Spine Surgery

What is Back Pain

Neck & back pain can be caused due to a variety of injuries & diseases, including trauma & arthritis. Physical therapy & pain management to orthopedics & neurosurgery is required to help relieve patients suffering from neck or spine problems. Several treatments are available including medical management to newer pain control techniques & back surgery for overcoming issues relating with spine. Although spine surgery helps relieve some causes of back pain, most back pain problems resolve of their own within two months of time. Low back pain is one of the most common ailments seen by doctors & which typically respond to nonsurgical treatments like physical therapy, gentle massage, heat & anti-inflammatory medications. Spine surgery may be an option only when conservative treatments have failed to relieve pain which is disabling & persistent. Spine surgery most often can be relied upon to relieve associated numbness or pain which goes down one or both legs or arms.

Back Pain Associated with Neurology

Many signs & symptoms of back pain are caused by compressed nerves in spine. Nerves can get compressed due to a variety of reasons, including the following.

• Herniated Discs – Rubbery discs which lie in-between vertebrae in spine consist of a soft nucleus surrounded by annulus which is a tougher exterior around the soft center. Herniated discs can occur when a part of nucleus pushes through cracks in annulus. Symptoms typically occur when herniation starts compressing a nerve.
• Overgrowth of Bone – Osteoarthritis results in formation of bone spurs on spine. This excessive bone growth can narrow amount of space which is available for nerves to pass through openings in spine.

However, quite often it can be difficult to pinpoint exact cause of back pain even after x-rays reveal that a patient is having bone spurs or disc problems. X-rays which have been taken for other reasons often show herniated or bulging discs which cause no symptoms nor require any treatment.

Causes of Back Pain

Back pain is usually caused when something is erring in the way spinal joints, discs, nerves & muscles fit together to enable movement. Back pain problems are one of the most common complaints among American adults & a leading cause of lost job time along with time & money which is spent in search of relief. Common spine conditions which cause back pain are listed below.

• Low Back Pain – Age plays a crucial role, while other low back pain causes include obesity, illnesses, poor posture, inactive lifestyle & injuries to spine.
• Herniated Disc – Various problems with spinal discs also play a major role in back pain.
• Osteoarthritis – Osteoarthritis is one of the most common types of arthritis & which can also involve the spine.
• Spinal Stenosis – This is narrowing of the spinal canal & which can result in back pain.
• Ankylosing Spondylitis – This is a type of arthritis which affects the spine causing stiffness & pain from neck down to low back. Vertebrae of the spine ruse together in this condition so as to result in a rigid spine.
• Spondylolisthesis – Spondylolisthesis is slipping of vertebrae over one another. In most cases this is found to happen at the base of spine.
• Spine Curvature Disorders – Whenever abnormalities of spine are found to occur, natural curvature of spine are exaggerated or misaligned in certain areas like they occur in scoliosis, kyphosis & lordosis.
• Back Injuries – Injuries causing back problems are often found to occur during home projects, work-related tasks, recreational activities, or while playing sports.

Signs & Symptoms of Back Pain

Signs & symptoms of back pain can range in intensity from being mild to severe. Most people experience back pain sometime or the other during their life span. There are numerous causes of back pain though. Some of these causes are self-inflicted due to bad habits, while other causes include sports injuries, muscle strains & accidents. Though causes of back pain may be different, they quite often share the same signs & symptoms including the following.

• Persistent stiffness or aching anywhere along the spine, from neck to the base including tail bone.
• Sharp & localized pain in lower back, upper back or neck, especially after engaging in strenuous activities or lifting heavy objects. Sometimes pain in the upper back can also be a sign of heart attack or some other life-threatening condition.
• Chronic aching in middle or low back, especially after standing or sitting for extended periods of time.
• Back pain which radiates from low back to buttock, down the back to thighs & into calf & toes.
• Inability of the patient to stand straight without experiencing muscle spasms or pain in lower back.

·People Should See a Doctor in the Following Conditions

• Feeling tingling, numbness or weakness in legs, arms or groin. This can signal damage to the spinal cord. People experiencing this symptom must seek immediate medical help.
• Back pain in the back extending downward along back to leg. Such patients may be suffering from sciatica.
• Back pain increasing with cough or bending forward at waist. This can mean to be a sign of herniated disc.
• Back pain which is accompanied by fever, burning while urinating, or frequent urge to urinate. This patient may have an infection.
• Back pain patients having problems in controlling bladder or bowels must seek immediate medical attention.

·Other Red Flags which Point to Serious Back Pain

• History of cancer
• Unintended weight loss
• Patients on steroids or medications which weaken immune system
• History of trauma
• Back pain which is getting worse & refuses to get better following rest
• Back pain which has lasted over a month
• Back pain at nighttime
• Unresponsive back pain to earlier therapies
• History of IV drug abuse

Common Spinal Conditions

·Sciatica

Sciatica is a painful condition which usually affects only one side of the body. Quite often, this pain extends from low back all the way through the back of thigh & down the leg. This pain may also extend to the foot & toes depending upon where the sciatic nerve is affected. Pain from sciatica can be severe & debilitating for some people, while for others it can be irritating & infrequent, but holds a potential to get worse over time. Sciatica patients should seek medical attention in case they experience progressive lower extremity numbness & weakness in upper thighs and/or loss of bowel or bladder control. Common signs & symptoms of sciatica include the following.

