Spine surgery is operative treatment of the spine and is reserved for patients whose problems related to neck or back have not responded favourably to conservative (non-operative) treatment. Surgery may however be the first choice in late cases and also where the disease is treatable by surgery only (Tumours, for example).

Conservative measures like physical therapy, NSAID treatment, steroid injections, and chiropractic manipulation may help manage a patient's back pain in some cases, particularly in degenerative disorders. Where these measures fail, or are inadvisable due to the nature or stage of the disease, spine surgery remains the only permanent solution available for alleviating pain, deformity and disability. In some ailments like tumour or infection spine surgery may be lifesaving.

Spine surgery is most commonly suggested as a treatment for conditions like degenerative disc disease, spinal infections, tumours, congenital (inborn)spine defects, spondylolisthesis (slipping of one vertebra over another), spinal stenosis (narrowing of the spinal canal), scoliosis (laterally bent spine), and spinal trauma. Procedures such as spinal fusion can help stabilize the spinal column and alleviate pain that results from movement or pressure over a spine made unstable by disease or injury.

Surgery is usually the last resort when treating degenerative spinal conditions. However, if various non-operative treatments have been properly tried without improvement or with worsening, surgical treatment is reasonable for certain specific conditions such as spinal disc disease, stenosis, sciatica, spondylolisthesis or degenerative scoliosis. The presence of spinal instability often tilts the balance in favour of surgery.

The decision for surgery has to be individualized to the patient and the patient’s symptoms, along with their level of functioning. In case of spinal tumours, however, surgery is the only treatment and must be done at the earliest opportunity. The specific indications for spine surgery include the patient who has a neurologic deficit and is becoming paralyzed because of nerve compression and the patient who loses control of bowel and/or bladder. Other indications would include someone who has an infection in their spine or tumour that requires removal of the affected part. Spine surgeries may also be required for correction of spinal deformities and for pain relief. Unbearable, incapacitating pain, not relieved by drugs and physiotherapy, is by itself an indication for surgery.

Spine surgery is performed as an elective procedure only after the patient and his/her surgeon agree that there is no scope of conservative management in the particular situation and that surgery is the best, if not the only, option available for cure or improvement of the quality of life.

Today, spine surgery is one of the most successful surgeries performed in our country, and has undergone a number of advancements since its introduction in the 1970s. Many procedures have been made minimally invasive, allowing patients to benefit from smaller incision sizes and reduced muscle and tissue interference. These benefits translate to less blood loss during surgery, quicker and less painful procedures, with a shortened post-operative recovery period and a reduction in the length of hospital stay.

Both, orthopaedic surgeons and neurosurgeons, are trained to perform spinal surgery. In recent times Spinal Surgery has become a speciality by itself. It is important that your surgeon is qualified, trained and experienced in treating the spine surgically.

Yes, surgery can and does work beautifully, although many rumours to the contrary are rife among individuals with little or no knowledge of modern science or medicine. Some horror stories are hand downs from one or two generations back. Certainly, individuals and their surgeons can have variable results from surgery. Not everyone will have complete success, but a competent surgeon doing the appropriate operation on the right patient has an extremely high likelihood of success. It is our policy to discuss threadbare the risks and benefits of a surgical procedure with the patient and relatives before undertaking any kind of surgical procedure.

The principle is to do the minimum amount of surgery necessary to control the disease and alleviate the symptoms. Sometimes, due to a patient's anatomy and pathology, a fusion is recommended to prevent instability or slipping of one vertebra on another, giving rise to additional pain or nerve root insult. Surgeons will identify those individuals at risk and recommend the additional procedure of a fusion of the spine to prevent such problems. There are numerous ways to perform a spinal fusion and each of these techniques has advantages and disadvantages. The actual pr0cedure needs to be carefully suited to the exact requirement of each particular patient. The surgical team’s knowledge, skill and experience are of paramount importance in making this choice.

Ninety-five percent of all the bending, in terms of being able to touch your hands to the ground or your toes, involves your hip joints, not your spine. Thus, patients undergoing a one or two-level fusion typically have no loss of ability to touch their toes. If more than two levels of the spine are fused, there is some permanent loss of motion, but, again, more than 95% of all the flexion occurs at the hip joints, not the spine. So overall there is minimal impact on the total range of movement.

Historically spinal fusion has been performed with a bone graft without implants. However, the fusion rate with this technique is notoriously low, in the 50% range. The clinical result of spinal fusion without implants is also not very good. In addition, patients treated in this manner are often immobilized with prolonged bracing and/or bed rest for weeks or months.

Modern techniques utilizing pedicle screw fixation with plates or rods in combination with devices replacing the disc have resulted in fusion rates of well over 95% and associated improvement in clinical results to around 70%. Thus, the use of implants is certainly an advantage in terms of rapid rehabilitation and better clinical results with higher fusion rates.

The difference between various implants is more important to the individual surgeon in terms of his familiarity with their particular surgical techniques rather than providing the patient with a specific advantage. The use of titanium rather than stainless steel does have certain advantages in terms of better imaging with MRI scanning. It is certainly reasonable for a patient to ask the surgeon the rationale of using a particular implant for their surgery.

