 3 months, 1 year and 2 years post-surgery. In each successive follow up, restrictions are progressively relaxed and the patient is encouraged and guided to return to his/her normal life-style and activities.
• Will I need a brace after surgery?
  The style of brace and how long a patient must wear it, if at all, depends upon the specifics of surgery and various other factors. Usually, for a standard micro-lumbar discectomy, brace is not required. In fact, patients are advised to do the exercises as demonstrated by the physiotherapy team.
• How painful will it be? Will I receive pain medications?
  Every person has a different level of pain tolerance. Pain medications are, therefore, individualised for each patient and prescribed by our Anaesthesiology team. Full pain control is achieved with oral medications before discharge from hospital.
• Do I need to take any other medication after the surgery?
  In addition to pain medications, oral antibiotics are prescribed for one week.
• How do I care for my surgical incision?
  Once the surgery is over, we cover the incision with a sterile dressing. After discharge from hospital, this dressing must be kept clean and dry. Any soakage of the dressing should be reported through our Helpline number. Stitch removal is done by trained OT technicians at the patient’s residence.
• Is there any need for physiotherapy after surgery?
  Our specialised physiotherapy team will advise and train every patient during the hospital stay. The regimen of exercises and manoeuvres are individually planned for the patient’s specific needs and need to be followed rigorously for the best results.

In severe or late cases patient may present with low back pain associated with feeling of heaviness and cramps in thighs and/or calves on walking. The ability to hold urine may be reduced or even lost. This canal space is usually encroached by age related degenerative changes like displaced discs or bony overgrowths. Lumbar decompression and fixation is a surgical procedure done to relieve the compression on the nerves. A midline incision on the back allows entry into the lumbar canal and also the involved disc space/s. The damaged and displaced disc/s as also any bony overgrowth compressing the nerves are completely removed. Any instability produced by the excision of bone and disc/s is corrected by the use of implants like screws, rods and cages.

FAQs:

• How many days do I need to stay in Hopsital?
  Patients are usually admitted to the hospital a day before surgery. After operation patients will be up and walking within the first day. If surgery is being done for leg pain due to nerve root compression, the pain improves significantly immediately following operation. Weakness or numbness, however, may take longer to improve. Patients are usually discharged on the 3rd day, allowing us to make sure that pain is well-controlled on oral medications and that the patient can move around indoors freely and without support prior to going home.
• How long does this surgery take?
  The time taken for operation depends on each individual patient’s physical structure (e.g. height and weight) and diagnosis. The actual time needed for operation also depends on the number of levels to be decompressed and fused.
• Are there risks involved in this surgery?
  There are risks and benefits of every medical and surgical intervention. Complications are rare, and, if they occur, usually mild. The risks of surgery include foot weakness, foot drop, persistent pain after surgery, spinal nerve damage and tear of the sac around the nerves and problems in passing/holding urine and stool. There is also a risk that the level above or below the operated level will have an accelerated rate of degeneration. Infection and malposition or loosening of the screws are occasionally encountered. Around 10% of patients will have some temporary complications most of which are treatable and improve with time. Only 1% of patients may have some permanent deficits most of which will be of a trivial or minor nature. The risks of anaesthesia are largely dependent on the patient’s general physical health which will be investigated by the anaesthesiology team prior to surgery. The treating surgeon and anaesthesiologist will discuss these risks in the fullest detail during the pre-operative visit.
• What is the follow up protocol?
  Follow up is usually scheduled at 1 month, 3 months, 1 year and 2 years post-surgery. In each successive follow up, restrictions are progressively relaxed and the patient is encouraged and guided to return to his/her normal life-style and activities.
• Will I need a brace after surgery?
  The style of brace and how long, if at all, a patient must wear it depends upon the specifics of surgery and various other factors. In this operation, the spine being fixed with screws and rods, the use of a brace is extremely rare.
• How much pain will I have, and will I receive pain medications?
  Every person has a different level of pain tolerance. Pain medications are, therefore, individualised for each patient and prescribed by our Anaesthesiology team. Full pain control is achieved with oral medications before discharge from hospital.
• Do I need to take any other medications after the surgery?
  In addition to pain medications, oral antibiotics are prescribed for one week.
• How do I care for my surgical incision?
  Once the surgery is over, we cover the incision with a sterile dressing. After discharge from hospital, this dressing must be kept clean and dry. Any soakage of the dressing should be reported through our Helpline number. Stitch removal is done by trained OT technicians at the patient’s residence.
• Do I need to do the physical therapy after surgery?
  Our specialised physiotherapy team will advise and train every patient during the hospital stay. The regimen of exercises and manoeuvres are individually planned for the patient’s specific requirements and need to be followed rigorously for the best results.

