Foraminotomy

What is Foraminotomy?

Foraminotomy is a surgical procedure performed to relieve pressure on spinal nerves caused by narrowing of the foramina—small openings in the spine through which nerve roots exit. This condition, known as foraminal stenosis, can result in pain, weakness, numbness, or tingling in the arms or legs, depending on the affected spinal region.

Types of Foraminotomy

Foraminotomy can be classified into different types based on the location and approach:

• Cervical Foraminotomy – Performed on the neck region.
• Thoracic Foraminotomy – Conducted on the upper back.
• Lumbar Foraminotomy – Focuses on the lower back.
• Minimally Invasive Foraminotomy – Uses small incisions and endoscopic techniques for quicker recovery.

 Causes of Foraminal Stenosis

A foraminotomy is typically recommended for individuals experiencing nerve compression due to:

• Herniated discs – When a spinal disc bulges and presses on a nerve.
• Bone spurs – Overgrowths of bone that encroach on nerve pathways.
• Spinal arthritis – Inflammation and degeneration of spinal joints.
• Thickened ligaments – Over time, spinal ligaments can thicken and contribute to narrowing of the foramina.
• Spinal stenosis – General narrowing of the spinal canal affecting nerve function.
• Trauma or injury – Accidents or repetitive strain may contribute to foraminal stenosis.

 Symptoms of Nerve Compression

Common symptoms that may indicate the need for a foraminotomy include:

• Chronic pain in the neck, back, arms, or legs.
• Numbness or tingling in extremities.
• Muscle weakness affecting mobility.
• Difficulty in standing or walking for extended periods.

 Why is Foraminotomy Performed?

A foraminotomy is typically recommended for individuals experiencing nerve compression due to:

• Herniated discs – When a spinal disc bulges and presses on a nerve.
• Bone spurs – Overgrowths of bone that encroach on nerve pathways.
• Spinal arthritis – Inflammation and degeneration of spinal joints.
• Thickened ligaments – Over time, spinal ligaments can thicken and contribute to narrowing of the foramina.
• Spinal stenosis – General narrowing of the spinal canal affecting nerve function.

 The Foraminotomy Procedure

1. Preoperative Preparation

• Patients undergo imaging tests such as MRI, CT scans, or X-rays to pinpoint the affected area.
• General or local anesthesia is administered to ensure comfort during surgery.

2. Surgical Process

• A small incision is made near the affected vertebra.
• The surgeon removes bone or tissue that is compressing the nerve, widening the foramen.
• In some cases, the procedure is performed using minimally invasive techniques to reduce recovery time and complications.
• The incision is closed, and the patient is moved to recovery.

 Diagnosis of Foraminal Stenosis

Doctors use various diagnostic methods to confirm foraminal stenosis, including:

• Physical examination – Evaluating movement, reflexes, and pain levels.
• Imaging tests – MRI, CT scans, or X-rays to identify nerve compression.
• Electromyography (EMG) – Assesses nerve function and detects abnormalities.

 Treatment Options

Treatment for foraminal stenosis varies based on severity and may include:

• Medications – Pain relievers, anti-inflammatory drugs, or muscle relaxants.
• Physical therapy – Strengthening and stretching exercises.
• Steroid injections – To reduce inflammation and provide temporary relief.
• Surgery (Foraminotomy) – Recommended when conservative treatments fail to provide relief.

 Cost of Foraminotomy in India

The cost of foraminotomy in India varies based on the hospital, surgeon, and procedure type. On average, the cost ranges between ₹1,50,000 to ₹4,00,000 ($1,800 - $4,800), including hospital stay and postoperative care.

 Recovery and Postoperative Care

• Hospital Stay: Many patients undergo foraminotomy as an outpatient procedure or require a short hospital stay.
• Pain Management: Medications and physical therapy help manage post-surgical discomfort.
• Activity Restrictions: Patients may need to avoid heavy lifting, bending, or strenuous activities for a few weeks.
• Physical Therapy: A guided exercise program helps restore strength and flexibility.
• Full Recovery: Most individuals return to normal activities within a few weeks to a few months, depending on the severity of the condition and overall health.

