SPINE
Scoliosis Treatment, Causes, Symptoms & Surgery in India
Scoliosis is a condition in which the spine is curved sideways. Usually, the spine is partially curved when looking from the side but it must appear straight when looked from the front. This article will delve into the signs & symptoms, and the treatment for scoliosis.
Possible Causes
Even though the exact cause of scoliosis cannot be determined, the most common causes are identified by the doctors and are listed below,
Cerebral palsy – It is a group of nervous system disorders that affect the movement, learning, hearing, vision, and thinking.
Muscular dystrophy – It is a group of genetic disorders that causes muscle weakness.
Birth defects affecting the spinal cord in the infants such as in spina bifida in which there is the incomplete formation of the spinal cord.
Other spinal injuries or infections.
Genetic lineage in the family.
It has been observed that females are more likely to develop scoliosis than males.
Signs and symptoms
Scoliosis is usually manifested in the form of the following symptoms,
Tilted shoulders
One shoulder blade may be higher than the other
Uneven buttocks
Uneven waistline
Prominent ribs on one side
The prominence of one shoulder more than the other
Rotation of spine
Reduced chest area for expansion of lungs causing difficulty breathing
Back pain
If the curvature is small, it goes unnoticed unless the child reaches a growth spurt during puberty.
How is it diagnosed?
The most common forms of investigations used for diagnosing scoliosis is the physical exam and the radiological examination.
The physical examination
This includes meticulous analysis of the back while one stands with arms at the sides. The spine curvature is well examined along with the position of the shoulders and waist. One is asked to bend forward, looking for any curvature in the upper or lower back.
There is a standard screening test called “Adam’s forward bend test”. The child is asked to bend forward with feet joined together, keeping the knees straight and arms hanging free. The doctor observes the back to look for any difference in the shape of the ribs on each side. A spinal deformity is noticed the most in this position.
Secondly, the child will need to stand in the upright position and the doctor will check if the hips and the shoulders are at the same level and if the position of the head is centered over the hips.
Lastly, any limb-length discrepancy is also looked for, along with some neurological findings or other physical problems.
Radio-imaging investigations
These are done to confirm the differential diagnosis made during the physical examination and include the following test,
X-ray
MRI scan
CT scan
Bone scan
Treatment
The treatment options are chosen from the least to the most invasive procedure, whatsoever is needed. Choosing the right treatment depends upon factors such as,
Age of the patient
The extent of curvature
Location of the curve
The number of remaining growing years.
Type of scoliosis
The treatment options include,
Wait and watch – If the spinal curvature is less than 25 degrees, or if he or she is almost fully grown, the chances of the condition getting worse are rare. One can wait and observe the condition regularly by getting checkups after every 6 to 12 months with an x-ray.
Bracing – If the curvature lies between 25 to 45 degrees, and the child is still growing, bracing is the treatment of choice. It does not straighten the curve but prevents it from getting worse and avoid surgery. Braces are of several types. Most of them are customized according to the child.
Surgery – This is the last option for treatment. The most common surgery is Spinal Fusion. It involves the fusion of the vertebrae together with each other by using substances such as bone graft, rods, and screws. The bone graft consists of a bone like material. The rod is used to keep the spine in the straight position and screws are used to hold them in place. As time progresses, the bone graft gets fused with the vertebrae and the rod can be adjusted at various stages as the child grows.
Some of the risks associated with the surgery are,
Excessive bleeding
Delayed healing
Infection
Pain
Damage to the surrounding nerve
Cost in India
Several latest methods to treat scoliosis are available in India at reasonable prices. The scoliosis spine surgery cost in India ranges from 4,000 to 9,000 USD. The cost is approximately 60-80% less than that in the US. The variation in the cost happens according to various factors such as the city, the hospital, expertise of the doctor, type of treatment and complexity of the case.
What is the best treatment for herniated disc in lower back
Herniated lumbar disc is a condition in which the soft, central portion bulges out beyond the damaged outer rings. The leaking of its inner material can aggravate a nerve or trigger back or leg pain.
Symptoms
Pain on one side of the body.
Pain extending towards the arms or legs.
Pain starting from low back and radiating towards the back of the thigh and leg.
Numbness or tingling in the leg.
Weakness in one side of the body.
