Spine Surgery - Procedure, Diagnosis, and Treatment

When Should I Consider Back Surgery?

A doctor usually recommends back surgery in the following conditions:

Pain in arms and legs: The spine consists of bones known as vertebrae, and the spinal cord runs through the center of these vertebrae. Some nerves travel between each vertebra and affect different areas of your body. If these nerves in the lower back get  damaged, you are likely to experience radiculopathy or pain that radiates to your arms and legs.

The most common causes of radiculopathy are herniated discs and bone spurs. When your disc herniates, the soft inner layer pushes through the outer layer and presses on the surrounding nerves. You can have pain in either your arms or legs, depending on which nerves it presses on.

Bone spurs form because of osteoarthritis in the spine. Osteoarthritis wears down the cartilage between the bones, and as a result, the bones rub together and form bone spurs.Surgery for radiculopathy is effective because it relieves the pressure on the nerves. So, if you have constant pain that radiates, it’s time to see a spine surgeon.

Constant Back Pain: If you have constant severe back pain, a doctor will  likely suggest back surgery. Most of the time, back pain is acute, and it lasts anywhere from a few days to less than 12 weeks, and there is no loss of function or symptoms that linger. However , chronic back pain continues for at least 12 weeks or longer, even after you’ve had treatment for the initial injury. There are different treatment options for back pain that include:

• Physical therapy
• Steroid shots
• Epidural injections
• Anti-inflammatory medications
• Lifestyle changes

If you’re still experiencing constant pain despite these treatments, you’ll need to see a spine doctor to discuss surgical options that will give you the back pain relief you need.

Experiencing reduced mobility: Constant back pain can also affect your ability to move normally. Chronic back pain often prevents you from taking hikes or playing sports. You may also find it limits your mobility at work, prevents you from doing your job, or affects your ability to work in certain industries.

If you’ve had to change your life completely because of back pain, then you must undergo spine surgery. Spine surgery can often reduce your pain, increase your mobility, and give you back control of your life.

Numbness or weakness in your legs: Having numbness or weakness in your legs is not a symptom to ignore for a long period. Conditions like spinal stenosis or narrowing of the spine can cause numbness and weakness. Spinal stenosis typically occurs with age and can happen in any part of your spine, but it most commonly occurs in your lower back or lumbar area.

If you have lumbar spinal stenosis, you will  likely notice trouble walking long distances. You are likely to experience pressure on your back. 

Usually, you won’t have many symptoms at first, but as the condition worsens, you can develop symptoms like

• Constant numbness and weakness in your legs
• Loss of sensation in your feet
• Burning pain that runs down your legs

Numbness and weakness can also be caused by disc herniation, tumors, or infections of the spine. If you have ongoing numbness or weakness in your legs, you’ll need to see a spine doctor for a thorough evaluation of your spine.

Spinal Deformity That’s Progressing: Spinal deformities result from abnormal curvature or rotation of the spine, and the most common spinal deformity in adults is scoliosis.

Scoliosis in adults often results from wear and tear to the back because of age or past back surgeries. You can have a minor curvature that continues to progress over time and eventually causes deterioration to your vertebrae and compresses organs like the lungs. If you’re already being treated for scoliosis and are feeling worsening symptoms of pain, numbness, weakness, and back stiffness, talk to a doctor about your surgical options.

Spinal Fracture: Severe back injuries can result from car accidents, a fall from a significant height, or a sporting event, and many times, a severe back injury results in a spinal fracture. In some cases, automobile accidents cause extension fractures which occur when vertebrae tear apart. You can also get a transverse process fracture where the spine bends or rotates sideways.

Treatment depends on the severity of the fracture, and it often takes up to 12 weeks to heal. You may require physical therapy and need to wear a back brace. However, sometimes conservative treatments aren’t enough, and you can often have lingering pain, along with numbness and tingling. If you have a spinal fracture, talk to a surgeon right away. There are minimally invasive options like laser spine surgery that can fix the damage and speed up the recovery process

Diagnostic Tests for Spine Disorders

Few diagnostic tests to understand the severity of the condition and identify any underlying health condition that may complicate the surgery. Some common diagnostic tests are as follows:

• X-ray: X-rays can help study the structural anatomy of the hard tissues of the spine to diagnose spine dislocation, kyphosis, scoliosis, bone spurs, disc space narrowing, vertebral body fracture, spinal collapse, or erosion.
• Magnetic resonance (MR) imaging: MRIs help diagnose aberrations of the soft tissue components of the spine, such as the spinal cord and nerves.
• Computed tomography (CT) scan: CT scans provide a detailed view of both hard and soft tissues of the spine to diagnose abnormalities of the vertebrae, spinal cord, spinal nerves, and other soft and hard tissues.
• Bone Scan: For older patients or those at risk of osteoporosis, a bone scan (DEXA scan) may be performed to assess bone health and risk of fractures.

