With the changing lifestyle people are facing various health problems and spine deformity has become a quite common in people. Spine plays a key role in our daily lives and acts as a messenger between our brain and other body organs. It sends and receives signals from brain resulting in normal functioning of our body. The structure of spine is a complex one with a web of nerves and arteries intervened together. Any deformity or any injury to spine needs immediate attention in order to avoid long term consequences. In case of Spine injury or deformity, doctors may suggest spine surgery which is conducted to restore and preserve spinal functions. The spine surgery is a unique sub-speciality of orthopaedic and neurosurgical surgery. The main focus is to relieve a patient from pain by stabilization of spine and decompression of spinal cord/nerves. The procedure includes both non-operative and complex operative treatment modalities.
BLK Centre of Orthopaedics, Joint Reconstruction & Spine Surgery specialises in offering world class services with a team of highly-skilled and experienced doctors to take care of your spine. The main focus is on 100% rehabilitation. A patient undergoing a slip-disc operation is discharged on the same day after the microsurgery while in case of Minimal Access Fusion Surgery; a patient is discharged from the hospital a day after the surgical procedure.
What is our spine made of?
Spine is the most important part of our body and controls almost all functions. It is made of a number of vertebral bones which are attached to each other with ligaments. These bones are further protected by a cushion like structure called ‘Disc’ between two vertebral bones.It acts as a shock absorber and provides mobility to the spinal column.The spinal column houses a very important structure within the spinal canal called spinal cord, which is a link between our brain and rest of the body and controls all the functions. There are lot of muscles around the spinal column that stabilizes our back, neck and also help in our movements.
What causes back / neck pain?
There is no particular reason for a back or neck pain. While some pains are entirely related to any ailment/disease in the body, there are chances of muscle spasm, slip disc or any injury to spine may cause neck or back pain. Also, any abdominal irregularity or inflammation may lead to pain in the back. Hence, a doctor will first ascertain the cause of pain with proper investigation.
What is disc prolapse?
Spine Disc related injuries or irregularities are the most common and painful disorder. Itacts like a cushion which protects the vertebral bones of spine. In case of disc rupture or Disc Prolapse, the soft inner material of a disc can come out and press the nerve leading to leg or arm pain either in the lower back or in the neck area. Though, surgery is not the only resort; at least 9 out of 10 patients suffering from disc prolapse get better with rest and medication. However, 1 out of 10 patients, who is unable to settle or has significant weakness in arm or leg because of disc prolapse may need surgery to remove the material pressing on the nerve.
What is discectomy/micro-discectomy?
Disc rupture is a common phenomenon and usually treatable through medicine and ample rest. However, in certain cases it may result in extreme pain. In that case, your doctor may go for Discectomy. It is asurgical procedure where a portion of the affected disc is removed along with a small amount of bone for treating disc prolapse. The procedure is done with a microscope which is inserted in the body by making a small incision. Because of the use of minimally invasive techniques, patient can be discharged from the hospital in less time and recover faster.
What is decompression?
Sometimes a patient may suffer from a decompressed nerve which may cause extreme pain and may unable a patient to do daily chores normally. In order to decompress a nerve, the affected bone is removed to release the nerve which is referred to as Decompression. The procedure is conducted through ‘Minimally Invasive Key Hole Approach’. Open surgery can also be followed in some critical cases.
What is vertebroplasty/kyphoplasty?
Vertebroplasty/Kyphoplastyis conducted in case of a fractured vertebral bone in the spine. The fracture may be caused by an accident, osteoporosis or sometimes by obesity also. This spontaneous fracture in the back bone is also referred to as ‘Vertebral Compression Fracture’ (VCF). The procedure involves insertion of bone cement into fractured vertebral bone resulting in pain relief. Most of these fractures can be managed by bracing, pain killer drugs and medicines for Osteoporosis. However, if pain does not subside, or the fracture is a critical one, then a doctor may go for a surgery which is done under local anaesthesia while the patient is awake. Patient can be relieved of pain and can walk soon after the procedure.
What do you plan to achieve from spine surgery?
A spine surgery is conducted to give relief from excruciation pain. The surgery leads to immediate relief from leg pain which is achieved by removing compression on the nerve i.e. disc, bone or scar tissue. In order to unstable segment of spine resulting in back pain may be relieved through Nerve Fusion. Sometimes persisting pressure on spinal cord may result in weakening of arms and legs, a spinal surgery will relieve stress from the muscles and will also improve mobility and quality of life and rehabilitating the patient.
How to prepare for spinal surgery?
Now that you have decided to undergo the knife to get relief in your back/neck pain, your stay at hospital will stretch to almost a week in the hospital after getting admitted one-day before the surgery. The surgery is usually conducted in the morning. A patient’s stay can stretch from 1 to 5 nights depending on the type of surgery. In case of micro-surgery like slip disc, a patient gets discharged in a day. In case of major decompression or fusion surgery you may have to stay longer.
What is the surgey procedure?
Surgery is usually conducted under general anaesthesia except vertebroplasty or kyphoplasty (injecting bone cement in osteoporotic spine fracture).
