Scoliosis: What You Need to Know | Low Cost Scoliosis Surgery in India

Surgery for adolescents with scoliosis is only recommended when their curves are greater than 40 to 45 degrees and continuing to progress, and for most patients with curves that are greater than 50 degrees.

Unlike back braces, which do not correct spinal curves already present, surgery can correct curvature by about 50%. Furthermore, surgery prevents further progression of the curve.

There are several approaches to scoliosis surgery, but all use modern instrumentation systems in which hooks and screws are applied to the spine to anchor long rods. The rods are then used to reduce and hold the spine while bone that is added fuses together with existing bone.

Once the bone fuses, the spine does not move and the curve cannot progress. The rods are used as a temporary splint to hold the spine in place while the bone fuses together, and after the spine is fused, the bone (not the rods) holds the spine in place. However, the rods are generally not removed since this is a large surgery and it is not necessary to remove them. Occasionally a rod can irritate the soft tissue around the spine, and if this happens the rod can be removed.

Two Approaches to Scoliosis Surgery

There are two general approaches to the scoliosis surgery - a posterior approach (from the back of the spine) and an anterior approach (from the front of the spine). Specific surgery is recommended based on the type and location of the curve.

1. ScoliosisSurgery from the Back (Posterior Surgical Approach)

This approach to scoliosis surgery is done through a long incision on the back of the spine (the incision goes the entire length of the thoracic spine).

·         After making the incision, the muscles are stripped off the spine to allow the surgeon access to the bony elements in the spine

·         The spine is then instrumented (screws are inserted) and the rods are used to reduce the amount of the curvature

·         Bone is then added (either the patient's own bone, taken from the patient's hip, or cadaver bone), inciting a reaction in which the bones in the spine begin fusing together

·         The bones continue to fuse after surgery is completed. The fusion process usually takes about 3 to 6 months, and can continue for up to 12 months

For patients who have a severe deformity and/or those who have a very rigid curvature, another procedure may be required prior to this surgery. A surgeon may recommend an anterior release of the disc space (removal of the disc from the front), which involves approaching the front of the spine either through an open incision or with a scope (thoracoscopic technique) and releasing the disc space.

After the discs at the appropriate levels of the spine have been removed, bone (either the patient's own bone and/or cadaver bone) is added to the disc space to allow it to fuse together.

Removing the discs allows for a better reduction of the spine and also results in a better fusion. These two factors are especially important if the patient is a young child (10 to 12 years old) and has a lot of skeletal growth left.

Without the anterior release procedure, the anterior column (the part of the spine facing the front of the body) can continue to grow, eventually twisting around the fused, non-growing posterior spinal column, forming a new scoliosis curve (called "crankshafting"). Fusing the spine anteriorly prevents this process.

2. Scoliosis Surgery from the Front (Anterior Surgical Approach)

For curves that are mainly at the thoracolumbar junction (T12-L1), the scoliosis surgery can be done entirely as an anterior approach.

·         This approach to scoliosis surgery requires an open incision and the removal of a rib (usually on the left side). Through this approach, the diaphragm can be released from the chest wall and spine, and excellent exposure can be obtained for the thoracic and lumbar spinal vertebral bodies.

·         The discs are removed to loosen up the spine.

·         Screws are placed in the vertebral bodies and rods are put in place to reduce the curvature.

·         Bone is added to the disc space (either the patient’s own bone, taken from the patient's hip, or cadaver bone), to allow the spine to begin to fuse together.

·         This fusion process usually takes about 3 to 6 months, and can continue for up to 12 months.

If this surgery is applicable because of the type of curvature, the anterior approach to scoliosis surgery has several advantages over the posterior approach.

·         Not as many lumbar vertebral bodies will need to be fused and some additional motion segments can be preserved

·         Saving motion segments is especially important for lower back curves (lumbar spine), because if the fusion goes below L3 there is a higher risk of later back pain and arthritis

·         Saving lumbar motion segments also helps prevent loading all the stress on just a few motion segments

·         This approach can sometimes allow for a better reduction of the curve and a more favorable cosmetic result.

  MEDWORLD INDIA

Our network hospitals have the most advanced spine surgery facilities. The spine surgeons here use minimally invasive and computer guided techniques in spine surgery. In a Minimally Invasive spine surgery the surgeon makes a few small incisions unlike the open surgery where a single large incision is made. Minimally Invasive spine surgery has several important benefits for the patients. If you have been advised spine surgery your first choice should be the latest minimally invasive technique developed by our world best hospitals in India. Most advanced Technology like Intra Operative MRI, Brain Suite and Computer Assisted Navigation System are deployed by highly trained surgeons for accurate and safe Spine Surgeries through a small incision.

