Management of Spine requires a variety of non-invasive and invasive investigations. The baseline primary investigation remains the plain X-ray. The patient may require dynamic or loading views depending on the pathology. Further imaging investigations include CT scans and MRI scans. Scans may require an Injection called contrast to increase their sensitivity. Other investigations include routine blood investigations, DEXA scans for osteoporosis, Nerve conduction studies and electromyography for identifying primary nerve and muscle problems.
Invasive diagnostics like discography, facet blocks and epidural injections may be required in particular cases.
Total Spine reaches The Right Answers by following a systematic protocol of investigations thus reaching the diagnosis with the least expense but making sure that the diagnosis is achieved.
Spine surgery is the art of combining the right diagnosis with the right procedure to attain maximum results with minimum residual effects on the patient.
A majority of spine conditions can be treated with a variety of non-surgical means like rest, physiotherapy, Injections and medication. The patients who will benefit from surgery need to be properly investigated and the best judge of this would be your spine surgeon.
If your spine surgeon feels that you require surgery, he will suggest it to you. At this point, the patient has a right to know what exactly the condition is and how surgery will alleviate the problem. The patient is entitled to know what are the risks and complications of the proposed surgery and is also allowed to get a second opinion from another specialist if he/she wills it.
Some spine surgery may require implants made of metal to be inserted into the spine. These implants will be of the highest quality and do not regularly need to be removed. Another question is regarding minimal invasive spine surgery (MISS, keyhole surgery, endoscopic surgery). MISS is an evolving area in spine surgery. Though it is fast progressing, all conditions are not amenable to minimal invasive surgery. Whether your particular condition can be done minimally invasive, is another decision better decided by your spine surgeon.
To know more in detail about the various Spine related services, please click on the tabs below.
Disc related problems and degenerative disorders of the spine form among the most common complaints related to the spine. Degeneration of the spine is a continuous process and cannot be stopped. However prevention of such problems is achieved by a healthy lifestyle, proper exercise, avoidance of smoking and preventing obesity.
In case you suffer from a disc problem either in your neck (cervical) or lower back (lumbar) you will require a thorough evaluation and assessment by your surgeon to ascertain the level of the disc and whether you require further investigation in the form of an MRI scan. The severity of the pain and the amount of disability will decide whether you require rest at home, admission to the hospital or surgery.
Majority of disc problems can be treated without surgery and your doctor will only advise surgery if the pressure on your nerve roots is very severe.
Other problems due to wear and tear (degeneration) of the spine are cervical and lumbar canal stenosis where the spinal canal is obliterated due to formation of extra bone (osteophytes) which cause pressure on the spinal cord or roots. When symptomatic these may require surgical treatment.
Degeneration can also lead to instability of the spine with abnormal movement causing pain. This instability may be a slipping forward (spondylolisthesis) or bending ( scoliosis) of the spine. This kind of instability when associated with back pain and not settling with medication may require surgery for relief of pain. This surgery will require screws to be inserted into the spine.
Disc surgery in the lumbar spine can be minimal invasive where the microscope helps the surgeon minimize injury to the nerves. Both cervical discs and lumbar discs can be operated through a very small incision and this allows early rehabilitation
Cervical and Lumbar disc replacement are newer trends in spine surgery which are directed towards motion preservation. Previously spine surgery was based on the idea of fusing(making one bone) the painful segment. This was associated with some unwanted effects on the adjacent segment which would take the extra load.
The current era allows the surgeon to aim towards motion preservation which would then theoretically prevent early degeneration of the adjacent segments.
Spine fractures of the neck and the back have become increasingly common with the increasing number of vehicles in our country. Fractures where the spine is unstable with spinal cord injury require fixation to protect and preserve nerve function while also allowing better recovery of the nerves.
A stable spine allows the patient to be mobilized early and he /she can be made to sit and stand early. Some fractures can be treated without surgery and the best person to judge this would be your spine surgeon. Your spine surgeon will require X-rays, a CT scan and an MRI scan for most injuries. The goal of all treatment of spine fractures is to get the patient up and return to normal activity as soon as possible.
Fractures should only be treated without surgery if the same result can be obtained without complete bed rest.
Infections of the spine are very dangerous conditions and must be treated with utmost care and a clear protocol. Most spine infections when diagnosed by symptoms and a scan require a biopsy and culture to be sent from the spine to confirm the diagnosis prior to initiating treatment.
This biopsy must be taken from the spine using a CT scan guided technique or under fluoroscopy in the operation theatre. In case of destruction of the bone or a large abscess( collection of pus) the surgeon may decide to open the spine to stabilize it with screws or clear the abscess and send the biopsy at that sitting. Surgery in spine infection does not cure the infection. The patient must be started on antibiotics and it must be continued for an extended period of time.
The type and duration of antibiotic will depend on the patient’s immunity and the type of infection
Bending of the spine either forwards (kyphosis) or sideways (scoliosis) can be due to congenital defects, muscle imbalances (polio, cerebral palsy) , following infection, following trauma or without any apparent reason. These deformities are associated with not only cosmetic concerns but also interfere with lung function and may cause pressure on the spinal cord and spinal nerves. Surgery for spinal deformity is complex and requires careful planning and execution to achieve a favorable result. The very fact that the spine is twisted and bent in multiple planes makes screw insertion difficult. Computer navigation aids accurate screw placement.
Spinal deformity surgery needs excellent supportive care with a team of anaesthetists, intensivists and the spine surgeon. Another cause for concern is neglect of the deformity because of fear of surgery. It is wise to contact your spine surgeon regarding your problem and take his advice rather than listen to uninformed suggestions from well-meaning but ignorant relatives and friends. As the deformity gets worse the surgery is more complex and this can easily be avoided by early surgery. Some spine deformities, when detected early, can be corrected by bracing
MISS is an evolving specialty of spine that allows achieving the same surgical goals with minimal damage due to access. The term envelops a vast variety of procedures which use small incisions, minimal dissection and relatively less muscle damage. These include percutaneous pedicle screws, MIS discectomies, MIS interbody fusions and procedures like vertebroplasty and kyphoplasty.
The success of MISS is dependant on the right patient choice and special MIS retractors and instruments. Your spine surgeon will be able to inform you whether your condition can be done with minimal invasive instrumentation. All surgeries are not amenable to minimal invasive surgery and it is important that the goal of surgery be achieved without compromising the final outcome.
The microscope has been used for spine surgery for many decades now. Current surgical microscopes are very sophisticated and allow a high degree of magnification with very good illumination.
They tremendously improve the surgeon’s vision and accuracy. Many minimal invasive surgical procedures require magnification either with a microscope or an operating loupe.
Nowhere is accuracy as important as it is in the spine. Computer navigation is a process by which the spine anatomy can be ascertained by a process similar to the GPS system in your car. This tremendously aids accuracy in deformed spines and in abnormal spinal anatomy.
Screw placement is more accurate and so correction of deformity and reliability of screws are much higher. Computer navigation is not uniformly available all over the country. Kindly contact us for more details.