TLIF is a surgical procedure through the back of the spine. Through an incision in the lower back a small portion of bone (lamina) and facet joint/s from one side of the vertebra are removed. This bony removal relieves the pressure on the nerves and allows the surgeon to access the disc between the vertebral bodies. Specialised instruments are used to remove the disc and any bone found to be impinging on the nerve root/s. A spacer device (cage) filled with bone graft is placed in the empty disc space. Finally screws and rods are put in place to firmly fix the vertebrae, completely preventing movement at the joints between them. As the bone graft sets, it fuses the vertebrae above and below to form a solid bony mass.



FAQs: Please see Lumbar Decompression and Fixation (above)....

The anterior lumbar interbody fusion is similar to TLIF except that in ALIF the disc space is fused by approaching the spine through the abdomen instead of from the back. An incision is made on the left side of the abdomen and muscles are retracted to one side. The intestines lying inside the peritoneal sac are also gently moved away allowing the surgeon to access the front of spine without actually entering the abdomen proper.

Removal of disc and bony outgrowths followed by placement of the spacer and bone graft are done as described for TLIF. The spacer restores the height between the bones, corrects the spinal curvature, and relieves pinched nerves. In some cases, where there is Osteoporosis and/or excessive degenerative changes the graft will need to be supported with metal plate and screws.



FAQs: Please see Lumbar Decompression and Fixation (above)....

Minimally Invasive Surgery (MIS) for the spine was developed to surgically treat spine disorders with minimum disruption of the muscles and soft tissue. This type of surgery uses smaller incisions than open spinal surgeries. This results in less blood loss, less post operative pain, shorter hospital stay, quicker recovery and early return to work. This technique involves progressive dilation of the soft tissues, as opposed to cutting directly through the muscles. By using tubes to keep the muscles out of the way, the surgeon works through the incision without having to expose the area widely. Sometimes, the surgeon will also utilize an endoscope or a microscope focused down the tube. Once the procedure is complete, the tubular retractor is removed, allowing the dilated tissues to come back together. Not all patients, however, are appropriate candidates for MIS. It is important to be absolutely certain that the same or better results can be achieved through MIS as compared to an open procedure.

The following conditions can potentially be treated using MIS Procedures:

• Degenerative disc disease.
• Herniated disc.
• Lumbar spinal stenosis.
• Spinal instability.
• Vertebral compression fractures.

FAQs:

