Lumbar Spine Surgery in India

Overview

Most of the cases of lower back pain, unless conservative treatment options didn't give good results, if there is critical traumatic injury, and if the patient exhibits signs of accelerating neurological problems such as loss of bladder and bowel control and leg weakness, lumbar spine surgery will not be suggested. Abnormal spine curvatures such as scoliosis would also involve surgery if the marked lateral deviation of the spine brings about serious pain and other signs. The traditional method of lumbar spine surgery was to open up the back through a wide incision. This is a very invasive procedure and the patient typically takes a long time to recover. It is also not uncommon for further complications to develop as a result of the invasive surgery. So often the patient ends up back where he started. But technological advances have made lumbar spinal surgery much more effective and less invasive.

What is Lumbar Spine Surgery?

Lumbar Spine Surgery is a procedure used to correct problems with the spinal bones (vertebrae), disks, or nerves of the lower back (lumbar spine). It is done for a wide range of procedure ranging from spinal decompression to spinal fusion surgery. More commonly known as low back pain surgery, it is typically undertaken to relieve pressure on nerve roots caused by spinal abnormalities, injury or disc degenerative disease. Discectomy and Laminectomy may also be performed through lower back surgery.

Why Lumbar Spine Surgery?

In many cases of lower back pain, unless traditional remedies didn't give good results, if there is severe traumatic injury, and if the patient exhibits indications of progressive neurological problems like impairment of bladder and bowel control and leg weakness, lumbar spine surgery will not be suggested. Likewise, if the deformity of the spine triggered by spine disorders like scoliosis brings about intense soreness and other symptoms, surgery will be required. In order for the doctor to be able to deal with the difficulty, the type of surgery to be performed will count on the site of the damaged area. For example, in many cases of spinal stenosis, anterior lumber spine surgery is performed together with anterior fusion as this is the best way to the lamina and foramen.

What are the Symptoms for Lumbar Spine Surgery?

Symptoms of lumbar spine problems that may require surgery at some point include:

• 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 or bladder control

How to Prepare for Lumbar Spine Surgery?

Preparing for Lumbar spine surgery goes beyond just mentally and physically preparing yourself. Of course you need be in good physical condition before you can have your surgery, but you will also want to prepare your home so that things are accessible once you return from surgery. Just follow the tips below:

• Stop taking medications, pain relievers and vitamin supplements two weeks prior to surgery. If there are medications or supplements you must take, keep a log of these to review with your surgeon prior to surgery.
  
  
• If you smoke, stop two weeks prior to surgery. Smoking increases the risk of serious complications with any surgery. It's best to try to stop at least two weeks before surgery.
  
  
• Organize your home so that things you may need once you return are easily accessible. This means putting the phone, shoes and toiletries in easy-to-reach places that don't require any bending. Make sure that rugs are either removed or secured to prevent you from tripping over them.
  
  
• Organize a ride to and from the hospital. You won't be able to drive when you are released and for some time after. Make sure you have someone who can assist with grocery store runs and other errands, such as making post-operative medical appointments or physical therapy, until you are released to drive.
  
  
• Prepare your hospital bag. This should include comfortable clothing such as pajamas or sweat pants, as well as a robe and comfortable non-slip slippers. Gather toiletries such as a comb, toothpaste and toothbrush. You should also include your health insurance card and credit or debit card for co-payments at the hospital.
  
  
• You should stop eating any solid foods after midnight before your surgery. Clear liquids can usually be continued, but it is better to follow your doctor's instructions about when to stop eating or drinking before your surgery.

What are the Types for Lumbar Spine Surgery?

The medical procedure Lumbar Spine Surgery actually talks about two different surgical methods:

• Decompression Lumbar Spine Surgery: This is the first type Lumbar Spine Surgery which basically involves just as it is called: decompression. Simply, there is a swelling, the swelling affects the nerve in the spine to be pressed or pinched. This results in pain. The relief from the pain is through surgery which involves the removal of a small fragment of the spinal bone or of the disc to give relief from the pain.
  
