Common Back Surgeries for Lumbar Disc Herniation : Best Spine Hospital in India

If you have a herniated disc, your symptoms may improve without surgery. But by how much? And by when? It’s possible to wait it out, and let nature takes its course by shrinking your disc and resorbing the herniated material. This process takes about a year and may require a lot of work on your part. Compare that to a successful back surgery, which may relieve your pain soon after the procedure is done.

If symptoms continue to interfere with your daily activities after you’ve tried conservative care for 6 weeks, your doctor may suggest surgery.

In many cases, a herniated disk is related to the natural aging of your spine.

In children and young adults, disks have a high water content. As we get older, our disks begin to dry out and weaken. The disks begin to shrink and the spaces between the vertebrae get narrower. This normal aging process is called disk degeneration.

Risk Factors

In addition to the gradual wear and tear that comes with aging, other factors can increase the likelihood of a herniated disk. Knowing what puts you at risk for a herniated disk can help you prevent further problems.

Gender. Men between the ages of 30 and 50 are most likely to have a herniated disk.

Improper lifting. Using your back muscles to lift heavy objects, instead of your legs, can cause a herniated disk. Twisting while you lift can also make your back vulnerable. Lifting with your legs, not your back, may protect your spine.

Weight. Being overweight puts added stress on the disks in your lower back.

Repetitive activities that strain your spine. Many jobs are physically demanding. Some require constant lifting, pulling, bending, or twisting. Using safe lifting and movement techniques can help protect your back.

Frequent driving. Staying seated for long periods, plus the vibration from the car engine, can put pressure on your spine and disks.

Sedentary lifestyle. Regular exercise is important in preventing many medical conditions, including a herniated disk.

Smoking. It is believed that smoking lessens oxygen supply to the disk and causes more rapid degeneration.

For most people with a herniated disk, low back pain is the initial symptom. This pain may last for a few days, then improve. It is often followed by the eventual onset of leg pain, numbness, or weakness. This leg pain typically extends below the knee, and often into the foot and ankle. It is described as moving from the back or buttock down the leg into the foot.

Symptoms

Symptoms may be one or all of the following:

• Back pain
• Leg and/or foot pain (sciatica)
• Numbness or a tingling sensation in the leg and/or foot
• Weakness in the leg and /or foot
• Loss of bladder or bowel control (extremely rare) This may indicate a more serious problem called cauda equina syndrome. This condition is caused by the spinal nerve roots being compressed. It requires immediate medical attention.

Not all patients will experience pain as a disk degenerates. It remains a great challenge for the doctor to determine whether a disk that is wearing out is the source of a patient's pain.

Common Back Surgeriesfor Lumbar Disc Herniation

Discectomy involves removing fragments of the disc that press on and irritate the spinal nerve root. Discectomy is the most common surgery performed for a low back disc herniation. It has about an 80% to 90% success rate for relieving radicular symptomssuch as sciatica, numbness, weakness and/or pain down one leg.

Discectomies may be full operations (called “open discectomies”) or they may be minimally invasive procedures. Due to technological advances in medical/surgical techniques, devices and equipment, the trend in surgery is toward the minimally invasive. Two types of minimally invasive procedures are the microdiscectomy and percutaneous arthroscopic discectomy.

If you are deciding which kind of discectomy to have, consider the skill set of your potential surgeon. Some doctors may insist on performing an open discectomy because they haven’t been thoroughly training in the minimally invasive types. Others may specialize in one type of procedure over the other. Check your doctor’s competencies and compare them with those of other surgeons before deciding who will perform the procedure.

Spinal fusion involves removing the disc and fusing the adjacent bones together. If you have instability in your spine or you’ve already had one or more discectomies, you may need a spinal fusion. Spinal fusion may require that hardware, such as plates and screws, be installed. It may also involve a bone graft. Doctors only rarely perform spinal fusions with microdiscectomies.

Surgery for herniated lumbar disc generally relieves leg pain with great success. It is less effective for relieving back pain, though. (Exercise often is the best way to manage back pain.) Along with leg pain relief, surgery may help stop your leg from getting weaker.

Speak with your doctor about the appropriateness of surgery for your herniated disc if you are unsure which treatment is right for you.

The results of microdiskectomy surgery are generally very good. The outcome of leg pain improvement is much more reliable than back pain and therefore this surgery is rarey performed for back pain only.

Most patients notice improvement over the first several weeks following surgery, but may also experience continued improvement over several months. Pain is typically the first symptom to improve, followed by improvement in overall strength of the leg, and then sensation. It is common for some patients to state that although pain symptoms are better, they still have a numb spot on their leg or foot.