• How many days do I need to stay in Hospital?
  Patients are usually admitted to the hospital a day before surgery. After operation patients will be up and walking within the first day. If surgery is being done for leg pain due to nerve root compression, the pain improves significantly immediately following operation. Weakness or numbness, however, may take longer to improve. Patients are usually discharged on the 3rd day, allowing us to make sure that pain is well-controlled on oral medications and that the patient can move around indoors freely and without support prior to going home.
• How long does this surgery take?
  The time taken for operation depends on each individual patient’s physical structure (e.g. height and weight) and diagnosis. The actual time needed for operation also depends on the number of levels to be decompressed and fused.
• Are there risks involved in this surgery?
  There are risks and benefits of every medical and surgical intervention. Complications are rare, and, if they occur, usually mild. The risks of surgery include foot weakness, foot drop, persistent pain after surgery, spinal nerve damage and tear of the sac around the nerves and problems in passing/holding urine and stool. There is also a risk that the level above or below the operated level will have an accelerated rate of degeneration. Infection and malposition or loosening of the screws are occasionally encountered. Around 10% of patients will have some temporary complications most of which are treatable and improve with time. Only 1% of patients may have some permanent deficits most of which will be of a trivial or minor nature. The risks of anaesthesia are largely dependent on the patient’s general physical health which will be investigated by the anaesthesiology team prior to surgery. The treating surgeon and anaesthesiologist will discuss these risks in the fullest detail during the pre-operative visit.
• What is the follow up protocol?
  Follow up visits are usually scheduled at 1 month, 3 months, 1 year and 2 years post-surgery. In each successive follow up, restrictions are progressively relaxed and the patient is encouraged and guided to return to his/her normal life-style and activities.
• Will I need a brace after surgery?
  The style of brace and how long, if at all, a patient must wear it depends upon the specifics of surgery and various other factors. In this operation, the spine being fixed with screws and rods, the use of a brace is extremely rare.
• How painful will it be? Will I receive pain medications?
  Every person has a different level of pain tolerance. Pain medications are, therefore, individualised for each patient and prescribed by our Anaesthesiology team. Full pain control is achieved with oral medications before discharge from hospital.
• Do I need to take any other medication after the surgery?
  In addition to pain medications, oral antibiotics are prescribed for one week.
• How do I care for my surgical incision?
  Once the surgery is over, we cover the incision with a sterile dressing. After discharge from hospital, this dressing must be kept clean and dry. Any soakage of the dressing should be reported through our Helpline number. Stitch removal is done by trained OT technicians at the patient’s residence.
• Is there any need for physiotherapy after surgery?
  Our specialised physiotherapy team will advise and train every patient during the hospital stay. The regimen of exercises and manoeuvres are individually planned for the patient’s specific needs and need to be followed rigorously for the best results.

The normal spine is curved in the front at the neck and the lower back, a backward curvature is at the chest and the level of the pelvis. The spine does not have any normal sideways bend. Scoliosis is a sideways curvature of the spine that makes the spine look more like an "S" or "C" than a straight "I". This sideways bending is almost always associated with a rotational component which makes the chest and back prominent on one side. It can occur due to the following reasons:

Idiopathic- Where the exact cause is not known, these types of deformities grow rapidly during puberty.

Congenital- Where there is an abnormality in formation of vertebrae during the foetal stage which causes spinal deformity as the child grows.

Neuromuscular- Patient has a nerve or muscle disease that causes spinal deformities (for example- polio, cerebral palsy, or myelomeningocele). The uneven muscle pulls on the spine cause abnormal curvature.

Syndromic– Patient has a spinal deformity along with other symptoms which appear together (for example Marfan Syndrome, Retts syndrome, Ehler-Danlos syndrome).

The patient usually presents with cosmetic disfigurement like uneven shoulders or waistline, a prominent chest wall on one side, hump on one side of the back, etc. These are the most common findings in a child with idiopathic scoliosis. It should be remembered that scoliosis other than idiopathic may present with weakness of arms or legs and loss of urinary control. A child with severe deformity may have difficulty in breathing due to impaired chest wall function.

Treatment protocols-

Following an extensive assessment, the doctor will decide to treat the condition with bracing or surgery depending on age, severity of curve, underlying disease processes and degree of breathing difficulty.

The treatment varies for each type of deformity. For idiopathic scoliosis surgery is usually done when the curve exceeds 40 degrees or in rapidly progressing curves. For other types of deformities surgery is done when child presents with pain, limb weakness, bladder disturbance and has achieved sufficient age and weight to sustain the operative procedure.

The surgical options are:

Posterior Fusion
Posterior fusion with instrumentation is the most common operation done for idiopathic scoliosis. In posterior fusion the spine is operated on from behind with an incision straight down the back. Various types of rods, hooks, wires or screws are used to partially straighten the spine and hold it fast while the bone fusion occurs.

Anterior Fusion
In anterior fusion, the spine is operated on from the front, or side. Anterior fusion is used in some special instances of idiopathic scoliosis. An incision is made along a rib and/or down the front of the abdomen to obtain access to the front of the spine. Bone graft from the hip, rib or bone bank is used for the fusion. Screws and washers attached to a rod may be used to straighten the spine.

Combined (Anterior and Posterior Fusion)
Some special cases of spinal deformity require both an anterior (front) and posterior (back) operation. Usually these can be done on the same day, but sometimes must be done at separate operations spaced 1-2 weeks apart.

These surgeries are performed under intraoperative neuro-monitoring system which gives continuous input to the surgeon about the function of the spinal cord throughout the surgery. This enables safe application of screws into the spine, bony correction and straightening of the deformed spine without risks of injuring the spinal cord.

