Minimally Invasive Spine Surgery in India- Balloon Kyphoplasty

Balloon Kyphoplasty at Best Spine Surgery Hospitals in India

Kyphoplasty in India

Kyphoplasty spine surgery is a minimally invasive procedure which supports fractured or compressed vertebrae and also helps in reducing back pain and as well as helps in restoring the height and spinal alignment. During the fracture of vertebrae, the bone which is shaped rectangular gets compressed causing terrible pain. During such cases of compression fractures, there could be a high possibility of collapse of the vertebrae in the spine and becomes a common symptom resulting in osteoporosis. This is a disease that results in loss of bone density, mass and strength leading to weak bones having a lot of pores and which are vulnerable for breaking.

In this Kyphoplasty procedure, balloons are used to elevate the fractured vertebrae to bring it back to its original and correct position. This balloon creates a cavity that is filled with cement which protects from future damages.

When is Kyphoplasty recommended ?

Kyphoplasty is done on patients who experience painful symptoms or spinal deformities due to vertebral compression fractures resulting from osteoporosis. Kyphoplasty is also performed on patients who:

• Are aged or are in poor health to tolerate open spinal surgery.

• Have too frail bones for surgical spinal repair

• Have a vertebral damage due to a cancerous tumor

• Are younger and have osteoporosis caused by a long-term steroid management or a metabolic disorder

How is Kyphoplasty Performed?

Kyphoplasty is performed under local or general anesthesia. Using image guidance x-rays, two small incisions are made and a probe is placed into the vertebral space where the fracture is located. The bone is drilled and a balloon, called a bone tamp, is inserted on each side. These balloons are then inflated with contrast medium (to be seen using image guidance x-rays) until they expand to the desired height and removed. The balloon does not remain in the patient. It simply creates a cavity for the cement and also helps expand the compressed bone.

The spaces created by the balloons are then filled with PMMA, the same orthopaedic cement used in vertebroplasty, binding the fracture. The cement hardens quickly, providing strength and stability to the vertebra, restoring height, and relieving pain.

Benefits of Kyphoplasty

Limitations in the traditional treatments of vertebral compression fractures have led to the refinement of such procedures as kyphoplasty. This procedure provide new options for compression fractures and are designed to relieve pain, reduce and stabilize fractures, reduce spinal deformity, and stop the "downward spiral" of untreated osteoporosis.

Additional benefits of kyphoplasty include :

• Short surgical time

• Only general or local anesthesia required

• Average hospital stay is one day (or less)

• Patients can quickly return to the normal activities of daily living

• No bracing required

How Does Kyphoplasty Compare to Non-surgical Treatment?

Kyphoplasty was shown to be more effective than non-surgical care for the treatment of acute vertebral compression fractures.

Patients treated with kyphoplasty had faster and greater improvement in back pain relief, back function and quality of life at one month after surgery. The benefits of kyphoplasty were sustained on average through 12 months. The overall frequency of patients with adverse events did not differ between the kyphoplasty and the non-surgical groups.1

Benefits of Disc Nucleoplasty for herniated or slipped disc, chronic lower back pain, Sciatica

• Minimally Invasive, Scarless , Minimal Pain & discomfort to the patient

• Quick recovery and return back to active work life

• Minimal Tissue trauma and no risk of complications that may result from open surgery

• Quick Symptom relief within two weeks of undergoing the Nucleoplasty Surgery.

Low Cost Lumbar Disc Replacement Surgery

Lumbar Disc Replacement Surgery in India

Lumbar disc replacement surgery comes as a relief for all those patients suffering from severe discogenic back pain for several years. Discogenic back pain refers to pain in the low back and legs arising from compression of neural structures by degenerated disc fragments. The surgery aims at replacing the diseased disc with a prosthesis (artificial disc) that mimics the movement of the natural disc.

The lumbar spine refers to the lower segment of the human spine in the low back region. This segment consists of 5 short bones called vertebrae arranged over one another, separated by soft cushion like structures called as intervertebral discs. The low back is subjected to maximum load during all the movements of the human body as maximum movement occurs here. As a result it is vulnerable to degenerative changes in the disc as well as in the vertebrae. When the disc degenerates it loses its water content, shrinks in height and disintegrates into fragments and bulges. This may compress the nearby spinal nerves passing in its vicinity. Also reduced disc height results in reduced intervertebral distance, which puts pressure on the facet joints causing their hypertrophy (thickening).

Lumbar Disc Replacement Surgery

Compression of the spinal nerves due to thickened ligaments, bony spurs on the lower surface of vertebral bodies or due to prolapsed disc leads to pain in the back and radiating pain numbness and tingling in the legs. In longstanding cases there may also be weakness in the legs.

The procedure aims at replacing the diseased disc with a metal or plastic prosthesis which maintains normal spine movement. It also aims at restoring normal intervertebral distance and enlargement of narrowed intervertebral foramen thus relieving the compression of nerves.