The most successful and most common treatment for herniated disc in microdiscectomy.
What is microdiscectomy?
It is a minimally invasive procedure to remove the herniated disc to treat the pain by relieving pressure on spinal nerves.
Procedure
The surgery is done under general anesthesia with the patient lying on the table facing downwards.
An incision is made over the affected area on the back.
Then, with the help of a microscopic camera and a slight amount of bone cutting (if needed), the surgeon approaches the herniated disk
With the help of a scissor-like tool, the herniated tissue is removed, relieving pressure on the pressed nerve.
Recovery
Microdiscectomy is a minimally invasive procedure. Hence, the patient is discharged within 24 hours from the surgery.
The patient is able to resume back to his normal life within 2-4 weeks. He /she will need to consult a physical therapist or an occupational therapist, who render guidance related to certain body postures and movement that will be needed to avoid. Also, the patient will be told about the exercises to strengthen the muscles and bones of the spine.
After the surgery, a person needs to avoid bending, climbing and lifting heavy loads (more than 5 pounds). He should also avoid long drives or sitting for long hours.
A patient named Zeinab Mohamed from Sudan felt a sudden severe pain in his low back while lifting some heavy weight. After making all the efforts in vain for about 2 weeks, he came to India, where he was advised to have microdiscectomy surgery for L4/L5 extruded herniated disc. While returning back after a successful surgery, he said, “ I must say that the surgical procedures are highly advanced with better outcomes than they were 10 years ago”. When recently contacted about his condition, he was perfectly fine and living his life normally.
Cost in India
The cost of microdiscectomy in India is usually affordable. However, it varies according to the hospitals.
Success rate
Microdiscectomy is relatively a safe procedure and the complications are rare. This procedure has a success rate of 90-95%. The complications might include bleeding, infection, dural tear, nerve root damage etc
A comparative research was conducted recently to know the difference in the results of surgical and non- surgical treatment. The score for pain, function, and disability was significantly lower for microdiscectomy. It also reported causing significant improvement in sciatica symptoms, patient’s confidence, and overall well-being.
Not only this, compared to other surgeries, microdiscectomy has been considered the best option by the doctors because this is a minimally invasive procedure and hence provides easier recovery.
Several latest techniques are used in the best hospital for microdiscectomy in India, which raise the success rate of the surgery.
Spine Surgery in India
The spine and the spinal cord pair to become one of the most important skeletal and neurological structures of the human body that undergoes a lot of severe clinical problems. Often a spine can undergo a fracture, can bend abnormally or can have a tumour. These problems require surgeries of different procedures. Some of the most common spine surgery procedures are:
1. Artificial Spine Lumbar Disc Replacement
The artificial spine lumbar disc replacement is performed on the lumbar vertebrae of the spine which is located between the rib cage and the pelvis.
Procedure
In this surgical procedure the painful disc is replaced by a prosthetic implant that is made of metal (with or without bearing a plastic surface). It relieves back pain and at the same time maintains the normal motion of the disc.
When is it performed?
Artificial Spine Lumbar Disc Replacement is performed when the patient undergoes acute back pain in the lumbar section of the spine because of damaged or worn out spinal discs. When no other treatment works, this surgery is performed on the patient.
Cost
The cost of an artificial spine lumbar disc replacement starts from approximately USD 6,800 in India.
Patient Stay
- In the hospital: 4 days
- In India: 8 days
2. Cervical Spine Surgery
The cervical spine joins the skull to the body. Commonly we call it neck. Cervical spine surgery is done in three procedures:
- Discectomy
- Artificial cervical disc replacement
- Cervical fusion
Procedure
• Discectomy: The procedure of discectomy involves removal of the disc that is pinching the nerves in the area or is pressing the spinal cord through a small incision at the front or the back of the neck. Microdiscectomy involves a much smaller incision and the removal of the disc with the help of a microscope.
• Artificial cervical disc replacement: This process is used to close the gap that has formed after the removal of the damaged cervical disc. A prosthetic disc implant is then placed in that area so that the gap would be filled, the patient will be relieved of pain and regular motion will be maintained.
• Cervical Fusion: Cervical fusion bridges the gap between two vertebrae after the removal of the worn out disc in the cervical spine by either a bone graft, by using metal plates or by using a metal implant. If needed, the entire veretebra can also be removed and then the spine fused.
