The spine is one of the most important parts of our body. Itsfunction is to receive signals from the brain and send them to different body parts. It is responsible for controlling movements and organ functions. Any problem in the spine can move a completely healthy person to bed, so it isnecessary to take good care and get proper treatment in case you suffer from any problem. A spine surgery, performed by an orthopaedic can restore the damaged part of the spine. The main focus is to relieve a patient from pain by stabilization of spine and decompression of spinal cord/nerves. The procedure includes both non-operative and complex operative treatment modalities.
At BLK, we have a specialized team of experienced doctors and highly advanced machines to per-form joint reconstruction and spine surgery. We focus on the complete rehabilitation. A patient undergoing a slip-disc operation is discharged on the same day after the microsurgery while in case of Minimal Access Fusion Surgery; a patient is discharged from the hospital a day after the surgical procedure.
What is our spine made of?
The spine is a very complex part of our body as it controls almost all the functions. It is highly flexible as it is made up of a number of vertebral bones joined by the ligaments. These bones are protected by cushion-like structures called Disk. It acts as a shock absorber and provides mobility to the spinal column.
The vertebral bones and Disks makes a tube like structure called the Spinal cord which forms a link between the brain an the rest of our body. The large number of muscles surrounding the chord protects it from external intrusions and stabilizes our back and neck.
Sometimes, when a person experiences a strong blow/trauma it can harm the spinal chord and the person may start suffering from back/neck pain. It can also be caused by any abdominal irregularity or inflammation. It is necessary to get yourself checked before the situation gets out of hand.
What is disc prolapse?
Disc-related injuries or irregularities are the most common and painful disorder.A disc’s function is to protect the spine from shock so that no harm is done to the chord. When a disc gets ruptured, the soft inner material of the disc can pop out and press the nerve ending giving rise to leg or arm pain in lower back or neck area. 9 out of 10 people who are suffering from this painful condition can get rid of this by proper rest and appropriate medication. But in some people it becomes necessary to remove the soft material pushing into the nerves.
The surgery performed to treat Disc ruptures is called Discectomy. Here the damaged portion of the chord is removed along a small part of the bone through a microscope and a small incision. Because of the use of minimally invasive techniques, the patient can be discharged from the hospital in less time and recover faster.
Sometimes the patient may suffer from a compression, a condition where a nerve is compressed in the spine. In this case, a procedure called decompression is performed on the person. The affected bone has to be released in order to release the nerve. This procedure is also conducted minimal invasively so that the recovery is fast and the person can get back to their normal routine fast. But in some cases there is a need to perform an open surgery.
What is vertebroplasty/kyphoplasty?
As already mentioned, the spine is made with a number of flexible bones which means there is possibility of fractures. A fracture can occur due to an accident or a condition called Vertebral Compression Fracture’. A fracture in the spine can be very painful and make a person really uncomfortable. In this case, Vertebroplasty or kyphoplasty is performed, a procedure where bone cement is added to the fractured area resulting in pain relief. The doctor provides medication and painkilling drugs for Osteoporosis to heal the spine. Normally people are treated through this. If the condition is a critical one the doctor may perform a surgery under local anaesthesia.
Effects ofspine surgery
A spine surgery is a very effective way to relief leg or arm pain as it removes the compression on the nerve that can be caused through disc, bone or scar tissue. It stabilizes the unstable segment of the spine and relieves back pain by getting rid of the persisting pressure. When the person is relieved from the hard pain mobility becomes easier and they can go back to performing tasks easily again.
How to prepare for spinal surgery?
Normally a person is admitted to the hospital a day before the surgery so that the doctors can get all the required tests and prepare the patient for the surgery. The patient’s stay at the hospital can be from a day to five depending on the complexity of the situation. In case of micro-surgery like slip disc, a patient gets discharged in a day. In case of major decompression or fusion surgery, you may have to stay longer.