Who may require Lumbar Disc Replacement Surgery

All those individual suffering from discogenic back pain as diagnosed by a combination of clinical symptoms of back pain, and radiating leg pain and diagnostic tests supported by radiological evidence of degenerative disc disease are ideally suited for this procedure. These patients must also have undertaken conservative treatment (bed rest, traction, physical therapy, medication) for a considerable period of time with no satisfactory results.

Details of the Surgery

Disc replacement surgery is done to stop the symptoms of degenerative disc disease. Discs wear out or degenerate as a natural part of aging and from stress and strain on the spine. Eventually, the problem disc collapses, which causes the vertebra above to sink toward the one below. This loss of disc height affects nearby structures - especially the facet joints.

When the disc collapses it no longer supports its share of the load in the spine. The facet joints of the spine begin to support more of the force that is transmitted between each vertebra. This increases the wear and tear on the articular cartilage that covers the surface of the joints. The articular cartilage is the smooth, slippery surface that covers the surface of the bone in any joint in the body. Articular cartilage is tough, but it does not tolerate abnormal pressure well for long. When damaged, articular cartilage does not have the ability to heal. This wear and tear is what is commonly referred to as arthritis.

Shrinking disc height also reduces the size of the neural foramina, the openings between each vertebral pair where the nerve roots leave the spinal column. The arthritis also results in the development of bone spurs that may protrude into these openings further narrowing the space that the nerves have to exit the spinal canal. The nerve roots can end up getting squeezed where they pass through the neural foramina.

Replacing the damaged disc with an artificial disc, or implant, called a prosthesis can restore the normal distance between the two vertebrae. The artificial disc sits between the two vertebrae and distracts or jacks up the upper vertebra. Enlarging the disc space relieves pressure on the facet joints. It also opens up the space around the spinal nerve roots where they pass through the neural foramina.

Another benefit of the artificial disc replacement is that it mimics a healthy disc. Natural motion is preserved in the spine where the new disc is implanted. And it helps maintain stability in the spinal joints above and below it.

Who can benefit from this procedure?

For many years, the standard of care for chronic pain from a degenerated disc has been spinal fusion surgery. Bone graft donated by a bone bank or taken from your pelvic bone is used to fuse two or more vertebral bones together. The spine is stabilized but you will lose motion at that level. The increased stress on the next lumbar vertebra can cause problems later.

The artificial disc replacement is used to reduce or eliminate the pain while still allowing motion. One advantage of the artificial disc is that it may also prevent premature breakdown of adjacent levels of the lumbar spine.

You may be a good candidate for a lumbar artificial disc replacement if you have chronic pain and disability from lumbar disc degeneration despite nonoperative treatment for at least six months. The artificial disc replacement provides an alternative to spinal fusion. The device helps restore the normal space between two vertebrae. You will still have movement at the level where the ADR is implanted.

Minimally Invasive Spinal Fusion Surgery in India - Best Spine Surgery Hospital India

Minimally Invasive SpinalFusion Surgery 

A person’s spine is subjected to a lot of forces throughout its lifetime. It may be subjected to age related wear and tear or infections like tuberculosis. As a result it undergoes degeneration which gives rise to a variety of problems like spinal osteoarthritis, disc prolapse, spondylolisthesis, osteoporotic fractures, vertebral collapse etc. All these conditions manifest as severe pain in the back and radiating pain, numbness, tingling in the upper or lower extremities (lower leg or arm) due to compression of spinal nerves,  spinal cord and spinal instability. When these symptoms become debilitating enough to preclude the patient’s day to day activity, a Spinal Fusion Surgery is advised.

What is Spinal Fusion Surgery?

The surgical procedure of spinal fusion (back fusion surgery) is performed to join one or more bony vertebrae of the spine permanently. This highly advanced procedure (disc fusion surgery) is an option for disability and pain in the spine which has been caused by some lesion and was not able to improve by other non surgical options such as medications or physiotherapy. Diseases, natural aging process and injuries are some of the causes for an unstable spine. These changes consents the abnormal movement of vertebrae and in turn the vertebrae starts to rub against each other. This can lead to either arm, back or leg pain. By fusing the vertebrae, it aligns and stabilizes the spine thereby maintaining the disc space in between the vertebrae. It saves from further damage of spinal cord and nerves.

When is Fusion Recommended

• Fracture
• Tumor
• Infection
• Spondylolisthesis
• Degenerative disc disease
• Scoliosis
• Spinal Stenosis

Types of Spinal Fusion Surgery

Lumbar spinal fusion can be divided into two categories-

Posterolateral Fusion : In the back of the spine, the bone graft is placed in amid the transverse processes. With the help of wires and screws, the vertebrae is carefully fixed throughout the particles of every vertebrae. A rod is made up of metal which is attached on the side of vertebrae.