When is it performed?
Cervical spine surgery is performed when the patient experiences cervical disc disease, arthritis and acute neck pain that leads to muscle spasms in the neck and numbness in the adjoining areas.
Cost
The cost of cervical spine surgery in India starts from approximately USD 7,500.
Patient Stay
- In hospital: 5 days
- In India: 10 days
3. Lumbar Laminectomy for Spine or Spine Decompression
Lumbar laminectomy, also known as spine decompression is the procedure through which nerve impingement in the lumbar section of the spine is relieved.
Procedure
The surgical procedure of lumbar laminectomy is approached from the back. After making an incision of 2-5 inches and removing the lamina so as to see the nerve roots, the facet joints that are directly over the nerve roots are undercut or trimmed to give it more space. This gets rid off the persisting pain in the lumbar area.
When it is performed
Lumbar laminectomy is mostly done on older people. The surgery is done when the patient undergoes spinal stenosis. The spinal stenosis is caused to older people through degenerative changes that lead to enlargement of the facet joints. The enlarged facet joints exert pressure on the adjoining nerve roots resulting in pain.
Cost
The cost of lumbar laminectomy of the spine starts from approximately USD 5,500 in India.
Patient Stay
- In hospital: 5 days
- In India: 12 days
4. Minimally Invasive Spine Surgery
Unlike traditional spinal surgeries that involved long incisions and painful recovery, minimally invasive spine surgery is the newest medical innovation. By adopting the technique of minimally invasive spine surgery, now the patient experiences negligible muscle damage and a speedy recovery.
Procedure
Since the spinal nerves, vertebrae and discs are located deep inside the body, a small incision is required to reach them, moving the muscle tissues away. Guiding instruments along with microscopic video cameras are put to use during these surgeries.
When it is performed
A minimally invasive spine surgery is performed in the following cases:
- Degenerative Disc Disease
- Herniated Disc
- Lumbar Spinal Stenosis
- Scoliosis
- Spinal infections
- Spinal Instability
- Vertebral compression fractures
- Spinal tumour
Cost
The cost of minimally invasive spine surgery in India starts from approximately USD 5,400.
Patient Stay
• In hospital: 3 days
• In India: 8 days
5. Spinal Fusion
The surgical procedure of spinal fusion is implemented to join two or more vertebrae of the spine. It is also known as spondylodesis or spondylosyndesis.
Procedure
While performing a spinal fusion the surgeon uses a bone graft either from the patient or from a donor to join the adjoining vertebrae. Metallic screws, rods or cages are also used to stabilize the vertebrae and enable bone fusion.
When it is performed
A spinal fusion is performed when the patient undergoes the following conditions:
- Degenerative disc disease
- Spinal disc herniation
- Discogenic pain
- Spinal tumour
- Vertebral fracture
- Scoliosis
- Kyphosis
- Spondylolisthesis
- Spondylosis
- Posterior Rami Syndrome
Cost
The cost of spinal fusion surgery starts from approximately USD 5,000 in India.
Patient Stay
- In hospital: 4 days
- In India: 8 days
6. Spinal Decompression
Spinal decompression surgery is a term that is used to categorize the surgical procedures performed to relieve pain caused by compression of the spinal nerves.
Procedure
Spinal decompression has three types of procedures which are:
- Microdiscectomy: This procedure involves removal of a part of the disc that is exerting pressure on the nerve compressing it.
- Lumbar Laminectomy: In the surgical procedure of lumbar laminectomy the bony roof (lamina) and thick ligaments present over the spinal canal is removed so that decompression can be performed from both sides of the canal.
- Laminotomy: In laminotomy, a single side of the spinal canal is decompressed by removing a small part of the laminar roof and ligaments above the spinal canal. Most parts of the lamina is left intact in this procedure.
When it is performed
Spinal decompression is performed when the patient experiences the following:
- Spinal Stenosis
- Slipped Disc or Sciatica
- Spinal Injuries or Fracture
- Metastatic spinal cord compression
Cost
The cost of spinal decompression surgery in India starts from USD 4,400.
Patient Stay
- In hospital: 5 days
- In India: 12 days
7. Spine Tumour Surgery
Whether malignant or benign, a tumour in the spine causes a lot of problems. It can not only compress the spinal nerves but can also exert enough pressure to make spinal fractures. Surgery of spinal tumor is dependent on the type of tumour and its location in the spine.
