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Spine Surgery

What is Spine Surgery?

Spine Surgery is categorically divided into Open Spine Surgery or Minimally Invasive Spine Surgery (MISS), also known as Endoscopic Spine Surgery (ESS), or Arthroscopic Spine surgery. It is a surgical procedure which is performed to relieve a person of pain due to spine injuries.
In the conventional approach of spine surgeries, the spine doctor makes a single long incision, spreads, or pulls a relatively large amount of muscle or tissues to fix the spine. Endoscopic spine surgery, on the other, is a state-of-the-art form of minimally invasive spine surgery which incurs less pain and provides quick relief to the patient. ESS, as the name suggests, is performed using a micro-sized incision with the help of an endoscope to visualize the surgical site.
The MISS is generally performed to stabilize spinal joints and vertebral bones caused due to herniated discs, bone spurs, instability of the spines, or spinal tumors.

When do you need spine surgery or back surgery?

If you are suffering from back pain, chances are, you can ease your pain without undergoing a surgical procedure. In many cases, back pain can be cured with conventional methods of pain management such as hot compressions, ice packing, spinal injections, physiotherapy, and non-steroidal anti-inflammatory drugs. But, if the back pain does not get resolved and continues to affect your daily routine, surgery might be a good option for you.
Spine surgery might be a good treatment option for you if conservative treatments show ineffective results and the pain does not subside. Spinal surgery not only relieves a patient of chronic back pain but also treats associated numbness that spreads to the shoulder or goes down to the legs.

Types of spine surgery

Endoscopic Spine Surgery

Vertebroplasty

Vertebroplasty

Kyphoplasty

Causes

  • Damage to the spinal cord or the nerves at the end of the spinal canal in any area.
  • A sudden blow or spine-related cut might result in a traumatic spinal cord injury.
  • A spinal cord injury frequently results in a lifelong loss of power, sensation, and function below the injury site.
  • Many spinal cord injury victims can live active, independent lives because to rehabilitation and assistive technology.
  • Symptom-reducing medications and spinal stabilisation surgery are used as treatments.

Symptoms

  • People may experience –
  • Muscular: a lack of strength in the muscles, issues with coordination, stiffness in the muscles, muscular spasms, or excessive reflexes
  • body as a whole: dizziness or perspiration
  • Sensory: diminished tactile sensitivity or pins and needles
  • urinary: urinary retention or urine leakage
  • Other frequent shortness of breath, leaky faeces, or an unusual and uncomfortable sensation

Diagnosis

SELF DIAGNOSIS

If the responses of the patient are not enough for the orthopedic doctors to determine the best treatment, or if the person shows signs of neurological injury, the doctor might run the following diagnostic tests:
MRI – MRI test uses strong radio waves to produce computer-generated images of the injured area. MRI test is useful in identifying blood clots in the spinal cord, herniated discs, and abnormal masses that compress the spinal cord causing pain.
X-ray – X-rays can help study the structural anatomy of the hard tissues of the spine to diagnose spine dislocation, kyphosis, scoliosis, bone spurs, disc space narrowing, vertebral body fracture, spinal collapse, or erosion.
CT Scan – A CT Scan provides a clear image of the injury in both soft and hard spinal tissues. The diagnostic test can also detect abnormalities of the vertebrae, spinal cord, and spinal nerves.

Diagnosis by the Doctor

Spinal abnormalities usually involve abnormal interactions between the soft and hard tissue components of the spine. A spine doctor may be able to rule out a spine injury by physical examination, by asking some questions about the accident that has caused the injury, or by testing for your sensory function and movement.
In addition to these tests, the doctor may ask you a few questions to understand the condition better,such as:
If you have any pain in your back or neck?
Have you suffered any injury on your back or had to undergo any surgery on your neck or back?
Do you feel weakness and loss of balance in your legs?
If the above procedures don’t suffice in giving out a clear indication of the condition, the spine doctor will conduct a more comprehensive and detailed exam to diagnose the level of injury and determine the best treatment.