Interbody Fusion : In this, the graft of the bone is placed in between the vertebrae and the area is generally engaged by the intervertebral disc. The disc is entirely removed in preparing for the spinal fusion. In order to maintain the disc height and spine alignment, a device can be placed in between the vertebrae. This device (intervertebral device) can either be prepared from titanium or plastic. Then the fusion starts in between the vertebrae’s endplates. Interbody fusion is of 3 types-

• Posterior Lumbar Interbody Fusion (PLIF)
• Transforaminal Lumbar Interbody Fusion (TLIF)
• Anterior Lumbar Interbody Fusion (ALIF)
• Transpsoas Interbody Fusion (XLIF or DLIF)

Posterior Lumbar Interbody Fusion (PLIF)

In Posterior lumbar interbody fusion, the spinal fusion is achieved through a surgical incision made on the posterior (back) aspect of spine. It aims at fusion of two adjacent vertebrae in cases of spinal instability and associated back pain. It is a popular procedure as it gives excellent results. The procedure provides almost complete relief of symptoms in 90-95% of the cases and the patients are able to return to their daily activities within a few weeks. The patients can also return to most of their recreational activities.

Procedure for Posterior Lumbar Interbody Fusion (PLIF)

PLIF surgery aims at achieving spinal stability through bony fusion by two ways:

The Open PLIF is the traditional technique which is performed using general anesthesia. The patient is made to lie down on his front side on the table with the low back exposed. A 3-6 inch long incision is made on the skin overlying the affected vertebrae. The skin and the fascia are cut open. The underlying muscles are retracted and the affected vertebrae are identified.  Fluoroscopic X-ray is used to confirm the exact location of the affected vertebrae. Then a complete laminectomy (removal of the lamina of the vertebrae) followed by bilateral foraminotomy (enlargement of the foramen by removing the bony spurs) and/or discectomy (removal of offending disc) are performed.

This relieves the compression off the spinal nerves, allowing them to come to their normal size and shape. The area is checked for any remaining bony outgrowth or disc fragments that may compress the nerves. Autogenic bone grafts or Metal or plastic implants are fitted in the empty disc space for initiating bone growth.

Minimally Invasive Posterior Lumbar Interbody Fusion (PLIF)

The other method is the Minimally Invasive PLIF procedure which is performed using x-ray guidance. 2.5-cm incisions are made on either side of the lower back

The muscles are gradually dilated and tubular retractors inserted to allow access to the affected area of the lumbar spine. The lamina is removed to allow visualization of the nerve roots. The offending disc material is removed from the spine and replaced with a bone graft and structural support from a cage made of bone, titanium, carbon-fiber, or a polymer, followed by placement of rod and screws. The tubular retractors are removed, allowing the dilated muscles to come back together, and the incisions are closed.

This procedure typically takes about 3 to 3 ½ hours to perform. There was less blood loss,tissue trauma, operative time, and quick recovery in this procedure as compared to the traditional one.Generally the patients can go home within 3-5 days after traditional PLIF and within 1-2 days after a minimally invasive PLIF

eXtreme lateral Interbody Fusion (XLIF)

The XLIF (eXtreme Lateral Interbody Fusion) is an approach to spinal fusion in which the surgeon accesses the intervertebral disc space and fuses the lumbar spine (low back) using a surgical approach from the side (lateral) rather than from the front (anterior) or the back (posterior).

The XLIF is one of a number of spinal fusion options that a surgeon may recommend to treat specific types of lumbar spinal disorders, such as lumbar degenerative disc disease, spondylolisthesis, scoliosis and deformity and some recurrent lumbar disc herniations and types of lumbar stenosis. It cannot be used for all types of lumbar conditions for which spinal fusion is a treatment option. For example, it cannot treat conditions at the lowest level of the spine, L5-S1 or for some people at L4-L5.

Spinal Fusion Surgery Benefits

This procedure can remove the pain as well as other symptoms. The advantages include-

• There are less chances of going through a surgery again when the level has been fused. In many cases, the facets or discs are pain producer and a fusion will make sure that the motion at the level is stopped by removing the lower back pain.
• The surgery drastically reduces the post-decompressive deformity. It has been seen that most patients have developed post-laminectomy kyphosis (abnormal alignment of the spine).
• Before the surgery, fusion can also correct the deformities of the patients so as to make sure the proper alignment of the spine is done.

Posterior Lumbar Interbody Fusion (PLIF) Surgery in India | Best Spine Hospital India

Posterior Lumbar Interbody Fusion (PLIF) Surgery in India

A posterior lumbar interbody fusion (PLIF) is a type of spine surgery that can be performed in a minimally invasive way. Posterior lumbar interbody fusion (PLIF) is a type of spine surgery that involves approaching the spine from the back (posterior) of the body to place bone graft material between two adjacent vertebrae (interbody) to promote bone growth that joins together, or "fuses," the two structures (fusion). The bone graft material acts as a bridge, or scaffold, on which new bone can grow. The ultimate goal of the procedure is to restore spinal stability.

