When is spine surgery considered a treatment option?
Spine surgery is offered as a treatment option to patients suffering from chronic pain due to –
- Disc herniation (ruptured or slipped disc)
- Spinal stenosis (narrowing of the spaces within the spine) – Surgery is performed to make the spinal bone canal more spacious and to relieve strain on the nerves
- Spinal fractures or spondylolisthesis (one vertebra slips forward over another) – Surgery is done to stabilise the unstable joint
- Scoliosis and kyphosis (S or C-shaped bend of the spine) – Surgery is aimed at realigning the spine
- Overgrowth of vertebral bone – The excess bone is removed surgically
- Spinal infections – The infected tissue is removed and the area is cleaned thoroughly to promote blood flow and healing
What are the types of spine surgeries?
- Microscopic discectomy – One of the most commonly done spine procedures, patients with a lumbar herniated disc undergo a microdiscectomy, commonly known as a microlumbar discectomy (MLD). The intervertebral disc that has herniated or protruded and is crushing the travelling spinal nerve root is removed during surgery. Minimally invasive microscopic lumbar discectomy helps in early mobilisation and return to day-to-day activities as well as pain reduction
- Laminectomy: This is done by creating more space in the spinal canala by eliminating bone spurs and tissues linked to spine arthritis. Typically, a tiny portion of the lamina, the rear of the spine’s small bones, must be removed (vertebrae). To relieve strain on the spinal cord or nerves, laminectomy enlarges the spinal canal and is frequently performed along with decompression surgery. People who have arthritis in their spines may develop bony overgrowths within the spinal canal, which might result in this pressure
- Laminotomy – During this surgery the surgeon creates an incision close to the affected spinal level. A retractor will be used to shift your skin, fat, and muscles to the side once the incision has been done so the surgeon can access your spine. The lamina and thicker ligaments are then cut away or removed to create more space around or close to the compressed nerves. After that is finished, the retractor is taken out and the wound is sutured shut
- Foraminotomy – This is the removal of bone from the region around the neural foramen, which is the canal through which the nerve root leaves the spine. This approach is employed when disc degeneration has resulted in the foramen’s height collapsing and pressing against a nerve
- Spinal fusion –This process consist of the following steps –
a. Incision. One of three places—your neck or back immediately over your spine, on either side of your spine, or in your abdomen or throat (in case the surgeon wants to access the spine from the front)—will be incisioned by the surgeon in order to obtain access to the vertebrae that will be fused
b. Bone graft preparation:The bone grafts that actually fuse two vertebrae together may originate from your own body, typically from your pelvis, or from a bone bank. If your own bone is being used, the doctor will create an incision above your pelvic bone, take a small amount of it out, and then sew it up
c. Fusion. The surgeon inserts the bone graft material between the vertebrae to firmly fuse them together. Metal plates, screws or rods may be used to hold the vertebrae together while the bone graft heals
- Disc replacement – In lumbar artificial disc replacement, the prosthetic or artificial disc is placed and instead the worn or damaged disc material between the vertebrae, is removed. In contrast to some other treatments, such as spinal fusion, the procedure’s objective is to ease back discomfort while preserving a wider range of motion than is normally permitted
- Deformity correction – Deformity treatment involves straightening a bone that has been abnormally bent or twisted. The arm, leg, or foot has normal alignment and function after the bone has been straightened. There are two ways to fix deformities:
During a surgical procedure (called acute correction)
During the course of a few weeks or months, gradually (called gradual correction). Spine deformities such as scoliosis, kyphosis, trauma are corrected
- Dynamic stabilisation – This is considered to be an alternative to typical spinal fusion surgery which involves stabilising the spine with flexible materials to provide the spine more motion. Because it helps lessen some of the issues associated with metal implants like disc degeneration in the discs close to the fusion site, dynamic spine stabilisation is an area of lumbar spine surgery that is expanding
- Minimally invasive spine surgery (MISS) – Minimally invasive spine (MIS) surgery aims to relieve pressure on the spinal nerves and stabilise the vertebral bones and joints for disorders like spinal instability, ruptured discs, scoliosis, malignancies etc. It can be quicker, safer, and less painful than open spine surgery
- Endoscopic spine surgery – This involves treating your spinal problems without opening up the spine. Adolescent disc herniations can be successfully treated with endoscopic spine surgery, especially in physically fit, active individuals who compete in sports that need minimal tissue trauma and rapid functional recovery
How do I prepare for spine surgery?
If you report to the hospital with a complaint that is suggestive of a spinal condition, your doctor will first take a medical history and physically examine you to identify the symptoms and signs and to find out the cause of your discomfort or pain.
You may be advised to undergo multiple tests including X-rays, MRI and CT scan to identify the damaged area and to assess the extent of the damage.
After diagnosis, if spinal surgery is your treatment plan, you may have to get admitted to the hospital prior to the surgery for further tests and planning.
Blood tests, electrocardiogram (ECG) and other tests would be performed as per requirement.
You will be required to stop eating and drinking food and fluids at least about 8 hours before the surgery. You have to avoid taking your diabetes medicines and blood thinners (aspirin (ecosprin), clopidogrel, dabigatran, rivaroxaban, heparin etc.) but may be required to continue your hypertension/thyroid medicines on the day of surgery. Do not forget to talk to your doctor about all the medicines you take and tell them about your complete medical history before the procedure.
What happens after the surgery?
You may experience mild pain and discomfort for which you will be prescribed painkillers by your doctor. You may have to stay in the hospital for 1 to 5 days before you get discharged.
You can return to regular movements and activities usually 4-6 weeks after surgery. Complete pain relief may be immediate or may take up to 6 months, depending on the duration and severity of illness. In chronic cases and extreme damage, recovery/prognosis may be guarded. Physiotherapy sessions are a must for early post surgical recovery
A back brace or corset can be used to support your back while sitting and walking. Avoid bending at the waist and lifting heavyweights. It’s crucial to adhere to the rehabilitation guidelines. Ankle pump exercise and chest exercises in the immediate postoperative period will help in the prevention of dreadful complications like embolism/chest infections.
What are the possible complications of spine surgery?
- Excessive bleeding
- Formation of blood clots in legs (Deep Vein Thrombosis) or lungs
- Nerve injuries
- Anaesthetic or drug reaction
- Persistent pain
- Pulmonary embolism
What can I do to prevent post-surgery complications?
- Performing deep-breathing exercises to prevent pneumonia
- Ankle and calf exercises will help prevent blood clots in your legs
- Anti-embolism hose (heavy white stockings) worn on your legs to help improve circulation
- Devices such as sequential compression devices shaped like ‘sleeves’ can be wrapped around your legs, from the ankles to the thighs, which also helps improve circulation in the legs
What are the benefits of spine surgery?
A few benefits of undergoing spine surgery include –
- Relief from pain
- Improved mobility
- Improved physical fitness
- Improved muscle power (depending on the stage of the disease)
Will my baby require additional nutritional supplements?
Compared to term babies your child will have greater nutritional needs. Doctors may recommend further supplements like –
- Additional vitamins and minerals
- Formula milk specifically created for preterm babies
- Additional nutrients from a tube