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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Spinal Fusion Surgery Types, Why It's Done ?

Medical professionals in India have recently given a new hope of life to all those patients suffering from chronic lower back pain  and who have not responded to physical therapy or  medical intervention. Most low back pain can be effectively managed with a variety of helpful interventions. Like Physical therapy, weight loss, smoking cessation and  medication  injections.

In case the above treatments do not work, the  best long-term outcome could be achieved with a Lumbar Fusion.

Lumbar Spinal Fusion (Arthrodesis)

Lumbar spinal fusion is surgery to join, or fuse, two or more vertebrae in the low back.

Spinal fusion is major surgery, usually lasting several hours. There are different methods of spinal fusion.

• Bone is taken from the pelvic bone or from a bone bank. The bone is used to make a bridge between vertebrae that are next to each other. This bone graft helps new bone grow.
• Metal implants are usually used to hold the vertebrae together until new bone grows between them.

Doctors at MedWorld India affiliated Hospitals in India have expertise and vast experience in performing  Spinal Fusion - an Advanced minimally invasive surgery  is designed to stop the motion at a painful vertebral segment, which in turn should decrease pain generated from the joint. A severely degenerated disc between two vertebral bones or to a "slippage" of the spine bones (which is referred to as "spondylolisthesis"). Slippage of the bones results in misalignment of the spine and possible entrapment of the spinal nerves.

There are many approaches to lumbar spinal fusion surgery, and all involve adding bone graft to an area of the spine to set up a biological response that causes the bone graft to grow between the two vertebral elements and create a fusion, thereby stopping the motion at that segment. Other circumstances exist in which a fusion may best treat the source of back and leg pain. A lumbar fusion may be recommended for diagnoses such as a recurrent disc herniation, scoliosis or curvature of the spine, or for a traumatic injury of the spine such as a fracture. All of these different conditions can cause back and leg pain.

The procedure is performed in an advanced surgical center with Intra-operative MRI  guidance. The patient is monitored with an electrocardiogram, blood pressure cuff and blood oxygen-monitoring device.

Medical evaluation includes a physical exam. Diagnostic tests such as MRI (magnetic resonance imaging), steroid injection or discography may be conducted to diagnose and locate the symptomatic disc herniation and determine if the procedure is appropriate.

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Spinal Disc Protrusions do not require Open Spine Surgery

Percutaneous Disc Nucleoplasty is minimally invasive surgery to reduce the volume of a bulging or herniated disc. In both cases the spinal disc puts pressure on a nerve root or the spinal cord and causes back pain or sciatic pain.

Spinal Disc Protrusions do not require open spine surgery

Many patients with back pain show no clear indication of a herniated disc. However with MRI investigation protrusion of the intervertebral discs can be diagnosed. This protrusion can put pressure on nerves or the spinal cord and can cause persistent, or stress-related chronic back pain. Normally this kind of back pain (lumbar or cervical), responds well to conservative treatment options.

When will your neurosurgeon consider Nucleoplasty?

If after six weeks, conservative treatment has not been successful, your spine specialist should consider an intradiscal procedure: The disc protrusion can be reduced by treating the liquid core of the spine simply by using an injection needle. This needle (cannula) allows a radiofrequency instrument to enter the core of the disc, thereby avoiding all the surgical risks associated with open back surgery. This is essentially the principle of the Nucleoplasty.

Nucleoplasty, as a minimally invasive treatment, covers only smaller disc herniations or disc bulges that have not yet broken through the solid fibre ring of the disc and are therefore are not accessible via an open surgical procedure (surgical removal of the disc material).

Endoscopic Nucleoplasty is safe for patients and is a minimally invasive procedure, which produces very good outcomes, without the risks and postsurgical complications associated with open back surgery.

Disc Nucleoplasty is performed on an outpatient basis, with minimal anesthesia requirements. Fluoroscopic guidance is employed as an introducer needle is placed at the nucleus/annulus junction. A SpineWand is introduced through the passage way, and advanced into the disc nucleus. Using Coblation, tissue is then removed by either creating channels (lumbar spine) or spheres (cervical spine). After sufficient tissue is removed, a bandage is placed on the skin and the patient is discharged home. Patients are then usually placed on a routine rehabilitation program.

Nucleoplasty is recommended for patients who have not responded to rest, medical intervention (including steroid injection), and/or physical therapy.

There are many people across the world who suffers from slipped disc problem. In 90 per cent of these cases, the disc prolapsed is contained or limited to the disc space and are not suitable for the traditional discectomy surgery involving the complete removal of the diseased disc. The open surgery is an overkill leading to unsatisfied results, more complications and costly procedure.

In such clinical circumstances, percutaneous treatment also known as disc nucleoplasty has emerged as the best alternative. Moreover the cost of Disc Nucleoplasty at Medworldindia affiliated hospitals in India is minimal. Conventionally the disc prolapse is treated with bed rest and analgesics but with limited relief.

Many successful Nucleoplasty procedures have been performed in India. This minimally invasive approach to treating contained disc herniations has helped most of the International patients return to active and productive lives with effective cost savings. 

Expert Neuro and Spine Surgeons in India who have ample experience in performing this procedure said that, “Spinal Surgery is fast becoming a major sub-speciality in neurosurgery”. Disc nucleoplasty is an innovative percutaneous method of healing disc disease. Disc prolapse can occur in lumbar as well cervical region causing low back pain, radiating pain and neck pain respectively. Related symptoms are excruciating pain, numbness, tingling sensation in hands and legs, burning and weakness of the limbs. The patient will have restricted movement, walking, bending and doing normal day to day activities becomes very difficult. The severe pain results in incapacitation leading to loss of man hours.

What are the advantages of minimally invasive lumbar spinal fusion?

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 of minimally 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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Scoliosis Surgery has Several Advantages over the Posterior Approach

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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