Today, a PLIF may be performed using minimally invasive spine surgery, which allows the surgeon to use small incisions and gently separate the muscles surrounding the spine rather than cutting them. Traditional, open spine surgery involves cutting or stripping the muscles from the spine. A minimally invasive approach preserves the surrounding muscular and vascular function, minimizes scarring, hastens recovery and decreases hospitalization stay.

How is it done?

PLIF surgery aims at achieving spinal stability through bony fusion by two ways: The Open PLIF is the traditional technique which is performed using general anesthesia. The patient is made to lie down on his front side on the table with the low back exposed. A 3-6 inch long incision is made on the skin overlying the affected vertebrae. The skin and the fascia are cut open. The underlying muscles are retracted and the affected vertebrae are identified. Fluoroscopic X-ray is used to confirm the exact location of the affected vertebrae. Then a complete laminectomy (removal of the lamina of the vertebrae) followed by bilateral foraminotomy (enlargement of the foramen by removing the bony spurs) and/or discectomy (removal of offending disc) are performed.

This relieves the compression off the spinal nerves, allowing them to come to their normal size and shape. The area is checked for any remaining bony outgrowth or disc fragments that may compress the nerves. Autogenic bone grafts or Metal or plastic implants are fitted in the empty disc space for initiating bone growth. Finally, pedicle screws are placed into the upper and lower vertebrae and connected with rods or plates. New bone is allowed to grow over these rods, helping to bridge the adjacent vertebrae and achieving interbody fusion. The total surgery time is approximately 3 to 6 hours, depending on the number of spinal levels involved.

The other method is the Minimally Invasive PLIF procedure which is performed using x-ray guidance: 2.5-cm incisions are made on either side of the lower back. The muscles are gradually dilated and tubular retractors inserted to allow access to the affected area of the lumbar spine. The lamina is removed to allow visualization of the nerve roots. The offending disc material is removed from the spine and replaced with a bone graft and structural support from a cage made of bone, titanium, carbon-fiber, or a polymer, followed by placement of rod and screws. The tubular retractors are removed, allowing the dilated muscles to come back together, and the incisions are closed. This procedure typically takes about 3 to 3 ½ hours to perform. There was less blood loss, tissue trauma, operative time, and quick recovery in this procedure as compared to the traditional one

Post-Operative Care after PLIF

Most patients are usually able to go home 3-5 days after surgery. Before patients go home, physical therapists and occupational therapists work with patients and instruct them on proper techniques of getting in and out of bed and walking independently. Patients are instructed to avoid bending at the waist, lifting (more than five pounds), and twisting in the early postoperative period (first 2-4 weeks) to avoid a strain injury. Patients can gradually begin to bend, twist, and lift after 4-6 weeks as the pain subsides and the back muscles get stronger.

Recovery from PLIF

Rehabilitation after PLIF can be a slow process. Many surgeons prescribe outpatient physical therapy beginning a minimum of six weeks after surgery. This delay is needed to make sure the graft has time to begin to fuse. You will probably need to attend therapy sessions for two to three months. You should expect full recovery to take up to eight months.

Cervical Disc Replacement Surgery in India | Best Spine Surgery Hospital India

Cervical Disc Replacement Surgery in India

This promising new procedure is a boon for all those suffering from severe and intractable neck pain. It has revolutionized the approach used for treating patients with severe longstanding cervical spondylitis, whiplash injuries, cervical disc prolapse, offering them a better quality of life. Also known as artificial disc replacement, this technique is fast becoming popular amidst surgeons and patients alike because of its excellent results. It is considered superior to cervical spine fusion surgeries as it maintains normal neck motion post operatively and ensures early return of patient to normal activities. In this procedure a stainless steel disc with a ball in trough design is inserted between the affected cervical vertebrae. This helps to simulate natural neck movements. The patient stays in the hospital for 1-2 days and resumes work in 45 days.

Working Anatomy of Cervical Spine

The cervical spine consists of 7 cervical vertebrae named C1, C2, C3, C4, C5, C6, C7 with shock absorbing intervertebral disc in between them. These discs allow for the smooth rotating and bending movements of the cervical spine. With age these discs lose their water content and get compressed between the vertebrae which may lead to herniation of disc contents. Along with this there is wear and tear of the vertebrae causing formation bony outgrowths known as (osteophytes). The prolapsed disc can compress the spinal cord within the spinal canal (myelopathy) or the exiting nerve roots at the intervertebral foramina (lateral openings between each vertebral pair) causing radiculopathy (radiating pain in the arm).

