Lumbar spine surgery in India

Overview

Lumbago, also known as low back pain is one of the most prevalent spinal problems in adults. It affects individuals of all genders equally. The reason for such persistent back pain is the presence of pathological problem in the lumbar spine, which makes the last five vertebrae of the spine.

Lumbar spine problems are most often caused by herniated inter-vertebral discs, anomalous developments on the vertebral bodies (osteophytes), which apply pressure on the spinal nerves that leads to narrowing of the spinal column around the spinal cord. The most popular and important procedures done in lumbar Spine Surgery are decompression and fusion.

Causes of Low Back Pain

The common causes for the low back pain are;

Intervertebral disc degeneration is the common cause of low back pain in which the disc shrinks and wear off as the age advances. As a result, the disc loses its integrity and cushioning ability and produce pain and discomfort in the low back.
Disc herniation or rupture often occurs when the weakened disc puts pressure on the centre of the intervertebral disc. Such discs are compressed and bulge outward resulting in disc herniation or sometimes rupture leading to back pain.
Radiculopathy / Sciatica is a condition in which the herniated /ruptured disc or spinal stenosis results in compression, inflammation or injury to the spinal nerve root resulting in numbness, tingling sensation and radiating pain from low back down to the buttock and the lower leg.
Spondylolisthesis is a condition in which the normal aging process makes it difficult for the spinal bones and ligaments to maintain its position resulting in slipping of the vertebrae of the lower spine out of place. In such case the spinal nerves are pinched by the bone causing back pain.
Spinal stenosis is the narrowing of the spinal canal that leaves less space for the spinal cord and the nerves, thus compressing them and causing pain and numbness while walking.
Skeletal abnormalities including scoliosis, lateral curvature of the spine and other congenital anomalies can cause discomfort and back pain.

The other conditions and causes that can develop low back pain includes;

Inflammatory disease of the spine including arthritis and spondylitis.
Infections of the vertebrae such as osteomyelitis
Tumours of the spine
Traumatic injury to the spine

Treatment options

The lumbar spine surgery is performed using either of the following technique;

Decompression : Lumbar spine decompression surgery is performed to relieve the pressure over nerves by removing the diseased discs, ligamentum flavum and bone which is pressing over the nerve. The surgery is generally recommended in cases of spinal stenosis caused by thickened joints, loosened ligaments, bony growths, or disc herniation i.e. there is not enough space for the nerves to breath.

The surgery entails removing a small portion of the bone over the nerve root and/or disc material from under the nerve root to give the nerve root more space and provide a better healing environment.

Various procedures used for Decompressing Lumbar spine are:

Fusion : Lumbar fusion surgery is designed to create solid bone between the adjoining vertebrae, eliminating any movement between the involved bones. The goal of the surgery is to reduce pain and nerve irritation. During the surgery, diseased discs are excised and replaced with spacer device, pedicle screws and rods are attached to the back of the vertebra and an interbody fusion spacer is inserted into the disc space from one side of the spine.

Lumbar fusion surgery has two individual approaches. The most common process used is the posterior approach, where the surgery is done from the back. The three main Posterior fusion techniques are:

Postero lateral gutter fusion surgery
Posterior lumbar Interbody fusion (PLIF) surgery
Transforaminal lumbar Interbody fusion (TLIF) surgery

The anterior approach involves placing the bone directly into the section between the vertebrae where the shock-absorption disc had been situated.

Candidates

Lumbar spine surgery is indicated for people who have pain that extends (radiates) from the back to the buttocks or back of thigh, pain that interferes with daily activities, weakness of legs or feet, numbness of legs, feet, or toes, loss of bowel of bladder control, had physiotherapy and medication treatment, but that hasn't helped.

Procedure

Lumbar decompression and fusion surgery is usually done through Minimally invasive technique for quick recovery of the patient. A small incision is made and the surgeon makes the access to the spinal column using small and sophisticated instruments. A sort of tunnel is created around the area where the problem exists in the spine. Using high powered microscopes, the surgeon removes the bone or disk material that has been causing the problem. For fusion, screws and rods are also placed through this small space.

The incisions are closed and area bandaged after the surgery.

Expected Results

Most patients can expect a dramatic and lasting improvement in their back and leg pain after lumbar spinal surgery. Though the success rates are excellent in Lumbar surgery, it can be lower in patients who smoke, are overweight, have diabetes or other significant medical illnesses, have osteoporosis, or who have had radiation treatments that included the lower back. Good nutrition and slowly increasing activity (as recommended by your physician) in the recovery period can help achieve success.

Recovery

You are likely to experience pain and discomfort after the surgery, which will be controlled with pain killers prescribed by the surgeon. You would be advised to walk the same day or the next after the surgery to prevent any clot formation. You would also be advised to do breathing exercises after the lumbar surgery for better circulation of blood and decrease the risk of any lung problem. You would need to stay at the hospital for about 5-6 days after the procedure and can go back home with specific instructions to follow. Many people return to work in 3-4 weeks after the surgery. But you may or may not be allowed to do heavy work depending upon your specific condition.

Time & Cost

The total duration of hospital stay required for the procedure is 4-7 days and a week to ten days in town before you can go back. One can generally return to work or other normal activities within five to six weeks of the surgery. A total of two weeks is required for Lumbar Spine Surgery in India.

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