• Low back pain
• Hip pain
• Pain in the rear or leg which is getting worse while sitting
• Tingling or burning down the leg
• Numbness, weakness or difficulty in moving leg or foot
• Shooting pain which makes difficulty in standing up
• Constant pain in one side of the rear

Sciatica is normally caused by irritation of nerve roots of lower lumbar & lumbosacral spine. Other causes of sciatica include the following.

• Lumbar Spinal Stenosis – This is narrowing of the spinal canal in the lower back region.
• Degenerative Disc Disease – This is breakdown of discs which normally act as cushions between vertebrae.
• Spondylolisthesis – This is a condition where one vertebra is found to slip forward over another vertebra.
• Pregnancy
• Muscle Spasm – Within the back or buttocks area

Other things which make back pain worse in sciatica include sleeping on mattresses which are too soft, wearing high heels, not exercising regularly & being overweight.

·Low Back Strain

Lower back pain is felt just about everyone at some point in their lives. Low back strain is one of the main causes of back pain, whether it is chronic or acute. A series of ligaments & muscles in back hold the spinal column & bones in place. People can often stretch these muscles by stretching them too far so as to cause tears in tissue. Muscles are weakened following this & they may not at times be able to hold bones correctly in place. Subsequently the spine becomes less stable & may then cause low back pain. Moreover, since nerves stretch out from spinal cord throughout the body, lower back strain can often cause pain which is other than back pain. Signs & symptoms of low back strain include the following.

• Stiffness & pain in back
• Pain in legs & buttocks & quite often in back of thigh
• Pain that worsens with sneezing, coughing, stretching or bending

Because there are some symptoms of low back strain which are similar to those of other more serious conditions, it is very important that patients get it checked by doctors. Weakness or numbness in legs or bladder & bowel problems can indicate nerve damage & which may require immediate medical attention. Doctors give patients a thorough examination for diagnosing low back pain. Patients may have to undergo CT, MRI or X-ray scans for this purpose. However, these tests are only required when pain does not go away on its own even after conservative treatments.

·Nighttime Back Pain

This is a special type of low back pain which can indicate serious problems with spine. More than 80 percent of the United States population experiences some type of low back pain at some time in their lives. Most instances are however manageable with adequate rest & proper exercise within a matter of weeks, even with the most debilitating back pain. Nevertheless, cause of nighttime back pain is not always clear. Back pain can be caused by any of the following factors.

• Most common of these is disc degeneration which involves either mechanical problems or the way spine moves. Discs are tissue located between vertebrae that are meant to function as a type of shock absorber, but often breakdown with age.
• Injuries like fractures or sprains or more severe injuries like falls or auto accidents.
• Conditions & diseases like scoliosis, curvature of spine or spinal stenosis which is narrowing of the spinal column. Certain cancers, endometriosis, pregnancy, kidney stones & various other types of arthritis can all lead to back pain.
• Sometimes cause of back pain may not be determined at all.

Preparing for Spine Surgery

Following steps can help patients prepare for spine surgery.

• Bring list of all current medications to orientation appointment for review.
• Consult the physician for special instructions when the patient is taking blood thinners, insulin & routine medications.
• Do not drink or eat anything for at least 8 hours prior to scheduled spine surgery. Do not also use tobacco products or chew gum.
• Bathe, or shower to minimize chances of infection & wear only loose fitting comfortable clothing.
• Leave jewelry or any other type of valuable items at home.
• Do not wear glasses or contact lenses in the operation theater & take out removable teeth prior to shifting to the operating room.
• Arrange for a responsible adult to drive back home & provide care for 24 hours at least in case the patient is undergoing same day (outpatient) spine surgery.
• It is recommended that patients who smoke should quit the habit at least 15 days prior to the date of spine surgery.
• Patients who have had any problems or allergies with anesthetics in the past should discuss this with the operating surgeon so that the anesthetist is aware of this prior to spine surgery.
• Patients currently using CPAP machine for sleep apnea should bring the machine with them on the day of surgery.

Types of Spine Surgeries

There are several types of techniques for back surgery; however they are not equally effective for everyone. Before a patient decides to undergo back surgery, it would be a good idea to familiarize with different surgical techniques. Unique symptoms & proper diagnosis will effectively help in determining as to which procedure might work best in a case. It is always good to be on top of latest medical technologies & innovations in order to discuss with the spine surgeon & be able to make informed decisions.

3D Image Guided Spine Surgery

This is a kind of GPS for the back & is revolutionizing how spine surgeries are performed nowadays. In fact there has never been a better time to undergo spinal procedures. This is because navigation & imaging techniques enable surgeons’ access, accuracy & enhanced visualization both during & before surgery.

• Before Surgery – Surgical planning software enable surgeons prepare for the patients’ spinal procedure.
• During Surgery – Intraoperative imaging technology provides detailed view of the patients’ anatomy in real time during the operating procedure.