Objective of the Procedure

The cervical segments C4- C5, C5-C6, C6-C7 are more vulnerable to disc prolapse and spondylitis due greater mobility at these joints. Disc prolapse results in reduction of intervertebral distance which causes pressure on the exiting nerve roots at intervertebral foramina. Disc replacement surgery aims at reducing the symptoms of degenerative joint disease. Replacing the damaged disc with an artificial implant or prosthesis, restores the normal distance between the two vertebrae and relieves the pressure on the nerve roots.

Why is Cervical Disc Replacement Surgery required?

A large number of people nowadays face neck, shoulder and/ or pain in the arms mainly because of the abnormalities in the neck. These complaints can be signs of disc herniations or disc degeneration, and/or arthritis of the neck.

The cervical spine is composed of vertebral bodies and intervertebral discs. These discs wear out with time causing pain and other symptoms and are referred to as degenerative disc disease, a subgroup of which includes cervical disc herniations. This means the disc becomes compressed, frayed, and/or herniates into the adjacent spinal canal where it can press on nerves or the spinal cord.

Most patients with these types of symptoms do not need surgery and improve with conservative like anti-inflammatory medications, physical therapy, or cold/heat therapy. However, if a person continues to have significant neck pain and/or radicular arm pain, he or she may be a candidate for cervical spine surgery. An anterior discectomy and fusion is the most common operation for treating patients with symptoms related to a degenerative or herniated disc in the neck.

Cervical Disc Replacement Surgery- The Procedure

The procedure for cervical disc replacement surgery consists of removing the problem disc entirely and replacing it with a piece of bone taken either from the patient's hip and a metal plate with screws and/or a cervical collar may also be used to help hold the bone in place and to allow this segment of the neck to fuse together. The purpose of an anterior cervical discectomy and fusion surgery is twofold:

• To remove the offending agent—either the herniated disc or the osteophytes that are compressing the nerves and/or spinal cord.
• To eliminate motion by inducing a fusion at the disc space where the disc has been removed, aided by the use of bone grafts and possibly plates/screws, etc. and thereby creating stability and/or eliminating pain associated with the motion.

This type of surgery typically improves the pain in over 90% of people with one-level disease. However, there may be complications in using bone grafts in pursuit of a fusion. Harvest of one's own bone may be associated with both acute and potentially long-term pain from the donor site. Any type of bone graft may fail to heal, resulting in a so-called 'non-union', which may require another fusion operation.

Also, by fusing a segment of the spine, the levels of the spine above and below the fused area are now forced to absorb more load since there is no longer any intervening motion shock absorption. These adjacent levels will then wear out and become symptomatic in more than 25% of these patients within ten years, meaning possibly more surgery. This is called adjacent-segment degeneration.

The development of artificial cervical discs is intended to accomplish the same objectives as the traditional decompression and fusion surgery in terms of providing pain relief and stability, but with fewer drawbacks. For example, the cervical artificial disc does not include the potential complications involved with using bone graft (e.g. 'non-unions') and theoretically should lessen the risk of developing adjacent-segment disc degeneration or disease.

Post operative Recovery and Rehabilitation Period

The patient stays in the hospital for 1-2 days and resumes work in 45 days post operatively. Avoid bending neck backwards. A brace or soft collar may be recommended after the operation to support the neck muscles. Physical therapy may be prescribed 1-2 weeks after surgery which has to be done on outpatient basis. The therapy will initially start with pain relieving modalities such as ice, electrical stimulation to reduce pain followed by gentle active exercises. Gradually gentle stretching, strengthening and endurance exercises to the neck muscles are introduced. The therapist gives instructions on how to maintain the neck postures during various tasks of daily living. This is followed by a home exercise program.

Treatment Options for Scoliosis - Children Scoliosis Surgery in India

Scoliosis is a condition in which the spine—in addition to the normal front to back curvature—has an abnormal side-to-side “S-” or “C”-shaped curvature. The spine is also rotated or twisted, pulling the ribs along with it to form a multidimensional curve.
Three to five children out of every 1,000 develop spinal curves that are considered large enough to require treatment. Idiopathic scoliosis does tend to run in families, although no one genetic link has been confirmed.

Scoliosis occurs, and is treated, as three main types:

• idiopathic scoliosis: the most common form, with no definite cause, mainly affecting adolescent girls, but existing in three age groups:

• adolescent idiopathic scoliosis

• juvenile idiopathic scoliosis

• infantile (early-onset) idiopathic scoliosis

• neuromuscular scoliosis: associated with a neuromuscular condition such as cerebral palsy, myopathy or spina bifida
• congenital scoliosis: present at birth, caused by a failure of the vertebrae to form normally—the least common form

In general, curves measuring 25 to 50 degrees are considered large enough to require treatment. Curves greater than 50 degrees will likely need surgery to restore normal posture.