 Risks and Complications

As with any surgical procedure, foraminotomy carries some risks, including:

• Infection at the surgical site.
• Bleeding or blood clots.
• Spinal fluid leaks.
• Nerve damage, though rare, could lead to prolonged pain or weakness.
• Recurrent symptoms, if the underlying condition progresses over time.

 FAQs About Foraminotomy

1. Is foraminotomy a major surgery?

While foraminotomy is a surgical procedure, it is often performed using minimally invasive techniques, making it less extensive than other spinal surgeries.

2. How long does the surgery take?

The procedure usually takes 1 to 2 hours, depending on the complexity and severity of the condition.

3. How soon can I return to work after foraminotomy?

Most patients return to light activities within 2 to 4 weeks, while full recovery may take up to 3 months.

4. Will I need physical therapy after surgery?

Yes, physical therapy is recommended to regain strength, improve mobility, and prevent further complications.

5. Are there alternatives to foraminotomy?

Yes, non-surgical treatments such as medications, physical therapy, and steroid injections can help manage symptoms. Surgery is considered when these options fail to provide relief.

 Conclusion

Foraminotomy is a highly effective procedure for relieving nerve compression and improving mobility and quality of life. While recovery varies by individual, following a comprehensive rehabilitation plan ensures the best outcomes. If you are experiencing persistent spinal pain or nerve-related symptoms, consult with a spine specialist to determine if foraminotomy is the right option for you.

Spinal Fusion Surgery

Spinal fusion surgery is a procedure that permanently joins two or more vertebrae in the spine to eliminate movement between them. This technique is commonly used to treat conditions such as spinal instability, degenerative disc disease, scoliosis, herniated discs, and spinal fractures. By fusing the affected vertebrae, the procedure helps reduce pain, improve spinal stability, and restore mobility.

Causes of Spinal Fusion

Spinal fusion may be required due to various reasons, including:

• Degenerative Disc Disease: Wear and tear on spinal discs leading to pain and instability.
• Scoliosis: An abnormal curvature of the spine.
• Spondylolisthesis: A condition where one vertebra slips forward over another.
• Spinal Fractures: Often caused by trauma or osteoporosis.
• Herniated Discs: Severe cases where disc damage affects nerve function.
• Spinal Tumors: Some cases may require spinal fusion to stabilize the spine after tumor removal.

 Why is Spinal Fusion Surgery Performed?

Spinal fusion is typically recommended for individuals experiencing chronic back pain or spinal instability that does not respond to conservative treatments such as physical therapy, medications, or injections. The procedure helps restore stability, reduce pain, and prevent further deterioration of the spine.

 Types of Spinal Fusion Surgery

There are several types of spinal fusion surgery, including:

• Posterolateral Fusion (PLF): Bone graft is placed between the transverse processes of the vertebrae.
• Interbody Fusion: Bone graft is placed between the vertebrae where the disc used to be.
• Minimally Invasive Spinal Fusion: Uses smaller incisions and advanced technology to reduce recovery time.
• Spinal Fusion (L1 + Decompression): Fusion of the L1 vertebra with decompression to relieve nerve pressure.
• Spinal Fusion (L2 + Decompression): Fusion of the L2 vertebra with decompression for enhanced spinal stability.

Three Types of Spinal Fusion Techniques in India

India offers various spinal fusion techniques, including:

1. Anterior Lumbar Interbody Fusion (ALIF): Fusion through the front of the body.
2. Posterior Lumbar Interbody Fusion (PLIF): Fusion from the back.
3. Transforaminal Lumbar Interbody Fusion (TLIF): A variation of PLIF for better access to the spine.

