I have been told by a few people that spine surgery is very risky and often patients get complicated? Is it true ?
Today, spine surgery is one of the most successful surgeries performed in the world. It has undergone a number of advancements in last 10 years. As it is a highly technical procedure and requires an extensive learning, complications were common with surgeons who were not comprehensively trained in Spine Surgery. As a result, some complications were noted. Even then in most of the cases recognized complications include nerve injury, dural tear or recurrence of pain. Paralysis widely believed to be common following surgery is however , extremely extremely rare even in the most untrained hands.
After recent advancements in last 7-8 years, Spine training is a recognized super-speciality now and for a recognized spine surgeon it is mandatory to train oneselfwith atleast 2 to 3 years of dedicated training (fellowship) for spine surgery. This has brought down the complications to extremely low levels and now spine surgery is considered a very safe and successful surgery. Many procedures have been made minimally invasive, allowing patients to benefit from smaller incision sizes and reduced muscle and tissue interference. These benefits translate to less blood loss during surgery, making the procedure quicker, less painful, with a shortened post-operative recovery period. To feel safe going into a surgical procedure, it is important to trust the surgeon. Dr. Ashish Jain , MBBS , MS, Mch, DipSICOT is a certified, Fellowship-trained spine surgeon, and is a thought leader in back pain treatment in India and the only exclusive spine surgeon in this whole region. Dr. Jain is an advocate of minimally invasive spine surgery for its benefits to the patient, and strives to make the experience as comfortable and relaxed as possible.
No surgery is major or minor. The condition of the patient for anaesthesia decides that. If the patient is not fit for anaesthesia , then the risks attached to surgery are considerably enhanced. Therefore we make a mandatory assessment of every patient before surgery whether he/she is fit for surgery or not. In our hands , discectomy , laminectomy and fusion are routine surgeries of lumbar spine.
Success of any surgery depends upon the objective with which it is performed. Discectomy isa simple procedure in which we remove a portion of the disc that is causing pressure to the nerves and damaging it. Relief of the nerve pain is the objective. Therefore the patient is relieved of the leg pain or weakness or tingling that is bothering him. Sometimes the surgery is done only to prevent further damage to nerves as nerve damage is often irreversible. Therefore it is important before surgery to discuss the expectations of the surgery.
Regular low-impact aerobic activities – those that don’t strain or jolt your back – can increase strength and endurance in your back and allow you muscles to function better. Walking and swimming are good choices. Talk with your doctor about which activities are best for you.
Build muscle strength and flexibility
Abdominal and back muscle exercises (core-strengthening exercises) help condition these muscles so that they work together like a natural corset for your back. Flexibility in your hips and upper legs aligns your pelvic bones to improve how your back feels.
Smokers have diminished oxygen levels in their spinal tissues, which can hinder the healing process.
Maintain a healthy weight
Being overweight puts strain on your back muscles. If you’re overweight, trimming down can prevent back pain.
Use proper body mechanics
• Stand smart. Maintain a neutral pelvic position. If you must stand for long periods of time, alternate placing your feet on a low footstool to take some of the load off your lower back.
• Sit smart. Choose a seat with good lower back support, armrests and swivel base. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve. Keep your knees and hips level.
• Lift smart. Let your legs do the work. Move straight up and down. Keep your back straight and bend only at the knees. Hold the load close to your body. Avoid lifting and twisting simultaneously. Find a lifting partner if the object is heavy or awkward.
• Sleep smart.People with back pain have commonly been told to use a firm mattress, but recent studies indicate that a medium-firm mattress might be better. Use pillows for support, but don’t use a pillow that forces your neck up at a severe angle.
Continue with normal activities as far as possible. This may not be possible at first if the pain is very bad. However, move around as soon as possible, and get back into normal activities as soon as you are able. As a rule, don’t do anything that causes a lot of pain.In the past, advice had been to rest until the pain eases. It is now known that this was wrong. Sleep in the most naturally comfortable position on whatever is the most comfortable surface.
Medication by itself cannot cure this problem. The treatment to this condition is NOT AT ALL by medicines. Painkillers are best to be taken as a short course as advised as it helps in initiation of exercises. These should be gradually decreased For nerve pains and bone strength however medications , calcium , Vitamins are often helpful in maintaining the strength .
Some people visit a physiotherapist or osteopath for manipulation and/or other physical treatments. It is debatable whether physical treatments would help all people with a prolapsed disc. However, physical treatments provide some short-term comfort.
Surgery is an option in some cases. It is often not necessary. However it is often required if the symptoms have not settled after about three months or so. More importantly whenever there is a weakness of the nerves is manifested such as weakness of toes or ankle or persistent numbness or persistent tingling which does not subside within 3 weeks , surgery is warranted. This is the minority of cases as in about 9 in 10 cases; the symptoms have eased off and are not bad enough to warrant surgery. The aim of surgery is to cut out the prolapsed part of the disc. There are different techniques available with us to do the same as it is a very minor surgery.