How to Prepare For Spine Surgery?

Spine surgery requires preparation on both physical and mental levels. The doctor is likely to provide the patient with all required guidance depending on the severity of the damage. However, here are a few points that may come in handy for anyone planning spine surgery: 

• Gather all necessary information about spine surgery: The key to preparation for any surgery is being well informed about it. Talk to the healthcare provider and the medical staff, and acquire all important information about the procedure, medicines, cost, and anything that comes to your mind. The more well-informed a person is about the surgery, the better he/ she is likely to do postoperatively.
• Continue to move: It is tough to live with constant back pain. Even then, a doctor usually recommends being physically active as much as possible. Going stagnant may add to complications during the surgery. Stay physically active, and try to achieve a healthy weight. This can speed up the recovery process and enhance blood circulation too.
• Avoid anti-inflammatory drugs: You must avoid taking drugs like ibuprofen, naproxen, and aspirin before the surgery. Blood thinners can increase the risk of complications during the surgery. If you are taking any over-the-counter pills, you must inform your doctor.
• Keep realistic expectations: The surgery is not a guaranteed cure for the condition. Although it improves the injury symptoms to a great extent, a lot also depends on the person’s dietary and lifestyle habits.

What is the Procedure of Spine Surgery?

Endoscopic spine surgery is a specific type of spine surgery. It  is a minimally invasive procedure for treating spinal conditions. It involves the use of an endoscope, which is a thin, flexible tube with a camera and light source at its tip.

Prior to endoscopic spine surgery, a doctor recommends a comprehensive evaluation, including a physical examination and diagnostic tests. A surgeon explains the procedure, discusses the associated risks and benefits, and addresses any questions you may have before the procedure. The surgery is performed under the influence of general anesthesia, rendering you unconscious throughout the procedure. In some cases, local anesthesia with sedation may be used instead.

During the surgery, a surgeon makes small incisions, usually less than an inch in length, near the affected area of the spine. Through these incisions, specialized instruments and a small endoscope is inserted. The endoscope helps in providing real-time visual images of the surgical site on a monitor, enabling the surgeon to observe the affected area, including the spinal discs, nerves, and surrounding tissues, without the need for a large incision. 

Using the endoscopic instruments, the surgeon assesses and prepares the target area. This may involve removing a small portion of the bone or soft tissue to reach the spinal structures causing compression or instability. The specific steps usually depend on the purpose of the surgery, such as decompression, fusion, or disc herniation repair.

Once the surgeon has gained access to the affected area, they carry out the necessary treatment or repair. This may include removing herniated or damaged disc material, repairing a disc, fusing vertebrae together, removing bone spurs, or performing other corrective procedures. After completing the necessary surgical steps, the surgeon removes the instruments and closes the incisions. Typically, the small incisions can be closed using sutures or adhesive strips, often without the need for stitches.

Following the surgery, a healthcare provider takes you to a recovery area, where you are monitored as you regain consciousness from anesthesia. Pain medication and supportive measures may be provided to manage any discomfort. The length of your hospital stay will depend on the extent of the surgery, and you may be discharged on the same day or after a short period of observation.

After endoscopic spine surgery, a doctor usually prescribes a rehabilitation program to aid in the recovery of strength, flexibility, and mobility. This may involve physical therapy and specific exercises. Your surgeon provides instructions for postoperative care, including any restrictions or limitations on activities, and schedules follow-up appointments.

Benefits of Minimally Invasive Spine Surgery (MISS)

The benefits of MISS are as follows:

• Lower risk of complications: In traditional spinal surgery, a surgeon makes a large incision to reach the affected area of the spine. The possibility of complications is high, including excessive bleeding and the possibility of infection in open surgery.  In minimally invasive surgery, small incisions are made so there is less opportunity for complications. Moreover, because the incisions are smaller, there is a lower chance of blood loss. Also, ue to less potential for complications, minimally invasive spinal surgery can be performed in an outpatient facility.
• Decreased Risk of Muscle Damage: Minimally invasive spine surgery helps in supporting and stabilizing the spine. While open surgery results in pulling muscles away from the affected area of the spine, which can result in damage to muscle and soft tissue.  Minimally invasive surgery does not involve the cutting of muscles or the pulling of muscles to the same extent.  Therefore, there is a lower chance of damage to the muscle and surrounding area.
• Faster recovery: Due to the smaller incision, recovery time of minimally invasive spine surgery is significantly low as compared to major surgery.  Moreover, with little to no muscle damage, patients after spinal surgery can often be discharged much quicker. In many cases, patients are discharged within a day of the procedure.  Therefore, recovery time is quick and much easier.

