Gardening is favourite occasional pass time for some of us and crucial daily part of life activity for some. Whether you like gardening or not, the activities involved in gardening like leaning over, lifting pots pulling weeds etc can take a big toll on your back.  After such strenuous activities you may notice a small pull in your back, stiffness or severe pain. This becomes all the more crucial for middle aged and elderly with some amount of pre-existing wear and tear in their spine. While you enjoy your gardening, it is also prudent that we act responsible spine wise to avoid accumulating more injuries. The following are some of the tips to avoid pain and back injury.

1.Maintain good hydration; Hydration is one of the key components of muscle function. This is all the more important if you are spending long hours in the garden. Muscle cramping after gardening work can be one of the signs of in adequate hydration. To avoid this, it is important to maintain hydration before, during and after the gardening activities

2. Warming up: Just like any other physical activity (like exercise) gentle back and limb stretches will help the muscles charge up before the anticipated strenuous activity.

3. Frequent breaks: Repeated actions required during gardening activities, like weed removing, digging through sand can put a lot of strain on upper limbs and neck. More so if done in quick succession. To prevent such repetitive overload, it is advisable to take frequent breaks.

5. Switching between tasks and staggering the activities over different days. Instead of doing all strenuous activities on the same day, it makes sense to schedule such activities on different days based on the severity of the stress/muscle work involved.

6. Being Appropriately dressed for gardening. Shoes with adequate support are required if working on uneven surfaces. Too tight or too loose wear are best avoided.

7. Follow proper ergonomic positioning while working. Sitting a gardening stool is better than standing and hunching over for long hours. It is better to use gardening mats and sit on them for ground/floor level activities.

8. Ask or recruit help: This particularly applicable for elderly and een younger individuals with previous back injury. Know your limitations. Heavy lifting or shifting large stones or pots is best outsourced to professional help.

9. Know when to stop- If you are experiencing severe pain or pain as become and aevery day event related to the gardening activity, it is best to stop and ask for professional help. Get back to gardening only after professional advice form your spine specialist.

I hope the above tips makes your gardening days more fruitful. Don’t let your back or neck pain hinder your expectations/ activities. All the best.

Dr Shashidhar B K

Spine Surgeon Bangalore

Phones have revolutionized our lives and infiltrated all spheres of our life from education to recreation to vocation. It is more than just a means of communication; it has become an inseparable part of our life- like an appendage attached to our bodies. However, smartphones have also become a reason for specific health concerns, including those that can affect our spine health. The slouch posture we use during smartphone use only adds to the stress on our spines due to overuse. In this article an outline of the spine issues due to smartphone use is discussed.

On an average the human head weighs approximately 10to 12 pounds of pressure, so rather it’s a heavy force our neck is designed to carry. The weight transferred to our spine via the neck also increase progressively in relation to the tilt angle of our neck. It has been shown that the more we lean forwards higher the equivalent forces transferred to our neck. For example, if we lean forward to an angle of around 60 degrees (as we do sometimes while we slouch on our phones) the weight transfer forces can increase up to 60 pounds. Roughly, pressure of around 10 pounds is transferred to our shoulders for every inch our head is tilted forward.

These forces are specifically transferred via our tendons, ligaments, muscles and the intervertebral discs (Shock absorbing cushions between the bones of spine). These structures take on the damage of the forces transferred over time. Most of us tend to slouch while using our phones subconsciously as our posture becomes involuntary with time. This form of unnatural slouching posture puts considerable strain on the structures of our neck and low back. These forces are particularly harsher when such posture is maintained for longer durations and consistently over longer periods of time. Our posture is more than just aesthetics. Good posture is protective shield against pain also. Poor posture due to constant and improper use of back and neck pain, can be a significant cause of disability.

Over longer periods, during our lifetime such poor posturing can lead to a plethora of other problems beyond our spine. These include Carpal Tunnel Syndrome (may lead to disabling pain, tingling and numbness in the fingers and palm of the hand), heart burn(acidity), circulation complications over longer time can lead pain in knees and other joints too. Digestive problems can also be attributed to hunched posture as our internal organs are squeezed into smaller space owing to hunching. In elderly with an already hunched spine, hunched posture can affect breathing also. Slouched posture while reading books as effects similar to slouched using of smartphones.

The above information helps us to make intelligent choices regarding our smartphone use It is advisable to take frequent breaks from excessive use of screens, be it smartphones or computers. It is easier said than done for professionals working on computers. For such professionals it is advisable to   pay strict attention towards proper posture. An ideal spinal posture is one where spine is not slouching, adequate back support is there for your lower back, the screen is at the level of your eyes (if its smartphone- holding it up to the eye levels) and the posture is frequently changed. Simple stretches out of the chair should be practised every half an hour to one hour. Smartphones are definitely a boon, its in our hand not to run into a curse. Little attention to our posture, can go a long way in avoiding the curse. All the best.