Most patients will slowly resume normal daily activities over the first several weeks following surgery.

Over the last several years, there has been extensive research on lumbar disk surgery and patient improvement. One of the most publicized research projects in this area is the Spinal Patient Outcomes Research Trial (SPORT). The study followed patients with herniated disk from across the country. Half were treated with conservative measures, and half with surgery.

The initial outcomes for patients treated with surgery were much better than those who followed conservative treatment, including improvement in pain relief and function. At the 2-year follow-up, patients treated with surgery again showed improvements over those treated conservatively. However, over the course of the study, numerous patients did change their treatments. Your surgeon will be best able to explain what the actual study results are with any recommended approach for you.

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FAQ About Minimally Invasive Spine Surgery : Best Spine Surgery Hospital in India

When should Iconsider surgery?
Surgery should always be the last resort when it comes to treating spinal conditions in the neck and back. However, if various non-operative treatments have been attempted without improvement or worsening over a 6-12 month period, then surgical treatment seems reasonable for certain specific conditions such as spinal stenosis, sciatica, spondylolisthesis or degenerative scoliosis. The decision for surgery should be individualized to the patient and the patient’s symptoms, along with their level of function.


Am I a candidate for minimally invasive spine surgery?
The field of minimally invasive spine surgery continues to grow. Most surgeries today can be treated with some aspect of minimally invasive surgery. However, there are certain conditions that require standard open treatment, such as high-degree scoliosis, tumors and some infections.

The best options should be individualized to the patient’s diagnosis and overall patient condition. At UCSD we perform both minimally invasive spine surgery, as well as open-surgery, and choose the type of treatment that is best suited for the individual patient. 


Why do I need to get an MRI, CAT Scan and an XRay before I have surgery?
The integration of our newest technolgies that assist in MISS surgery often require that radiologic procedures be tailored to fit each operation and will often require a new scan.


How long willI be in the hospital?
I general, minimally invasive spine surgery decreases the hospital stay by one-half. In a typical endoscopic discectomy, the surgeries are performed in the same day, and the patients go home shortly after surgery on the same day.

For various types of lumbar fusion surgery, the patient typically goes home in 2-3 days, where previously they stayed in the hospital 5-7 days. Furthermore, the immediate post-operative period is marked by much less pain when using minimally invasive techniques.


When can I go back to work after minimally invasive back surgery?
The decision to return to work should be individualized to the patient, as well as the patient’s occupation. For patients with sedentary jobs, such as office work, a minimally invasive discectomy would allow that patient to begin part-time work within 1-2 weeks. For a larger surgery such as a fusion, this may take 4-6 weeks. Again, return to work is much faster using minimally invasive surgery vs. standard open surgery but this decision is individualized to special needs of each patient. 


How long is the recovery?
Recovery from each surgery is different. Some patients return to full activity in 6 weeks while other patients require more time. We encourage all patients to participate in a physical therapy program to safely begin the process of returning to all normal activities. 


After surgery, how long will my pain last?
On average, patients who have had minimally invasive spine surgery are discharged in half the time of traditional surgery and the pain usually follows this rule. Each procedure will have a differnent rate of recovery. 


Will I have totake pain medication after my surgery? Will I become dependent?

There is no evidence that post-operation pain treatment leads to addiction. 


Do I have to wear a brace?
Although most patients are provided a brace, this is for comfort only. The use of minimally invasive techniques that preserve muscle function, along with specialized implants that act as an internal brace, allows one to avoid having to wear a brace. Most patients find that the brace improves their pain for about 1-2 weeks, and thereafter it is only worn occasionally.


Will I need physical therapy after I get minially invasive spine surgery?
Physical therapy is an important component of a rapid recovery. This is individualized to the patient, but in most cases, physical therapy started 2-6 weeks after surgery, depending on the surgery performed and the patient’s overall condition. 


Do you use lasers for minimally invasive back surgery?
Minimally invasive spine surgery utilizes a wide variety of advanced techniques, including lasers, endoscopes, operating microscopes, as well as computer-assisted navigation systems, so that procedures typically done with a large, open decision can be done through small openings.

By necessity, advanced technologies are needed to accomplish the same task that we would otherwise do with an open procedure using more basic equipment. The decision to use one or other types of advanced technologies depends on the individual condition and the surgery performed.

Most Advanced Surgically Back Pain Treatments in India

MinimallyInvasive 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.

