What sets the Bangalore Spine Specialist Clinic apart?

We believe that every person is entitled to an individualized approach. Your spine is not a cookie cutter, nor is your spinal pathology. And therefore, we take the time to listen to you, to accurately diagnose, to view your studies, and to come up with a plan which is made for you and not for someone else. That is probably the most important aspect of any medical or surgical procedure, and certainly when it relates to spinal surgery.

Do most spinal conditions need surgery?

Absolutely not. The majority of spinal conditions are lumbar sprains and strains, cervical sprains and strains and mild disc herniations which can be managed with a combination of conservative modalities such as physical therapy, anti-inflammatory medications, mild narcotic medications, and at times, injections. Modalities such as chiropractic and acupuncture also play an important role. In instances when these conservative modalities fail, then a patient can be considered for spinal surgery. In a very, very small instance of cases, spinal surgery is emergent but that is very rare.

Can my surgery be done minimally invasively?

Over the last 20 years, spinal surgery has gone from a maximal conditional invasive approach to a more minimally invasive approach. However, each case has to be evaluated on an individualized basis. Your case may be amenable to a minimally invasive spinal surgery. Within minimally invasive spinal surgery there are various categories. It is important to be well-examined by your physician, including the x-ray, CT scan and/or MRI studies and then an appropriate plan. Approximately 10 – 20% of the time, spinal pathologies and spinal surgeries can be done through a minimally invasive or a hybrid minimally invasive approach.

How much time will I need to be out of work?

That depends. If surgery is done on a minimally invasive level, the answer is perhaps only two weeks or more. However, even in those settings, it is a good idea to try and allot some time off; perhaps a 3 to 4weeks. In other instances, in which there is fusions and/or osteotomies which need to be done, the time off from work will be much more extensive, perhaps in the range of 1 – 2 months and sometimes beyond. Again, each case is different and no two spinal situations are alike.

Can my discs be replaced?

Yes. Over the last 10 – 12 years, more and more lumbar and cervical discs have been replaced. However, depending on the pathology, a disc replacement may be too aggressive a procedure for your given case. Discuss the issue of disc replacement with your spine surgeon.

If surgery is necessary, what should I look for in a doctor?

Be sure that the doctor that you choose to perform your spinal surgery has taken his time to fully examine you, fully evaluate your studies, and fully describe to you the procedure and/or risks and complications. If he or she is unable to do so to your liking, think twice about that doctor.

Second of all, the best results are in the settings of a spine specialist who has spent dedicated time in training for spine surgery.

Can the surgery be done in any hospital or center?

It depends on the case. Some of the more minimally invasive procedures can be safely done in most hospitals which have a microscope and imaging facility. Even those surgeries which are slightly more complex, such as a one-level cervical disc replacement or fusion or a lumbar disc replacement or fusion, can often be done in most of the hospitals with above facilities. Patients with comorbidities and/or for longer procedures are more safely done in a bigger hospital setting. Be wary of physicians or practices which are steering you to have a surgery done in a particular setting, when you are uncomfortable with it.

How can I keep from having problems with my spine after spine surgery?

After spine surgery, it is possible that you could develop back discomfort in the future. To take care of your spine if soreness or other symptoms return, your spine specialist will give you a thorough home program when you complete your treatment. Continuing with your home program is a way to keep your spine healthy over time. These may include the use of ice, heat, positioning, or rest.

Why do I need to quit smoking before having spine surgery?

Healing tissues require a fresh and steady supply of blood. Your blood supply carries needed oxygen, nutrients, blood cells, and other important healing agents to the area. It also provides a way for chemicals, enzymes, and other debris to be flushed away. Smoking puts nicotine in your blood. Nicotine causes blood vessels to become narrower (vasoconstrict) (vase-oh-con-strict), which limits how much oxygen, nutrients, blood cells, and other important healing agents can get through.

Certain parts of your spine, especially in the lumbar area, have naturally limited blood supply. Smoking after spine surgery can further limit the blood supply. This can slow the healing process, and may even lead to other complications during your recovery.

You can maximize your ability to heal by stopping smoking well before surgery and staying smoke-free at least until well after surgery. You may even want to quit smoking permanently. Your Spine specialist can give you some helpful ways to stop smoking.

