Laparoscopic Spine Surgery in India

Overview

Back problems are one of the most common reasons to see a doctor. Approximately 80% of people will experience back pain during their lifetime. Fortunately, for the vast majority of these people the pain will subside naturally without the need for surgery. However, for those with chronic conditions, surgery may be an option. Laparoscopic spine surgery whether back or neck surgery is an advanced treatment option for pain and disability caused by an identifiable lesion in the patient’s anatomy that has not adequately improved with non-surgical treatments.

What is Laparoscopic Spine Surgery?

Laparoscopic Spine Surgery is an advanced treatment option for pain and disability caused by an identifiable lesion in the patient's anatomy that has not adequately improved with non-surgical treatments. This procedure uses small puncture holes which are used instead of long incisions. A special lighted telescope is inserted through one of these puncture holes projecting a picture on a television screen allowing your surgeon to see the spine. Additional puncture holes are used to allow other specialize surgical instruments into your abdomen to perform the Spine Surgery.

Why Laparoscopic Spine Surgery?

Minimally invasive spine surgery has developed out of the desire to effectively treat disorders of the spinal discs with minimal muscle related injury, and with rapid recovery. Traditionally, surgical approaches to the spine have necessitated prolonged recovery time. For example, in the 1990s the state-of-the-art procedure for fusion of the lumbosacral spine has been the instrumented Posterolateral fusion. In order to perform this procedure, the back muscles are moved away from their spinal attachments, allowing the surgeon space to place rods, screws, and bone graft. First, this surgical approach (i.e., dissecting the muscles) produces the majority of the perioperative pain and delays return to full activity. The degree of the perioperative pain necessitates the use of significant pain medication with their inherent side effects. Also, the degree of the perioperative pain delays return to normal daily activities and nonphysical work. Second, the dissection of the Para spinal muscles from their normal anatomic points of attachment results in a healing by scarring of these muscles. In addition, it has been found that this type of dissection results in the loss of innervations of the muscles with subsequent wasting away. A permanent weakness of the back muscles results. This weakness itself may be symptomatic and/or limit the patient's function - particularly in those who perform physical work.

What Medical Conditions are treated by Laparoscopic Spine Surgery?

• Herniated discs, deformities,
• Compression fractures, and
• Degenerative disc disease

Are you the Candidate for Laparoscopic Spine Surgery?

Although, Laparoscopic Spine Surgery is the direction in which much of the medical field is headed, it is not necessarily right for everyone in every situation. In most cases of surgical spine treatment, minimally invasive surgery can be performed on patients. However, a standard open treatment may be required under some specific conditions - high degree scoliosis, tumors and some infections. After proper diagnosis of the patient's condition, the surgeon will recommend the best suited treatment.

How to Prepare for Laparoscopic Spine Surgery?

Preparing for Laparoscopic 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:

• Pre-operative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
• After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
• Blood transfusion and/or blood products may be needed depending on your condition.
• It is recommended that you shower the night before or morning of the operation.
• Your surgeon my request that you completely empty your colon and cleanse your intestines before surgery. Usually, you must drink a special cleansing solution. You may be requested to drink clear liquids, only, for one or several days prior to the operation.
• After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon has told you are permissible to take with a sip of water the morning of surgery.
• Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
• Diet medication should not be used for the two weeks prior to surgery.
• Quit smoking and arrange for any help you may need at home.

What are the Common Procedures for Laparoscopic Spine Surgery?

