What’s a Spine surgery?
Spine surgeries are the major undertakings where the surgical procedures are performed on one or multiple anatomical structures of the spine. These surgeries vary based on the symptoms, few allowing for quick recoveries and others which are more extensive and take longer periods for recovery. The surgeries in the spine are majorly performed to relieve pain, weakness in the limbs , loss of sensations and difficulty in passing urine and loss of control over bowel due to compression of spinal cord and neural structures.

What are the symptoms you need to be aware of?
These symptoms are most common among people who are suffering with spine or back related issues.

• A severe pain in the back which still persists despite medication and/or physiotherapy
• A radiating pain in the limbs
• Decrease in the sensation of the limbs
• Weakness in a single or group of muscles in the affected area
• A loss of bowel and bladder control due to the compression of neural structures

Different types of spine surgeries
Based on the objective of the surgery, here are the different types:

• Decompression – A spinal decompression surgery is done to relieve the pain caused by the pressure on the neural structures i.e. on spinal cord or nerve roots. This is more of an age-related issue and can also occur due to thickened ligaments, enlarged joints and bulging discs.
• Stabilization with or without fusion – This surgery is done based on the instability of segments of the spine due to fractures, birth defects and degenerative problems.
• Decompression and Stabilization – This surgery deals with few complex cases where there are both compression of neural structures and also there is an instability in the spine.

There are more complex surgeries which are performed in few complicated cases usually for the correction of deformities, tumor excisions and which cannot be treated just with medications and physiotherapy. Here the reason for surgery and recovery and cure depends on the condition.

Based on how the surgeries are performed, the spine surgeries are of 5 types:

• Open Surgery is the most common type of surgery where the surgeon makes a long incision and extensive tissue dissection. It is the conventional way of surgery where post operative recovery is a bit slower as tissue handling is a bit more.
• Minimally invasive surgery is a surgery where incisions are small and also tissue dissection is as minimal as possible. It requires special instruments like endoscopes and microscopes and needs expertise. The recovery post surgery is faster as the tissue handling is minimal. Can only be performed in specific conditions.
• Endoscopic spine surgery is a type of minimally invasive spine surgery where specialised video cameras and instruments are passed through small incisions and the procedure is performed with minimal tissue damage.
• Microscopic surgery is also a type of minimally invasive spine surgery where the microscope allows the surgeon to do the procedure through small incision and specialised instruments.
• Robotic spine surgery is a surgery performed with the assistance of a robot with the help of specialised computer software assistance called navigation. Usually robotic assistance is for highly complex surgeries where the scope of error is high. With the help of navigation and robotic precision, operating time and complications can be considerably reduced.

How much time will a spine surgery take?
The time period of a spine surgery varies depending on what has to be achieved

• surgeries like Discectomy, Laminectomy and Fenestration based on the number of levels take around 45-90 minutes.
• Stabilization surgery takes around 60-120 minutes depending on the levels.
• Decompression and Stabilization combined surgery based on the number of levels takes 120-180 minutes.

The other complex surgeries like deformity correction and tumor excision, based on the severity of the disease, take longer time.

What are the limitations after a spine surgery?

Though the surgery is a success and the issue is resolved, there are few limitations immediately after a spine surgery. Let’s now check out those-

• Ambulation is usually after one or two days after the surgery with/without aids depending on the strength of the lower limb muscles.
• Physiotherapy is required during the postoperative period which usually relieves the muscle stiffness of the operated area.
• If there are inflamed nerve roots during or after the surgery, there may be a radiating pain for 2 to 3 weeks.
• It takes a good amount of time ranging from 2 weeks to 12 months for the recovery of sensations and power of the limbs and also to regain the control of bladder and bowel movements.

Also based on the type of surgery performed, the severity and chronicity of the condition there are further limitations:
Patient who has undergone a decompression surgery has to make lifestyle changes to prevent unnecessary loading to the spine to avoid the damage from spreading further. Restrictions are for 3 weeks post-surgery for the tissues to heal. The patient needs to undergo physiotherapy to build up the muscle strength of the back.
For Stabilization patients who had fractures, ambulation is on the first or second day post operation with restriction of activities for about 3 months.
Patients who have undergone Decompression and Fusion will have stiffness in the operated area and ambulation will be on first or second day post operation. The spine and the affected area shouldn’t be loaded for at least 3 months.
For complex surgeries, limitations depend on the condition of the patient and the complexity of the procedure the patient underwent.

What’s the diet plan after the surgery?
There is no special diet chart for patients who had spine surgeries. But it’s important that the patient takes good food in sufficient amounts to regain the strength. However for a faster recovery, this is what you have to eat-
Protein food is a must at least for 6 weeks post operation. It helps in healing of tissues.
A balanced diet is what every doctor suggests to maintain a healthy body after a complex surgery.