My Spine specialist has suggested that I have a spine fusion in my lower spine. How will this affect my ability to bend over?

There is not very much movement in the joints of the lumbar spine when you bend forward. The total amount of flexion (fleck-shun) (bending) at each level of the lumbar spine is only about three degrees. Most of the movement of bending forward takes place at your hips, so as long as your hips are okay, you should not have any problems bending forward after lumbar spinal fusion.

I have metal screws in my back from a spine fusion. Will I be able to go through a metal detector at the airport?

Yes. Most metal implants will not set off a metal detector. But if you have a concern, your Spine specialist can provide you with a card confirming that you have metal implants in your body.

If I have a spine fusion surgery using metal screws and rods, will they ever need to be removed?

Metal implants used in surgery are not always removed. Once your spine fusion has healed, the metal rods and screws are no longer necessary. Still, the implants are usually not removed unless they cause you pain or discomfort, can be felt or seen under your skin, or have broken. If a follow-up x-ray shows that an implant is broken, it may be a sign that your fusion did not heal successfully. Your surgeon may suggest additional tests to see whether your fusion has healed before taking out the broken implants.

What are the risks of minimally invasive spine surgery?

MIS is associated with the same risks as any general surgical procedure. During the procedure, however, the surgeon may decide to convert from minimally invasive to traditional surgery if visualization is limited or if other complications arise.

What is spinal decompression and spine fusion surgery?

Spinal decompression and spine fusion surgery are two common surgical procedures that can be performed using minimally invasive surgical approaches.

When can I play golf, ride a bike, or go hiking after spine surgery?

How quickly you can go back to doing the activities you enjoy after spine surgery depends on the type and location of your surgery. For example, a micro-discectomy requires much less healing and recovery time than a fusion surgery. It also depends on the stress of the activity. You will need to begin any activities gradually, and in a gentle, controlled manner. You do not want to cause yourself pain—or worse, re-injure your spine.

Be sure to follow all recommendations from your Spine specialist and physical therapist. Be patient, and follow your rehabilitation program closely. It has been developed to give you the best chance of returning to full function. No activity is worth causing more injury to your spine.

My Spine specialist has suggested that I have a spine fusion surgery using a metal plate in my back. Will my body will reject the metal plate?

The human body rarely rejects metals that are used in surgical implants. Most metal implants used in spine fusions are made of either stainless steel or titanium. Alloys are another type of metal that may be used in a fusion surgery. An alloy is a mixture of several metals such as cobalt, chrome, and nickel. A good rule of thumb is that if you can wear a watch or jewelry without problems, you are not likely to reject a surgical implant. Sometimes implants may have to be removed because of an infection, but this does not mean that your body has rejected the implant.

Is minimally invasive surgery a new technique?

No, it’s common for many operations, including:

Heart surgery

Bariatric (weight loss) surgery

Total hip replacement

Appendectomy

Gall bladder removal

Benefits of Minimally Invasive Surgery:

Smaller incisions

Less postoperative pain

Less surgical blood loss

Shorter hospital stay

Less postoperative pain medicine

Faster return to work and daily activities

Are lasers used in spine surgery?

Yes. The laser is being used in spine surgery mainly to treat disc problems. A procedure called thermodiskoplasty (ther-mo-disk-oh-plas-ty) is when your surgeon uses a laser to change the shape of a disc. This procedure may be used in combination with microdiscectomy (mick-row-disk-ek-toe-mee). Although the use of lasers in spine surgery is still pretty new, it shows promise as a minimally invasive way to treat disc problems of the spine. It reduces scarring around the nerve roots and can lead to a faster recovery. Also, the hardening effect that lasers have on the disc itself may help keep your spine from becoming unstable after disc surgery.

If I have surgery to take out a disc in my back, what will replace the disc that the Spine specialist removes?

Usually, surgeons do not remove the entire disc. Instead, they take out just the material in the middle of the inside of the disc. After a simple discectomy surgery, scar tissue fills the area where disc material has been removed.

When a fusion using a bone graft is needed, the disc is taken completely out and the bone graft is put in place of the disc between the two vertebrae. In an anterior interbody fusion surgery, a metal cage may be used in place of the disc between the vertebrae. Total disk replacement (TDR) may be a solution for some people with degenerative disc disease as an alternative to spinal fusion. TDR can reduce the risk of bone graft donor site pain and pseudarthrosis (sewd- arth-row-sis), which is improper movement of a joint after healing.

