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Spine Surgery- Are You Really A Candidate?

The Global Burden of Disease, the most extensive worldwide observational epidemiological study, has suggested that Low back pain is the leading cause of disability the world over. On an average, 31 million Americans experience back ache at any given time and spend approximately US $ 86 billion a year for the treatment of their backs, which is almost the same as much as they spend on Cancer treatment! The enormity of the condition is quite shocking, however, what is more surprising is that less than 5% of this population actually needs surgery!

Low Back Ache and Spine Surgery:

Low Back Ache or Lumbago varies from a sharp, shooting pain of acute onset to a pain that increases gradually and is dull in nature, below the waist region. The pain may also radiate or move down into the buttocks, back of the thighs, legs and groin region, with varied intensity.

The other symptoms associated with back pain are stiff back, spasm in back muscles, limited range of motion in spine and difficulty in bending forwards or sidewards, paresthesia or tingling and numbness in buttocks or legs. These are symptoms which though are highly bothersome and exasperating, they are not frightening.

There can, however, be alarming signs analogous with back pain that need immediate attention, which include loss of bladder and bowel control, inability to stand or walk and severe back pain, requiring urgent surgical intervention.

Common Causes of Low Back Pain:

Low back pain is commonly caused by mechanical issues like muscular strains, sprained ligaments, improper posture, extreme bending and twisting of the spine or by accident or trauma to the spine. These are conditions where no baseline pathology is involved, however, there may be serious pathologies involved, which may lead to chronic low back pain.

The common spinal pathologies are:

  • PIVD (Prolapsed Intervertebral Disc)/ Disc Herniation- The term herniation refers to bulging out of a part of the body through an abnormal opening. A disc herniation happens when the jelly-like, soft tissue between the vertebrae protrudes out and compresses the nearby nerves leading to pain and paraesthesia, i.e numbness and tingling. Also known as Slipped disc, this can happen suddenly due to trauma or more commonly due to age-related degeneration and wear and tear of the disc.
  • Arthritis of Spine- Like other bones and joints, Osteoarthritis affects the vertebral joints, leading to the formation of bone spurs, which compress the nerves leading to pain and abnormal sensations.

  • Spinal Stenosis- Spinal Stenosis is narrowing of the Spinal Canal, which irritates and puts pressure on the spinal cord and nerves, leading to pain, tingling and numbness in buttocks and legs.

  • Spondylolisthesis- Spondylolisthesis is a condition where one vertebra slides over the vertebra below it thereby causing compression and irritation of spinal nerves leading to pain, numbness and tingling in back and one or both lower extremities and bladder/ bowel incontinence in rare cases. Spondylolisthesis may be due to a congenital defect, spinal trauma, infection in the spine etc.

  • Tumours in Spine- Spinal tumors of benign and malignant nature compress and irritate the spinal nerves and depending on the region of their origin, they lead to back ache and paraesthesia. They may also lead to radiating or referred pain, which may be the first symptom leading to their diagnosis.

  • Osteomyelitis- Osteomyelitis is a bacterial infection of the bones caused by Staphylococcus aureus. Vertebral Osteomyelitis is a relatively rare condition where the vertebral bodies are affected by the bacteria and lead to a severe backache, along with other systemic symptoms like Fever, nausea etc.

Conservative treatment options for Low backache:

The Vertebral column and spine are intricate structures made up of bones, muscles, nerves, and ligaments. Since the spine is so complex, diagnosing the pathology behind low back ache is a difficult proposition and requires highly trained medical personnel, starting from the primary physician, a chiropractor to an orthopedic spine surgeon or neurosurgeon specializing in spinal surgeries. Who is the right doctor for you and what kind of intervention you require depends on the severity of your condition and your baseline pathology.

Most cases of low back ache which are mechanical or non-pathological in nature, respond well to conservative treatment methods like physical therapy, pain medication, NSAIDS or Non-Steroidal Anti-Inflammatory Drugs and muscle relaxants. Once you start to feel better and the pain has improved, your therapist would advise you exercises that would strengthen your musculature, which would further keep the pain at bay. It is also important that a good posture is maintained along with following good ergonomics and maintaining a good regimen of stretching and other exercises advised by the therapist.