True lumbar instability occurs when the supporting ligaments, discs and joints of the spine are damaged to the point they can no longer hold the bones together. As the vertebrae move out of alignment, they can pinch nerves and cause leg pain and weakness. The abnormal motion is microscopic and can be measured on standing bending x-rays.
The pain is often severe, and usually comes on suddenly. The pain is usually eased by lying down flat, and is often made worse if you move your back, cough, or sneeze.
Other nerve root symptoms
The irritation or pressure on the nerve next to the spine may also cause pins and needles, numbness or weakness in part of a buttock, leg or foot. The exact site and type of symptoms depends in which nerve is affected.
Cauda equine syndrome – rare, but an emergency
Cauda equine syndrome is a particularly serious type of nerve root problem that can be caused by a prolapsed disc. This syndrome can cause low back pain plus: problems with bowel and bladder function (usually unable to pass urine), numbness in the saddle area (around the anus), and weakness in one or both legs. This syndrome needs urgent treatment to preserve the nerves to the bladder and bowel from becoming permanently damaged. This is the only condition where surgery is absolutely necessary and required in emergency.
Sciatica is a common name given to a condition when a nerve coming from the spinal cord is pressed, trapped or irritated by a prolapsed disc. Although the problem is in the back, you feel pain along the course of the nerve in addition to back pain. Most commonly paingoes downto a leg on the back side and then along the calf till foot. This pain is often worse than the back pain.
However this is not a disease and not a diagnosis. It is only a symptom and signifies that the disc or bone of spine is causing some effects to nerve and the management needs to be more aggressive. Many people or physician with inadequate understanding of this symptom scare the patients. You should not be afraid of sciatica , but do follow the treatment sincerely and be more aware.
Some people may have a weakness in the outer part of the affected disc. Various things may trigger the inner softer part of the disc to prolapse out through the weakened outer part of the disc. For example, sneezing, awkward bending, or heavy lifting in an awkward position may cause some extra pressure on the disc. In people with a weakness in a disc this may be sufficient to cause a prolapse. Factors that may increase the risk of developing a prolapsed disc include: a job involving lots of lifting, a job involving lots of sitting (especially driving), weight bearing sports (weight lifting etc), smoking, obesity and increasing age (a disc is more likely to develop a weakness with increasing age). Besides this , poor posture causing an altered balance and damage to curves of spine remain the more important cause.
Traditionally, bed rest was the recommended treatment for back pain. However, recent studies show that bed rest is counterproductive and often detrimental in treating back pain. Bed rest allows muscles to de-condition and significantly slows the rate of recovery from acute back pain. The recommended activity modification for patients with back pain is to stop whatever activity causes back pain. Specifically, if bending and lifting cause back pain, then avoid bending and lifting. If a twisting motion causes back pain then stop that. However, persons with back pain should remain as active as possible as long as they are not having pain. Bed rest should only be used in cases where it is specifically advised by doctor and in limited conditions like TB , tumour or fracture or if the patient is having severe pain and cannot even tolerate simple activities of daily living, such as standing, walking, or sitting without suffering severe pain.
A prolapsed disc compresses the adjacent nerve roots. This pressure on the nerve roots tends to cause low back pain and leg pain which can be accompanied by numbness and weakness. When disc herniations are very severe, they can even affect the function of the control of the bowel and bladder. This is called cauda equina syndrome and tends to be a very unusual complication of disc herniation. This is an emergency and needs immediate medical attention.
The spine is made up of many bones called vertebrae. These are roughly circular and between each vertebra is a disc. The discs are made of strong rubber-like tissue, which allows the spine to be fairly flexible. A disc does not actually slip. What happens is that part of the inner softer part of the disc bulges out through a weakness in the outer part of the disc. This is more technically known as “prolapsed disc”. The bulging disc may press on nearby structures such as a nerve coming from the spinal cord. Some inflammation also develops around the prolapsed part of the disc. The seriousness of the condition depends on the nerves being pressed by the prolapsed disc. Although , any disc in the spine can prolapse, most prolapsed discs occur in the lumbar part of the spine (lower back). The size of the prolapse can vary. As a rule, the larger the prolapse, the more severe the symptoms are likely to be.
Bulging discs are extremely common. The incidence of significant disc changes on an MRI scan is almost identical to the age of the patient. For example, if one hundred 40-year old patients underwent MRIs of the cervical spine, approximately 40% of them would show some degenerative disc changes. While these changes are technically abnormal, they are extremely common and occur as a consequence of the normal aging process. These are not at all serious.
Back pain is one of the most common ailments; approximately 80% of the adult population will develop a significant episode of back pain sometime during their life. Fortunately, most of these will spontaneously resolve. However, approximately 10% to 20% will develop into significantback pain which might last long or come in episodes. Wear and tear conditions which occur with age are more common causes. Low back joint restrictions and/or sacroiliac joint restrictions are also a common cause of acute low back pain. Muscle pulls and tears may also cause low back pain, but usually the symptoms from muscular causes are short-lived. Weak muscles, poor flexibility, and poor posture all aggravate underlying conditions and worsen symptoms. Uncommon and more serious causes of pain include infection,cancer, fractures, aneurysms, and/or internal organ problems.