FAQs:

• How many days do I need to stay in Hopsital?
  Spinal deformity correction is major surgery. These are long duration surgeries which typically involve multiple levels of the spine. Some amount of pain may be expected after the surgery. The surgery and anaesthesiology teams, nursing staff and our physiotherapy team put a lot of emphasis on pain management to help the patient get up and about. Typically a patient needs about five to seven days to be able to sit, stand and walk. Usually before discharge from hospital a patient should be able to go to the toilet and climb stairs unaided.
• How long does this surgery take?
  Spinal deformity corrections are long surgeries which involve a coordinated team work of spine surgeons, anaesthesiologists, electro- physiologists, operation theatre technicians and nursing staff. It usually takes around 5-7 hrs.
• Are there risks involved in this surgery?
  There are risks and benefits of every medical and surgical intervention. These complications are very few and infrequent. The risks of surgery include leg weakness, infection, screw malposition or loosening, nerve or spinal cord damage, tear of the sac around the nerves and bowel and bladder symptoms. Because of advancement in technology like neuro-monitoring, anaesthesia techniques, major improvement in screw design and operative instruments, these complications have come down significantly. Around 10% of patients will have some temporary complications most of which are treatable and improve with time. Only 1% of patients will have permanent deficits, many of which will be trivial. The risks of anaesthesia are largely based on the patient’s general physical health which will be investigated and managed by the anaesthesiologist prior to surgery. The treating surgeon and anaesthesiologist will discuss these risks in full detail at the pre-operative visit.
• What is the follow up protocol?
  Follow up is usually scheduled at 1 month, 3 months, 1 year and 2 years post-surgery. In each successive follow up restrictions are progressively relaxed and the patient is encouraged and guided to return to his/her normal life-style and activities.
• Will I need a brace after surgery?
  The type of brace and how long a patient must wear it, if at all, depends upon the specifics of surgery and various other factors. If indicated, the treating surgeon will prescribe the particular brace required by the individual patient and the physiotherapy team will train and guide the patient in its use.
• How much pain will I have, and will I receive pain medications?
  Every person has a different level of pain tolerance. Pain medications are, therefore, individualised for each patient and prescribed by our Anaesthesiology team. Full pain control is achieved with oral medications before discharge from hospital.
• Do I need to take any other medications after the surgery?
  In addition to pain medications, oral antibiotics are prescribed for one week.
• How do I care for my surgical incision?
  Once the surgery is over, we cover the incision with a sterile dressing. After discharge from hospital, this dressing must be kept clean and dry. Any soakage of the dressing should be reported through our Helpline number. Stitch removal is done by trained OT technicians at the patient’s residence.
• Do I need to do the physical therapy after surgery?
  Our specialised physiotherapy team will advise and train every patient during the hospital stay. The regimen of exercises and manoeuvres are individually planned for the patient’s specific requirements and need to be followed rigorously for the best results.

Vertebral compression fractures often occur as a result of weakening of bone due to osteoporosis. It can also occur following primary cancer (such as myeloma) or secondary cancer spread (metastasis). Vertebroplasty is a minimally invasive surgical procedure in which bone cement is injected into the vertebral body to provide strength to the weakened vertebra. While vertebroplasty provides pain relief by stabilising the fracture, kyphoplasty can restore the original height of a fractured vertebra. Both the techniques have equivalent functional outcomes. It is a short duration (30 minutes) procedure and may be done under general or local anaesthesia. Under image guidance technique a chemical known as bone cement is injected into the fractured bone using a hollow needle inserted through the skin. In kyphoplasty, a balloon is first inserted into the fractured bone through the hollow needle to create a cavity or space in the fractured vertebra followed by removal of the balloon and injection of cement. Usually patient is able to walk the same day and go home the next day.