Benefits of surgical imaging & navigation techniques include the following.

• These allow the surgeon to navigate through delicate anatomy while avoiding critical structures in spine
• Allow performing more minimally invasive procedures
• Able to preserve healthy anatomy during the surgical intervention
• Intraoperative images help doctors make better decisions during the operation
• Intraoperative images provide high-definition & real-time images before, during & post spine surgery procedures

These are highly sophisticated tools which are not yet available at every hospital facility specializing in spinal procedures. However, patients must make it a point to ask the orthopedic surgeon or the healthcare provider about 3D image guided spine surgery.

Spinal Fusion

There are many approaches to spinal fusion surgery & doctors will determine as to which one best suits individual needs of the patient. Spinal fusion is a permanent joining of two or more than two vertebrae so that there is no movement at that segment between them. Over time they will heal into a single & solid bone. Spinal fusion surgical procedure generally involves roughening bone between two adjacent vertebrae & subsequent placement of bone graft between them. Moreover, in some cases disc material may also be replaced with donated bone or in case of degenerative disc disease cases metal or plastic spacers which may be used instead. Screws & rods are then applied to create an internal cast which supports the vertebrae & holds it together until fusion or re-growth of bone can occur. Spinal fusion surgery involves creating a single incision & stripping muscles from spine. However minimal invasive techniques in comparison to open surgery techniques offer the following key benefits.

• Increased Access to Spine – This includes removing intervertebral discs or the damaged bone with lesser likelihood of leaving compressive elements behind.
• Greater Visibility – Minimally invasive techniques allow spine surgeons greater visibility in order to place screws, rods & bone graft materials which are required for stabilizing spinal bones. This technique also creates lesser risk of damage to nerves & surrounding structures.

Approaches to Disc Space for Spinal Fusion

• ALIF Anterior Lumbar Interbody Fusion – This approach for spinal fusion involves making an incision in the patients’ abdomen.
• PLIF Posterior Lumbar Interbody Fusion – This approach for spinal fusion involves making an incision in the back region of the patient.
• TLIF Transforaminal Lumbar Interbody Fusion – During this approach for spinal fusion, an incision is made in the back region of the patient right next to the spine in order to access vertebra at an angle.
• DLIF Direct Lateral Interbody Fusion – This approach technique for spinal fusion involves making an incision on the side of the abdomen.

Potential risks of spinal fusion surgical procedure include common surgical complications caused by anesthesia, rare allergic reactions, undiagnosed medical problems like silent heart disease & blood clots. Specific spinal surgery complications include instrument malfunction when used, damage to surrounding soft tissue & neurological damage as well. Nevertheless, most of these complications can be effectively treated once detected, but this sometimes requires additional surgery, additional medications & longer periods of hospitalization & recovery. Most of these risks will be explained to patients by the primary surgeon depending upon the type of surgery under consideration. Other risks specifically associated with implants include loss of spinal curvature, device migration & correction. It is therefore important for the patient to follow doctors’ advice in order to achieve best possible outcome.

Decompression Surgery for Pinched Nerve

Spinal decompression treatments offer an effective solution when leg pain, low back pain or a herniated disc is impinging life. Nerves or spinal cord are being squeezed when impinged by bone or disc material. Decompression is an effective surgical procedure which can relieve pressure & alleviate pain which is caused due to this impingement. During this procedure, small portion of bone called lamina over the nerve root and/or disc material from under nerve root is removed so as to give more space to the nerve.

Three Common Types of Spinal Decompression Procedures

All of these 3 procedures can also be performed through minimally invasive techniques.

• Laminotomy / Foraminotomy – This involves shaving away part of the lamina in order to create a larger opening to relieve pinched nerves.
• Laminectomy – This involves complete removal of the lamina.
• Discectomy – This involves removing a portion of the disc which is compressing the nerve.

Each one of these procedures can be performed as independent surgeries or may also be combined together if needed. Like for example, discectomy can be done in combination with laminotomy. However, it will be the doctors who will determine which individual procedure or a combination of procedures will be able to give the patient most relief.

Laminotomy & Laminectomy

Laminotomy & laminectomy primarily are spinal decompression surgeries on lower spine which involve removing bone known as lamina in order to relieve pressure on spinal nerves. While laminotomy is partial removal of lamina in order to create a larger opening, laminectomy is complete removal of the lamina. Both these procedures are most commonly done to relieve signs & symptoms of spinal stenosis including numbness, weakness or pain which can radiate down legs or arms. Doctors usually recommend any one of these procedures when nonsurgical treatments have failed to improve symptoms or when numbness or muscle weakness makes walking or standing difficult. Moreover, there are several other spinal conditions which may effectively be treated with laminotomy & laminectomy, including the following.

• Sciatica
• Herniated Disc
• Spinal Stenosis

These procedures in some cases may also be necessary as part of a surgical program so as to treat herniated spinal discs. Spine surgeons may sometimes need to remove portions of or complete lamina in order to gain access to damaged discs. Both, laminotomy or laminectomy can be performed as open surgery procedures where surgeons use a single large incision to access spine or use a minimally invasive approach involving smaller incisions which gently separate muscles instead of cutting through them.