What will make the spine go back to being straight again?

A scoliosis curve will not get straight on its own. Bracing will help it from getting worse. Surgery — a spinal fusion — is the only thing that will straighten out the spine, but it will not make it completely straight.

What happens if my child has just a slight curve?
Children who have mild curves (less than 20 degrees) or who are already full grown, will be monitored to make sure the curve is not getting worse. Your doctor will check your child's spine every 6 months and schedule follow-up x-rays about once a year.

Will having so many x-rays cause future health problems?
X-rays are necessary to follow the progression of the curve. There can be small negative effects with frequent x-rays, but these effects are minimized by using protective shields over certain body parts to protect the child from unnecessary exposure.

What happens if no treatment is done? Will the curve get worse?
Two factors can strongly predict whether a scoliosis curve will get worse: young age and a larger curve at the time of diagnosis. Children younger than 10 years with curves greater than about 35 degrees tend to get worse without treatment.

Once someone is done growing, it is very rare for a curve to progress rapidly. We know from studies that once someone is fully grown, scoliosis less than 30 degrees tends not to get worse, while those curves greater than 50 degrees can get worse over time, by about 1 to 1 1/2 degrees per year.

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Spinal Fusion Benefits - Spinal Fusion Surgery in India

Spinal Fusion Surgery

Lumbar spinal fusion is a type of back surgery in which a bone graft is inserted in the spine so that the bones in a painful segment of the spine fuse together. The fusion aims to stop the motion at a vertebral segment, which should decrease the pain caused by the joint. After the surgery it will take several months (usually 3 to 6, but sometimes up to 18 months) before the fusion is set-up. This surgery has been improved over the last 10 to 15 years, allowing for better success rates, and shorter hospital stays and recovery time.

Indications and contraindications for spinal fusion

The vast majority of people with low back pain will not need fusion surgery and will be able to manage the pain primarily with physical therapy and conditioning. A fusion surgery may, however, be recommended for patients with: 

Before beginning the main part of a spinal fusion procedure, your surgeon will need to gather material for a bone graft, which is used later on to join the targeted spinal bones together. Depending on individual circumstances and your surgeon’s preferences, this graft material can come from bone harvested from one of your own hips or ribs, from bone harvested from a special donor cadaver, or from artificial materials such as plastics or ceramics.

Once the graft material is ready, your surgeon will make an incision and create an opening that exposes the site of the fusion. Potential locations of this incision include your abdomen, your back and the side of your neck or torso. After exposing the site of procedure and removing the spinal disc that sits between your spinal bones, your surgeon can place the bone graft in one of several ways. First, he can place the graft material directly into the empty space left by the removed spinal disc. Alternatively, he can place the graft material inside a device called a spacer or cage, then insert this device into the gap between your spinal bones. Your surgeon can also lay the graft material over the rear surfaces of the targeted spinal bones.

All of these techniques will lead to fusion of your bones and incorporation of the graft material by triggering your body’s natural healing process. Frequently, bone grafts are held in position by metal rods or plates and screws during this healing period.

Fusion surgery success rates vary between 70% and 95%, and there are several factors that will impact the success rate of the surgery, including:

·                     Low back pain caused by degenerative disc disease that limits the patient's ability to function (after non-surgical treatments, such as physical therapy and medication, have failed)

·                     Isthmic, degenerative or postlaminectomy spondylolisthesis

·                     A weak or unstable spine (caused by infections or tumors), fractures, or deformity (such as scoliosis)

Spinal Fusion Uses

Problems in your spinal column that can lead to a need for spinal fusion include a form of bone slippage called spondylolisthesis, debilitating forms of abnormal spinal curvature or deformity, and mechanical spinal instability caused by problems such as accidents or injuries. Surgeries that can produce enough spinal instability to require fusion as a follow-up procedure include complete or partial removal of a damaged spinal disc (discectomy) removal of all or part of the section of spinal bone that forms the back of the spinal canal (laminectomy); and widening of the gaps in your spinal column that allow nerves to pass through from your spinal cord (foraminotomy).

Spinal Fusion Benefits

The rigidity and stability provided by spinal fusion can prevent dangerous degrees of spinal motion, ease pain and other symptoms associated with unwanted or excessive spinal motion, and help prevent damage in the soft tissues situated near your spine. In the vast majority of cases, these benefits are either permanent or remain for extremely extended periods of time.

Success rates for fusion

·                     Spine fusion for conditions that arise from gross instability (e.g. isthmic or degenerative spondylolisthesis) tends to be more successful than surgery done for pain alone (e.g. degenerative disc disease).

·                     Individuals with only one badly degenerated disc (especially L5-S1) but an otherwise a normal spine tend to fare better than those undergoing multilevel fusions. Fusion surgery is generally considered for one or possibly two levels, and multilevel fusions should be avoided except in cases of severe deformity.

