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Center of Spine Surgery

Spine is one of the strongest parts of the human body. It balances the entire body weight and our workload. Spine suffers a lot of wear and tear continuously throughout life. Before the age of 30, we can jump/run and endure long hours of work and play. This is because the spine and muscles are strong. All we feel is a tired ache or cramp due to overactivity which is relieved with proper rest. After the age of 30, your spine starts getting weaker and stiffer thereby losing its performance endurance and strength. Hence, to support the spine better, our muscles need to gear up.

The Centre of Spine Surgery at Nanavati Super Specialty Hospital offers a wide range of services to diagnose and treat acute and chronic spinal disorders. From non-surgical treatments to surgical options, we develop patient-centric treatment plans intending to help our patients return to a normal and active lifestyle.

The centre is known for providing comprehensive care to each patient using a multidisciplinary approach, leading-edge technology, state-of-the-art infrastructure, and managing all kinds of spinal surgeries such as:- 

Type of Spinal Injury

1. Minimally Invasive Spine Surgery:

    Minimally = as little as possible
    Invasive  = intrusive; involving less Soft tissue damage

Minimally Invasive Surgery (MIS) is a surgical procedure which is performed using specialised instruments and advanced techniques that causes less disruption to the body's tissues as compared to traditional open surgical procedures. Some of the major advantages of minimally invasive procedures include:

  • Less wear and tear to muscles or soft tissues
  • Smaller incisions, therefore, less scaring
  • Reduced hospital stay post-surgery
  • Less recovery time
  • Faster return to normal activities
  • Reduced risk of infection at the site of incision
  • Less pain and discomfort 

Our team of surgeons at the centre performs MIS spinal procedures by making a few small incisions and using a specialised instrument which passes down to the spine through an incision, with the help of a retractor. This instrument has a high-quality camera attached to its tip, which when passed down to the spine, provides clearer images of the area to be operated. The surgeon may use any of the following tools (instrument) and techniques:

  • Microscopy: It involves the use of a surgical microscope that has a high-definition camera on its tip. A microscope is placed over the retractor and inserted into the body through an incision thus providing a highly magnified, brightly illuminated view of the surgical area.
  • Fluoroscopy: This technique involves the use of X-ray beams to produce real-time X-ray images, like a video X-ray. These images are projected onto a screen for the surgeon.
  • Navigation: This technique allows a surgeon real-time positioning of the instrument/ implants into the body without the need for repetitive C-arm/ X-ray shoots minimising radiation exposure. 

Minimally invasive surgical procedures include:

  • Image-Guided Surgery: It is a procedure that helps surgeons to obtain real-time feedback, using a special camera, during the operation regarding the position of surgical instruments and implants concerning the spine. 
  • Vertebroplasty: A procedure used to treat osteoporotic compression fractures. It is performed by inserting a small balloon inside the vertebrae and injecting cement into the space created by the balloon in order to fill the fractured bone and to provide immediate relief from pain.
  • Microdecompression / Laminectomy: removing the lamina, a bone that makes up part of the vertebra, in the lumbar spine (low back). This type of surgery involves the removal of a small bone from the spine and helps to relieve chronic pain developed due to nerve root compression in the back or lower limbs.
  • Lumbar Microdiscectomy: This type of spinal surgery is for patients suffering from herniated intervertebral discs. It involves removal of prolapsed (‘slipped’) discs in the lumbar spine, using a microscope and microsurgical tools, thereby relieving the pressure on the nerve. 
  • Percutaneous Pedicle Fixation: The placement of metal rods and screws in sturdy sections of vertebrae called the pedicles.
  • Transforaminal Interbody Lumbar Fusion (TLIF): It is a procedure in which the surgeon replaces a damaged disc (or discs) with a new bone.

2.    Conventional Spine Surgery

3.    Pain Management

Treatment for pain always begins with a conservative approach. A brief period of rest coupled with pain killers and physiotherapy is the first line of therapy. Epidural steroid injections (nerve blocks) are used to reduce severe nerve radiation pain. A plan to recondition the spine muscles with exercises, postural adjustments, and diet modification is mandatory.