This is a possibility, particularly if the surgical technique of inserting the implants is not performed appropriately. Rarely even after a perfect surgical placement there may be delayed damage to the spine above and/or below the fused segment. However, in the hands of well trained and experienced surgeons such occurrences are extremely infrequent.

Making the right decision for treatment begins with an accurate diagnosis of the condition. We need to evaluate the patient's condition using imaging techniques, such as MRI, X-ray, CT Scans, Nerve conduction studies (EMG/NCV), bone scan or bone mineral density(BMD), etc. These tests help the Surgeon assess the exact nature and severity of the patient's disease and to determine if spine surgery is the right management option and also the actual type of surgery to be performed. Once a decision for surgery is made every patient will need to get evaluated by our team of anaesthesiologists with a battery of other investigations like blood tests, Chest X-rays, ECG, and Echocardiography, etc. Patients are advised to continue all medications they may have been taking and not to discontinue any drug without consulting our anaesthesiology team.

After undergoing spine surgery, patients may have difficulty in lifting heavy objects for several weeks or months. For this reason, it is helpful to place common objects of daily use within easy reach and reduce activities that involve bending over. For example, pots and pans in the kitchen should be placed in upper shelves, rather than the lower ones where one has to bend over to reach them.

Placing toiletries, clothes, and other everyday items on shelves and countertops within easy reach can help the patient recover more quickly and to avoid post-operative pain.

Following spine surgery, patients should forego lifting heavy objects and bending over for a few weeks. This precautionary measure allows the spine to heal without experiencing excessive stress.

Physical therapy and rehabilitation exercises will be prescribed by our specialised Physiotherapy team following the procedure. These exercises help support the spine by strengthening the supporting muscles and ligaments. Drugs are prescribed by our surgical team in consultation with our anaesthesiology team. Each patient is carefully assessed and reviewed repeatedly and the most modern and effective protocol for smooth and rapid recovery is offered.

Braces are not prescribed routinely after spinal surgery and there are only a few special cases where a brace has to be worn for a short time following which they may be used occasionally for providing some pain relief and comfort. The use of minimally invasive techniques that preserve muscle function, along with specialized implants that act as internal braces, allow most patients to avoid wearing a brace.

The field of minimally invasive spine surgery continues to grow. Many conditions can be treated today with some type of minimally invasive surgery. However, there are certain conditions that require standard open treatment, such as high-degree scoliosis, tumours and some infections. The best options should be individualized for the particular patient depending on the exact diagnosis and his/her overall general condition.

In general, it depends on the type of surgery, condition of the patient and the need for rehabilitation. Minimally invasive surgery decreases the hospital stay by one-half. In a typical micro-discectomy patients go home 3-4 days after surgery. In cases of bone- injection procedures like vertebroplasty or kyphoplasty patients are usually discharged the next day. For various types of cervical or lumbar fusion surgery, the hospital stay is around 4-5 days. The stay may have to be prolonged in the event of any medical or surgical complication or when there is a need for special and extended course of physiotherapy and rehabilitation in hospital.

The use of physiotherapy following surgery is totally individualized for the patient. In general, patients should avoid excessive lifting, twisting, squatting and stooping for 4-6 weeks following any spine surgery. Exercises taught to the patients need to be continued at home after discharge. Physiotherapeutic modalities of pain control (E.g. IFT, SWD etc.) are very seldom required. Patients who need prolonged rehabilitation are appropriately counselled by our team and provided complete professional support even after discharge.

Our doctors are available 24X7 over dedicated helplines. The numbers are made available to all patients on their discharge summaries. Review dates and appointments are provided at the time of discharge.

This is our time to meet you before the surgery and discuss about the anaesthesia procedure. We will do the physical examination and check your investigations like Blood parameters, Chest X ray, ECG, 2D Echo etc. We will take necessary steps to make sure you are in the best possible health. We also try to answer as many questions as we can. We call this entire procedure as Pre-Anaesthesia Check-up (PAC). In case of emergency, we can do PAC in hospital if you are already admitted. Research has shown that this visit can go a far way to reduce your anxiety about your surgery.

The aim of a general anaesthetic is to make sure you remain unconscious and in no pain for the duration of your operation. It is a specialised medical procedure and only undertaken by anaesthesiologists who have been highly trained to do this. Afterwards you should have no memory of what happened under the anaesthetic. Before the operation, drugs will be injected into a vein, or gases will be given for you to breathe. These drugs or gases make you become unconscious and pain-free during surgery.

Depending on the procedure, your anaesthesiologist might insert a tube in your mouth down your windpipe while you sleep. This tube will help you get enough oxygen and medications during the procedure and protects your lungs from fluids, such as stomach fluids. While you are asleep, the anaesthesiologist will continuously monitor you and adjust the medication, breathing, temperature and blood pressure as needed throughout the procedure.

When your surgery is finished, the anaesthesiologist will reverse the medication to allow your body to wake up naturally. You will most likely feel a bit groggy when you first wake as the anaesthesia begins to wear off.

You may experience common side effects after waking up including:

• Nausea
• Dry mouth
• Sore throat
• Muscle soreness
• Shivering
• Sleepiness

The side effects you have often depend on your health status and the type of surgery you are having. Your anaesthetist will discuss these risks in further detail at your pre-operative visit.