• Less painful process: Spinal procedures are usually performed to help relieve compression of the spinal nerves that causes pain in the patient’s back, arms, legs, or other areas of the body.  Traditional, open surgery can cause significant  discomfort and pain because it involves a larger incision. Patients who undergo minimally invasive spinal surgery often suffer less pain throughout each aspect of the procedure.  They may also experience less postoperative pain, reducing the need for pain medications post-surgery.

What are the Risks and Complications of Spine Surgery?

Like any surgical procedure, spine surgery also carries certain risks and complications. The potential complications of spine surgery include:

• Infection: There is a chance of infection caused by bacteria or fungal organisms. A doctor usually suggests antibiotics to the patient before, during, and often after the surgery to lessen the risk of infections.
• Pseudarthrosis: It is a condition in which there is not enough bone formation, and a spinal fusion does not completely heal. In such cases, a second surgery may be required to obtain a solid fusion. The chances of patients of pseudarthrosis are high in patients who smoke.
• Nerve damage: There is a chance of nerve or blood vessel damage during the surgery. However, these complications are very rare.
• Blood clots: There is a rare chance of the formation of blood clots in the legs (deep vein thrombosis) after surgery. They pose a significant danger if they break off and migrate to the lungs.
• Bleeding: In some cases, a certain amount of bleeding is expected, but this is not typically significant.
• Pain at graft site: In some rare instances, patients experience persistent pain at the bone graft site.
• Recurring symptoms: In some cases, patients may experience a recurrence of their original symptoms.

Some long-term complications involved in spine surgery are as follows:

• Spinal instability and pain due to implant screws loosening
• Non-union of the spinal bones that were fused together
• Implants breaking due to excessive forces on the spine
• Injury and degeneration to the facet joints 
• Spinal muscle injury

What is the Average Cost of Spine Surgery In India?

The average cost of spine surgery in India typically ranges from around INR 150000 to INR 370000. This is the average cost of surgery, the final cost can vary depending on various factors, including:

• Type of spine surgery
• Cost of medication
• Choice of the hospital
• The severity of the spinal condition
• Cost of diagnostic tests
• A consultation fee of an orthopedic surgeon
• Type of anesthesia
• Patient’s age and overall health condition
• Insurance coverage

What to Expect After Spine Surgery?

Recovery and results after spine surgery can vary depending on the type of surgery performed, the specific spinal condition being treated, and how well they follow postoperative instructions. Here are some general guidelines to follow after spine surgery:

• After spine surgery, take good care of the spine. Begin with short walks and gradually increase the distance and time. 
• Moderate exercise enhances muscle toning and builds strength. Some of the exercises to do after spine surgery include core-strengthening exercises, upper and lower extremity exercises, breathing exercises, etc. However, avoid twisting, lifting, and bending. If you have had a spinal fusion, avoid lifting weights. 
• Eat a well-balanced diet rich in fruits and vegetables. Since you will be less active physically, do not load the body with high calories and fatty foods. Healthy eating is crucial for a smooth recovery.
• Follow the advice of the healthcare provider for bathing and incision care. Typically, doctors recommend keeping the surgical site clean and dry for 3-4 days. Avoid getting into the bathtub or the swimming pool until the doctor deems fit.
• Take medicines for pain management after the surgery as recommended by the doctor and make sure there are no gaps. Do not take any medicine without informing your doctor.
• Wear a postoperative brace if the surgeon prescribes one. The brace provides support to the neck and back and limits movements of the spinal levels. 
• Ask your surgeon what is the best position to sleep in without hurting the back, and try to follow it. Ideally, the following tips help relieve the stress from the back and the adjacent body parts.
• Place a pillow under the knees or the back to keep the hips slightly bent, Don’t get up suddenly from the bed. Use the ‘log roll method.’ While getting up, push your arms and legs rather than exert pressure on the waist or back.