SPINE SURGERY

Our spine is one of the most important parts of our body; that is why keeping our spine healthy is vital if we wont to live on active life. Pinnacle Orthocentre is committed to counter the various issues that people face because of spinal problems. We comprise of world class specialists that ore dedicated to ensure that the best of treatments ore delivered with uncompromising expertise. This along with the state of the art facilities provides every patient with the assurance they hope for. The centre caters to the patient's individual need for both surgical and non surgical treatment of spine and bock related problems.

Spine is made up of multiple small rings like bones (vertebra) stacked one on top of each other. There are seven cervical (C1 to C7), twelve thoracic/ dorsal (T1 to T12) and five Lumbar (L1 to L5) vertebrae. Sacral vertebrae (S1 to S4) are usually united and form a single bone below lumbar vertebrae. Two vertebrae are joined together by Intervertebral Discin the front and two facet joints in the back. Spinal cord runs from brain down to the tailbone between these vertebrae. A branch of spinal cord (spinal nerve) comes out at each vertebral level on right and left side, which supplies respective area of skin, muscles and other body organs.

Pain in neck / back is due to degeneration (chronic wear and tear) of the disc, arthritis of facet joints, pressure on nerve structures, muscle spasm and problem in the bone itself (fracture, infection, tumor). Outward projection of the disc, arthritic facet joints, overgrown ligaments and in some cases bone itself can compress nerve structures and can cause tingling-numbness, loss of sensation and weakness in arm / legs.

Slip disc or prolapsed intervertebral disc can cause pressure on spinal nerves and causes tingling-numbness, loss of sensation and weakness in arms (in case of neck) or legs (in case of lower back).

Treatment : Micro-endoscopic removal of the prolapsed part of the disc. In cases with associated back-pain, minimally invasive instrumentation might be required. In selected cases, LASER disc decompression or Endoscopic disc removal can also be done.

Progressive narrowing of spinal canal area from prolapsed disc, arthritis facet joints and overgrown ligaments causes nerve pressure. Along with typical symptoms of nerve pressure (tingling / loss of sensation / weakness), patient also have difficulty in walking long distances and have to rest after every short interval.

Treatment : Decompression of spinal canal is required. This can be done using micro-endoscopic techniques in majority of cases, however, in certain cases with more severe and multi-level pathology, traditional decompression techniques might be required for best results.

Spondylosis means arthritis at spinal joints (disc and facets). Typical symptoms are neck pain (in case of cervical spine) and back pain (in case of lumbar spine). This may be associated with spinal canal stenosis with nerve pressure related symptoms.

Treatment : These cases usually require instrumentation and fusion surgery. A decompression procedure is done simultaneously if spinal stenosis / disc prolapse is also present. Majority of instrumentation surgeries can be done with microscopic / key hole techniques.

Spondylolisthesis is very common spinal problem where one bone slips forward on the bone below. Sometimes there is associated fracture in the posterior part of the vertebral ring (pars-interarticularis fracture / pars defect). Symptoms are severe back pain and nerve pressure

Treatment : An instrumented fusion surgery is recommended. In cases of pars fracture, early surgery is recommended to prevent further progression of the slip which might need a more extensive surgery in the future.

In old age, especially in females (where bones are very fragile), vertebrae may collapse from trauma. Sometimes trivial fall or normal day-to-day activitiesare sufficient to cause these fracture. Osteoporotic fractures are difficult to heal on their own at this age and can cause persistent pain, progressive collapse leading to increasing pain, forward bent posture and pressure on spinal cord.

Treatment : A period of bed rest with gradual mobilization using brace support usually is enough in majority of cases to let the fracture heal. In cases with persistent / increasing pain, vertebroplasty / kyphoplasty might be required. In cases with progressive collapse and spinal cord compression, formal decompression and instrumentation surgery is required.

Medical treatment for improvement in bone density also is given along with.

In cases of TB spine, disc and surrounding bones gets damages by infection. This causes significant pain in spinal area and spinal cord can get compressed from the pus, extruded bone pieces and abnormal spinal curvature leading to paralysis in the part of the body below the affected level.

Treatment : A thorough decompression and instrumentation with spinal reconstruction surgery is usually required. Recovery in cases of paralysis is usually slow, but eventually majority of patients get excellent functional status. Simultaneous treatment of TB with anti-tubercular drug is must to eradicate the infection.

Spinal tumors can be in the spinal cord or in the spinal bone (Vertebra). Spinal cord tumors cause significant pressure on nerve tissue. Vertebral tumors are usually metastatic in nature where primary tumor is in some other part of the body, which reached vertebra by blood. Vertebral tumors can cause back-pain, destruction of vertebra leading to collapse of the spine and pressure on the spinal cord from the tumor and the collapsed bone itself.

Treatment : Spinal cord tumors usually require surgical removal for nerve recovery and to prevent progression of nerve damage. Tumors in spinal bone requires a CT guided biopsy and surgical decompression and instrumentation if there is significant destruction of the bone and spinal cord compression. Chemotherapy and Radiotherapy may be required based on the type of tumor.

Spinal segments need to be in a particular alignment for proper body posture and balance. When this balance is lost, spinal deformity develops. A side way curvature of spine is called Scoliosis. Patient develops rib hump, chest deformity and body tilts to one side. An abnormal forward bending is called Kyphosis. In very severe cases, spinal cord might get compressed.

Treatment : If the deformity is severe and progressively increasing, spinal instrumentation and fusion is required to correct and to prevent further progression of the deformity.

MEET THE EXPERTS

Dr. Amit Sharma
MS Orthopaedics
Consultant
Spine Surgery
  • MBBS
  • MS Orthopaedics: Seth GS Medical College, Mumbai
  • Fellow Adult and Pediatric Spine: HSS, NY, USA
  • Consultant since 5 years
  • Special interests: Minimally Invasive Spine Surgery, Spine Deformity Correction (Kyphosis, Scoliosis)