Infections of the spine are relatively rare compared to other spine conditions like slip disc. But if a spinal infection happens, it can cause significant damage which can cause paralysis or sometimes even be life threatening if not treated at the earliest. Spinal infections can affect the bones (vertebrae), the discs (cushions between the bones) and the fluid or the soft tissues in and around the spine.
Back pain or tender back is the usually the first presentation of spinal infection. However not all back pains are caused due to infections. The symptoms which when associated with back pain can serve as indicators of infections are: Back pain which is severe at night, fever and chills, Sudden mobility limitation with severe muscle spasms, accompanying headaches, weight loss, pain or difficulty while urinating, abdominal pain. Some spinal infections can also cause neurological problems. Symptoms of neurological issues related to a spinal infection may include loss of balance, weakness, vision changes, or an inability to speak, numbness and the inability to move, walk, stand or sit.

Causes

Spinal infections are usually caused by bacteria. Occasionally associated with other organisms like fungi. Infection from other parts of the body can reach the spine via blood stream or infection can directly reach the spine by direct spread. Urinary tract infections or chest infections (like pulmonary tb) can spread to the spine. Once it reaches the spine infection commonly affects the spinal discs. Once discs are involved, they begin to erode and collapse, with gradual spread of infection to other structures in spine, which results in back pain due to the inflammation. When the infection reaches the nerves and starts pressing on the nerves, it can result in weakness of the legs or arms with shooting radiating pain like sciatica.
Other predisposing factors for spinal infections include conditions which result in decreased immunity like prolonged steroid use, advanced age, HIV, intravenous drug use, cancer, malnutrition and diabetes.

Diagnosis

Blood tests and imaging (radiology play a major role in diagnosis of infections. Blood tests include – Complete Blood count, ESR and CRP. Imaging studies include x-rays, MRI and CT scans. MRI is the most important investigation in characterisation of infection. Use of contrast injection (given in veins of the patients) helps in better delineation and identification of infection in MRI. CT scans help in identifying the amount of bone destruction, which in turn helps in surgical planning if indicated. Biopsy is one of the key components of spine infection diagnosis. Biopsy is a procedure of collecting sample of the infection tissue for diagnosis. Biopsy can be done by open method in operation theatre or under CT guidance under local anaesthesia in the radiology room. Biopsy helps to identify the type of bacteria and also helps to rule out some cancer which can present very similar to an infection. One of the problems with biopsy, is the result can come out negative, needing a repeat biopsy procedure in some instances.

Treatment

Both surgical and non-surgical methods can be used for treatment of spinal infection based on the individual case. If there is no imminent or present danger to the structure of spine and the function of the nerves, antibiotics based on the culture reports of the biopsy are the usual line of treatment. In more extensive cases where the structure of the spine sis damaged or the nerves are in danger or already damaged – surgical evacuation of infective pus with stabilisation becomes the option. If a spinal infection can be treated using non-surgical methods, a patient is usually started on an antibiotic or anti-fungal therapy. This is often conducted through a long-term intravenous treatment and possibly extended hospital stay. If non-surgical treatments fail to control the infection, or it’s determined that the infection is too deeply involved in the spine, then also surgery will be needed. The surgery is meant to remove the infection and clean the affected area. Surgical intervention can also permit a closer look that will ensure all of the infection is removed, plus allow better blood flow to the affected areas and stop any further neurological damage.
Though it is true that all back pains are not infections, it is true that all back pains need to be evaluated to by spine health expert due the impact which back pain can have if caused by more sinister diagnosis. It is important to remain vigilant about such back pains as described in the blog and meet the nearest spine surgeon or spine specialist at the earliest.

What is Spinal Nerve Compression?

Spine specialists refer to any condition that applies pressure to the spinal cord or nerve roots as spinal nerve compression. A variety of factors can cause spinal nerve compression. The spinal cord is a bundle of nerves that carries messages between our brain and the rest of our body. The spinal cord is protected by a series of bones known as vertebrae which are collectively known as the spinal column. The spinal column contains the spinal canal which is like a tunnel or passageway for the spinal cord. The spinal nerves radiate outward from the spinal cord to the rest of the body through openings in our vertebrae. Sometimes known as spinal stenosis, spinal nerve compression occurs when the spinal canal narrows. This reduced space can cause a pinched nerve. Factors that can lead to narrowing of the spinal canal(causing spinal compression) include:

  • Degenerative disc disease
  • Wear and tear of the joints in spine- osteoarthritis
  • Bulging or herniated disc
  • Injuries or trauma to the spine
  • Spondylolisthesis- Misalignment of the spine
  • Rarely- Spinal infections and Spinal tumours

Symptoms of Spinal Nerve Compression

The most common symptoms of compression include:

  • Pain in the neck or back
  • Sciatica— pain that originates in the buttocks and spreads down the legs
  • Radiculopathy—radiating pain that spreads to other areas of the body
  • Difficulty with coordination, especially in the hands or legs
  • Foot weakness that causes you to limp
  • Cramping, weakness, or numbness in the extremities
  • Severe cases can cause loss of bowel or bladder control, numbness in the legs, and difficulty walking.