Procedure for Spinal Fusion Surgery

The surgery involves several steps:

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: The surgeon makes an incision in the back, neck, or side, depending on the affected area.
3. Bone Grafting: A bone graft, either from the patient's own body or a donor, is placed between the affected vertebrae to promote fusion.
4. Stabilization: Metal screws, rods, or plates are inserted to hold the vertebrae together while they heal.
5. Closure: The incision is closed, and the patient is monitored for recovery.

 Techniques/ Approaches for Spinal Fusion Surgery in India

  India offers various approaches, such as:

• Open Surgery: Traditional spinal fusion with larger incisions.
• Minimally Invasive Techniques: Smaller incisions, less tissue damage, and quicker recovery.
• Robotic-Assisted Surgery: Advanced technology for precision and efficiency.

 Recovery After Spinal Fusion Surgery

Recovery time varies based on the patient's overall health and the extent of the surgery. Key aspects of recovery include:

• Hospital Stay: Patients typically stay in the hospital for 2-4 days.
• Pain Management: Medications are prescribed to manage post-surgical pain.
• Physical Therapy: Rehabilitation exercises help restore strength and mobility.
• Activity Restrictions: Patients are advised to avoid heavy lifting, bending, or twisting movements during the healing process.
• Full Recovery: Fusion may take several months to a year to fully develop.

What are the Risks and Complications Associated with Spinal Fusion Surgery?

As with any surgery, spinal fusion carries potential risks, including:

• Infection
• Blood clots
• Nerve damage
• Limited range of motion
• Failed fusion (pseudoarthrosis), requiring further surgery

 How Much Does Spinal Fusion Surgery Cost in India?

The cost of spinal fusion surgery in India varies based on factors such as hospital, surgeon expertise, and procedure type.

Spinal fusion surgery cost in India starts from INR 420,000 ($5,000). The cost difference is distinctly huge when compared to the hospitals in any other medically advanced country, including the US, UK, UAE and Singapore.

This cost could vary on various factors such as:

• Type of spinal fusion technique used. The techniques vary depending upon the level of the spine, which includes surgery on the cervical spine, thoracic spine and lumbar spine.
• Surgeon experience.
• The total cost of spinal fusion surgery in India primarily depends upon the type of package you choose. These include costs of medications, medical supplies, operating room services, room and board expenses, recovery room expenses, hospitals and imaging charges, physical therapy expenses and charges of surgeons.

 Best Hospitals for Spinal Fusion Surgery in India

Some of the top hospitals offering spinal fusion surgery in India include:

• Apollo Hospitals
• Fortis Hospitals
• Manipal Hospitals
• Medanta – The Medicity

Frequently Asked Questions (FAQ) About Spinal Fusion Surgery in India

Q. What is the duration of hospital stay after spinal fusion surgery in India?

Typically, a hospital stay of 2 to 4 days is required after spine fusion surgery in India. During this period, the doctor and nurses monitor the patient’s recovery and keep a check on any complications. Physiotherapists and occupational therapists also help the patient and guide them through various exercises to help them with movement.

Q. How long does the complete recovery after spinal fusion surgery take?

Recovery time after spine fusion surgery varies for every individual, depending on age, severity of disease, type of surgery and other factors.

Usually, it takes 6 to 8 weeks to recover enough to carry out daily activities. The complete fusion of the bones may take 3 months or more if proper rest and healing takes place. The patient may return to more physically demanding activities after 6 months following the surgery.

Q. When can I resume work after the surgery?

Most people can resume work with a desk job and light activities in 4 to 6 weeks depending on their recovery and healing speed. The doctor will analyze the patient’s condition and advise a suitable time to go back to work.

Q. Is a minimally invasive procedure for spinal fusion available in India?

Spine surgery hospitals in India offer minimally invasive spine surgery for various types of fusion procedures. These hospitals are equipped with the latest medical techniques and surgical equipment that are required for minimally invasive procedures.