  
• Lumbar Spinal Fusion: is the second type of lumbar spine surgery. Just as it says, fusion here means bone grafting. The surgeon removes a piece of bone from another part of your body and this is paced on that area in the spine that is moving around too much. This movement causes a friction between the bones which results in pain. The bone graft should hat that movement and allow the area to heal.

What is the Procedure of Lumbar Spine Surgery?

There are two types of Lumbar Spine Surgery, and is discussed as under:

1)  Decompression Lumbar Spine Surgery:

The surgical procedure that alleviates pain caused by pinched nerves is decompression. Lumbar decompression is the removal of material (bone or disc) that is taking up space resulting in pressure on the nerve root in the lumbar region. For those who suffer from back or spine conditions, this form of surgery may be recommended.  Common conditions that may target you as a candidate for lumbar decompression may be spinal stenosis or disc herniation.  While there are other conditions that may prompt lumbar decompression, they are not as common.

The most common types of spine surgery procedures for decompression are:

• Microdisectomy: is typically performed in response to a lumbar herniated disc. The surgery consists of removing small portions of bone and/or disc material to relieve neural impingement. This video gives a clear picture of how a Microdisectomy can help to alleviate pain caused by a herniated disc. During surgery, you are carefully positioned on a padded frame in a manner that allows the space between your vertebrae to be opened as widely as possible.  A small incision is made on your back over the ruptured disc.  The muscles are dissected over to the side to allow us to look at the back part of your vertebrae called the lamina.  A small amount of bone is trimmed from the lamina to create a space between the two vertebrae.  Some ligaments between the vertebrae will also have to be removed.  Utilizing a microscope, the nerve is visualized and then retracted towards the middle of the spine.  We then enlarge the hole in the disc where the rupture has occurred and we remove any loose fragments or material within the disc space. The recovery time for this particular surgery is usually much less than is required for traditional lumbar surgery.
  
  
• Laminectomy: Back pain can grow progressively worse and more disabling, depending on the cause. At some point, your doctor may suggest surgery. The lumbar laminectomy may be one procedure. Laminectomy is a surgical procedure to relieve pressure on the spinal nerves. Degeneration, or wear and tear, in the parts of the spine may narrow the spinal canal. This puts pressure on the nerves in the canal. This condition is called spinal stenosis. A laminectomy involves removing a section of the bony covering over the back of the spinal canal. This takes pressure off the spinal nerves. Surgeons perform lumbar laminectomy surgery through an incision in the low back. The surgery involves the pedicle and lamina bones. These bones attach to the back of the spinal column, forming a bony ring that encloses the spinal canal. Surgeons may remove bone spurs from the facet joints along the back of the spine during the laminectomy procedure, taking pressure off the spinal nerves. Patients are usually able to get out of bed within a few hours after surgery. However, you will be instructed to move your back only carefully and comfortably. Patients are able to return home when their medical condition is stable.

2)  Lumbar Spinal Fusion:

The two approaches followed to perform a lumbar fusion surgery are:

• Posterior Approach
• Anterior Approach

Posterior Approach: The most common surgical approach used for the spine fusion surgery is the posterior approach, or from the back. There are basically three main posterior fusion techniques, all 3 of which usually use pedicle screw fixation.

• Posterolateral gutter fusion surgery. This is the most used procedure and involves placing bone graft in the Posterolateral portion of the spine (a region just outside the back of the spine).
  
  
• Posterior lumbar interbody fusion (PLIF) surgery. A PLIF involves placing bone graft and/or spinal implant (e.g. cage) directly into the disc space in the front of the spine.
  
  
• Transformational lumbar interbody fusion (TLIF) surgery. A TLIF is essentially like an extended PLIF, as it also involves expanding the disc space by removing one entire facet joint.

Anterior Approach: An anterior approach (from the front) to spine fusion allows the surgeon to place bone directly in the space between the vertebrae where the disc had been. Because approximately 80% of the forces of the spine are borne through the disc space, it is much more likely that a solid fusion will be achieved and patients will have pain relief if the fusion includes the disc space. There are two primary techniques to accomplish this.