Why should you choose to get Indian hospitals offer the best spinal surgery treatment in India at affordable prices. MedWorld india associated best spine surgery hospitals in India have the latest technology and infrastructure to offer the most advanced spine surgery at low cost.

Salient features of these hospitals are:

• Comprehensive management of spine disorder from birth defects to degeneration of tumor and trauma.
• Dedicated team of International trained and vastly experienced Spine Surgeons, Rheumatologists, Neurologist, Physicians and Physiotherapist.
• Expert evaluation of spinal problems by dedicated team of experienced spine Surgeons, Rheumatologists, Neurologist, Physicians and Physiotherapist.
• Latest Generation Diagnostic and Imaging facilities including dynamic digital X rays, Spiral CT scanning , MRI and Electrophysiology unit all under one roof.
• Physiotherapy and Rehabilitation by experts after the surgery help you regain functional abilities quickly helping in vastly improved overall results.
  

For more information visit:          http://www.medworldindia.com       
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  Please scan and email your medical reports  to us at care@medworldindia.com and we shall get you a Free Medical Opinion from India’s Best Doctors.
  
  
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  Mail Us : care@medworldindia.com
  
  

Treatment and Surgery options for Spinal Cord Injury : Best Spine Hospitals in India

There are a variety of treatment and surgery options for Spinal Cord Injury depending on the affected area of the spine.

Spinal cord injury

Is the result of a traumatic injury such as a bruise or contusion, a partial tear or a complete tear in the spinal cord. It can also result indirectly from damage to surrounding bones, tissues or blood vessels. 

Spinal Cord Injury Diagnosis

Spinal cord injuries are very serious. If you are suffering from any symptoms of spinal cord injury, it is very important to seek immediate medical attention. In order to diagnose your condition, your doctor will perform both a physical and neurological exam. If the location of the injury is not known, one of more of these tests will help locate the exact point of injury:

·         CT scan or MRI – shows the location and extent of the damage. These scans can also reveal internal problems such as hematomas or blood clots.

·         Spine X-rays – show damage or fractures to the bones in the spine

·         Myelogram – Dye is injected into the fluid-filled space between the bones in your spine. The dye is able to move through the space in order to allow the spinal cord and nerve roots to be seen more clearly. This is used in rare cases to find the source of a problem that was not detected by other tests.

·         Somatosensory evoked potential (SSEP) – Test which evokes response from the nervous system through magnetic stimulation. It can show if nerve signals are able to pass through the spinal cord, or if an injury is blocking the transmission.

Nonsurgical Treatment for Spinal Cord Injury
Since spinal cord injury is such a serious and time-sensitive condition, it is critical to seek treatment as soon as possible. Time between injury and treatment will have a huge impact on the outcome. Some nonsurgical treatment options for spinal cord injury include:

·         Methylprednisolone – Steroid medication used to decrease inflammation at the site of the injury as well as reduce damage to nerve cells. If given within eight hours of injury, you will experience mild improvement.

·         Immobilization – This is done to stabilize and/or realign your spine after injury. Immobilization can be accomplished by using metal braces and a body harness to keep your head from moving. A special bed or neck brace can also be used to secure your head and prevent movement of the spine.

·         Experimental treatments – Scientists are working on methods to prevent cell death, promote nerve regeneration and control inflammation.

Surgery for Spinal Cord Injury 
In many cases, spinal cord surgery is necessary to remove bone fragments, herniated discs, foreign objects, fractured vertebrae and anything that may be compressing your spine. Because there are different types of injuries and different sections of the spine that can be injured, there are many different types of surgery for spinal cord injury:

·         Lumbar discectomy – surgical procedure used to remove all or part of a herniated or ruptured disc in the lower part of the spine

·         Cervical discectomy – surgery used to remove one or more discs from the neck

·         Microdiscectomy – Minimally invasive surgery on a ruptured disc in the neck or back. This procedure aims at removing a small part of the ruptured disc in order to alleviate pain while avoiding any possible instability in the spine.