The spine surgeons in India are highly trained and skilled in performing advanced spine surgery for the treatment of various spine and disc problems.

Q. Why is it recommended to quit smoking before the spine fusion surgery?

Smoking has negative effects on the recovery process as tobacco can affect the blood vessels and wound healing ability of the body. It also raises the risk of lung problems and infections after the surgery.

Q. Will I have to wear a brace after spine fusion surgery?

At times, the surgeon may recommend wearing a back brace after spinal fusion surgery to help patients during the recovery. The need for a brace depends on the number of levels fused, the type of procedure, the patient’s age, the damage to bone and whether the patient has other health problems such as diabetes, obesity and others.

 Conclusion

Spinal fusion surgery can be a life-changing procedure for individuals suffering from chronic spinal conditions. While it requires careful consideration and a significant recovery period, it can provide long-term relief and improved quality of life. If you are considering spinal fusion, consult with a spine specialist to understand the risks, benefits, and alternatives available to you.

Advantages of PELD(Percutaneous Endoscopic Lumbar Discectomy) - Advanced Minimal Invasive Technique

Percutaneous Endoscopic Lumbar Discectomy (PELD)

Percutaneous Endoscopic Lumbar Discectomy (PELD) is a unique approach which is quickly getting popular amongst patients and surgeons in the treatment of nonsequestrated disc herniation (disc prolapse) as it reduces the post operative hospitalization and recovery time.

An advanced minimal invasive technique, Percutaneous endoscopic lumbar discectomy (PELD) is performed for the decompression of the lumbar disc space and removal of nucleus pulposus via a posterolateral approach. In addition to decompression surgery, the technique has been found effective in management of spinal tumors and structural deformities. This surgery is recommended in patients who fail to respond effectively to conservative treatment with pain killers like NSAIDs (Non Steroidal Anti inflammatory Drugs) or when the pain threshold is low. In this form of surgery, an instrument called endoscope is used and the whole surgery is done under local anesthesia with the patient fully awake during surgery.

Who may require PELD?

Individuals suffering from chronic low back pain and disability may benefit from a PELD procedure. It is often used to treat patients suffering from degenerated discs, bulging discs or herniated discs that compress upon the surrounding structures within the spinal canal causing nerve compression, sciatica and low back pain. It can also be used if the patient fails to respond to conventional management therapies including direct injection therapies for three months or more. The surgery is also found to be successful in resection of spinal tumors, fusion and structural deformities of the spinal cord.

Relevant Anatomy

The human spine is made up of 33 bony segments called vertebrae which are stacked one above the other. These vertebrae are separated by small, soft, cushion like structures called the intervertebral discs that act as shock absorbers. These discs undergo degeneration due to age related wear and tear, resulting in disc herniation or prolapse. They compress the surrounding soft tissues or nerves giving rise to severe pain. If the vertebral discs in the lower back or the Lumbar region are compressed, they result in pain and tingling in the legs and spasms in the back.

Procedure and types of PELD

Percutaneous endoscopic lumbar discectomy is the ultimate form of minimal invasive spine surgery. It is an endoscopic daycare surgical procedure which is conducted in about 60 minutes, under local anesthesia with mild sedation. Patient is made to lie on his front on the operation table and exact entry point is mapped on patient’s body using image intensifier x-ray system. A small incision is made about 8-10 centimeters from the midline on the posterior part of the body. Now there are two different ways in which the inter-vertebral disc material can be removed (i.e. manually or using laser).

• Manual procedure also known as automated percutaneous discectomy involves insertion of a long spinal needle from side of back, directly into the disc, by-passing other bone and ligaments. Through this needle, guide wire is passed and after taking 5mm incision, dilator and working cannula are passed, through which endoscope is inserted. Camera and monitor is attached to endoscope and prolapsed part of disc is removed under vision.
• The laser surgery is referred to as percutaneous laser discectomy (PLD), which uses an external imager called the fluoroscope to direct the probe. The probe delivers laser energy which vaporizes a part of the inter-vertebral disc material and decompresses the nerve root. The most frequently used laser for treatment is Holmium yttrium- aluminum-garnet (Ho:YAG) laser.