It is in your best interest to get evaluated by a Spine specialist nearby for best assessment of your spine compression symptoms. It is important to be assessed by a spine specialist so that your symptoms can be matched with the appropriate treatment which might range from medications to rarely spine surgery suited to your condition. The best spine surgeon in Bangalore, can do a thorough evaluation and do the best spine treatment as appropriate.

In this article, we will try to put various types of back surgery into perspective from a patient’s point of view. I hope this will give patients a better foundation while discussing the technical terms related to surgical options with your spine surgeon. Broadly spine surgeries related to back can be divided into 3 categories:             

  1. Decompression surgery
  2. Stabilisation and spinal fusion surgery
  3. Motion preservation or disc replacement surgery

Decompression surgery

Majority of back surgeries fall into this category. As the name suggests decompression surgery aims at removing compression related to structures in the spine. Decompression surgery removes material that is placing pressure on a nerve (or nerves), resulting in pain, weakness, or numbness. Most of the times, decompression alone solves the problem, and patients are able to resume their daily activities pain-free. Based on the culprit compressive element removed decompression surgery includes: Laminectomy, facetectomy, foraminotomy and discectomy.

Laminectomy/Laminotomy

The lamina is the bony “roof” covering the spinal canal, which runs down the length of your spine. The lamina itself isn’t often the problem, but a surgeon may need to remove a portion of the lamina to gain access to the problem area—the spinal canal or the nerve root. It’s like removing a wall of a room to gain good access and visualisation of the structure in the room. The procedure also provides more room for the structures. During a laminotomy, a surgeon removes a small amount of the lamina; a keyhole laminotomy requires an even smaller removal and incision. It is akin to creating a window in to the room, rather than removing the whole wall. In some cases, these smaller procedures are all that’s needed to gain entry into the canal and successfully address the nerve issue.

Facetectomy

A degenerating facet joint may become enlarged or develop bone spurs (an outgrowth of bone), causing compression of a nearby nerve. Or, a small portion of a facet joint may need to be removed in order to gain access to a troublesome disc. In such a scenario a facetectomy is performed, where part or whole of the facet joints need to be removed. The facet joints are vital to overall stability of the spine, so depending on how much of the joint is removed it may be necessary to do additional surgery for stabilization purposes.

Foraminotomy

The foramen is the exit passageway for nerves leaving the spinal canal. If that passageway becomes smaller for any reason it will pinch the nerves, causing pain. In a foraminotomy, a surgeon tries to open the space up again by removing small portions of material on the inside of the passageway—the pedicle on top, facet joints on the sides, and the disc.

Discectomy

If a disc is herniated, pushing past its outer rim, it may interfere with the surrounding nerves. Removing a portion of the disc—known as a discectomy—is usually enough to ease the pain, but may require an accompanying laminectomy or facetectomy to reach the affected area.

Stabilisation and spinal fusion surgery

During back surgery a stabilization procedure may be required for one of two reasons:1, Significant material was removed during decompression surgery and the spine becomes unstable. 2. Or a subtle instability has been identified prior to surgery due to something like multiple recurrent disc herniations, or worn-out joints adjacent to a previous spinal fusion or an inherent break in one of your bones. Spinal fusion is the traditional method used to stabilize, the spine. During fusion, a surgeon removes the disc and the facet joints, packs the space with bone graft, and inserts spacers, screws, and rods into the bones to temporarily hold everything in place. Eventually the bone graft fuses, the body heals, and what were once two or more separate vertebrae are now joined as one solid mass of bone. The joint has been eliminated from your spine, and, as a result, your range of motion will be impacted.

Motion preservation

Disc Replacement: For a very small number of patients who have an isolated issue with a single disc and healthy surrounding facet joints (a condition that’s not common among patients with back pain), a disc replacement would help stabilize the spine should a disc need to be removed for any reason.

It is in your best interest to get evaluated by a Spine specialist nearby for best assessment. It is important to be assessed by a spine specialist so that your symptoms can be matched with the appropriate spine surgery suited to your condition.

