What does a spine specialist do?
Spine specialist is a surgeon, who is trained in treating spine related disorders. These surgeons are best in deciding requirement of medical and surgical intervention on the spine.
What is spine surgery?
Any procedure on spine which is aimed at relieving pain and preventing neurological problems are collectively known as spine surgery. These procedures are also aimed towards infections of spine and tumors of spine and spinal cord.
When do we require to undergo spine surgery?
- Any spine related pain, which does not get relieved with adequate lifestyle changes and conservative treatment
- Spine ailments associated with weakness and numbness of body parts
- Spine ailments wherein there is impending neurological deficits
- Difficulty in passing urine
- Difficulty in holding objects, imbalance while walking, progressive difficulty in walking, pain radiating to upper limb of lower limb
Can spine surgery be an emergency?
Yes, spine surgeries can be an emergency in condition of:
Sudden development of limb weakness
Sudden inability to pass urine
Sudden onset of erectile dysfunction
Fracture of spine
What are common degenerative disorders of spine?
- Spondylosis – this is an umbrella term, which is used to signify the age related degeneration of the spine. This can be cervical spondylosis or lumbar spondylosis.
- Slipped Disc – In this condition the disc in between two vertebra gets displaced and causes compression over one of the nerves. This is most of the time due to age related degeneration, but at time it has been seen in youngsters lifting very heavy weight without any adequate back support and trauma.
- Listhesis – In this condition, one of the vertebra slips forward or backward over adjacent vertebra. This also can be due to fracture or degeneration.
- Scoliosis – In this condition, the spine has abnormal bending to one side.
How complex a spine surgery can be?
In trained hands, the spine complexities are very safe to be dealt with. The spine surgery does not only involve surgery on bony part. It involves surgeries on nerves and spinal cord which are integral part of the spine as well. To make the surgery safe a spine surgeon always uses technology like operating microscope, high speed drills, intraoperative neuromonitoring and microinstruments.
What are the types of spine surgeries?
The spine surgeries are of varied types. Sometimes these are complete procedures in themselves; other times, these may be one of the steps in the bigger surgery. The procedures commonly performed are:
- Laminectomy – here spinal cord and nerves are released by remove part of bone and making space for these structures.
- Microdiscectomy – removal of herniated discs under microscope
- Fusion – this procedure is performed in case of spinal instability. Metallic screws, plates and rods are used in these type of surgeries.
- Disc replacement surgeries –here after removal of disc, artificial disc is replaced
- Other complex procedures like scoliosis surgeries, tumor surgeries, surgeries for TB and other infections, Spinal cord stimulation, Pump implantation
Can the spine surgeries be done in children?
Spine surgeries in children are a different kind of group. The usual spine surgeries required in children are:
- Surgery for split cord malformation
- Surgery for tethered cord syndrome
- Surgery for myelomeningocele
- Surgery for meningocele
- Surgery for chiari malformation
What has to be done before going for surgery?
The patient with spine related disease is evaluated by spine specialist and diagnosis is made. If required, a trial of conservative management is provided. In case there is failure of non-surgical treatment or impending neurological deficits, a surgery is planned. After discussing the benefits and risks of the proposed surgery, patient is admitted one day prior to the procedure. Anesthesia fitness is obtained. Night prior to the surgery, the patient will be fasting. After the surgery observation shall be performed in ICU for pain relief. The next day of surgery, the patient is shifted to wards after mobilization by physiotherapy team. Further antibiotics and pain killers will be administered. Usually postoperative day 4 the patient is discharged home.
What are the benefits of undergoing spine surgery?
Pain relief
Recovery from neurological deficits if any
Prevention of fresh neurological deficit
Improvement in Quality of Life
What are the risks of spine surgery?
Apart from the usual risks of any surgery in any part of the body like infection and bleeding, the specific risks are the following:
- Weakness of limbs
- Numbness of limbs
- Partial relief from pain
- Associated risks like heart related risks in elderly cardiac patients
What makes the spine surgery less risky?
- Correct Diagnosis
- Thorough preoperative evaluation
- Sugar control
- Advanced equipment like use of Operating Microscope, Intraoperative Neuromonitoring system, High speed Drills
What is Intraoperative Neuromonitoring System (IONM)?
IONM is a machine which gives indication of proximity to nerve when pedicle screws are placed in spine. This provides assurance to the surgeon regarding placement of screws in bone and prevents inadvertent injury to nerves. This makes the surgery very safe and effective.
How is the recovery after surgery?
Initial few days the pain induced by surgery will require drugs. Antibiotics shall be continued. The patient is encouraged to walk as much as possible. Usually there is no restriction on climbing stair case. Rehabilitation and physiotherapy should be continued. The patient may feel occasional crampy sensation and numbness in limbs for about 6 months, which usually subsides.
How often revisit to hospital is required?
After discharge, we encourage first follow up after one week so as to monitor skin healing and curtail the drug list according to requirement. Next visit is usually after one month and probably thereafter 3 months later. Usually fourth visit is not required.
What are the lifestyle changes required after spine surgery?
Avoid bending, weight lifting
Avoiding driving in initial period
Continuing of lumbar or cervical belt
Avoiding smoking
Continuing Core strengthening exercises
Healthy food
Weight reduction in case of obesity
Control of diabetes mellitus