·         Spinal fusion – Surgical procedure for fusing or joining two or more vertebrae. There are different types of this surgery for different areas of the spine:

•Anterior Lumbar Interbody Fusion – In this procedure, the spine is operated on from the front. The surgeon removes a disc from the lower part of the spine and replaces it with bone graft. The desired result is for the two surrounding vertebrae to grow or fuse together into one solid bone.

•Posterior Lumbar Interbody Fusion – This procedure is virtually the same as the anterior fusion except that the surgeon approaches the spine from the back.

•Transforaminal Lumbar Interbody Fusion – In this procedure, the spine is approached from the side.

·         Laparoscopic Fusion – A minimally invasive surgical alternative to open surgery that requires a much smaller incision in the back to gain access to the spine. Recuperation time and pain levels are significantly reduced compared to other types of spinal fusion surgery.

·         Intradiscal Electrothermal Therapy – Minimally invasive treatment for lower back pain. This procedure utilizes fluoroscopic (x-ray) guidance and an electrothermal catheter to heat up the affected lumbar disc. The goal is to destroy pain receptors in the disc.

·         Surgical Decompression – A small portion of the bone over the nerve root is removed to allow more space for the nerve root while helping it to heal. There are different types of surgical decompression:

•Foraminotomy – The foramen, or opening where the nerve root comes out of the spinal column, is widened by shaving away a portion of the bone.

•Laminotomy – Partial removal of the lamina, or bony arches in the canal of the spine

•Laminectomy – Complete removal of the lamina, or bony arches in the canal of the spine

•Corpectomy – The entire degenerated vertebrae is removed and replaced by bone graft.

•Laminoplasty – The lamina, or bony arches in the spinal canal, is cut open on both sides to create an open flap to relieve pressure on the spinal cord. The bone flap is propped open with small wedges or pieces of bone.

·         Kyphoplasty/Vertebroplasty – Kyphoplasty and vertebroplasty are both minimally invasive procedures that treat pain and other symptoms caused by a spine fracture resulting from osteoporosis. Each procedure can also restore vertebral body height lost due to a compression fracture.

·         Anterior Cervical Disectomy and Fusion – Surgical procedure used to treat neck problems resulting from fractures, herniated discs and spinal instability.

·         Spinal Cord Stimulation – This procedure uses an electrical current to treat chronic back pain by implanting a small pulse generator in the back. The pulse generator sends electrical pulses to the spine in order to block the nerve signals which make you feel pain.

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Conditions Treated with Minimally Invasive Lumbar Fusion Surgery : Best Spine Surgery Hospitals in India

Lumbar fusion surgery is a procedure used to treat a variety of conditions of the lumbar spine (lower back). This article will focus on minimally invasive lumbar fusion, although open lumbar fusion incorporates some of the same steps. 

Conditions Treated with Minimally Invasive Lumbar Fusion Surgery

Lumbar fusion may be used to treat a variety of conditions. These include lumbar instability, spondylolisthesis, degenerated lumbar discs, back pain, fracture, tumor, recurrent herniated discs, and failed back syndrome, among others. The most common levels in the spine requiring treatment are L4-5 and L5-S1. Many patients requiring lumbar fusion surgery also have pinched nerves from herniated discs or spinal stenosis. As a result, the surgery is often performed in conjunction with micro lumbar discectomy or lumbar laminectomy. 

Lumbar spinal fusion is a common technique to help patients with back pain, who have failed non-operative treatment. Once you and your physician have decided that you need fusion of your lumbar spine, you should realize that there are many different ways this procedure can be done. The choice of which technique is best for you is dependent on what is wrong with your spine. Your surgeon may have more experience with fusion techniques from the front of the spine (anterior), the back of the spine (posterior), or some of the newer, less invasive approaches. These newer techniques are often called Minimally Invasive Spinal (MIS) surgery. The goals of all these techniques remain the same, to achieve a lumbar fusion, and lessen the patient's pain.

The most common method of spinal fusion involves the posterior approach, with an incision along the back of the patient's spine. Often, this procedure is used if bone spurs, thickened ligaments, or disc ruptures need to be removed to alleviate pressure on the nerves. The fusion procedure then involves placement of metal screws, rods and bone graft. Anterior spinal fusions require an incision through the abdomen. After removal of the degenerated disc, a metal cage with bone graft is usually placed between the spinal bones (vertebral bodies). Some patients will require both front and back procedures.