• Anterior/posterior lumbar fusion surgery. An anterior/posterior fusion surgery is typically performed through an incision in the abdomen, with removal of the disc and placement of bone graft where the disc material has been removed. A separate incision is made in the back to place the pedicle fixation and bone graft. This approach may include a large amount of trauma to the muscles, a long hospital stay, and may at times be associated with a fair amount of blood loss. However, in cases where there is a lot of instability, an anterior/posterior fusion surgery can be necessary as it provides the greatest amount of stability.
  
  
• Anterior lumbar interbody fusion (ALIF) surgery. An anterior lumbar interbody fusion is a surgery technique that involves the placement of bone graft with a plate or secured spacer or bone graft with an anterior interbody cage within the disc space. The most efficient way to place this is through the abdomen into the disc space. Most commonly, persons who have undergone this spine fusion surgery are able to return to their activities more rapidly. This type of approach can be used in cases where there is not a lot of associated instability and the disc space is narrow. The results of stand alone anterior fusions are not as good for multilevel constructs.

What is the Post-Operative Care of Lumbar Spine Surgery?

Following your Lumbar Spine Surgery, you may not be able to sit for extended amounts of time, because your spine and back muscles need to heal first. Try abiding the following instructions:

• In the first two to three days after any type of lumbar surgery, sitting for minimal amounts of time is recommended, basically only to get in and out of bed and to use the toilet. They recommend standing while eating, not sitting up in bed to do so (because it uses the muscles you are trying to heal).
  
  
• After that first few days of extremely restricted activity, you should still try to minimize the amount of time you spend sitting. If you need to sit, only use straight-backed chairs to minimize the pressure on your lumbar region--no sofas or recliners that will put strain on your low back and lumbar area. If you need to lie down, you may only do so in a bed.

1. While your doctor will give you specific instructions tailored to your individual needs, one has more piece of advice about these first few days of post-op care: "If you question whether or not you can do something beyond the instructions given, it is safe to assume that the answer will be no.

What is the Lumbar Spine Surgery Recovery?

Lumbar surgery, even the least invasive may cause a great deal of pain as your muscles, bones, and nerves recover. Total recovery time can take anywhere from eight weeks to six months, depending on a number of factors like severity of condition, age, health, and type of surgery performed. Post-surgery you will be prescribed pain medication like Vicodin (hydrocodone) or DarvosetN100. If you need additional pain relief do not use any anti-inflammatory drugs like aspirin, Buffrin, ibuprofen or naproxen sodium, because these medications are blood thinners and will interfere with the clotting process. Avoid taking pain relief medication in anticipation of physical exertion either, because you will not be able to gauge whether the activity is hurting your lumbar region. If you feel pain even after you have taken pain relief medication, contact your doctor before reaching for more medicine. Overdosing on pain medication can cause a number of blood and organ conditions that are devastating or fatal. You should also be careful with taking prescription medication, as it has been known to be addictive. As your lumbar region heals, you should experience less pain. If you do not feel your pain diminishing, or you notice unexplained or increased leg pain, unusual swelling, bruises, changes in behavior, or a high-grade fever in the first two to three weeks of recovery, contact your doctor immediately, as these symptoms may indicate an infection or a more serious condition.

Why Lumbar Spine Surgery in India?

Of late, India has become the most preferred destination for foreign patients suffering from back pains. A large number of patients from across the globe travel to India every year in order to get various procedures of Lumbar Spine Surgery. Patients in abundance come to India due to many factors as they can easily access high quality healthcare facilities at the most affordable price.

The high quality, training and specialization of orthopedic surgeons and medical staff contribute to India being a worldwide reference in almost all medical procedures. India has one of the worlds best equipped hospitals and highly skilled surgeons. The quality and standard often surpasses from the developed nations like US and UK. 

The hospitals and clinics delivering Lumbar Spine Surgery in India are spread all over the country with presence of the most advanced medical centres and hospitals in the world. These are available at hospitals in the following cities with latest amenities and state-of-art-facilities.

What is the Cost of Lumbar Spine Surgery in India?

The cost difference is very vast which goes from 60-80% less as compared to medical treatments performed in USA and other developed nations. If a person opts to get the Low cost Lumbar Surgery in India he/she can have not just the cost saving but even enjoy tourism in India arranged by the medical tourism in India. The following table can give you a fair idea of the cost difference which is evident in India.

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