In either procedure, the wound is closed with single stitch. Patient gets immediate pain relief and he can go home in 24 hrs and can resume his work soon.

Advantages of PELD

• Surgery is done under local anesthesia with conscious sedation.
• No muscle, ligament or normal tissue damage and minimal blood loss.
• Patient can be discharged in 24 hrs. No prolonged bed rest required after surgery.
• Early return to work.
• Even prolapsed, migrated, extra-foraminal, recurrent discs can be removed.
• Very good technique for old and medically compromised patients.
  
  
  
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Why do so many people suffer from low back pain?

Have you ever asked, "Why do so many people suffer from low back pain?" The answer involves a brief overview of the lumbar spine. Although the entire spine is involved in everyday activities of rest and movement, the low back can be vulnerable to many pain-provoking disorders. Simple sprains and strains from overexertion, a herniated disc from a slip and fall, degenerative disc disease or spinal stenosis from normal aging, and other disorders can cause low back pain.

To help you understand back pain, the following brief and illustrated anatomy lesson is provided.

What Is the Lumbar Spine?

The lumbar spine (low back) is the third major region of the spine; it is below the cervical spine and thoracic spine. Most people have five bones (vertebrae) in the lumbar spine, although it is not unusual to have six. Each vertebra is stacked on top of the other and between each vertebra is a gel-like cushion called an intervertebral disc. The discs help to absorb pressure, distribute stress, and keep the vertebrae from grinding against each other.

Ligaments and Tendons: Connective Lumbar Spine Soft Tissues

The vertebrae and discs are held together by groups of ligaments . Ligaments connect bone to bone, whereas tendons connect muscle to bone. In the spine, tendons connect muscles to the vertebrae. The ligaments and tendons help to stabilize the spine and guard against excessive movement in any one direction.

Lumbar Spine Joints

The spine also has joints that are similar to knees, elbows, and other joints. The spinal joints are called facet joints 

The facet joints have been described as finger-like, and they link the vertebrae together. The facet joints are located at the posterior area of the spinal column (on the back side of the spinal column).

In addition, the facet joints help to make the spine flexible and enable you to bend forward, backward, and side to side.

The lumbar spine has several distinguishing characteristics:

·         The lower the vertebra is in the spinal column, the more weight it must bear. The five vertebrae of the lumbar spine (L1-L5) are the biggest unfused vertebrae in the spinal column, enabling them to support the weight of the entire torso.

·         The lumbar spine's lowest two spinal segments, L4-L5 and L5-S1, which include the vertebrae and discs, bear the most weight and are therefore the most prone to degradation and injury.

·         The lumbar spine meets the sacrum at the lumbosacral joint (L5-S1). This joint allows for considerable rotation, so that the pelvis and hips may swing when walking and running.

·         The spinal cord travels from the base of the skull through the spinal column and ends at about T12-L1 - where the thoracic spine meets the lumbar spine. At that point numerous nerve roots from the spinal cord continue down and branch out, forming the "cauda equina," named for its resemblance to a horse's tail. These nerves extend to the lower extremities (buttocks, legs and feet). Because the spinal cord does not run through the lumbar spine, it is quite rare that a lower back problem would result in spinal cord damage or paralysis.

Lumbar Intervertebral Segment

Physicians usually explain a patient's pathology by focusing on one intervertebral segment, or spinal segment. The lumbar spine has 5 intervertebral segments, termed lumbar segment 1 through 5 (e.g. L1, L2, L3, L4, and L5).

Each lumbar spine segment is comprised of:

·         Two vertebrae, such as L4-L5, stacked vertically with an intervertebral disc between them. A healthy disc is cushiony, with a lot of water, and has a sponge-like substance. It acts like a shock absorber in the spine, allowing flexibility and providing protection from jarring movements.