Risk and complications

Syringomyelia

About 3 percent of people suffering a spine injury may develop syringomyelia – a condition in which syrinx or fluid-filled cysts form within the spinal cord. Syringomyelia may sometimes cause pain and discomfort, and at other times, cause no symptoms at all.

Spasticity

Long-term muscle contraction due to injury to the spine may cause stiffness and rigidity in the muscles. Spasticity can make movement, including walking and running, difficult for a person. About 70-78 percent of people with spine cord injury suffer from spasticity.

Neuropathic joint arthropathy

Neuropathic joint arthropathy is a common complication of spinal cord injury. Neuropathic joint arthropathy is a slow destruction of the joint. The condition may develop even 10-15 years after the spine injury. Conservative monitoring, medications, and spinal fusion surgery can treat the condition of Neuropathic joint arthropathy.

Autonomic Dysreflexia

Autonomic Dysreflexia is a serious systematic complication of spine injury that hampers proper communications between the brain and the body. Autonomic Dysreflexia causes unregulated breathing, heart rate, and blood pressure.

Spinal shock

The temporary loss of neurological activities including the sensory and motor reflux below the spinal cord lesion is known as a spinal shock The complication can occur immediately after an acute spinal injury. While the reflexes above the spinal cord remain unaffected in the condition, the reflexes below the level either become absent (the condition is known as areflexia) or depressed (the condition is known as Hyporefexia). The extent of reflex disruption can vary from one patient to another.

Neurogenic shock

Neurogenic shock can result due to severe damage to the central nervous system. The condition is also known as Vasogenic Shock. Consequences of neurogenic shock include loss of autonomic control and loss of stimulation to the blood vessels.

Risks during surgery

Like any other surgery, there are certain risks associated with endoscopic spine surgery or MISS, such as:
infections at the surgical site
allergic reactions
blood clotting
pain and discomfort
paralysis
reaction to anesthesia
stroke
To cut down these risks, it is important that you consult a trained and experienced spine doctor. Before the surgery, discuss all the questions and concerns, weigh the benefits and the risks and then undergo the surgery.

Different Treatments

Spinal Decompression

It is generally performed for spinal stenosis patients. The surgeon removes bony spurs or walls compressing the spinal column to relieve the nerve pressure.

Vertebroplasty/Kyphoplasty

Vertebroplasty and kyphoplasty are performed to fix compression fractures due to osteoporosis. The surgeon injects a glue-like bone cement that hardens and strengthens the vertebrae.

Discectomy (or Microdiscectomy)

It is a slipped disc surgery that is performed to remove a herniated disc compressing the nerve root and spinal cord. It is often performed in conjunction with laminectomy.

Foraminotomy

This is performed to widen the spinal column where the nerve root exits the spinal canal in case it has narrowed due to aging.

Nucleoplasty

Nucleoplasty, also called plasma disk decompression is a minimally invasive laser surgery in which the surgeon uses a plasma laser device to reduce the disk size and treat mild disk hernia.

Spinal Fusion

The surgeon removes the spinal disc and fuses the adjacent vertebrae together using bone grafts or metal implants to allow the fusion of vertebrae together via the bone grafts, for example, ACDF surgery (Anterior cervical discectomy and fusion), TLIF surgery (Transforaminal Lumbar Interbody Fusion).

Artificial disk replacement

For people with severely damaged vertebral discs, the surgeon removes the disc and replaces it with a synthetic implant to help restore vertebral height and movement.

Factor Affecting Spine Surgery Cost

The above-mentioned costs for different minimally invasive spine surgeries are like to change based on the following factors:
The consultation fee of the spine surgery specialist
The age of the patient
Admission fee at the hospital
Type of surgery performed
The medical condition of the patient
Post-surgical complications involved, if any
The hospital and the category of the room the patient opts for
Any other lab tests and examination tests such as ECG, X-rays, etc.