There are many new surgical techniques that are being developed to improve the results of lumbar fusions. Minimally invasive spine surgery for lumbar fusion is one of these newer techniques. MIS procedures have smaller incisions, cause less trauma to the surrounding normal tissues, and hopefully results in a faster recovery for the patient. One of these MIS techniques is a procedure known as extreme-lateral lumbar interbody fusion (XLIF). During the XLIF procedure the lumbar spine is approached from the side through a small skin incision. The surgery is performed through a muscle that lies next to the lumbar spine known as the psoas muscle.

With the XLIF procedure, approximately 2/3 of the disc can be safely removed. After the disc is removed, an artificial graft is placed in between the vertebrae, to allow the bones to fuse together. For a single level XLIF procedure, the surgery can be usually be performed in about an hour. Most patients stay in the hospital for 24 hours following the procedure, and do not require a brace. Occasionally, weakness may be noticed while lifting your leg after surgery. This psoas muscle weakness should return to normal fairly soon after surgery.

Not everyone is a candidate for this surgery, once conservative (non-operative) treatments have failed, you should consult a surgeon to see if you are an appropriate candidate.

What are the advantages ofminimally invasive lumbar spinal fusion?

The major advantage of all of these minimally invasive techniques is that there is less damage caused to the surrounding tissues. Unfortunately, in traditional spinal surgery it is necessary to cut through muscles and move them out of the way in order to reach the spine. This can cause a large amount of pain following surgery, and it can lengthen the recovery time. Instead of cutting and moving muscles, the minimally invasive techniques can more gently spread through the muscles to allow access to the spine. This is much less painful for the patient, and it does not require as long of a recovery period for the muscle to heal.

Another benefit of less muscle damage is less blood loss and thus a reduced need for blood transfusions using the minimally invasive techniques. There is often less need for narcotic pain medications following this form of surgery, and a shorter hospital stay.

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Nonsurgical Vertebroplasty Is Effective Treatment for Spinal Fractures

Vertebroplasty is a pain treatment for vertebral compression fractures that fail to respond to conventional medical therapy, such as minimal or no pain relief with analgesics or narcotic doses that are intolerable. Vertebroplasty, a nonsurgical treatment performed by interventional radiologists using imaging guidance, stabilizes the collapsed vertebra with the injection of medical-grade bone cement into the spine. This reduces pain, and can prevent further collapse of the vertebra, thereby preventing the height loss and spine curvature commonly seen as a result of osteoporosis. Vertebroplasty dramatically improves back pain within hours of the procedure, provides long-term pain relief and has a low complication rate, as demonstrated in multiple studies.

Vertebroplasty also known as Percutaneous Vertebroplasty is a spinal procedure in which bone cement is injected through a small hole in the skin (percutaneously) into a fractured vertebra with the goal of relieving the pain of osteoporotic compression fractures and providing strength to the bone. Vertebroplasty is used for patients with vertebral compression fractures due to osteoporosis, metastatic tumors, or benign tumors such as vertebral heamangiomas. It also provides vertebral stabilization when the lesion threatens the stability of the spine. Vertebroplasty can increase patient mobility, decrease narcotic needs, and prevent further vertebral collapse. 

If the vertebra isn't shored up, it can heal in a compressed or flattened wedge shape. Once this occurs, the compression fracture cannot be treated effectively. It is very important for someone with persistent spinal pain lasting more than three months to consult an interventional radiologist, and people who require constant pain relief with narcotics should seek help immediately.

Vertebroplasty is an outpatient procedure using X-ray imaging and conscious sedation. The interventional radiologist inserts a needle through a nick in the skin in the back, directing it under fluoroscopy (continuous, moving X-ray imaging) into the fractured vertebra. The physician then injects the medical-grade bone cement into the vertebra. Vertebroplasty takes from one to two hours to perform depending on how many bones are treated. The cement hardens within 15 minutes and stabilizes the fracture, like an internal cast.

Vertebroplasty is considered for patients with painful compression fractures in the spine, often caused by osteoporosis. Because the treatment often results in a dramatic decrease in pain, the advantages are numerous.

Decreased Pain : A compression fracture causes sharp and debilitating pain. Those suffering from these fractures are often prescribed bed rest and pain medication. Vertebroplasty reduces and in some cases eliminates the need for pain medication, and it also restores mobility in many patients.

Prevention of further vertebral collapse. The cement fills spaces in bones made porous by osteoporosis, strengthening the bone so that it is less likely to fracture again.