Spinal discs act as cushions between the vertebrae in your spine. They’re composed of an outer layer of tough cartilage that surrounds softer cartilage in the centre. Spinal discs are the shock-absorbing rings of fibrocartilage that separate our bony vertebral bodies while allowing movement at each spinal level, and enough room for the major spinal nerves to exit from the spinal canal and travel to our limbs. The annulus is the outer section of the spinal disc, consisting of several layers of multi-directional fibrocartilaginous fibres all densely packed to create a wall around the glycoprotein filled jelly-like central disc nucleus. The degree of spinal disc injury varies considerably from mild disc strains or internal derangements, mild-moderate-severe disc bulges through to complete disc rupture and herniation of the nucleus through the annular wall. As discs age, biochemical changes occur, they lose their water content, collapse and start to bulge. Again, this occurs in all human beings over time. As a disc slowly degenerates, the surrounding bone sees more stress and bone reacts to stress by forming more bone, hence the development of bone spurs. This is a normal aging process of the spine. Whereas 100% of us develop bulging discs and bone spurs beyond 60 years, roughly 7-10% of people end up having surgery on the lumbar spine. About 1% of us have surgery on the cervical spine. The most common reason for this is because the nervous system, which runs down the middle of the spine for protection, becomes impinged by either disc material or bone spurs. At the cervical and thoracic levels, the spinal cord could be pinched or the nerve roots that come off the spinal cord in the lumbar region could be pinched.

Disks show signs of wear and tear with age. Over time, disks dehydrate and their cartilage stiffens. These changes can cause the outer layer of the disk to bulge out fairly evenly all the way around its circumference. A bulging disk doesn’t always affect the entire area of a disk. Only the outer layer of tough cartilage is involved. A herniated disk, on the other hand, results when a crack in the tough outer layer of cartilage allows some of the softer inner cartilage to protrude out of the disk. Herniated disks are also called ruptured disks or slipped disks, although the whole disk does not rupture or slip. Only the small area of the crack is affected.

The most common cause for a bulging disk is age. This condition can happen to people in their 20’s, but it is more commonly found in people who are in their 30’s and 40’s. When you get older the cartilage dries out or stiffens and a part of the outer layer of your disk will starts to bulge out. If the bulging disk comes in contact with the spinal nerve, the condition can cause discomfort and pain. The prevalence of disk degeneration in asymptomatic individuals increased from 37% of 20-year-old individuals to 96% of 80-year-old individuals. Disk bulge prevalence increased from 30% of those 20 years of age to 84% of those 80 years of age. Disk protrusion prevalence increased from 29% of those 20 years of age to 43% of those 80 years of age. The prevalence of annular fissure increased from 19% of those 20 years of age to 29% of those 80 years of age. A bulging disc is usually considered a normal part of aging. Some discs most likely begin to bulge as a part of both the aging process and the degeneration process of the intervertebral disc. A bulging disc is not necessarily a sign that anything serious is happening to your spine.

A herniated disc on the other hand, means that the outer layer of the disk gets ruptured or cracked and the inner and softer part gets squeezed out. As previously stated, a herniated disk is likely to cause more pain since it usually extends further out and therefore is more likely to irritate nerve roots. Symptoms of a herniated disk include back pain, numbness or weakness in an arm or a leg. If you feel any back pain or neck pain you should visit a spine specialist. Compared with a bulging disk, a herniated disk is more likely to cause pain because it generally protrudes farther and is more likely to irritate nerve roots. The irritation can be from compression of the nerve or, much more commonly, the herniation causes a painful inflammation of the nerve root.

As with many mechanical problems in our body. If we try and keep ourselves mobile and strong, we can hopefully prevent a lot of injuries. The same applies with discs.  Hence, it is important to try and maintain a good posture as much as possible. Avoid slumped postures, slumping will over-stress a disc over time. Perhaps it could cause an injury, or predispose to one if the area is weakened. Practice good lifting technique. Use your legs as much as you can when lifting to avoid the strain coming through the back. Stand straight onto the object you’re lifting, and hold the object close to your body where possible. Don’t overdo it! If it’s too heavy for you, ask for help or wait until someone is around to help you.

Most people with back pain with leg symptoms have a herniated disc on MRI. If an imaging test indicates that you have a herniated disk, that disk might not be the cause of your back pain. Many people have MRI evidence of herniated disks and have no back pain at all. Both scenarios are possible. Hence it is important to be assessed by a spine specialist who deals with such issues as a routine in his/ her practice. Herniated disc with alarming symptoms will need more invasive treatment like surgery as elaborated in our website elsewhere whereas most disc bulges may need only life style modifications and simpler treatment. It is in your best interest to get evaluated by a Spine specialist nearby for best assessment. It is important to be assessed by a spine specialist so that your symptoms can be matched with radiologic findings.