Seven (7) common conditions that require surgery

1. Slipped Or Herniated Disc

It is a condition of nerve compression which arises when the disc in the lower back area of the spine starts degenerating (weakening). People within 25 to 40 years of age are more prone to a rapid model of nerve compression due to high activity levels. The chances of slipped disc increases in patients who are obese, have a sedentary lifestyle or an individual who occasionally indulges in unaccustomed strenuous activity at one end of the spectrum versus who challenges the mechanical endurance of the back with very strenuous activity.

Slipped disc, also termed as Prolapsed Intervertebral Disc (PID) represents acute or repetitive failure of the disc due to abnormal forces transferred to it when the supporting muscles are inefficient to carry the pressure. This protrusion in the disc causes a mechanical compression and the nucleus pulposus (disc gel) causes severe inflammation of nerve, resulting in enhanced pain.

Treatments: In order to treat a slipped disc, a patient is advised to take complete bed rest for over 3-6 weeks, thereby, reducing the force on injured disc and allowing it to heal. During the course of recovery, the pain is controlled with medications, steroids, injections and physiotherapy. Once the pain is reduced to tolerable limits, the doctor advises a patient to gradually get back to daily activities. A patient is also advised to perform some exercises on a regular basis.

However, in most complex cases of a herniated disc, doctors remove the fragment by performing a minimally invasive (key-hole) surgery. The major aim of this surgical treatment is to remove loose fragments and free the nerve, thereby relieving the pain and annulus (disc covering) starts healing naturally. A patient can resume daily tasks within a week of the surgery.

2. Stenosis Or Narrowing Of Nerves In The Elderly

Represents a slow progressive compression of neural elements. The spine is a part of the human body that starts degenerating with ageing. It is an ongoing process that accelerates after 30 years of age. 

The wear and tear in the spine results in loss of turgidity and compressibility of the disc. This reduces the effective space available for nerves in the neural foramen and central canal, resulting in narrowing of nerves and space, as long as possible.

The rate of narrowing of nerves and effective space varies from person to person. However, an individual can reduce the effect of stenosis with the help of regular exercises and lifestyle modification. 

If a condition of “slow progressive functional paralysis" arises, then surgical intervention is a must. Though a true paralysis is rare, the activities slow down to an extent wherein routine activities are painfully restricted.

3. Slippage Of Bone Or Spondylolisthesis 

Spondylolisthesis is a Greek word which is bifurcated as spondylos, meaning vertebrate, and oliothesis, meaning slipping. It means the abnormal slipping or dislocation between two vertebrae. It’s a pure mechanical failure where a link in the central pillar is unstable

What Are The Symptoms?

The symptoms of spondylolisthesis vary from person to person, some may experience no symptoms while others may experience chronic low back pain, leg pain, or neurogenic claudication from spinal stenosis. 

The pain may arise due to weakness of spine or abnormal movement at the level of the spondylolisthesis causing irritation or inflammation. This pain is typically relieved with proper rest and worsens with activities such as standing and walking. This posture-related pain or type of activity is referred to as mechanical pain. 

In other patients, symptoms may include leg pain (sciatica, radiculopathy) or even weakness and or numbness due to irritation of nerve roots that can be stretched or compressed by the slipped vertebrae. 

However, in adult patients, the slippage may be a result of other degenerative changes, such as arthritis or spondylosis of the spine, such as enlarging ligaments (hypertrophy), disc bulging, bone spurs and facet joint overgrowth. These changes affect the spinal canal by narrowing it, leading to neurogenic claudication and spinal stenosis.

Tests And Diagnosis

  • X-ray: X-rays provide an overall assessment of the bone anatomy as well as the curvature and alignment of the vertebral column. Flexion/extension or dynamic X-rays (that show the spine in motion) are obtained to learn if there is any instability or abnormal /excessive movement in the spine at the affected levels.
  • Magnetic Resonance Imaging (MRI): It is an advanced imaging technique that provides detailed images of soft tissues like nerve roots and spinal cord. MRIs are useful in locating stenosis and its complexity by identifying nerve root or spinal cord compression.
  • Computed Tomography (CT) scan: This scan uses X-rays and a computer to provide images that are more detailed than general X-rays.