·                     Individuals who have significant disc degeneration usually find more pain relief from a fusion than those with only minor degeneration on the MRI scan (e.g. still have a tall disc).

The most important success factor in fusion surgery is confirming that a patient's back pain is truly caused by degenerative disc disease, rather than some other condition. This is done by a combination of a careful review of the patient's history, a physical exam, and diagnostic tests (such as x-ray and MRI), and/or possibly a discogram.

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Back Pain Surgery - Slip DiscTreatment in India

Slip Disc Treatment 

The spine is made up of many bones called vertebrae. These are roughly circular and between each vertebra is a 'disc'. The discs are made of strong 'rubber-like' tissue which allows the spine to be fairly flexible. A disc has a stronger fibrous outer part, and a softer jelly-like middle part called the nucleus pulposus. 

The spinal cord, which contains the nerves that come from the brain, is protected by the spine. Nerves from the spinal cord come out from between the vertebrae to take and receive messages to various parts of the body. 

Strong ligaments attach to the vertebrae. These give extra support and strength to the spine. Various muscles also surround, and are attached to, various parts of the spine. (The muscles and ligaments are not shown in the diagram below for clarity.) 

At what age can a slipped disc occur? 
A slipped disc in the lower back is most often seen between the ages of 30 and 50. In the cervical vertebrae around the neck, slipped discs are most often seen between the ages of 40 and 60. 

Who Gets A Slipped Disc? 
Bouts of back pain are very common. However, less than 1 in 20 cases of acute (sudden onset) back pain are due to a prolapsed disc. (Most cases on back pain are classed as 'simple low back pain'. This is thought to be caused by a minor problem to a muscle, ligament, or other structure in the back. For example, a strained muscle. See separate leaflet called 'Low back Pain in Adults' for a general overview of the different types of back pain.)  The commonest age to develop a prolapsed disc is between 30 and 50 years. Twice as many men as women are affected. 

What Are The Symptoms Of A Slipped Disc? 

Back pain

The pain is often severe, and usually comes on suddenly. The pain is usually eased by lying down flat, and is often made worse if you move your back, cough, or sneeze. 

Nerve root pain (usually 'sciatica')

Nerve root pain is pain that occurs because a nerve coming from the spinal cord is pressed on ('trapped') by a prolapsed disc, or is irritated by the inflammation caused by the prolapsed disc. Although the problem is in the back, you feel pain along the course of the nerve in addition to back pain. Therefore, you may feel pain down a leg to the calf or foot. Nerve root pain can range from mild to severe, but it is often worse than the back pain. With a prolapsed disc, the sciatic nerve is the most commonly affected nerve. (The term 'sciatica' means nerve root pain of the sciatic nerve.) The sciatic nerve is a large nerve that is made up from several smaller nerves that come out from the spinal cord in the lower back. It travels deep inside the buttock and down the back of the leg. There is a sciatic nerve for each leg. 

Lumbar Spine Surgery in India

Lumbago, or what is more commonly known to people as lower back pain , is one of the most widespread and prevalent spinal problems. The reason for such persistent back pain is any kind of pathological problem in the lumbar region of the spine, which is made up of the last five vertebrae.

Lumbar spine problems are most often caused by herniated inter-vertebral discs, anomalous developments on the vertebral bodies (osteophytes), which apply pressure on the spinal nerves that leads to narrowing of the spinal column around the spinal cord. The most important procedures followed in a lumbar Spine Surgery are decompression and fusion.

Decompression : Lumbar Decompression spine surgery in India is performed to assuage pain caused by pinched nerves. The surgery is generally recommended in cases of spinal stenosis caused by thickened joints, loosened ligaments, bony growths, or disc herniation.

The various procedures used for Decompressing Lumbar spine are:•  Discectomy•  Laminotomy or Laminectomy•  Port Hole Decompression•  Foraminotomy or Foraminectomy•  Osteophyte removal•  Corpectomy

Fusion : Lumbar fusion surgeryin India has two individual approaches. The most common process used is the posterior approach, where the surgery is done from the back. The three main Posterior fusion techniques are:

•  Postero lateral gutter fusion surgery•  Posterior lumbar interbody fusion (PLIF) surgery•  Transforaminal lumbar interbody fusion (TLIF) surgery
The anterior approach involves placing the bone directly into the section between the vertebrae where the shock-absorption disc had been situated.

Candidates

Lumbarspine surgery in India is indicated for people who have pain that extends (radiates) from the back to the buttocks or back of thigh, pain that interferes with daily activities, weakness of legs or feet, numbness of legs, feet, or toes, loss of bowel of bladder control, had physiotherapeutic & medication input, but that hasn't helped.