For various reasons, the following are the types of Laparoscopic Spine Surgery which remain unproven. The minimally invasive techniques include:

Discectomy: Discectomy involve the removal of intervertebral discs. At our practice we do many discectomies minimally invasively, using small incisions to access the spine and to perform the discectomy. It is performed under general anesthesia. The procedure takes about an hour, depending on the extent of the disc herniation, the size of the patient, and other factors. A discectomy is done with the patient lying face down, and the back pointing upwards. In order to remove the fragment of herniated disc, your surgeon will make an incision over the center of your back. The incision is usually about 3 centimeters in length. Your surgeon then carefully dissects the muscles away from the bone of your spine. Using special instruments, your surgeon removes a small amount of bone and ligament from the back of the spine. This part of the procedure is called a laminotomy. Patients often awaken from surgery with complete resolution of their leg pain; however, it is not unusual for these symptoms to take several weeks to slowly dissipate. Pain around the incision is common, but usually well controlled with oral pain medications. Patients often spend one night in the hospital, but are usually then discharged the following day. A lumbar corset brace may help with some symptoms of pain, but is not necessary in all cases.

Anterior Lumbar Interbody Fusion (ALIF): This is a far less invasive procedure than the traditional approach, but is also safer than the laparoscopic technique. Anterior Lumbar Interbody Fusion (ALIF) is a back surgery that involves approaching the spine through an incision in the abdomen. A portion of the affected disc space is removed from the spine and replaced with an implant. Titanium or stainless steel screws and rods may be inserted into the back of the spine to supplement the stability of the entire construct. Patients who are suffering from back and/or leg pain are potential candidates for the ALIF procedure. This pain is generally caused by natural degeneration of the disc space. The ALIF back surgery is performed with the patient lying on his or her back. The surgeon makes an incision in the patient's abdomen to access the spine. To have a clear view of the spine, the surgeon then retracts the abdominal and vascular structures. Once the spine is in view, the surgeon removes a portion of the degenerated disc from the affected disc space. After the surgery, the patient will normally stay in the hospital between 2 to 5 days. The specific time of stay in the hospital will depend on the patient and the surgeon's specific post-operative treatment plan. The patient will normally be up and walking in the hospital by the end of the first day after the surgery. Your surgeon will have a specific post-operative recovery/exercise plan to help you return to normal life as soon as possible.

Posterior Lumbar Interbody Fusion (PLIF): is a procedure used to treat problems such as disc degeneration, disc herniation, and spine instability. This procedure is often used to stop symptoms from lumbar disc disease. In this procedure, the surgeon works on the spine from the back and removes a spinal disc in the lower spine. The surgeon inserts bone graft material into the space between the two vertebrae where the disc was removed. The graft may be held in place with a special fusion cage. The goal of the procedure is to stimulate the vertebrae to grow together into one solid bone. A fusion creates a rigid and immovable column of bone in the problem section of the spine. This surgery is done through an incision in the low back. The incision reaches to the spinous processes, the bony projections off the back of the vertebrae. A large block of bone, called the vertebral body makes up the front section of each vertebra. The vertebral bodies are separated by a soft cushion called an intervertebral disc. On the back of the vertebral body, the lamina and pedicle bones form a protective ring around the spinal canal. The spinal nerves are enclosed in the spinal canal and exit through small openings on the sides of each vertebral pair, one on the left and one on the right. These passageways are called the neural foramina.

Pedicle Screws: Until recently, the insertion of pedicle screws has required the surgeon to expose the pedicles. Today, we use different techniques that allow us to implant pedicle screws through the skin without disturbing muscles and tendons. The pedicle screw, which is sometimes used as an adjunct to spinal fusion surgery, provides a means of gripping a spinal segment. The screws themselves do not fixate the spinal segment, but act as firm anchor points that can then be connected with a rod. The screws are placed at two or three consecutive spine segments (e.g. lumbar segment 4 and 5) and then a short rod is used to connect the screws. This construct prevents motion at the segments that are being fused. In the Posterolateral gutter fusion, use of pedicle screws has improved spinal fusion rates from approximately 60% to 90%. Many surgeons also believe that pedicle screws enhance patient recovery because they provide immediate stability for the spine and early mobilization for the patient. Initially, the safety and effectiveness of pedicle screws was called into question. However, the initial controversy has been favorably resolved and pedicle screws are now approved by the FDA for use in the lower (lumbar) spine for specific conditions. There is, however, a steep learning curve in the technique for placing the pedicle screws, and only surgeons comfortable and experienced with the technique should use them.