Procedure
Spine tumour surgery involves the following procedures:
- Decompression: Used to remove the entire or part of the tumour
- Embolization: It is an interventional technique that cuts down the blood supply to the tumour and causes it to shrink.
- Kyphoplasty or vertebroplasty: These minimally invasive spine surgery procedures are used to fix the fractured vertebrae caused by the tumour.
When it is performed
A spine tumour surgery is performed when the tumour is malignant. It is also performed on benign tumours when they grow in size and effect the spine adversely.
Cost
The cost of spine tumour surgery in India starts from approximately USD 4,800.
Patient Stay
- In hospital: 4 days
- In India: 8 days
8. Spine Osteotomy
Spine Osteotomy is a surgery procedure that helps to correct spine deformities and restore balance. It is often used as a part of spinal reconstruction surgery.
Procedure
The surgical procedure involves cutting and removing the bone from a part of the vertebral segment so as to realign the spine in its proper position. There are three types of osteotomy:
- Smith-Peterson Osteotomy: Recommended to patients who require a small amount of correction that is approximately ten to twenty degrees for each level.
- Pedicle Subtraction Osteotomy: When a correction of thirty degrees is required, especially in the lumbar section, a pedicle subtraction osteotomy is performed.
- Vertebral Column Resection Osteotomy: It involves the complete removal of a single or multiple vertebral bodies.
When it is performed
A patient has to undergo spine osteotomy when he or she does not get the expected relief from medication and other non-surgical treatments. A spine deformity if left untreated may aggravate causing a lot of pain along with other symptoms. It is in these conditions that a spine osteotomy is suggested by the spine doctor or surgeon.
Cost
The cost of spine osteotomy in India starts from around USD 4,500.
Patient Stay
- In hospital: 7 days
- In India: 8 days
Cost of Other Spine Surgeries in India
- Scoliosis Spine Surgery
- Comprehensive Myelopathy – Spinal Cord Surgery
- Spinal Endoscopic Surgery
- Spinal Instrumentation
Spinal Decompression Surgery in India
What is Spinal Decompression
Spinal decompression is a general term used to describe various surgical procedures that are performed to relieve pain caused by compressed or pinched spinal nerves (neural impingement). Bulging or collapsed disks, thickened joints, loosened ligaments and bony growths can narrow the spinal canal and the spinal nerve openings (foramen), causing irritation. Compression on the spinal nerve roots leads to leg pain.
Spinal decompression surgery is frequently used to treat the following conditions:
pinal stenosis – narrowing of a section of the spinal column, which puts pressure on the nerves inside
Slipped disc and sciatica – where a damaged spinal disc presses down on an underlying nerve
Spinal injuries – such as a fracture or the swelling of tissue
Metastatic spinal cord compression – where cancer in one part of the body, such as the lungs, spreads into the spine and presses on the spinal cord or nerves
Overview of Spine
Spine is buildup of 33 small bones called vertebrae, which are arranged one above the other, having a soft intervertebral disc between each pair of the vertebrae. Intervertebral disc contains a soft jelly-like substance called, nucleus pulposus present in the center, and is surrounded by multiple layers of collagen called the annulus fibrosis (like an onion). This disc attaches and helps in the movement between vertebrae and also acts as a shock absorber of the spine. Hence, the vertebrae acts as a protective shield for the spinal cord & nerve roots.
Who Needs a Spinal Decompression Surgery?
Spinal decompression surgery is recommended in patients suffering from of spinal stenosis. Spinal stenosis is a condition in which there is narrowing of the spinal canal which can causes chronic pain, numbness, and muscle weakness in the arms or legs. This condition mainly affects the elderly people and is mostly caused by degenerative changes that result in enlargement of the facet joints and thickening of the ligaments.
Spinal decompression surgery is recommended for a person who is suffering from:
Pain, weakness, numbness, or needles in the leg or foot
Leg pain that is worse than back pain
Not responding to any kind of physical therapy or medication
Causes a difficulty in walking or standing that can affect the quality of life
In rare cases, pressure on the bladder can lead to paralysis or complications with bladder or bowel function.