- Micro-discectomy for slip disc: an incision of may be 2 cm or above is given depending on patient’s weight
- Minimally Invasive Fusion (decompression and stabilization): There may be 4-6 small stab incisions and one 3-4 cm incision
- Open decompression and stabilization – incision length may be 8 cm or above
When you wake up following your operation you can expect (any or all) the following:
- You will be lying flat on your back with a dressing over the wound
- A drip for fluids may be attached to your arm until you start eating and drinking
- A wound drain may be attached to your back to minimize bruising and swelling
- Pain control may be administered via a drip in the arm or in the tablet form
- Occasionally, a catheter may be fitted to assist you in urination
What is the recovery process?
BLK offers the full rehabilitation process with its expert team of doctors for a faster healing process.
Physiotherapy plays a key role in rehabilitation. It is required to retain maximum movement in the body. Regular physiotherapy is always advised. At BLK, you will get expert’s assistance in giving you required and correct physiotherapy. Our physiotherapist will see you the day after operation and will consult you on the further physiotherapy sessions. You will be assessed and shown the best way to get in and out of bed and will be encouraged to attain mobility as soon as possible.
Spine is a very sensitive part and it needs proper care, post-surgery in order to retain proper functioning.After you get discharged it is extremely important to follow the general advice given to you for the period of time as suggested by your doctor. Here are few guidelines which your doctor might insist on. The doctor will also share a picture-chart to guide you.
- Transferring from lying to sitting / standing position: Extra care should be taken while sitting, lying or getting up. While there were attendants in hospital to help you; now that you are home, you must follow your doctor’s advice. Do not put pressure on your abdomen while moving from lying to sitting position. Roll onto your side while trying to maintain a natural position of the spine. Bring your uppermost arm across your body, placing your hand on the bed. Push through both arms to help sit up as your legs are lowered to the floor. Try to gently contract your abdominal muscles during the movement.
- Lying down: Spend short and regular periods of time lying on your bed in any position you find comfortable.Do not lie on the bed for longer period.
- Sitting: After the surgery the wound is fresh and needs time to heal and retain its normal functioning. Though, you have been discharged from the hospital but you would have to follow the instruction for at least two-weeks. Sitting can cause stress on the back. You should gradually build up the length of sitting time to approximately 30 minutes. On discharge from hospital, you may find perching on a high stool or chair more comfortable. You can use a lumber roll, or a small rolled up towel to support the curve of your lower back
- Wound dressing: The wound will be covered by skin staples and a dressing. This dressing will need to stay dry until the wound is healed. The dressing can usually be taken off after 10 days by when you will be required to come to the hospital for a follow-up visit.
At BLK, you will not have to worry about any complication. We stand by our commitment in offering you the best health services. The success rate of surgery is more than 90%. Prior to surgery, surgeons at BLK will counsel you about the potential risk and complications of your surgery. Possible complications of spinal surgery may include:
- Further disc prolapse: It is possible that more disc material can prolapse out in the future causing back or leg symptoms
- Nerve scarring: Scar tissue will form in the area following the operation as part of the normal healing process. If this is excessive, it can constrict the nerve and prevent it from moving normally. This can cause possible leg pain
- Back pain: Back pain sometimes occurs after surgery due to the cutting of muscle and removal of disc material. This is common in the first few weeks, however, it usually settles over time. Occasionally, back pain can become constant and severe
- Nerve damage: Nerve damage may occur especially if the disc prolapse is large or the spinal canal is narrow. If the nerve is accidentally cut during the surgery there will be permanent weakness of those muscles and altered sensation in the area of the leg the nerve supplies. Nerve or Dural tear can lead to CSF leak also
- Haematoma: There is occasional bleeding in the spinal canal or within the wound causing blood clot. This usually settles independently but it may be necessary to evacuate it surgically
- Infection: To minimize the risk of infection you are given antibiotics in operation theatre. Infection can occur in the operative wound but one can also get infection of the disc, which is rare but more serious
- Deep vein thrombosis (DVT blood clot in the leg): There is a small risk following surgery of developing DVT. This is minimized by early mobilization
Will I be able to do all physical activities as before?
- Mobility: You won’t start running straight after the surgery. It is a gradual process, the doctor will advise to increase the frequency and distance you walk. Take regular short walks around the house. As soon as you feel you are able to walk longer distances, go for a walk few times a day. Build the routine slowly.
- Return to work: Post operation, your return to work will depend on the nature of your job. Normally, you can return to work after 4-6 weeks. If you are in a less than active job, you can return to work after 4 weeks, and after 6 weeks if your job involves physical activities. After microsurgery for slip disc, many patients return to work much earlier if the job is sedentary. For more extensive spinal fusion surgery, return to work may be delayed a little more.
- Driving: Do not drive until after your first outpatient appointment as your doctor needs to review your back first. You can be seated as a passenger as long as the journey is short and you can sit comfortably for that period of time. Usually you can start driving after 4-6 weeks.
- Lifting, twisting and bending: During the first 6 weeks avoid lifting, twisting and bending as much as possible. If you are bending and lifting, make sure the object you are moving is as close to your body as possible. Bend both your knees and try to keep your back straight. Always ensure you tighten your abdominal and buttock muscles while bending and lifting.
- Sports and other activities: Participation in any activity or sport would require the advice of your consultant and therapist– on when you can resume them and how you can gradually build up your fitness.