Not all back and neck pain need detailed investigations and evaluation, as majority of them are self-limiting or their severity can be limited by non-operative measures like physiotherapy and life style changes. However, there are few scenarios where back and neck pain would need more detailed scrutiny. All of the below, mentioned symptoms should initiate an appointment with spine specialist at the earliest. The best spine surgeon in Bangalore, can do a thorough evaluation and do the best spine treatment as appropriate. These include, but not limited to:

  1. Radiating pain which is aggravated by movements of back or neck. Which is reproduced or increased by coughing/ sneezing, bending forwards and sitting for certain duration of time.
  2. Numbness or tingling sensation in the hands or legs
  3. Weakness of grip or power in legs. Inability to do certain activities, might indicate pressure on the nerves.  History of dropping things recently, change in hand writing, not able dress self like before etc.
  4. Pain in the back, legs, thighs or buttocks which is reproduced every time you stand or sit for certain duration.
  5. Pain in the back, legs, thighs or buttocks which is reproduced every time you walk for a certain distance.
  6. Any swelling over the back or neck which was not there before or if it is suddenly growing in size, compared to before
  7. Back pain or neck pain which wakes you up from sleep (once you have slept- Night pain) Or back pain or neck pain which does not let you sleep.
  8. Back pain or neck pain in a patient who has previously been treated for cancer (anywhere in the body).
  9. Neck pain which is associated with head ache or severe stiffness in the neck.
  10. Severe Neck pain or back pain which is associated with fever.
  11. Feeling unsteady during walking. It is important to get this evaluated at the earliest since most of the times it might be corrected by early intervention.

All of the above, mentioned symptoms should initiate an appointment with spine specialist at the earliest. The best spine surgeon in Bangalore, can do a thorough evaluation and do the best spine treatment as appropriate.

What is an MRI?

An MRI (Magnetic Resonance Imaging) scan uses magnets and radio waves to capture images inside your body without making a surgical incision. The scan allows your doctor to see the soft tissue of your body, like muscles and organs, in addition to your bones.

An MRI can be performed on any part of your body. A lumbar MRI specifically examines the lumbar section of your spine — the region where back problems commonly originate. Similarly, cervical spine MRI covers the neck part of your spine and Thoracic spine covers the chest part of spine.

Why an MRI is done?

An MRI scan provides a different kind of image from other imaging tests like X-rays (which is most of the times a preliminary screening tool for spinal conditions) or CT scans (Which give more detail about the bones and joints). An MRI of the spine shows the bones, disks, spinal cord, nerves, muscles and the spaces between the vertebral bones where nerves pass through.

Your spine surgeon may recommend an MRI to better diagnose or treat problems with your spine. Injury-related pain, disease, infection, or other factors could be causing your condition. Your doctor might order a lumbar MRI if you have the following symptoms:

back pain or neck pain accompanied by fever

birth defects affecting your spine

injury to your spine

persistent or severe neck pain or back pain

multiple sclerosis

problems with your bladder or toilet functions

weakness, numbness, or other problems with your legs

rarely signs of spinal cancer

Your spine surgeon might also order an MRI if you’re scheduled for spinal surgery. The MRI will help them plan the procedure before making an incision.

How to prepare for a lumbar MRI

Before the test, tell your doctor if you have a pacemaker. Your doctor may suggest another method for inspecting your lumbar spine, such as a CT scan, depending on the type of pacemaker. But some pacemaker models can be reprogrammed before an MRI so they’re not disrupted during the scan. This can be done by your spine surgeon in co-ordination with your heart doctor. The MRI technician will ask you to remove all jewellery and piercings and change into a hospital gown before the scan. An MRI uses magnets that can sometimes attract metals. Be sure to tell your doctor if you have any metal implants or if any of the following items are present in your body which h might include (but not limited to): artificial heart valves, clips, implants, pins, plates, prosthetic joints or limbs, screws, staples or stents.

If a contrast is required for your MRI (in conditions like history of previous surgery, suspicion of infection or cancer etc), tell your spine surgeon about any allergies you have or allergic reactions you’ve had.

What to do if the patient is Claustrophobic?

If you’re claustrophobic, you may feel uncomfortable while in the MRI machine. Tell your doctor about this so they can prescribe anti-anxiety medications. In some cases, you can also be sedated during the scan. Or recently we have option of open MRI.

What are the risks of a MRI scan?

Unlike an X-ray or CT scan, an MRI doesn’t use ionizing radiation. It’s considered a safer alternative, especially for pregnant women and growing children. To date, here have been no documented side effects from the radio waves and magnets used in the scan.

There are risks for people who have implants containing metal. The magnets used in an MRI can result in problems with pacemakers or cause implanted screws or pins to shift in your body.