·         The two adjacent vertebrae are connected in the back of the spine by two small joints called facet joints. The facet joints of the lumbar spine allow movement to bend and twist the low back in all directions.

·         There are nerves that branch off from the spinal column at each level of the spine. They pass through small holes in the back of the lower spine. They then connect together to form the sciatic nerve, which travels into the legs down the back of each thigh and into the calves and feet.

Doctors usually talk about a patient's lumbar disc problem, or nerve or other lower back problem, as the level that includes two vertebrae and the disc between them, such as L3-L4 or L4-L5. If the disc at the very bottom of the spine is affected, that segment is called the lumbosacral joint L5-S1

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Minimally invasive Surgery (MIS) and spinal fusion (mending the spine bones together)

Using innovative technology, a minimally invasive surgery (MIS) spinal fusion (mending the

spine bones together) can now be accomplished using two small poke-hole incisions with

minimal tissue dissection resulting in a faster recovery. Using the MIS procedure, Posterior

lumbar fusions (PLF) and transforaminal lumbar interbody fusions (TLIF) can both be

performed in less time, with less tissue damage, and less pain than traditional open spinal

fusion surgery.

Posterior Lumbar Fusion (PLF) is the general term used to describe the technique of

surgically mending two (or more) lumbar spine bones together along the sides of the bone.

Bone graft is placed along side the spine bones (not in between the disc spaces, which is

called an interbody fusion), and ultimately fuses together. Minimally invasive PLF is

generally always performed in conjunction with instrumentation (use of metal screws/rods)

so as to impart immediate stability while the bone mends and to increase the fusion rate

(percentage of patients where the bone successfully mends together). MIS TLIF includes the

PLF described above, as well as performing an interbody fusion, which means the

intervertebral disc is removed and replaced with a bone spacer (metal or plastic may also be

used). A MIS TLIF involves placing only one bone graft spacer in the middle of the interbody

space, without retraction of the spinal nerves.

The MIS PLF technique is often favored as the 2nd staged procedure when a multiple level

ALIF is performed, and a laminectomy is not necessary. A MIS TLIF is commonly performed

when one or two spinal levels are being fused in conjunction with a partial posterior

decompression (facetectomy and laminectomy), and interbody fusion is indicated.

MIS PLF and MIS TLIF are commonly performed for a variety of spinal conditions, such as

spondylolisthesis and degenerative disc disease, among others.

Surgical Technique

The surgery is performed utilizing general anesthesia. A breathing tube (endotracheal tube)

is placed and the patient breathes using a ventilator during the surgery. Preoperative

intravenous antibiotics are given. Patients are positioned in the prone (lying on the

stomach) position, generally using a special operating table/bed with special padding and

supports. The surgical region (low back area) is cleansed with a special cleaning solution.

Sterile drapes are placed, and the surgical team wears sterile surgical attire such as gowns

and gloves to maintain a bacteria-free environment.

A 1 inch (depending on the number of levels) poke-hole incision is made on each side of the

low back, directly over the involved spinal levels. The fascia and muscle is gently divided

using special cannulated retractors and sleeves. The pedicle screws and rods are implanted

and the facet joints are fused through the two tiny incisions under x-ray guidance. If a TLIF

is to be performed, a partial laminectomy (removal of lamina portion of bone) and complete

facetectomy is performed to allow visualization and removal of the intervertebral disc. The

intervertebral disc is then removed using special biting and grasping instruments (such as a

pituitary rongeur, kerrison rongeur, and curettes), an operating microscope, and x-ray

guidance. Special distractor instruments are used to restore the normal height of the disc, as

well as to determine the appropriate size spacer to be placed. A bone spacer (metal or plastic

spacers may also be used) is then carefully placed in the disc space.