Spinal Decompression Procedure
There are several type of surgical techniques which are commonly used to provide relief from nerve decompression:
Microdiscectomy (Microdecompression): This is mostly performed for leg pain caused by lumbar herniated disc, known as Sciatica. The procedure involves removal of a part of the disc that is compressing the nerve & is done by using microsurgical techniques.
Lumbar Laminectomy (open decompression): This is mostly performed for leg pain caused by lumbar spinal stenosis: This procedure involves complete removal of the bony roof (lamina) & thickened ligaments present over the spinal canal to decompress both sides (left and right) of the spinal canal.
Laminotomy: This process involves decompression of one side of the spinal canal (left or right) by removing a small portion of the laminar roof & ligaments present above the spinal canal, leaving the majority of the lamina intact. With the help of this method, the natural support of the lamina is not disturbed, which in turn decreases the chances of postoperative spinal instability. Occasionally an endoscope may be used, which will allow for a smaller, less invasive incision.
All these procedures can be performed as an independent surgery or may be done in combination, depending on the severity & requirement of the case.
Before the procedure:
Surgical tests (e.g., blood test, electrocardiogram, chest X-ray) are performed prior to the surgery.
Patient’s medical history (allergies, medicines/vitamins, bleeding history, anesthesia reactions, and previous surgeries) is taken.
Patient is advised to stop taking all non-steroidal anti-inflammatory medicines (Naprosyn, Advil, Motrin, Nuprin, Aleve, etc.) and blood thinners (Coumadin, aspirin, etc.) one week prior to the surgery.
Patient is also advised to stop smoking, chewing tobacco, and drinking alcohol one week prior and 2 weeks after the surgery, as these can cause bleeding problems.
Patient is hospitalized on the same day of the procedure. And is advised not to have any food or drink past midnight the night before surgery. An intravenous (IV) line is placed in the arm.
During the procedure:
Surgery is performed under general anesthesia & the entire procedure may take approximate 1-3 hour, depending on the complexity.
Patient is prepared for the surgery
Incision: is made down the middle of the back over the appropriate vertebra .Back muscles are split down the middle and then moved to either side, to expose the lamina of each vertebra.
Laminectomy or Laminotomy: An X- ray is taken of the exposed bone, to confirm the correct vertebrae & accordingly the preferred procedure is performed.
Decompress the spinal nerve: Facet joints, which is present directly over the nerve roots, may be undercut (trimmed) to provide more room for the nerve roots (procedure is called foraminotomy) .This will enlarge the neural foramen (where the spinal nerves exit the spinal canal). If compression is caused by a herniated disc then discectomy is performed.
Closure: Muscle and skin incisions are stitched together with sutures or staples. Dissolvable sutures are mostly used.
After the procedure
Patient will be hospitalized for four or five days, depending upon the procedure. Patient will be kept on pain killers to provide relief from the post-operative pain. After the surgery patient will be allowed to take sips of fluids and then gradually progress to a full diet. Patient can shower 4-5 days after the procedure.
Patient may require help with daily activities (e.g., dressing, bathing) initially (for the first few weeks). Fatigue is common after the procedure .One can slowly return back to their normal activities.
Post –hospital care
After the `surgery, patient should follow the following restrictions:
Patient is advised not to drive for 2 to 4 weeks after surgery or till he is permitted by the doctor
Should avoid sitting for longer duration.
Should not lift anything heavy& should not bend or twist at the waist.
After the first –follow up visit, patient will be allowed to do any housework and yard –work. This includes gardening, moping vacuuming, ironing, and loading/unloading the dishwasher, washing clothes or drying etc.
Patient is advised to avoid smoking. As smoking delays healing by increasing the risk of complications (e.g., infection) and inhibits the bone fusion.
Patient is advised to walk. Initially, one should start with a short distance and slowly increase the distance.
Spinal Decompression Risks
Following are the risk associated with the spinal decompression surgery:
Infection
Bleeding
Nerve or tissue damage or persistent pain
Paralysis
Allergic reaction to anesthesia
Damage to the surrounding soft tissue
Deep Vein Thrombosis (DVT)
Vertebrae failing to fuse
Bone graft migration: Immediately after the surgery the bone graft can move from the correct position in between the vertebrae.
Leakage of cerebrospinal fluid(CSF)