Discectomy

Discectomy is a surgical procedure which is designed to remove herniated discs which are causing back pain and/or leg numbness, pain or muscle weakness. When intervertebral discs rupture in spine, they put pressure on one or more nerve roots. This is often known as nerve root compression & may also cause pain & other symptoms in legs, arms & neck areas. Doctors may therefore recommend any one of these procedure when nonsurgical treatments have failed to improve symptoms & the patient continues to experience pain in leg which is limiting normal daily activities or numbness or weakness in feet or legs. This procedure can also be performed using open or the minimally invasive approach. However, it will be the doctors who will determine which one is the best method, depending upon the condition of the spine. Typically, this surgical intervention is performed with patients positioned as lying upon their stomach. Potential risks & complications like with all surgical interventions include rare allergic reactions, undiagnosed medical problems like silent heart disease, blood clots & unforeseeable problems caused by anesthesia. Other problems associated with discectomy spinal surgery include instrument malfunction when used, damage to surrounding soft tissue, paralysis & other neurological damage. However, most of these complications are treated as they are detected, but they also require longer period for recovery or hospitalization along with additional medications & sometimes additional surgery as well. These potential risks are explained by the primary spine surgeon to the patient depending upon the type of surgery which is to be performed. It is however important for the patient to understand & follow the surgeons’ advice so that best possible outcomes can be achieved through discectomy. Nevertheless, this surgery is not for everyone & therefore the patient must consult the spine surgeon prior to undergoing discectomy for back problems.

Minimally Invasive Spine Surgery

Nowadays, advances in spine surgery mean smaller incisions, smaller scars, decrease in blood loss & lesser time of stay at the hospital. Minimally invasive spine surgery has brought a new day in back surgery. Although open spine surgery may be the best surgical approach for specific conditions, but when minimally invasive approach is an ideal operation procedure, patients may experience the following benefits.

• Smaller size of incision & scar
• Decreased loss of blood
• Lesser time for stay at the hospital
• Lesser pain medications required during healing

Exact length of time required for stay in hospital with minimally invasive spine surgery will invariably be less, but the exact requirement of this will vary with each patient depending upon the individual procedure as well. Spine surgeons may quite often recommend specific exercises as part of the postoperative treatment plan. However, one should bear in mind that even though spine surgeries are being performed though minimally invasive techniques, it is still surgery & therefore risks & complications are involved. Potential risks & complications associated with this procedure include adverse effects because of undiagnosed medical problems like silent heart disease, allergic reactions, blood clots & complications due to anesthesia. Moreover, injuries to blood vessels & nerves can also occur. Additionally, the spine surgeon may have to convert the operation into open surgery if required.

Balloon Kyphoplasty for Spinal Fractures

• Balloon kyphoplasty is basically a minimally invasive surgical treatment which can repair spinal fracture caused by benign lesions, cancer or osteoporosis. Orthopedic balloons are used during this procedure to gently elevate the fractured vertebra as an attempt to return bone in the correct position. Bone cement is subsequently injected in order to stabilize the fracture. Normally, balloon kyphoplasty takes up to one hour time per fracture level which is treated. This can either be performed as an outpatient or inpatient procedure depending upon the overall health of the patient as determined by the physician. Most often patients experience relief from spinal fracture pain one week following the procedure. Surgeons will most likely schedule follow-up visits where they will also explain limitations on physical activity, if there were any. Patients having undergone balloon kyphoplasty have faster & greater improvement from back pain relief & back function along with improvement in quality of life at one month following surgery. Benefits of this procedure are sustained on average through 12 months post operation.

·Restoring Height in Kyphosis Patients

• Balloon kyphoplasty also restore height & corrects stooped posture in kyphosis patients. Compression fractures are often found to result in stooped posture & height loss due to changes in shape of affected vertebrae. This is a spinal deformity which eventually leads to kyphosis is corrected by balloon kyphoplasty as it restores & normalizes vertebral shape & height.

Common Types of Spine Conditions

There are several medical conditions which affect the spine. Some of these spine conditions which can be expertly treated by orthopedic surgeons include the following.

Low Back Pain

Lower back pain is by far the most common complaint of spine, especially among the adults in United States. This usually affects the back anywhere below ribs & above legs. Causes for low back pain include diseases like osteoporosis & arthritis, aging, compression fractures, injury, strain & overuse. Treatments for low back pain vary according to severity but generally include the following.

• Physical Therapy
• Medications
• Epidural Steroid Blocks
• Facet Blocks
• Selective Nerve Root Blocks
• Transforaminal Epidural Steroid Blocks
• Spinal Fusion
• Laminectomy

Radiculopathy

Radiculopathy is basically a disease of spinal nerves & spinal nerve roots. Cervical radiculopathy generally affects nerve roots near neck & which radiate through hands & arms. Lumbar radiculopathy cause nerve irritation in lower back region which radiate through feet & legs. Primary causes for radiculopathy include traumatic injury, herniated discs, degeneration & general wear & tear. Treatment options for radiculopathy include the following.