Treatments

Non-operative treatment is usually recommended for patients as the first line of treatment to patients’ experiencing mechanical pain. The careful use of over the counter anti-inflammatory medications is suggested for the management of pain. However, for chronic pain spinal injections are also given to patients.

Along with medication, your doctor may also suggest undertaking physical therapy to work on posture, balance and spinal mechanics. This therapy is often combined with strengthening of back, abdominal muscles and flank to provide dynamic support to the lower lumbar spine.

Some weight loss, reconditioning, and lifestyle modifications and ergonomic efficiencies may also be useful.

For severe, progressive and intolerable pain in back/legs that does not improve with conservative treatments such as medication, physical therapy, and activity modulation, surgery is suggested. The objective of the surgery is to relieve the pressure that is on any of the nerve roots and to strengthen the attachment between the vertebrate.
Surgery is also suggested to patients with numbness and/or weakness. However, in adult patients with spondylolisthesis, this usually consists of decompression and spinal fusion.

4. Spinal Deformity

5. Osteoporosis
6. Infection 
7. Trauma Or Fractures 

Advances in technology

  • Magnification Of Nerves Using A Microscope Or Endoscope improves clarity and precision. This has allowed key-hole operations with great accuracy.
  • Computer-Guided Navigation offers high precision and provides accurate guidance for placing screws around the nerves. Complex spine deformity has an effective solution.
  • 3 D C-Arm is a modern technology that helps in providing the view of spine in a 3-dimensional plane during surgery. This has been a great help in performing complex surgeries that require extra vision.
  • Neuro-Monitoring: The safety of monitoring the nerves during the surgery cannot be overemphasised. This has come a long way in minimising (1-2%) the risk of nerve complications during surgery. 
  • Advances In Anaesthesia And Hospital Care is of paramount importance to help the most painful and disabled patient get holistic care and new lease of life 

FAQs

What is keyhole surgery?

Previously due to poor technical support and visualisation, surgeons used to take longer incisions to expose a small area. However, with magnification tools (loupes, microscopes and endoscopes) and specialised instruments, it is now possible to perform a discectomy through an incision less than one inch. This MIS or keyhole surgery helps in protecting the muscles and allow faster recovery.

How much bone is removed during the surgery?

During the surgery, a fenestration or small tunnel is made in the bone to gain access to the nerves and the disc. This does not result in weakening of the spine.

How much disc is removed during the surgery?

Only the herniated portion of the disc is removed. This decompresses the nerve and gives pain relief. The rest of the disc is kept intact. The hole in the disc heals naturally.

Can there be a recurrence?

The major aim of keyhole surgery is to control pain and it does not strengthen or weaken the spine. However, if a person performs an uncontrolled activity that affects the disc, then there are chances of recurrence. An individual must increase core muscle strength by exercise is the best protection against a recurrence.

Is this a safe procedure?

It is one of the safest and effective surgeries that allow a patient to immediately restore daily activity. The chances of nerve injury are minimised by the use of a microscope. The rate of complication is 1% or less.

What is Transforaminal Interbody Lumbar Fusion (TLIF)?

At times, there are chances that the disc (which is left behind) is incapable of taking normal loads and results in dynamic instability. In such cases, the segment is stabilised using an implant (screw-rod construct). This can be done by a minimally invasive approach.

Can a patient lead a normal life after a disc surgery?

The spine is like any other machine that needs maintenance for better functioning. Disc surgery is one of the safest surgeries that is used to maintain the functioning of the spine and does not refrain a person from pursuing a normal lifestyle. However, for optimal functioning of any machine, the load on it (in case of spine its body-weight) should reduce and it should be serviced core strengthening exercises, for spine) regularly.

Find Complete Relief from Nanavati Experts

If you think you are facing similar conditions, or have suffered from them in the past, please contact the Nanavati team to schedule an appointment at : +91 22 2626 7500

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