Another complication is an allergic reaction to contrast dye Allergic reactions to the dye are often mild and easy to control with medication. But, sometimes anaphylactic reactions (and even deaths) can occur.

How an MRI is performed?

An MRI scanner looks like a usually has a doughnut like central part with a bench that slowly glides you into the central part. If you follow all the instructions of the technician and removed all metal items before entering, the MRI machine is a very safe place to be.  The entire process can take from 30 to 90 minutes. The technician will have you lie on the bench with a pillow and a blanket. The technician will control the movement of the bench from another room. They can communicate with patient through a speaker. During the MRI the machine makes some loud humming and thumping noises as it takes the images. Many hospitals offer Ear muffs or plugs to shield from the noise. As the images are being taken, the technician will ask you to hold your breath for a few seconds. You won’t feel anything during the test. If contrast dye will be used, a nurse or doctor will inject the contrast dye through a tube inserted into one of your veins. In some cases, you may need to wait up to an hour for the dye to work its way through your bloodstream and into your spine.

After an MRI

After the test if you took sedatives before the procedure, you shouldn’t drive otherwise there are no special precautions. It would be best to let your spine surgeon have a look at the report and make the required conclusions for you rather than googling your report findings.

Spine surgery has become very safe now due to the wide spread availabiltiy and opportunities for training like spine fellowships,observerships, cadveric workshops, conferences etc. Spine surgery has also become more safer than before, due to the availablity of advanced imaging which helps in better planning and execution of surgeries and due to advances in anasthesia and neuromonitoring facilities which are widely available a cheaper price now. Neverthless, all surgeries have some inherent risks.( There is no surgery with zero risk). It is important to discuss with your doctor what he/she feels the overall chances of a particular complication are in your condition.Spinal cord and spinal nerves are more sensitive when compared to other tissues. Delay in diagnosis with continued pressure can add to the chances of complications particularly in conditions like Cancer, infections( like tb), high speed collision accidents etc. Earlier the surgery is done during the disease process lesser the chances of complications. It is best to visit a spine specialist and get neccesary evaluation earlier then later.

All surgery has inherent risks. Certainly, spinal surgery has its own set of risks which may include infection, pain at the incision site, lack of fusion, as well as neurologic complications. However, with well-trained hands, the incidence of complications differs very little than from other surgical conditions. It is important to discuss with your doctor what he feels the overall chances of a particular complication are in your given setting.

Potential Complications of Surgery

You should discuss the complications associated with surgery with your Spine specialist before surgery. The list of complications provided here is not intended to be complete and is not a substitute for discussing the risks of surgery with your Spine specialist. Only your Spine specialist can evaluate your condition and inform you of the risks of any treatment that may be recommended.

Anaesthesia — Any surgery that requires anaesthesia can be potentially harmful. Surgery on the cervical spine usually requires that you be put under general anaesthesia. General anaesthesia means that you are put to sleep. Anaesthesia carries a risk of allergies to the medications. There are also different life-threatening situations that can occur during anaesthesia. It is extremely unlikely that these complications will occur, but you should be aware that they are possible.

Infection — Any surgery involving an incision in the skin can become infected. In addition, the bone graft and area around the spine may become infected. An infection will usually require some type of antibiotic medication to treat the infection. If the infection involves the bone, it may require one or more additional surgeries to drain the infection. The risk of infection is usually less than one percent.

Blood Vessel Damage — There are large arteries and veins that travel through the neck into the brain. The carotid artery and the jugular vein are nearby. It is possible to damage these blood vessels during the surgery. Again, it is extremely unlikely that this will occur, probably less than one in a thousand.

Nerve Damage — There are nerves in the neck that travel along the area where the incision is made to perform an anterior cervical discectomy and fusion. These nerves go to the vocal chords. There is the possibility that these nerves can be damaged during surgery. This can lead to hoarseness. If this occurs, the nerves will usually recover unless they are permanently damaged or cut. Again, this is unlikely.

Spinal Cord Damage — Surgeries that are performed on the cervical spine place the spinal cord at risk for injury. Spinal cord damage is probably much more likely in the larger, more serious operations such as the corpectomy and strut grafting procedures. These are complex, difficult operations and are done for extremely serious problems that are unlikely to respond to any other type of treatment. Routine anterior discectomy and fusion are common surgeries that are extremely safe. While damage to the spinal cord is possible, it is highly unlikely.

Graft Displacement — One of the more common problems that can occur after an anterior cervical discectomy and fusion is that the bone graft may move out of position. If it moves too much, it may require a second surgery to place a new bone graft in its place.

