- 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.
- At BLK Centre of Orthopaedics, Joint Reconstruction & Spine Surgery, we offer world class services with a team of highly-skilled and experienced doctors to take care of your worries.
- 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.
- Spine is the most important part of human anatomy as it sends and receives signal from the brain and plays a key role in controlling movement and organ functions. Any deformity or disorder can result in problems in daily routine of a person and may also lead to a person totally getting bed-ridden. In cases like these, doctors may suggest spine surgery which is conducted to restore and preserve spinal functions.
Composition of the Spine
- 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.
Causes of back / neck pain
Spine is a complex bone structure and any blow/trauma can result in back/neck 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.
- Disc related injuries or irregularities are the most common and painful disorder. Disc is the cushion which protects the vertebral bones of spine.
- In case of disc rupture, 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.
Discectomy and Micro-discectomy
A Discectomyis performed when the Disc ruptures resulting in extreme pain then. 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 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.
In case of compressed nerve in the spine, the procedure of Decompression is conducted on the patient. In order to decompress a nerve, the affected bone is removed to release the nerve.
The procedure id conducted through ‘Minimally Invasive Key Hole Approach’. Open surgery can also be followed in some critical cases.
- The procedure wherein the bone cement is inserted into fractures vertebral bone resulting in pain relief is known as Vertebroplasty/Kyphoplasty.
- The fracture in vertebral bone can occur due to an accident or in case of Osteoporosis; this spontaneous fracture in the back bone is also referred to as ‘Vertebral Compression Fracture’ (VCF). It can be a very painful condition for a patient.
- 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 to expect from spine surgery
- Relief from leg pain which is achieved by removing compression on the nerve i.e. disc, bone or scar tissue.
- Nerve fusion to get relief from back pain and stabilize the unstable segment of spine.
- To ease any persisting pressure on spinal cord or nerves if it causing weakness in arms or legs.
- Improve mobility and quality of life and rehabilitating the patient.
Preparation for spinal surgery
You need to spend 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.
- 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.
BLK offers the full rehabilitation process with its expert team of doctors for a faster healing process.
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.
After you get discharged it is extremely important to follow the general advice given to you.
Spine is a very sensitive part and it needs proper care, post-surgery in order to retain proper functioning. 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: You are not supposed to 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: Do not lie on the bed for longer period. Spend short and regular periods of time lying on your bed in any position you find comfortable.
Sitting: 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: Your 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.
Success rate of surgery is more than 90%. Prior to surgery, your consultant will discuss potential risk and complications of your surgery.
Possible complications of spinal surgery:
- 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
What are the various activity levels, post surgery?
- Mobility: Gradually 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.
- 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.
- 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.
- 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.