• Physical Therapy
• Epidural Steroid Blocks
• Selective Nerve Root Blocks
• Transforaminal Epidural Steroid Blocks

Sciatica

Sciatica is numbness, tingling or pain which is caused by irritation of sciatic nerve in the lower back region. Sciatica can result from injury-induced pinched nerve, arthritis, spinal stenosis, or from herniated discs pressing against nerve roots. Treatment options for sciatica include the following.

• Physical Therapy
• Medications
• Epidural Steroid Blocks
• Sympathetic Blocks
• Selective Nerve Root Blocks
• Transforaminal Epidural Steroid Blocks
• Spinal Fusion
• Laminectomy

Lumbar Disc Disease

Lumbar spine or lower back region of spine is made up of five vertebrae separated by cushioning discs of cartilage. Trauma or degenerative conditions can damage discs & allow the materials inside to bulge into spinal canal & cause effects like herniated discs. Treatment options for herniated discs include the following.

• Physical Therapy
• Medications
• Epidural Steroid Blocks
• Selective Nerve Root Blocks
• Transforaminal Epidural Steroid Blocks
• Microendoscopic Discectomy
• Laminaplasty
• Spinal Fusion
• Artificial Disc Replacement

Spinal Stenosis

Spinal stenosis is basically a medical condition in which the spinal can narrows so as to pinch nerves & which can result in back & leg pain. Spinal stenosis is most often found to occur in older adults, although younger people born with small spinal canal can also develop these symptoms. Treatment options recommended for spinal stenosis include the following.

• Physical Therapy
• Medications
• Epidural Steroid Blocks
• Selective Nerve Root Blocks
• Transforaminal Epidural Steroid Blocks
• Interspinous / Interlaminar Implant
• Spinal Fusion
• Laminectomy
• Laminaplasty

Cervical Disc Rupture

Vertebrae in spine are typically cushioned by soft discs. When any one of these discs in neck region, known as cervical area of spine, ruptures will eventually result in neck pain.

Arthritis of Spine

Arthritis in pelvic area & lower back region can cause pain & loss of motion. There are several reasons as to why arthritis develops to put people at risk alongside many treatment options which can be helpful.

Degenerative Disc Disease

Most vertebrae are found to be separated by flexible discs of cartilage which act like shock absorbers so as to allow spine to efficiently move. However, with age these discs can lose height & their ability to cushion. This process is recognized as degeneration disc disease. Treatment options which are available for degeneration disc disease include the following.

• Physical Therapy
• Medications
• Epidural Injections
• Epidural Steroid Blocks
• Selective Nerve Root Blocks
• Transforaminal Epidural Steroid Blocks
• Spinal Fusion
• Artificial Disc Replacement

Spondylolisthesis

Spondylolisthesis basically is a forward slip of one vertebra in spinal column & which is usually found to occur in the lumbar region. Moreover, some people are born with defective vertebra as well, while in others disease, infection, stress fracture or trauma may cause the problem. This condition is on the rise among children & adolescents who are especially active in athletics. Treatment options for spondylolisthesis include the following.

• Physical Therapy
• Epidural Steroid Blocks
• Selective Nerve Root Blocks
• Transforaminal Epidural Steroid Blocks
• Spinal Fusion

Cervical Arthritis

Neck is the upper region or cervical part of spine which is a column of 33 bones known as vertebrae. Cervical arthritis is basically a medical condition which occurs when cartilage & vertebrae in neck are found to wear abnormally. However, there are several causes as to why this condition develops & so are many treatment options available.

Myelopathy

Myelopathy is basically is gradual loss of nerve function which is caused by disorders of spine. This condition most often results from injury to spine or spinal stenosis which is a progressive narrowing condition of the spinal canal. Treatment options for myelopathy include the following.

• Physical Therapy
• Medications
• Spinal Fusion
• Laminectomy

Kyphosis

Kyphosis is basically a progressive disorder of spine which causes curvature of thoracic spine among children & adults. This is most often resulting from developmental problems, osteoporosis with compression fractures, degenerative diseases like arthritis & trauma. Treatment options for kyphosis include the following.

• Physical Therapy
• Spinal Fusion

Scoliosis

Basically a medical condition which causes spine to curve sideways, scoliosis can develop during childhood or adolescence & is found to range from mild to severe in nature. There are several reasons as to why scoliosis occurs. Treatment options available for scoliosis include the following.

• Physical Therapy
• Facet Blocks
• Spinal Fusion

Compression Fractures

Compression fractures are basically broken vertebra in spine. These are usually found to occur due to severe trauma, but are also found to result from osteoporosis or cancer. Compression fractures are most common in vertebrae of lower back region. The best treatment option for compression fractures is kyphoplasty.

Ankylosing Spondylitis

Ankylosing spondylitis is basically a type of arthritis which primarily affects ligaments & joints of spine, especially in the lower back region. With progression of the disease, this condition can often lead to a stooped posture.