Expected Results
Most patients can expect a dramatic and lasting improvement in their back and leg pain after the lumbar spinal surgery . Though the success rates are excellent in Lumbar surgery , it can be lower in patients who smoke, are overweight, have diabetes or other significant medical illnesses, have osteoporosis, or who have had radiation treatments that included the lower back. Good nutrition and slowly increasing activity (as recommended by your physician) in the recovery period can help achieve success.
RecoveryYou are likely to experience pain and discomfort after the surgery which will be controlled with pain killers prescribed by your surgeon. You would be advised to walk the same day or the next after the surgery to prevent any clot formation. You would also be advised to do breathing exercises after the lumbar surgery for better circulation of blood and decrease the risk of any lung problem. You would need to stay at the hospital for about 5-6 days after the surgery and can go back home with specific instructions to follow. Many people return to work in 3-4 weeks after the surgery. But you may or may not be allowed to do heavy work depending upon your specific condition.

Scoliosis Surgery in India

Scoliosis 

Surgery for adolescents with scoliosis is only recommended when their curves are greater than 40 to 45 degrees and continuing to progress, and for most patients with curves that are greater than 50 degrees.

Unlike back braces, which do not correct spinal curves already present, surgery can correct curvature by about 50%. Furthermore, surgery prevents further progression of the curve.

There are several approaches to scoliosis surgery, but all use modern instrumentation systems in which hooks and screws are applied to the spine to anchor long rods. The rods are then used to reduce and hold the spine while bone that is added fuses together with existing bone.

Once the bone fuses, the spine does not move and the curve cannot progress. The rods are used as a temporary splint to hold the spine in place while the bone fuses together, and after the spine is fused, the bone (not the rods) holds the spine in place. However, the rods are generally not removed since this is a large surgery and it is not necessary to remove them. Occasionally a rod can irritate the soft tissue around the spine, and if this happens the rod can be removed.

Two Approaches to Scoliosis Surgery

There are two general approaches to the scoliosis surgery - a posterior approach (from the back of the spine) and an anterior approach (from the front of the spine). Specific surgery is recommended based on the type and location of the curve.

1. Scoliosis Surgery from the Back (Posterior Surgical Approach)

This approach to scoliosis surgery is done through a long incision on the back of the spine (the incision goes the entire length of the thoracic spine).

·         After making the incision, the muscles are stripped off the spine to allow the surgeon access to the bony elements in the spine

·         The spine is then instrumented (screws are inserted) and the rods are used to reduce the amount of the curvature

·         Bone is then added (either the patient's own bone, taken from the patient's hip, or cadaver bone), inciting a reaction in which the bones in the spine begin fusing together

·         The bones continue to fuse after surgery is completed. The fusion process usually takes about 3 to 6 months, and can continue for up to 12 months

For patients who have a severe deformity and/or those who have a very rigid curvature, another procedure may be required prior to this surgery. A surgeon may recommend an anterior release of the disc space (removal of the disc from the front), which involves approaching the front of the spine either through an open incision or with a scope (thoracoscopic technique) and releasing the disc space.

After the discs at the appropriate levels of the spine have been removed, bone (either the patient's own bone and/or cadaver bone) is added to the disc space to allow it to fuse together.

Removing the discs allows for a better reduction of the spine and also results in a better fusion. These two factors are especially important if the patient is a young child (10 to 12 years old) and has a lot of skeletal growth left.

Without the anterior release procedure, the anterior column (the part of the spine facing the front of the body) can continue to grow, eventually twisting around the fused, non-growing posterior spinal column, forming a new scoliosis curve (called "crankshafting"). Fusing the spine anteriorly prevents this process.

2. Scoliosis Surgery from the Front (Anterior Surgical Approach)

For curves that are mainly at the thoracolumbar junction (T12-L1), the scoliosis surgery can be done entirely as an anterior approach.

·         This approach to scoliosis surgery requires an open incision and the removal of a rib (usually on the left side). Through this approach, the diaphragm can be released from the chest wall and spine, and excellent exposure can be obtained for the thoracic and lumbar spinal vertebral bodies.

·         The discs are removed to loosen up the spine.

·         Screws are placed in the vertebral bodies and rods are put in place to reduce the curvature.

·         Bone is added to the disc space (either the patient’s own bone, taken from the patient's hip, or cadaver bone), to allow the spine to begin to fuse together.

·         This fusion process usually takes about 3 to 6 months, and can continue for up to 12 months.

If this surgery is applicable because of the type of curvature, the anterior approach to scoliosis surgery has several advantages over the posterior approach.

·         Not as many lumbar vertebral bodies will need to be fused and some additional motion segments can be preserved

·         Saving motion segments is especially important for lower back curves (lumbar spine), because if the fusion goes below L3 there is a higher risk of later back pain and arthritis

·         Saving lumbar motion segments also helps prevent loading all the stress on just a few motion segments

·         This approach can sometimes allow for a better reduction of the curve and a more favorable cosmetic result.