The wound areas are usually washed out with sterile water containing antibiotics. The deep

fascial layer and subcutaneous layers are closed with one or two sutures. The skin can

usually be closed using special surgical glue, leaving a minimal scar and requiring no

bandage.The total surgery time is approximately 2 to 3 hours, depending on the number of

spinal levels involved.

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Latest Back Pain Treatments in India

Minimally Invasive Lumbar Discectomy (MILD) for Back Pain

One of the safe procedures to cure Lumbar Spinal Stenosis is called MILD. If you have pain or numbness in your lower back when you are standing upright or tingling when you walk, you might be having Lumbar Spinal Stenosis. MILD is an effective treatment option which can deliver significant pain relief for patients with Lumbar Spinal Stenosis.

Lumbar Spinal Stenosis is a condition, where the spinal canal narrows and compresses the spinal cord nerves in the lower back. It may occur as a result of natural wear and tear due to ageing. Other factors that cause narrowing of the spinal canal are:

• Formation of excess bone
• Compression or bulging of discs
• Thickening of ligament tissue etc.
  
  

Pain and numbness are the main symptoms of Lumbar Spinal Stenosis. As the disease progresses, the symptoms also will increase. When other medications and therapies fail to cure the disease, the doctor will suggest for MILD procedure.

MILD is a short outpatient procedure done using a small incision. The procedure does not require anesthesia, implants or stitches. The doctor will use an imaging machine and specialized tools for the procedure. During the procedure, the doctor will remove excess ligament tissue and small pieces of bone through the small incision in the back. This will help to restore the space in the spinal canal and decreases the nerve compression. So that, the patient will get relief from pain and can restore mobility.

The patient will be able to go home on the same day of surgery itself. The doctor may suggest you to avoid strenuous physical activities. Reliable surveys have found the fact that, MILD has given significant results to about 79% of patients. MILD has proven to be a very low risk procedure. But, it can be complicated for people who have other health issues. All the people may not be apt for the procedure. Talk to your doctor in order to confirm how far the procedure is suitable for you.

Some of the other latest back pain treatments are :

• Endoscope Assisted Discectomy
• Ozone Arthroplasty

Endoscope Assisted Discectomy

Discectomy is the surgical procedure employed to remove herniated discs from the spinal canal. Endoscope assisted disectomy is a minimally invasive method which makes use of endoscope and small surgical tools. Herniated disc will cause compression of nerve roots and spinal cord. Fragment of the spinal disc that is putting pressure on the nerves is so removed.

Discectomy is performed under a light anesthesia. A very small incision is made in the middle of your back neck. A small metal tube is inserted into the herniated disc through this incision using x-ray fluoroscopy. This will help your surgeon to locate the herniated disc using x-rays and camera. The inserted tube acts as a passage for endoscope and surgical instruments. Then surgical tools and an endoscope with small camera will be guided through this passage. After identifying the disc, fragments that put pressure on the nerve is removed using special instruments. Camera attached with the endoscope will visualize live the damaged disc which is to be removed.

After all fragment tissues are removed, your surgeon will withdraw tools from the spine and dress the incision using bandages with utmost care.

ADVANTAGES

• Less tissue injury and scar formation
• No need of large skin incision
• Shorter recovery period
• Very little blood loss

Ozone Arthroplasty

Each bone in the spine is separated by cushion like disc called intervertebal disc which acts as shock-absorbers. Any damages to this disc or its rupturing can cause protrusion of jelly like nucleus of disc outwards. This condition is called disc herniation which causes compression of nerve roots and spinal cord. It ultimately leads to lower back pain or leg pain.

Many people show no symptoms from herniated disc. To relieve symptoms of herniated disc, pain medications and muscle relaxers may be prescribed to patients. If the pain continues or persists, inflammation-suppressing steroid injections would be given.

Physical therapies like heat or ice application or electrical stimulation may be useful.