Risks & Complications of Spine Surgeries

There are risks & complications involved with any type of surgical interventions. When surgery is performed near spine & spinal cord, these risks & complications in case they occur can be very serious. These can result in subsequent pain & impairment which may even require additional surgery. Patients should therefore make it a point to discuss these complications & the consequences with the surgeon before undergoing the procedure. Moreover, it is the surgeon who can evaluate the patients’ condition & inform them of risks of medical treatments that they are recommending.

Complications with Anesthesia

Majority of surgical interventions require administration of some type of anesthesia before surgery. This is essential as the patient should not feel any pain or be aware of the procedure. Simplest form of anesthesia is local anesthesia which is administered by injecting a medication, usually Novocain, around the area of the surgical site. This is meant to numb the skin & surrounding tissue. Most complex form of anesthesia is general anesthesia, where the patient completely goes to sleep during the surgical intervention. These medications are usually given by intravenous lines & special machinery is used to breathe for the patient, monitor vital signs & to alert the anesthesiologist in case any problems develop while the patient is asleep. Patients are kept asleep during the entire operation by a combination of medicines provided through the IV line & anesthetic gases which patients are made to inhale through special devices controlling breathing. Nevertheless, most spine surgeries are performed under general anesthesia. However, only a small number of patients are found to have problems with general anesthesia & which are mainly due to reactions to drugs used in the process, problems arising from other medical conditions & problems due to anesthesia itself. Therefore patients should make it a point to discuss these complications with the anesthesiologist before undergoing surgery.

Thrombophlebitis

• This is a condition when blood clots form inside veins of legs. Normally referred to as DVT or Deep Venous Thrombosis, it is a common problem which follows several types of surgical procedures. However, these blood clots are also found to form in certain individuals who have not undergone any recent surgery. Typically, these blood clots form in large veins of calf & may continue to grow & extend into veins of thighs & in some cases also into veins of pelvis. Moreover, risk of developing DVT is higher following surgery involving pelvis & lower extremities. Reasons for developing DVT following surgery include that the body is trying to stop bleeding associated with surgery. Secondly, the body’s clotting mechanism is hyperactive during this period. Additionally, injury to blood vessels around surgical site can set of the clotting process due to normal tugging & pulling during surgery. Lastly, blood which does not move well sits in veins & becomes stagnant & so begins to clot.

Worry from blood clots is that they fill deep veins of legs & stop normal flow of venous blood from legs back to the heart. This eventually causes pain & swelling in the affected leg. Swelling may thus become chronic when blood clots inside veins do not dissolve & subsequently cause permanent discomfort & swelling. While this is bad enough, real danger due to blood clots in veins is far more serious. When portions of these blood clots break free inside veins of leg & travel through blood vessels to lungs & lodge inside tiny blood vessels of lungs, they can cut-off & block blood supply to that portion of the lung. Now this portion of the lung which is blocked cannot survive & may eventually collapse. This is known as pulmonary embolism. When pulmonary embolism affecting the lung is large enough, it can even cause death. Keeping this in mind, it is easy to understand as to why prevention of DVT is a serious concern. Reducing risk of developing DVT is therefore high priority following any type of surgical intervention. All steps that can be taken to reduce risk of developing DVT are taken. These normally fall into the following two categories.

Mechanical

This includes mechanisms of getting to move the blood faster.

Medical

Involves use of drugs which can slow the clotting process.

Mechanical Complications

Blood which moves less is most likely to clot. Surgery patients are therefore encouraged to move around after the operation so as to get their blood circulating. This is perhaps the most effective treatment against DVT. Other things can also be done to increase circulation of blood from legs to the heart while the patient is still in bed. Simple pumping feet up & down like pushing on a gas pedal will contract the muscles of calf, squeeze veins & push blood back to the heart. Pulsatile stockings also work in the same way. There is a pump which inflates these special stockings wrapped around calf & thighs every few minutes. They work by squeezing veins in calf & thigh in order to push blood back to the heart. Support hose, which are also known as TED hose, are also commonly used following surgery. These work by squeezing shut veins of legs while reducing amount of stagnant blood which is pooling in veins of legs & thereby reduce risk of blood clotting. Finally, getting the surgery patient out of bed & walking will result in muscle contraction of legs so as to keep moving blood in veins of legs.

Medical Complications

Drugs which slow down the clotting mechanism of the body are widely used following surgeries of knee & hip in order to reduce risk of developing DVT. These drugs normally include aspirin in low risk situations & shots of heparin twice a day in moderately risky situations. Moreover, several highly potent drugs are available which can effectively slow down the clotting mechanism in high risk DVT conditions. Heparin can also be administered through intravenous injections, another drug known as Lovenox can be given as shots twice a day & Coumadin may be given orally. Coumadin is a drug of choice when the blood clotting mechanism of the body must be slowed down for a few days since it can be orally consumed. However, both mechanical & medical measures are simultaneously used in most cases of spine surgery. Using pulsatile stockings immediately following surgery, getting out of bed faster & beginning exercises as soon as possible alongside some type of medication to slow blood clotting mechanism has become normal practice nowadays.