Vertebroplasty and Kyphoplasty: These relatively new procedures are used to treat vertebral compression fractures by injecting orthopedic cement into the affected vertebrae. We have considerable experience with these techniques, and excellent outcomes. Vertebroplasty and kyphoplasty are minimally invasive procedures for vertebral compression fractures (VCF), which are fractures in vertebra, the small bones that make up the spinal column. When a vertebra fractures, the usual rectangular shape of the bone becomes compressed and distorted, causing pain. These compression fractures, which may involve the collapse of one or more vertebrae in the spine, are a common symptom and result of osteoporosis. Osteoporosis is a disease that results in a loss of normal bone density, mass and strength, leading to a condition in which bones are increasingly porous or full or small holes and vulnerable to breaking. Vertebrae can also become weakened by cancer. In Vertebroplasty, physicians use image guidance to inject a special cement mixture through a hollow needle into the fractured bone. In Kyphoplasty, a balloon is first inserted through the needle into the fractured bone to create a cavity or space to control where delivered cement goes; it may also restore some of the compressed height of the vertebra. Once the balloon is removed, the cement mixture is injected into the cavity where the balloon was.

What is the Post-Operative Care after Laparoscopic Spine Surgery?

Most patients are usually able to go home 1-3 days after surgery. Patients will typically stay longer, approximately 2-5 days, if an anterior spinal surgery is also performed. Before patients go home, physical therapists and occupational therapists work with patients and instruct them on proper techniques of getting in and out of bed and walking independently. Patients are instructed to avoid bending at the waist, lifting (more than five pounds), and twisting in the early postoperative period (first 2-4 weeks) to avoid a strain injury. Patients can gradually begin to bend, twist, and lift after 4-6 weeks as the pain subsides and the back muscles get stronger.

What is the Cost of Laparoscopic Spine Surgery in India?

What are the Benefits of Laparoscopic Spine Surgery?

• Small incisions and little blood loss
• Less post-operative pain and need for pain medication
• Earlier discharge from the hospital
• Shorter post-operative disability at home
• It prevents complications associated with prolonged bed rest.

What are the Risks of Laparoscopic Spine Surgery?

Any surgical procedure can be associated with risks. A spine surgery may involve risks including inter operative complications, infection, bleeding, hardware failure etc.

What is the Laparoscopic Spine Surgery Recovery?

Successful recovery from a Laparoscopic Spine Surgery requires that you approach the operation and recovery period with confidence based on a thorough understanding of the indications, alternatives, and risks of your procedure. The better informed you are the better prepared you will be for the post operative period. Do not hesitate to ask questions and be certain that you clearly understand the answers. Your surgeon has had training and has the expertise to perform the operation; he or she and the rest of the health care team will support your recovery. Your body will work to heal the involved muscle, nerve, and bone tissues. Full recovery, however, will also depend on you having a strong, positive attitude, setting small goals for improvement, and working steadily to accomplish each goal.

Why Laparoscopic Spine Surgery in India?

Laparoscopic spine surgery in India is prime destination for the patient looking for cost and quality effective treatment. Any medical treatment comes with most advanced technology and modern treatment methods. India offers World Class Medical Facilities, comparable with any of the western countries. India has the best infrastructure and the best possible medical facilities.

The medical team handling the Laparoscopic spine surgery in India is best in terms of quality and experience. 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.

Every day, more and more people are choosing to take their elective medical care abroad. The hospitals and clinics delivering Laparoscopic 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.

Cities in India where one can find best centers providing Laparoscopic Spine Surgery are as follows:

Besides having the medical treatment, the patients can add to this the chance to explore a fantastic country full of culture and history and it's easy to see why this trend has become so popular.

Some of the common countries from which patients travel to India for surgery are:

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