But sometimes, least number of patients may need surgery to heal their disc hernation. Protruded or bulged portion of disc shrinks over a time within a few weeks after surgery. Herniated disc would be removed during the surgery.Apart from these treatment options, a new method has been innovated called ozone arthroplasty.

Ozone artroplasty is a new practice performed by some physicians to cure herniated discs. In this procedure, ozone gas would be directly injected into the herniated disc. This injected ozone gas will fill the disc and bubbles out through protrusion. The chemical reaction of the gas with the nucleus of the disc causes the shrinking of herniated portion of disc. The pressure on the nerves become relieved. Consequently, symptoms of leg pain and lower back pain start to disappear. Recent studies reveal that it can produce long lasting results with a single ozone injection.

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Best Spine Hospitals in India | Low Cost Scoliosis Surgery in India

Our spine is an engineering marvel that supports our weight and ties our body together. The spinal column consists of a stack of small bones that range in size from 2-3 inches to 5-6 inches in diameter. When viewed from the front, the spine appears to be straight, but when looked at from the side, the normal spine has two gentle S-curves. 

Scoliosis is an abnormal curvature of the spine. In scoliosis, the spine curves to the side when viewed from the front, and each vertebra also twists on the next one in a corkscrew fashion. 

Scoliosis affects girls twice as often as it affects boys. About three to five of 1,000 people are affected. Scoliosis usually occurs in those older than 10 years, but the condition can be seen in infants. 

What causes scoliosis? 

In most cases, the cause of scoliosis is unknown (idiopathic). This type of scoliosis is described based on the age when scoliosis develops. If the person is less than 3 years old, it is called infantile idiopathic scoliosis. Scoliosis that develops between 3 and 10 years of age is called juvenile idiopathic scoliosis, and people that are over 10 years old have adolescent idiopathic scoliosis. 

Another surgery option for scoliosis is an anterior approach, which means that the surgery is conducted through the chest walls instead of entering through the patient's back. The patient lies on his or her side during the surgery. During this procedure, the surgeon makes incisions in the patient's side, deflates the lung, and removes a rib in order to reach the spine.

What are various types of scoliosis?

Functional Scoliosis

In this type of scoliosis, the spine is normal, but an abnormal curve develops because of a problem somewhere else in the body. This could be caused by one leg being shorter than the other or by muscle spasms in the back.

Neuromuscular Scoliosis

In this type of scoliosis, there is a problem when the bones of the spine are formed. Either the bones of the spine fail to form completely or they fail to separate from each other during fetal development. This type of scoliosis develops in people with other disorders, including, birth defects and muscular dystrophy and cerebral palsy, or Marfan's disease. People with these conditions often develop a long C-shaped curve and have weak muscles that are unable to hold them up straight. If the curve is present at birth, it is called congenital. This type of scoliosis is often much more severe and needs more aggressive treatment than other forms of scoliosis.

Degenrative Scoliosis

Unlike the other forms of scoliosis that are found in children and teens, degenerative scoliosis occurs in older adults. It is caused by changes in the spine due to arthritis known as spondylosis. Weakening of the normal ligaments and other soft tissues of the spine combined with abnormal bone spurs can lead to an abnormal curvature of the spine. The spine can also be affected by osteoporosis, vertebral compression fractures, and disc degeneration.

What type of surgery is done for treatment of scoliosis in India?

If the curve stays below 40 degrees until the person is finished growing, it is not likely to get worse later in life. However, if the curve is greater than 40 degrees, it is likely to continue to get worse by 1-2 degrees each year for the rest of the person's life. If this is not prevented, the person could eventually be at risk for heart or lung problems. The goals of surgery for scoliosis are correcting and stabilizing the curve, reducing pain, and restoring a more normal curve and appearance to the spinal column.

There are various techniques used for scoliosis surgery. One type of surgery involves posterior spinal fusion with instrumentation and bone grafting. This surgery is performed through the patient's back while the patient lies on his or her stomach.

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