Lung Problems

Success of spine surgery includes taking good care of lungs following the procedure. It is very important for lungs to function at their best after surgery in order to ensure that the patient gets plenty of oxygen to tissues of the body which are trying to heal. Lungs which are not properly exercised following operations eventually lead to poor blood oxygen levels & can even develop infections in lungs like pneumonia. There are many reasons as to why lungs may not work properly following surgery. Some patients are put to sleep with general anesthesia or medications used for anesthesia for surgery may temporarily cause lungs not to function normally. This is one reason as to why spinal type of anesthetics may be recommended for operations whenever possible. Moreover, lying in bed also prevents complete normal function of lungs & medications taken for pain often hamper deep breathing as normally one would do. Lungs having collapsed areas do not move oxygen into the blood, nor can they remove mucous & fluids which are normally produced by them. This can eventually create areas which are ripe for developing bacteria & produce lung infection including pneumonia.

Patients will therefore need to do several things in order to keep the lungs working at their best following surgery. For this reason the healthcare team will ask patients to take frequent deep breaths & make them cough often. They will constantly be there to coach patients following surgery. Getting out of bed & even upright in a chair allow lungs to function better. This is why patients will be encouraged to get into a chair as soon as possible after surgery. Respiratory therapists apply several tools to help maintain optimal lung function. Incentive spirometer is a small medical device which measures how hard patients are breathing & gives them a tool with which they can improve deep breathing. Respiratory therapists also use medications which are given through breathing treatments to help open air pockets in lungs for patients having other lung diseases like asthma.

Infection

There is risk of infection every time surgery is performed. However, infections are found to occur in less than one percent of all surgical operations. Infections can either occur in skin or can also spread deeper to involve areas around the vertebrae & spinal cord. Wound infection which involves only the skin at incision site is considered superficial infection. These are less serious & easy to treat than deeper infections. Spine surgeons take all precautions to prevent infections. Surgery patients will probably be given antibiotics just before surgery, especially in cases involving plates, metal screws or bone grafts which are used for spine surgery. This is meant to reduce risk of infection following surgery. When surgical wounds get swollen, hot & red, are signs of infection. Moreover, infections usually cause an increase in pain. Surgery patients may also run a fever or have shaking chills. Surgical wounds may ooze yellow pus or clear liquid & wound drainage may smell bad. In such a scenario, patients must immediately contact the surgeon who will treat the wound & prescribe antibiotic medication if required. Superficial wound infections are usually treated with antibiotics & sometimes skin stitches are also removed. Deeper wound infections are a serious concern & may even require additional surgery to drain infection. In worst cases, plates, metal screws & bone grafts which were used may be required to be removed or replaced.

Hardware Fracture

In several different types of spine surgeries, rods, plates & metal screws are used as part of the medical procedure designed to hold vertebrae in alignment while tissues heal. These metal devices are generally known as ‘hardware’. After the bone has healed, these hardware have nothing much to do. Hardware can sometimes either break or move from the right position before the surgery is completely healed. Such a condition is known as ‘hardware fracture’. Whenever this occurs, it may require a second surgery to either remove or replace the hardware.

Implant Migration

Implant migration is basically a term which is used to describe the fact that implant has moved from the location where the spine surgeon initially placed. This is usually found to occur fairly soon following surgery, before the healing process has progressed to the point when the implant is firmly attached by bone growth or scar tissue. In case the implant moves too far, it may not be able to perform the job of stabilizing the two vertebrae. Moreover, in case it moves in a direction towards large blood vessels or spine, it may even damage these structures. When patients have this kind of a problem with implant migration, spine surgeons may decide to perform a second operation to replace the implant which has moved. Spine surgeons usually check the status of hardware with x-rays during follow-up visits.

Spinal Cord Injury

Every time the spine is operated upon, there is some amount of risk involved regarding injuring spinal cord. Such a situation can lead to serious injuries to nerves or to the covering of spinal cord called dura. Spinal cord is a column of nerves which connects the brain with the rest of the body & allows the person to control movements. Nerve fibers in spinal cord branch off in pairs of nerve roots which travel through small openings called foramina, between vertebrae. Nerves within each area of spinal cord connect with specific parts of the body. Therefore, damage to spinal cord can cause paralysis in certain areas & not others which depend upon the spinal nerves which are affected.

Persistent Pain

Some spine surgeries are simply unsuccessful. One of the most common complications of spine surgeries is that they are unable to rid the patient of back pain. Moreover, in some cases they may in fact actually increase pain. Prospective spine surgery patients therefore must be aware of this risk before they undergo surgery & must make it a point to discuss this at length with the spine surgeon. Spine surgeons will be able to give them some idea as to chances which the patient may not be able to get the amount of relief which is expected. Some amount of pain following spine surgery is expected, but when patients experience chronic pain well after the spine operation, they should let the surgeon know.

Sexual Dysfunction

Spinal nerves & spinal cord carry nerve signals which allow the rest of the body to function & feel sensation, including sexual arousal. Damage to spinal cord & nerves around the spinal cord can sometimes cause several problems. When a nerve is damaged which connects with the pelvic region, it could result in sexual dysfunction.