What are the exercises to be done post spine surgery?
Exercise is one of the best ways to reduce the pressure on the spine and increase the strength of the muscles. Usually this works best after a surgery as these would be customised by the physiotherapist as per the patient condition, the type of surgery performed . The different types of exercises are-

• Ergonomics – This is a lifestyle modification to prevent the load on the spine after a surgery. This includes few postures which have to be introduced into the lifestyle at home, work and sports.
• Stretching exercises – These are the most common type of exercises suggested to any age group which reduces the stiffness of the muscles and helps for a better flexibility of the spine.
• Strengthening exercises – These exercises are generally suggested to patients who had complex surgeries to strengthen their spinal muscles.

Rehabilitation
Rehabilitation is the most important practice to get the best benefit from surgery. Physiotherapy and exercise are included in it which helps the patients recover from the surgery at the earliest. This rehabilitation helps you come back to a good physical condition. Though the surgery helps in the cure of any spine related problems, the willingness of a person and the after-surgery practices takes the person on the road of recovery.

What is the cost of the Surgery?
The cost can’t be mentioned as there are a wide range of procedures and there will be a difference in cost due to its extensiveness and the equipment involved.

How is Zoi equipped for spine surgeries? Zoi Hospitals is known for its state-of-the-art facility and the best team of neurologists. The equipment available in Zoi Hospitals for its spine surgeries are:

– Vertical laminar flow theaters- C-arm Machine- Endoscopic spine surgery equipment- Operation Theatre- Expert doctors and nurses.In times like these, when we are forced to be indoors, make the best use of it by exercising regularly and staying active. Let’s take care of our spine and stay healthy!

Surgery without risks? Not really

Doctors usually suggest surgery when it is the only way or when an early intervention can prevent further damage. Which brings us to the next most common question of the risks involved.

Every drug you take, every needle prick and every surgery has a percentage of risk involved. There is risk involved even when you cross a road but that doesn’t mean you stop crossing roads, right? Similarly, despite the risks, some conditions just cannot be treated without a surgery. In my years of experience as a surgeon, I have seen cases where surgery was warranted before and patients who had stalled the procedure, ended up becoming inoperable.

So, it goes without saying that risk is a part of any surgery and can also be related to the drugs used or the patient’s pre-existing health condition including complications. All of which have to be explained to the patient prior to any procedure with a written consent taken from them.

Testing times

Another question I get asked often is regarding the tests prescribed before any surgery. Why are there so many? There is a battery of tests that surgeons do before the patient lands up in the Operating Room. And in the event of an abnormality, further testing may be required and other doctors may be consulted for fitness for surgery.

Here is a list of some common tests that a patient is asked to undergo before a surgery:

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Comman Pre Operative Investigations

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Recovery and beyond

The time taken to recover from a surgery depends naturally, on the type of surgery itself, the organs involved and the setup in which the surgery is performed. Certain procedures that used to require 3-4 days of hospital stay are now being done in day care surgery with a hospital stay of less than 24 hours.

That has been made possible with the help of minimally invasive procedures like laparoscopy. It is a low risk procedure that requires only small incisions to be made to the body. This type of surgery uses an instrument called a  laparoscope which is a long, thin tube with a high-intensity light and a high resolution camera at the front. The infection rates, pain, recovery and back to mobility are all better in such surgeries. Not all cases though are eligible for laparoscopic surgeries. But that is a topic for another day.

Ultimately, if there is a surgical cure to a particular condition, a non-invasive or a medical approach will only delay the natural course of disease but not prevent the patient from going under the knife if the delay has not resulted in inoperability. Upon medical advice, the percentage of people who have opted for a surgery at an appropriate time has been growing and it has been directly proportional to the recovery rates.

For some people, there is a good structure and support at home for recovery and for others it’s not so solid. Laparoscopic surgery may be an option for the latter group in view of the recovery time.

There are costs involved

Another concern for people is the cost of getting a surgery done. While there are situations where money or the lack of it is a real issue and one should find a centre where treatment is subsidised, if necessary. But in all other situations, it’s really a cost vs benefits assessment. If your quality of life, physical, mental, social is affected by your medical condition and if surgery will resolve that, then the money factor is a small cost of the elevated quality of life post surgery and alleviation of the symptoms.

You have to assess for yourself on how much is the medical condition hampering you from living confidently and freely. If it is stopping you from what you want to and need to do in your daily routine; if it’s like a sword hanging over your head to wake up to it every morning; if it is stopping you from engaging in activities freely; do factor in the limited lifestyle and what is possible if you undergo surgery. Weight it between the cost of surgery and the cost of quality of life.

Clarity pulls for action

The ideal thing to do for a patient to do is to have a very positive and strong approach if and when undergoing a surgery and trust their surgeon. Put all your fears and questions on the table to your surgeon. Get them clarified. Talk to people who have successfully undergone that surgery. Get all the information and then look at what is the best option for you with the symptoms you are dealing with and also as importantly the quality of life you desire.