Non-Union — In spite of a successful surgery and good bone graft, a fusion may not occur between the vertebrae. This is termed a non-union or pseudarthrosis. Usually your surgeon will be able to tell whether a fusion has occurred by looking at X-rays taken over a three- to six-month period after surgery. If a fusion does not occur and you have no pain, a second surgery will not be necessary. If you continue to have pain, and a non-union is diagnosed after surgery, your surgeon may suggest a second attempt at fusion. When trying for the second time after a failed fusion, most surgeons will usually include some type of internal fixation, such as a plate and screws.

What is minimally invasive spine surgery and how is it different from traditional spine surgery?

Traditional spine surgery typically requires long incisions in the back. Muscles are cut and separated from the spine to allow access to the spinal anatomy. Minimally invasive spine surgery is performed through small incisions in the back. Surgeons use specialized instruments and navigational tools such as interoperative x-ray, pedi-guard, microscopes and tubular retractors. Like traditional spine surgery, the goal of minimally invasive surgery is to relieve your back and/or leg pain. But it adheres to a different philosophy—that as little muscle tissue as possible should be damaged.

What are the complications of spine surgery?

Like any surgery, there are a number of complications related to spine surgery. There are certain risks of general anaesthesia that are extremely rare and include death and other life-threatening reactions to anaesthesia. In experienced and well-trained hands, risk of paralysis or permanent nerve damage are extremely rare but can unfortunately still occur even in the best of hands. People with more severe preexisting spinal cord or nerve compression are at greater risk of this. There are certain measures that I take preoperatively and intraoperatively to monitor the spinal cord and nerves closely so that I am aware of the status of the spinal cord and nerves at all times during complex spine surgery cases when working around the spinal cord and placing instrumentation.

Other risks include infection, which is lessened by the use of antibiotics perioperatiely as well as placement of antibiotics directly into the wound.

Rods, screws, and plates, may fail and break or pull out. This risk is increased in people with poor bone quality including those with osteoporosis and smokers. Therefore preoperatively I try to assess risk of this problem in my patients and take measures pre and intraoperatively to prevent the likelihood of this from happening. I also advise all smokers to quit smoking prior to spine surgery as it increases the risk of infection, hardware failure, and generally an unhappy outcome.

There is a risk of the patient not actually improving after the spine surgery. I always advise patients who have seen a spine surgeon who recommended surgery for them to seek a second opinion on whether or not surgery is indicated and what surgery should be performed. I do not take the decision to operate on someone lightly and neither should the patient. I only operate on patients who I think I can help with surgery. If I do not feel surgery will benefit you, I will advise against it

In my practice as a spine surgeon in Bangalore at Bangalore spine specialist clinic as an orthopaedic spine surgeon in Bangalore, I have come across that people in Bangalore are unaware about the  risks and benifits of spine surgery. The mistrust towards spine surgery results is still prevelant.  Bangalore spine specialist Clinic, the best orthopaedic spine clinic in Bangalore agrees with the above details relating to the spinal surgery. Best spine surgeon in Bangalore can deal with variety of spinal disorders related to back pain treatement and neck pain treatment in Bangalore. Top Spine Surgeons in Bangalore can provide proper evaluation and treatment for back pain in Bangalore

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Neck pain and Back pain in Ankylosing spondylitis:

Ankylosing spondylitis belongs to a group of arthritis conditions that tend to cause chronic inflammation of the spine (spondyloarthropathies). It is one of the causes of back pain and neck pain in adolescents and young adults with a genetically inherited tendency where is the HLA-B27 gene can be detected in the blood of most patients. The optimal treatment involves medications that reduce inflammation or suppress immunity, physical therapy, and exercises. In this blog, we will explore the common questions related to Ankylosing Spondylitis

What is Ankylosing spondylitis?

Ankylosing Spondylitis is a disease process associated with chronic inflammation of the joints related to spine, particularly the sacroiliac joints. The sacroiliac joints are located at the base of the low back where the sacrum which is the bone above the tailbone meets the iliac bones which are bones on either side of the upper buttocks. Chronic inflammation in these spinal joints leads to pain and stiffness in and around the spine, including the neck, middle back, lower back, and buttocks. Over time, chronic inflammation of the spine can lead to a complete cementing together of the bones, a process referred to as ankylosis which leads to loss of mobility of spine presenting as stiffness. Ankylosing spondylitis is also a systemic disease and it can cause inflammation in and injury to other joints away from the spine manifest as arthritis, as well as to other organs, such as the eyes, heart, lungs, and kidneys. It is two to three times more common in men than in women. The most common age of onset of symptoms is in the second and third decades of life.

What causes Ankylosing Spondylitis?