Transitional Syndrome

Another interesting fact about the working of spine is that it behaves like a chain of repeating segments. Each segment works in tandem to share load throughout the spinal column when the entire spine is healthy. Every segment of spine works with the neighboring segment to share stress imposed by movement & forces acting upon the spine. However, when sometimes one or two segments fail to work properly, the adjoining segments have to take on more of load. In such a situation, the segment which is closest to the non-performing segment has to take on most of the extra stress. Effectively, this means that when one or more levels are fused together in spine, the spine segment which is next to where the spine surgery was performed has to take on more stress. This can lead to increase wear & tear to this segment over time, eventually causing pain transferred from the damaged segment. This is known as transitional syndrome because this is occurring where transition to normal area of spine from an abnormal area which has been fused.

Pseudoarthritis

Term ‘pseudo’ means false while ‘arthrosis’ refers to joints. Pseudoarthritis therefore means a false joint. Spine surgeons use this term to describe either an attempted fusion which has failed to be successful or a fractured bone which has not healed. Pseudoarthritis generally means that there is still motion between two bones which should have fused or healed together as one. Moreover, there usually is continued pain when vertebrae involved in surgical fusion do not heal or fuse together as one. This pain may also increase over time in some cases. Moreover, spinal motion can also stress upon the metal hardware which was used to hold the fusion. Rods & screws may also break, leading to increased pain. In such a scenario, pseudoarthritis may require additional surgery to try & get bones to heal. Spine surgeons during this surgical intervention may add more bone graft, replace metal hardware or even add an electrical stimulator to try & get fusion to heal.

Spine Surgery Outcomes

Surgical management of spinal disorders has dramatically evolved since the middle twentieth century. Techniques which were formerly experimental pr not so widely available earlier are now routinely available. Some of these include the following.

• Improved assessment & imaging techniques
• Better understanding of spinal technologies
• Refined surgical techniques which include minimally invasive procedures
• Refined device designs for fusion & fixation
• Selective use of biologics in order to enhance fusion
• Intraoperative monitoring of nerves
• Refined techniques in anesthesia
• Motion preservation devices, techniques & philosophies
• Focused physiotherapy & early mobilization
• Specialist rehabilitation services whenever necessary

Most of these areas still continue to evolve & medical science stays committed to do so in each of these areas.

Medical Tourism is a Smart Idea

As individuals look for ways to curb escalating costs of healthcare around the world, medical tourism which is traveling across the world seeking high-quality affordable medical procedures, is becoming more common. Roughly, over a million Americans alone are expected to travel to other countries for healthcare procedures. With more & more countries joining the band-wagon, the international medical marketplace is bound to take off. Access to information & communication through the world-wide-web & convenient travel across countries in the world have made this task far simpler. Although most people seeking surgeries abroad themselves pay for medical procedures, since they are typically uninsured or underinsured or seek services which are not covered by medical plans like expensive dental restoration or cosmetic procedures. However, these days both employers & insurers, private & public, are picking up cost of overseas care including some who are also throwing cash bonus for employees.

Obtaining a first opinion locally is a normal starting point. The physician at home makes a diagnosis & evaluates patients’ fitness for travel. Patients need to make sure that they are also willing to share records with medical professionals abroad who are involved in healthcare. It would also be ideal if the local doctor is prepared to coordinate with the patient concerning aftercare. Obviously, there may sometimes be a pushback as they are competing for the same business. International patients must seek board-certified specialists having successfully performed procedures in question numerous times. This is exactly where a medical tourism company can fit in to close the gap. They can effectively handle introductions & manage appointments alongside handling travel plans. Medical travel facilitators or accredited hospital facilities will arrange to receive medical records & make sure to let the patient know about the treatment plan before they start on a healthcare journey. They are normally picked up at the airport by English-speaking concierge & shifted to hotels & to hospitals for tests & blood works or for meeting with surgeons. Quite a few medical tourists spend a night at the hotel before being admitted to the hospital. In several cases there will be someone by the side of the patient throughout the stay at the hospital. International patients should expect to stay in the hotel for a few days more after discharge from the hospital, or avail a recuperation holiday at an exotic resort if it is possible depending upon the severity of the case. However, they should avoid sunbathing, swimming, or drinking alcohol without the doctor’s clearance. Taking a companion along for the healthcare journey is a sensible idea. It can provide peace of mind for the patient & if something goes wrong, there will be someone who knows the preferences & the patients’ medical history. In fact, most medical tourism companies expect the patient to be traveling with a spouse or other companion & will make proper arrangements accordingly.

Affordable Spine Surgeries with AVAN MediTour

Based in South Asia, AVAN MediTour  is a globally reputed medical tourism company catering to a growing number of international patients willing to travel to other countries for high-quality & affordable medical procedures.

AVAN MediTour  is associated with top doctors & surgeons & internationally accredited hospital facilities around the world including in countries like Germany, Turkey, United Arab Emirates (Dubai), India, & South Korea (Seoul) & which enables the patient convenience of choosing the medical tourism destination of his liking. Seamless & hassle-free services offered by AVAN MediTour  in fact cover every detail of patients’ requirements while seeking affordable medical procedures in a foreign country. All they have to do is pick up the phone & call, AVAN MediTour  will ensure that all arrangements are in place for your healthcare travel.