One of the artificial discs with the longest clinical history is the CHARITÉ® Artificial Disc. Approved in August 2006, Prodisc is the first FDA approved artificial disc on the market. It has been approved for use in patients that have one diseased disc in the lumbar area of the spine.

I’m scheduled for a spine fusion of my low back. Will I be able to get up and walk without difficulty after I have surgery?

After spine fusion surgery, some people need to use a walking aid such as a walker or cane for a short time. When you start walking, do a little at a time and be careful to avoid injury and complications. Try not to overdo it the first few times you get up and walk. Build up gradually to avoid a flare-up of symptoms.

I’ve had pain and problems with my low back for many years. What can I expect from my spine surgery?

The surgical procedure for lumbar surgery can last from one to eight hours depending on what needs to be done. For example, spine fusion usually takes much longer than discectomy. Many people report immediate improvements in the way they feel after awakening from the surgery. However, strengthening your weakened muscles and soft tissue surrounding and supporting your trunk will require a long-term program of exercise and physical therapy. Although many people see and feel immediate improvements, they often get added benefits with a comprehensive rehabilitation program.

What are the risks of minimally invasive spine surgery?

MIS is associated with the same risks as any general surgical procedure. During the procedure, however, the surgeon may decide to convert from minimally invasive to traditional surgery if visualization is limited or if other complications arise.

My surgeon says I need a fusion between the C5 and C6 vertebrae in my neck. How can I turn my neck after it is fused?

Your ability to turn your head takes place mainly between the two joints at the top of your cervical spine. When you turn your head, about 50% of the movement happens between the first and second levels (between C1 and C2). The other 50% takes place between all the other neck vertebrae combined. So a fusion of one level in the lower part of your neck will not drastically affect your ability to turn your neck, probably less than 10%.

If I have a spinal surgery, what are the chances of me needing additional surgery at a later date?

Overall, it can be said that there is approximately a 5 – 15% chance of the necessity for revision or additional surgery in the spinal setting. That additional surgery may be at the level which was operated on, because of further degeneration or collapse, or at an additional level, either above or below the surgery. This means that we have to think very carefully about choosing the spinal surgery which we undergo, choosing the levels, as well as choosing the physician to perform the operation.

I have heard so many bad things about spinal surgery. How can I feel confident in proceeding with a procedure even though I am in pain?

Spinal surgery has gotten a bad rap over the last 10 – 15 years. Although it is true there is the potential for major complications, the most feared and dread complication- i.e., that of paralysis, is the rarest and most unlikely to actually take place. Very often, friends and/or relatives are giving opinions which are based very little on fact. As often as we hear that a patient has been told that they could end up paralyzed, it is very rare to actually find someone who suffers from this dreaded complication from the result of a routine spinal surgery.

Why does back surgery fail?

There are number of reasons for why back surgery fails.  In some cases, back surgery fails because the spine goes on to degenerate further at levels which were not addressed surgically.  At other times, back surgery fails because the procedure was performed incorrectly, the wrong procedure was performed, or the patient goes on to develop more severe symptoms and worsening of the condition at the operated-on levels.  A fusion operation may fail because the fusion does not heal and there are still other reasons for back surgery failure including infection and poor bone quality.

Spine surgery is not yet an exact science. Unfortunately, I see a lot of patients as a second opinion who have had failed back operations previously and are not happy with the results. Failures occur and sometimes nothing can prevent this. However, some surgeons have more success than others. The first surgery has the highest likelihood of success.  This is why it is extremely important to pick the right spine surgeon with the best training and education who cares about you as a patient and is up to date with latest practices and techniques with the highest success rates. I only operate on patients who I feel will actually benefit from surgery based upon a combination of symptoms, physical examination, and radiographic imaging. I do not advocate for gimmicks but only tried and true techniques with evidence-based outcomes.  If I do not feel you will benefit significantly from surgery I will not advocate for surgery. I only decide to operate on people that I think will benefit in the long term from surgery. For other patients, non-operative treatment is a better alternative.

Is spinal surgery dangerous?

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