FAQs:

• How many days do I need to stay in Hopsital?
  Vertebroplasty and Kyphoplasty are one day procedures. Patients are usually admitted one day before the procedure. Usually the patient will be fit to go home the same day or next morning. Pain control is achieved with oral medication.
• How long does this surgery take?
  The time taken for surgery depends on the individual patient’s physical characteristics, diagnosis, and the number of levels to be treated.
• Are there risks involved in this surgery?
  There are risks and benefits of every medical and surgical intervention. These complications are very few and infrequent. The risks of surgery include cement leakage, pulmonary embolism, cerebrovascular and cardiovascular ischemia, potential nerve damage and urinary symptoms. There is also a risk that the vertebra above or below the operated one may develop another osteoporotic fracture. Around 10% of patients will have some temporary complications most of which are treatable and improve with treatment. Only 1% of patients may have permanent complications. The risks of anaesthesia are largely based on the patient’s general health which will be investigated and managed by the anaesthesiology team. The treating surgeon and anaesthesiologist will discuss these risks in the fullest detail prior to surgery.
• What is the follow up protocol?
  Follow up is usually scheduled at 1 month, 3 months, 1 year and 2 years post-surgery. In each successive visit restrictions are progressively relaxed and the patient is encouraged and guided to return to his/her normal life-style and activities.
• Will I need a brace after surgery?
  The type of brace and how long a patient must wear it depends upon the specifics of surgery and various other factors. The treating surgeon will prescribe the particular brace required by the individual patient and the physiotherapy team will train and guide the patient in its use.
• How much pain will I have, and will I receive pain medications?
  Every person has a different level of pain tolerance. Pain medications are, therefore, individualised for each patient and prescribed by our Anaesthesiology team. Full pain control is achieved with oral medications before discharge from hospital.
• Do I need to take any other medications after the surgery?
  In addition to pain medications, oral antibiotics are prescribed for one week. Patient will also be prescribed anti-osteoporotic medications depending on bone mineral density.
• How do I care for my surgical incision?
  Since Vertebroplasty and Kyphoplasty procedures are done using a narrow gauge needle, there are no stitches to care for or remove.
• Do I need to do the physical therapy after surgery?
  Our specialised physiotherapy team will advise and train every patient during the hospital stay. The regimen of exercises and manoeuvres are individually planned for the patient’s specific needs and need to be followed rigorously for the best results.

Tuberculosis (TB) is an infectious disease caused by the bacteria, Mycobacterium tuberculosis, which can affect any and every part of the body.One of the oldest recorded diseases in human history, TB has been detected in Egyptian mummies dating back to the fourth millennium BC, and remains to this day a disease of significant public health concern. Spinal involvement occurs in less than 1% of patients with respiratory tuberculosis. The bacteria usually gain access to the vertebra via the blood stream. The commonest presenting complaint is back-pain but there may be other problems like weakness and tingling-numbness of the limbs along with loss of bladder and bowel control. Systemic features like fever, loss of appetite and weight loss may also be present. Occasionally bending of the spine and formation of abscess with pus discharge may occur. Early diagnosis and prompt treatment is essential to prevent permanent neurological deficit like paralysis and severe deformity due to collapse and bending of the spine. Diagnosis is established with the help of Laboratory investigations and X-rays, CT scans and MRIs. Culture of the TB bacteria remains the final and confirmatory diagnostic criterion. In early and uncomplicated cases the treatment is conservative with multiple drugs and supportive measures like nutrition and physiotherapy.In complicated cases such as compression of nerves, bending of the spine, collapse of vertebra etc., surgical procedures have to supplement medications.

The recent advent of multidrug-resistant TB and also the tendency of TB to attack and spread rapidly in immunocompromised individuals have caused a setback in the management of the disease. At the same time great technical advancements and refinements in surgical techniques have provided tools for achieving what was hitherto considered impossible. The Spine Foundation has a huge and enviable record of success in the management of this dreaded condition.

Craniovertebral junction disorders may be present at birth (congenital) or develop later (acquired). These are the various abnormalities of the bones that join the head with the neck. This junction consists of the bone that forms the base of the skull (occipital bone) and the first two vertebrae, viz., the atlas and the axis. Cranio-cervical junction disorders can put pressure on the lower parts of the brain, the highest part of the spinal cord, and/or on the nearby nerves. The resulting symptoms can be serious. For example, misalignment of the first and second spinal bones (atlantoaxial subluxation or dislocation) can result in paralysis, and loss of sensation.Most commonly, patients have neck pain and headache, but there may also be difficulty in sensing pain, vibration, and temperature with weak muscles, dizziness, and impaired vision. In severe cases breathing difficulties, loss of consciousness and even death may occur following trivial trauma.