Recovery :

The patient recovery is quick as it is a minimally invasive surgery with very little blood loss and damage to surrounding tissues. The patients are kept under observation for 1-2 hrs after which they are discharged. They return to normal day to day activities within a week.

About Osteoporosis

Osteoporosis is characterized by low bone mass and structural deterioration of the bone resulting in an increased susceptibility to fractures. Osteoporosis is a condition where the bone density decreases with advancing age, due to deficiency of calcium and vitamin D. Osteoporosis makes the bones of the body weak and susceptible to fractures, especially of the spine. Approximately 85% fractures in old age are caused by osteoporosis and remaining 15% are caused by bone weakness caused by other conditions such as spread of cancer to the bones. Percutaneous Vertebroplasty is indicated for painful osteoporotic or neoplastic vertebral compression fractures refractory to medical therapy.

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Advantages of PELD (Percutaneous Endoscopic Lumbar Discectomy) : Best Spinal Surgery Treatment in India at Affordable Price

PercutaneousEndoscopic 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. 

Advantages

- Under the local anesthesia, the elderly patients or even the diabetes patients could tolerable the procedure.
- Cosmetic effects since it is minimally invasive spinal surgery.
- It preserves vertebrae and normal nucleus pulposus and removes only the lesional site so that there is no risk of evoking the neural adhesion. Bloodless surgery, no transfusion is required.
- It saves the time and the costs. 75% of the patients discharged on the same.
- Due to rapid recovery, comparing to open surgeries, it is recommendable for the workers or students with the desire of early return-to-work.

Surgical Techniques

- Patient is in prone position under the local anesthesia so as to communicate with the surgeons and nurses. The surgeon inserts the thin wire into the disc. With the 0.6cm (diameter) of endoscope, the surgeon could observe the inside with safety. With the better view under endoscope, minute forceps, radio-frequency, and Holmium-YAG laser, the surgeon could make the disc shrink so as to diminish the pain. This treatment, regarded as the third generation, is more advancing that the previous first, second generation laser therapy with following additional effectiveness.

- Minimized excision effect (with laser, as fine as hair, which could approach into the small and narrow spinal canal)

- Prevent lumbar pain effect (pain nerve that distributed to posterior annulus fibrosis)

- Disc diminishing effect (diminish the extruded disc)

- Disc intensifying effect (remodeling the collagen component of disc material)

- Hemostasis effect (coagulation) 

Indications

This surgical technique is in between the conservative therapy and open surgery. Therefore, either lumber disc herniation or extraforaminal stenosis is an indication, which shows no improvement after conservative therapy.

Prognosis

Successful rate is 93% and 7% showed the recurrence. The 7% recurrence was due to combined spinal canal stenosis. 

Most Advanced Minimally Invasive Percutaneous 

Endoscopic Lumbar Discectomy (PELD) Surgery in 

India  

                                                      

Our network hospitals have the most advanced spine surgery facilities. The spine surgeons here use minimally invasive and computer guided techniques in spine surgery. In a Minimally Invasive spine surgery the surgeon makes a few small incisions unlike the open surgery where a single large incision is made. Minimally Invasive spine surgery has several important benefits for the patients. If you have been advised spine surgery your first choice should be the latest minimally invasive technique developed by our world best hospitals in India. Most advanced Technology like Intra Operative MRI, Brain Suite and Computer Assisted Navigation System are deployed by highly trained surgeons for accurate and safe Spine Surgeries through a small incision.

Why should you choose to get Indian hospitals offer the best spinal surgery treatment in India at affordable prices. MedWorld india associated best spine surgery hospitals in India have the latest technology and infrastructure to offer the most advanced spine surgery at low cost.

Salient features of these hospitals are:

·         Comprehensive management of spine disorder from birth defects to degeneration of tumor and trauma.

·         Dedicated team of International trained and vastly experienced Spine Surgeons, Rheumatologists, Neurologist, Physicians and Physiotherapist.

·         Expert evaluation of spinal problems by dedicated team of experienced spine Surgeons, Rheumatologists, Neurologist, Physicians and Physiotherapist.

·         Latest Generation Diagnostic and Imaging facilities including dynamic digital X rays, Spiral CT scanning , MRI and Electrophysiology unit all under one roof.

·         Physiotherapy and Rehabilitation by experts after the surgery help you regain functional abilities quickly helping in vastly improved overall results.