Minimally Invasive Surgery for Spine Tumors : Vertebral Fracture Treatments , Vertebroplasty and Kyphoplasty (Vertebral Augmentation)

Minimally Invasive Spine Tumor Surgery

Tumor is abnormal mass of rapidly growing cells without any physiological function. That means it does not perform any function for the body but derives its nutrition from the body.  It can occur anywhere in the body. The cause is unknown. Those tumors that are found in and around the spinal cord are known as spinal tumors. They may be primary tumors whose cells of origin is the spinal tissue, or they may be secondary tumors which have spread (metastasize) via blood stream from some other focus in the body.
 

The Spinal cord is covered by a layer of protective tissue called as meninges. The entire spinal cord is encased within the vertebral column.
 

The Spinal tumor are of three types depending on their location:

• Intramedullary – within the substance of the spinal cord.
• Intradural-Extramedullary- within the layers (meninges) covering the spinal cord
• Extradural- between the meninges an the vertebral body. Most of the spinal tumors are extradural.  

Tumors are also classified as benign and malignant. Tumors that are confined to a particular area in the body are known as benign tumors. Those tumors that spread rapidly to various parts of the body are known as malignant tumor. A tumor can initially start as a benign one and can convert to a malignant one in a few cases. The benign tumors are easier to treat as they are localized in their extent and their complete removal is possible. Whereas incase of metastatic or malignant tumor, the earlier they are detected, the better the chances of their removal. But in the malignant tumor the chances of recurrence are also there as they are rapidly growing tumors.
 

What are the Symptoms of Spinal Tumor?

Tumor may cause generalized symptoms in the body (like persistent low energy levels, unexplainable weight loss, lump formation, enlargement of lymph nodes, malaise, irregularities of menstruation in females etc) as well as symptoms pertaining to the affected organ in the body. In case of spinal tumor the patient may present with any of the following:

• Back pain, often radiating to other parts of the body and worse at night
  
• Loss of sensation or muscle weakness, especially in the legs
• Difficulty walking, sometimes leading to falls
• Decreased sensitivity to pain, heat and cold
• Loss of bowel or bladder function
• Paralysis may occur in varying degrees and in different parts of the body, depending on which nerves are compressed.
• Scoliosis or other spinal deformity resulting from a large, but non cancerous tumor
• Erosion and Destruction of vertebral body

Minimally Invasive Surgery for Spine Tumors

Surgery is considered minimally invasive when it involves small incisions (e.g. ½ inch) and minimal tissue disruption. Most minimally invasive procedures are done on an outpatient basis, meaning that the patient can go home the same day, and have relatively short recovery times.

Vertebral Fracture Treatments
Vertebroplasty and Kyphoplasty, also referred to as vertebral augmentation, are typically reliable procedures designed to provide pain relief for patients who have a vertebral fracture associated with a spinal tumor.

Vertebroplasty
This procedure involves inserting a needle through a small incision in the back so that a medical-grade bone cement can be inserted into a fractured vertebra to fill in the empty spaces and act as an internal cast to stabilize the bone. The treatment is designed to reduce pain, prevent further collapse of the vertebra, and restore the patient's mobility.

Kyphoplasty (Vertebral Augmentation)
Kyphoplasty also involves injecting bone cement into a vertebra, and involves the additional step of first inserting a balloon into the bone and inflating the balloon to create a cavity. This treatment is designed to stop the pain caused by a spinal fracture, and to stabilize the bone via an internal cast.

Transarterial Chemoembolization
This procedure involves a small incision in the thigh for access to the femoral artery. A catheter guided by a wire is directed through the vascular system to the tumor with the aid of imaging. Once the tumor is located, a chemotherapeutic agent is injected directly into the tumor to shrink or destroy the tumor to remove pressure on individual nerve roots or the spinal cord.

Recovery

Recovery after tumor surgery is a relatively slow process as the patient is weakened by the tumor and all the medications, chemotherapy and radiotherapy, he has been subjected to. Regular follow ups are required to detect any recurrence of tumor. Positive mindset combined with a strong support system can work wonders for the patient’s recovery. The patient should take nutritious diet to replenish his body reserves. 

Tumor or cancer as it is referred to in common man’s language, is a much feared disease. Many of those who are affected feel their world go crumbling around them with the mere mention of such a diagnosis. They go through a variety of emotional phases from denial to acceptance to defeat against the killer. Not only the patient but also the caretaker or the family member is totally drained out while attending to the patient. The picture may seem very dismal, but tumor patients still have a hope to live a normal life, provided the condition is detected early and the remedial measures are begun in time. We provide these patients with a world class diagnostic setup to detect tumors as early as possible and also advanced surgical techniques to treat them. We provide a multidisciplinary approach towards handling of such patients as they require medical, surgical, emotional and psychological support. We make the stay of the patient as well as that of the caretaker as comfortable as possible and try our best to allay their fears and anxieties. All this is offered at our hospitals at very affordable costs.