There are numerous disorders present at birth that affect the Craniovertebral Junction. These disorders may occur in isolation or be part of a generalised anomaly like Achondroplasia, Down Syndrome, Mucopolysaccharoidosis, Osteogenesis-Imperfecta, etc. Craniovertebral junction disorders may also occur later in life. They can result from motor vehicle accident, fall from a height, and certain disorders like Rheumatoid arthritis, Paget’sDisease, Ankylosing spondylitis etc. Various imaging methods like MRI, CT Scan, X rays are used for diagnosis.

Main goal of treatment is to maintain/provide spinal stability and to prevent neurological compression or trauma. Treatment depends on the exact nature of the disorder, duration of symptoms, age of the patient, degree of nerve compression, quality of bones and comorbidities, if any. Conservative management (cervical collars/braces/traction) is preferred in patients having mild symptoms without any evidence of compression of nerves and/or spinal instability. Surgery is reserved for patients with spinal instability and/or neurological symptoms.

Spine tumours may arise from any of the structures of the spine. They may originate in the spinal cord itself, the spinal roots, the dural sac which envelops the spinal cord, or the vertebrae (bones). They may be primary, originating from the spine or spinal cord, or metastatic, originating elsewhere (e.g. lung, breast, etc.). Depending on the type of tumour, its location, and patient’s medical condition, treatment may include chemotherapy, radiation therapy, and/or surgical removal of the tumour. Surgery for spinal tumour is generally indicated for progressive weakness of arms and/or legs and loss of bowel and/or bladder control. In addition, surgery may be required in situations where the spine has become unstable because of the tumour. Lastly, surgery may be the only available intervention for some tumours that are insensitive to radiation or chemotherapy. Surgery involves the partial or total removal of the spine tumour. Spinal fusion may be used to reconstruct and stabilize the spine.

Spinal cord injury (SCI) or damage to the spinal cord causes temporary or permanent changes in its function. It is a potentially life-threatening condition that can even kill instantly. SCI usually results from physical trauma from motor vehicle accidents, gunshot wounds, fall from a height, or sports injuries. The injury may be complete or incomplete. All functions of the cord are lost below the level of injury in the former, while there is partial sparing of some functions in the latter. Injuries to the spinal cord can cause weakness or complete loss of muscle function, loss of sensation, loss of control of the bowels and bladder and loss of normal sexual function. The first step in treatment of a suspected spinal cord injury is immobilisation of the spine. It is absolutely essential to ensure this at the site of the injury prior to being transported to hospital. Lack of immobilisation may cause further and irreversible cord damage leading to permanent neurological deficit and even death. SCI in the upper cord can cause stoppage of breathing necessitating intubation of the airway and ventilatory support. The patient of SCI will often have multiple other injuries involving the chest, abdomen, brain, limbs, etc., and may also be suffering from the effects of shock and blood loss. Apart from the initial emergency supportive care a multidisciplinary consultation may be required.The exact location and extent of SCI is established by investigations like X-Rays, CT scans and MRI. The presence of spinal cord compression and/or fractures of the vertebrae, especially if accompanied by instability, are the usual indications for operative treatment of the spine. Where no such indication exists the management is non-surgical. Physiotherapy, Rehabilitation and Occupational Therapy play a most important role in the treatment and outcome of SCI.

The selective nerve root block procedure is an injection of a small amount of steroid and local anaesthetic medication under x-ray guidance around a very specific nerve root/spinal nerve that exits out of the spinal cord. The selective nerve root block procedure can be done in the cervical (neck), thoracic (chest) and lumbar (low back) areas. Selective nerve root block injections are used to treat an inflamed nerve root caused by a herniated disc, degenerative changes in the vertebrae, such as bony spurs, causing nerve compression. In any of these conditions, there may be a chemical irritation or pinching of the nerve due to mechanical compression. The medication reduces inflammation and numbs the pain transmitted by the nerve. Pain usually improves immediately after the injection from the local anaesthetic and the steroid usually takes two or three days to have an effect in most people, peaking in about two weeks. There may be some temporary discomfort at the puncture site. After the procedure, patient is encouraged to perform his/her normal activities.