There are a number of surgeries performed for spine and most of them are done under general anaesthesia except vertebroplasty/kyphoplasty. These surgeries are briefly explained below:
- Micro-discectomy for slip disc: an incision or maybe 2 cm or above is given depending on pa-tient’s weight
- Minimally Invasive Fusion (decompression and stabilization): There may be 4-6 small stab inci-sions and one 3-4 cm incision
- Open decompression and stabilization – incision length may be 8 cm or above
- When the patient wakes up following the operationhe/she can expect (any or all) the following:
- lying flat on back with a dressing over the wound
- A drip of fluids may be attached to your arm until you start eating and drinking
- A wound drain may be attached to your back to minimize bruising and swelling
- Pain control may be administered via a drip in the armour in the tablet form
- Occasionally, a catheter may be fitted to assist you in urination
At BLK, we offer a complete recovery procedure with a team of experts to ensure faster recovery. A physiotherapist is assigned to the patients so that they could relax your muscles and improve the functioning of the operated muscles.
After the patient is discharged the doctor give them a proper care plan as spine is a very sensitive part and needs proper care and attention. It is extremely necessary to follow the instruction to ensure proper function. Some of the common precautions are:
- Transferring from lying to sitting/standing position: You are not supposed to put pressure on your abdomen while moving from lying to sitting position. Roll onto your side while trying to maintain a natural position of the spine. Bring your uppermost arm across your body, placing your hand on the bed. Push through both arms to help sit up as your legs are lowered to the floor. Try to gently contract your abdominal muscles during the movement.
- Lying down: Do not lie on the bed for a longer period. Spend short and regular periods of time lying on your bed in any position you find comfortable.
- Sitting: Sitting can cause stress on the back. You should gradually build up the length of sitting time to approximately 30 minutes. On discharge from the hospital, you may find perching on a high stool or chair more comfortable. You can use a lumbar roll, or a small rolled up towel to support the curve of your lower back
- Wound dressing: Your wound will be covered by skin staples and a dressing. This dressing will need to stay dry until the wound is healed. The dressing can usually be taken off after 10 days by when you will be required to come to the hospital for a follow-up visit.
Likelihood of complications?
Though the success rate of the spinesurgeryis 90%, there are stillsome complications associatedwi-thit. The patient need to keep a close eye on anyunusualness as told by the doctor. These are the complications associatedwith the surgery :
- Further disc prolapse: It is possible that more disc material can prolapse out in the future caus-ing back or leg symptoms
- Nerve scarring: Scar tissue will form in the area following the operation as part of the normal healing process. If this is excessive, it can constrict the nerve and prevent it from moving normally. This can cause possible leg pain
- Back pain: Back pain sometimes occurs after surgery due to the cutting of muscle and removal of disc material. This is common in the first few weeks, however, it usually settles over time. Occasionally, back pain can become constant and severe
- Nerve damage: Nerve damage may occur especially if the disc prolapse is large or the spinal canal is narrow. If the nerve is accidentally cut during the surgery there will be a permanent weakness of those muscles and altered sensation in the area of the leg the nerve supplies. Nerve or Dural tear can lead to CSF leak also.
- Haematoma: There is occasional bleeding in the spinal canal or within the wound causing a blood clot. This usually settles independently but it may be necessary to evacuate it surgically.
- Infection: To minimize the risk of infection you are given antibiotics in operation theatre. Infec-tion can occur in the operative wound but one can also get an infection of the disc, which is rare but more serious.
- Deep vein thrombosis (DVT blood clot in the leg): There is a small risk following surgery of developing DVT. This is minimized by early mobilization.
What are the various activity levels, post surgery?
- Mobility: Gradually increase the frequency and distance you walk. Take regular short walks around the house. As soon as you feel you are able to walk longer distances, go for a walk few times a day. Build the routine slowly
- Lifting, twisting and bending: During the first 6 weeks avoid lifting, twisting and bending as much as possible. If you are bending and lifting, make sure the object you are moving is as close to your body as possible. Bend both your knees and try to keep your back straight. Always ensure you tighten your abdominal and buttock muscles while bending and lifting
- Return to work: Post operation, your return to work will depend on the nature of your job. Normally, you can return to work after 4-6 weeks. If you are in a less than active job, you can return to work after 4 weeks and after 6 weeks if your job involves physical activities. After microsurgery for slip disc, many patients return to work much earlier if the job is sedentary. For more extensive spinal fusion surgery, return to work may be delayed a little more
- Driving: Do not drive until after your first outpatient appointment as your doctor needs to re-view your back first. You can be seated as a passenger as long as the journey is short and you can sit comfortably for that period of time. Usually, you can start driving after 4-6 weeks.
- Sports and other activities: Participation in any activity or sport would require the advice of your consultant and therapist– on when you can resume them and how you can gradually build up your fitness.