Ankylosing spondylitis is believed to have a genetically inherited tendency with nearly 90% of such patients born with a gene known as the HLA-B27 gene, which can be detected by Blood tests. Even among individuals whose HLA-B27 blood test is positive, the risk of developing ankylosing spondylitis appears to be further related to heredity. These genes seem to play a role in influencing immune function. How inflammation occurs and persists in different organs and joints in ankylosing spondylitis is a subject of active health research.

What are the symptoms and signs of Ankylosing Spondylitis?

Inflammation of the spine can lead to fatigue, pain and stiffness in the low back, upper buttock area, neck, and the remainder of the spine. The onset of pain and stiffness is usually gradual and progressively worsens with loss of range of motion noticeable over months. The symptoms of pain and stiffness are often worse in the morning or after prolonged periods of inactivity. Motion, heat, and a warm shower often reduces pain and stiffness in the morning. Those who have chronic, severe inflammation of the spine can develop a complete bony fusion of the spine (ankylosis). Once fused, the pain in the spine disappears, but the affected individual has a complete loss of spine mobility. A sudden onset of pain and mobility in the spinal area of these patients can indicate bone breakage.

Chronic spondylitis and ankylosis cause forward curvature of the upper torso (thoracic spine), which limits breathing capacity. People with ankylosing spondylitis can also have arthritis in joints other than the spine. This feature occurs more commonly in women. Patients may notice pain, stiffness, heat, swelling, warmth, and/or redness in joints such as the hips, knees, and ankles. Other areas of the body affected by ankylosing spondylitis include the eyes, heart, and kidneys.

Which health care professionals treat Ankylosing Spondylitis?

Rheumatologists are internal-medicine subspecialists with a particular interest in diagnosing and treating patients with ankylosing spondylitis. Orthopaedicians and primary care physicians can also aid in pain management. Spine surgeons are involved in the management of spinal deformities once fixed fusion or ankylosis affecting daily life as occurred due to the fusion of bones.
What are the tips for home management of Ankylosing Spondylitis?
Home management includes instructions and exercises to maintain proper posture. This includes deep breathing for lung expansion and stretching exercises to improve spine and joint mobility. Exercise programs need to be customized for each individual. Swimming and aerobic exercises are best suited for these individuals. Patients with advanced ankylosis need workplace adjustments to suit their limited motion in the spine.

What are the tests which aid in the diagnosis of Ankylosing Spondylitis?

The diagnosis of ankylosing spondylitis is based on evaluating the patient’s symptoms (as elaborated above), a physical examination, X-ray findings (radiographs), and blood tests. The examination can demonstrate signs of inflammation and a decrease in the range of motion of joint. The flexibility of the low back and/or neck can be decreased. There may be tenderness of the sacroiliac joints of the upper buttocks. Chest expansion with full breathing can be limited because of the rigidity of the chest wall. Severely affected people can have a stooped posture. Signs of ankylosis can be seen on X-rays. The presence of the genetic marker HLA-B27 can be identified by a blood test. Other blood tests including ESR, CRP, Blood counts provide evidence of inflammation in the body.

What are the management options for Ankylosing Spondylitis?

The treatment includes the use of medications to reduce inflammation and/or suppress immunity to stop the progression of the disease, physical therapy, and exercise. Medications, commonly used to decrease pain include aspirin and other nonsteroidal anti-inflammatory drugs. In some people with ankylosing spondylitis, inflammation of joints does not respond to the above and these individuals need the addition of disease-modifying antirheumatic drugs (DMARDs) that suppress the body’s immune system. These medications, such as Sulfasalazine (Azulfidine), may bring about the long-term reduction of inflammation. An alternative to sulfasalazine that is somewhat more effective is methotrexate, which can be administered orally or by injection. Newer, effective medications for spine disease attack a messenger protein of inflammation called tumor necrosis factor (TNF). These TNF-blocking medications include etanercept, infliximab, adalimumab, etc. Oral or injectable corticosteroids are potent anti-inflammatory agents and can effectively control spondylitis and other inflammations in the body. Surgery may be required in severe cases of ankylosis of hips or spine.

What is the role of Spine surgery in Ankylosing Spondylitis?

Signs which may suggest that surgery might me required in Ankylosing Spondylitis include: Inability to lift up the head and look forward due to abnormal fixed flexed position of spine, a fracture through the ankylosis wit compromised stability of spine leading to severe pain un responsive to medications, Presence of neurologic deficits, inability to carry out activities of daily living due to bony ankylosis and severe pain and also a combination of above scenarios. The type of spine surgery recommended is based on the type of presentation. Decompression surgery like laminectomy is required for neurological compression with deficits. Spinal instrumentation is required when stability is compromised due to fracture. Osteotomy which is breaking the bones, with screw fixation is required when the spine is fused in an abnormal position. Spine surgery has become safe with recent advances and availability of modern equipments.