Preparation of Spine surgery

Preparation before a spine surgery includes both physical and psychological aspects. Depending upon the condition of the injury, the doctor is likely to guide the patients with everything necessary. However, here are a few points that may come in handy for anyone planning spine surgery.
Gather all necessary information about spine surgery – The key to preparation for any surgery is being well informed about it. Talk to the doctor, the medical staff, and acquire all important information about the procedure, medicines, the cost, and anything else that comes to your mind. The more well-informed a person is about the surgery, the better he/ she is likely to do postoperatively.
Don’t stop moving – We understand it is tough to live with constant back pain. Even then, it is recommended to be physically active as much as possible. Going stagnant may add to complications during the surgery. Stay physically active, try to achieve a healthy weight. This can speed up the recovery process and enhance blood circulation too.
Don’t take any anti-inflammatory drugs – You should stop taking drugs like ibuprofen, naproxen, and aspirin before the surgery. Blood thinners can increase the risk of complications during the surgery. If you are taking any over-the-counter pills, it is essential that you inform your doctor.
Keep realistic expectations – Don’t expect the surgery to fix everything. The surgery is not a guaranteed cure for the condition. Although it improves the injury symptoms to a great extent, a lot also depends on the person’s dietary and lifestyle habits too.

Cost of Spine Surgery

"Spinal laminectomy/ spinal decompression – The cost of spinal laminectomy or spinal decompression may range from INR 1.4 lakh to INR 1.8 lakh in India.
Vertebroplasty/Kyphoplasty – The cost of Vertebroplasty or Kyphoplasty may range from INR 2.3 lakh to INR 3 lakh in India.
Discectomy (or Microdiscectomy) – The average cost of Discectomy may range anywhere between INR 1.4 lakh to INR 1.8 lakh in India.
Foraminotomy – The cost of Foraminotomy may range between INR 1.8 lakh to INR 2.5 lakh in India.
Spinal Fusion – The cost of Spinal Fusion in India can be anywhere between 2.5 lakh to INR 5 lakh.
Artificial Disk Replacement – Artificial disk replacement surgery in India costs between INR 2 lakh to INR 4 lakh in India.
Lumbar Interbody Fusion – The cost of Lumbar Interbody Fusion ranges from INR 2.5 lakh to INR 4 lakh in India."

Insurance Coverage

Most insurance companies cover the cost of all spine surgeries. But the exact amount of coverage depends on your health insurance policy. To know the details, it is best that you talk to your insurance provider to discuss the insurance coverage of our surgery.

Recovery Rate

Once you are home from the surgical center, you must focus on your recovery. Allowing the spine to heal properly, taking adequate rest, and eating healthy foods are the keys. However the best advice is to follow the post-care tips provided by the spine surgeon for a speedy and safe recovery.
Take good care of the spine. Start with short walks and gradually increase the distance and time. Moderate exercise helps with muscle toning and builds strength. Avoid twisting, lifting, and bending. In case of a spinal fusion, avoid lifting weights.
Eat a well-balanced diet rich in fruits and vegetables. Since you will be less active physically, do not load the body with high calories and fatty foods. Eating healthy is crucial for smooth recovery.
Follow the doctor's advice for bathing and incision care. Typically, doctors recommend to keep the surgery site clean and dry for 3-4 days. Avoid getting into the bathtub or the swimming pool until the doctor deems it fit.
Take medicines to manage pain after the surgery as directed by the doctor and make sure there are no gaps. Do not take any medicine without informing your doctor.
Ask your surgeon about the best position to sleep in without hurting the back and try to follow it. Ideally, the following tips help relieve the stress from the back and the adjacent body parts.
– Place a pillow under the knees or the back to keep the hips slightly bent.
– Don’t get up from the bed suddenly. Use the ‘log roll method.’
– While getting up, push your arms and legs rather than exert pressure on the waist or back.
Wear a post-operative brace if prescribed by the surgeon. The brace provides support to the neck and back and limits movements of the spinal levels.
Consult with your doctor about physical therapy after the surgical treatment. Physiotherapy helps gain and build bone and muscle strength, and increase physical endurance. Ask your doctor if you need to include any form of exercise in the recovery regime.
The post-operative routine you adopt as part of your recovery from spine surgery can help prevent future or additional spine/health-related problems. So, it is important to maintain an active life, practice exercising, eat well, and get lots of rest to stay on that recovery road for a long time.
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