In patients where there is no improvement and pain continues to bother even after following your doctor’s instructions and taking the medication for an extended period of time, a surgical intervention may be considered.

Indications for Spine Surgery:

Spine surgery is generally indicated for patients who have:
  • Prolonged backache and other associated symptoms, not responding to conservative treatment methods
  • Severe condition significantly disrupting the patient’s day to day life
  • Specific diagnosis that can be treated with Spinal surgeries
It is only when you have tried all conservative means and failed in it, you should think and opt for Spinal Surgery. Your Orthopaedic doctor/ Neurosurgeon would guide you about it and advice for the right surgical option. It is extremely important that the baseline pathology of your condition is diagnosed well so that you get the appropriate surgical treatment. A thorough workup is thus advisable, including X-rays, CT Scans/ MRI, and other investigations to pinpoint the exact cause of pain.

Spinal Surgery:

Spinal surgery is a complex procedure that requires detailed evaluation and planning. A comprehensive multi- disciplinary team of Surgeons, Anesthetists, therapists, nutritionists, nurses work together to chalk out the best treatment plan for the patient.

Grossly, the spinal surgeries are divided into four main types:

  • Laminectomy- The term Laminectomy refers to the removal of Lamina, the thin plate of bone on the posterior side of a vertebral body, to relieve the underlying nerves from compression. Also known as Decompression surgery, the procedure is particularly effective in treating sciatica caused by spinal stenosis. The surgery is performed under general anesthesia and generally, requires a hospital stay of 3-4 days. The procedure may be coupled with spinal fusion, depending on the underlying pathology for which the procedure has been done. Recovery after Laminectomy generally takes around 4-6 weeks or more, depending on whether the surgery has been performed using an open technique or by minimally invasive technique. Most patients are advised physical therapy after the surgery to regain muscle strength and flexibility.

  • Discectomy- Discectomy or Disc removal is a surgery to remove a part or whole of the intervertebral disc to alleviate pressure from a compressed nerve root. The procedure is generally performed to treat PIVD or Prolapsed Intervertebral disc and gives excellent results. The two commonly used techniques to perform Discectomy are:

    • Microdiscectomy- Microdiscectomy is a minimally invasive technique of performing discectomy in which a small incision around 1-1.5 inches is given in the back and muscles are only separated rather than cutting them, thus significantly reducing the downtime after the surgery and much faster recovery.

  • Percutaneous Endoscopic Discectomy- This is the most advanced minimally invasive procedure for discectomy in which thin disposable scope is put on the surgical site using small incisions and the protruded disc is removed using specially designed instruments with minimal disruption of the muscles and nearby tissues.    

  • Spinal Fusion- The permanent union of two or more vertebrae is referred to as spinal fusion, medically known as ‘Arthrodesis’. The procedure can be performed as a standalone surgery or in combination with decompression surgery. The surgery provides stability to the vertebral column and can correct the deformity. Bone pieces harvested from the hip or pelvic bone are placed between the vertebrae, which when fused provide stability to the vertebral column. Spinal instrumentation like bone screws, wires, plates etc. are also used to provide additional stability.

  • Artificial Disc Replacement- Disc Replacement is the latest and most advanced technique for treatment of slipped disc, wherein the protruded and damaged intervertebral disc is replaced with a new artificial one, which is a metal prosthesis. It is done as a substitute to spinal fusion. The advantage of this procedure is that range of motion is still maintained at the affected joint. However, not all patients are candidates for disc replacement and the patients have to be chosen carefully.

Spine Surgery in India

India is counted amongst the top destinations in the world; not only for serious medical surgeries but for elective procedures such as cosmetic surgery and dental surgery as well. Indian surgeons are highly respected for their surgical skills and expertise and are extensively trained in India abroad.
Most of the renowned surgeons in India are board certified and have treated few of the most complex spinal disorders with great success. These surgeons are counted among the best spinal surgeons in the world.

Cost of Spine Surgery in India

Besides having some of the best surgeons, the cost of spine surgery in India is one of the major reasons why so many patients from across the globe prefer to travel to India.  Spinal surgeries are extremely expensive in the US and other Western countries. A simple spinal fusion surgery at single level may cost around $ 30- 40,000 in the US, without including the overhead expenses like Rehab, medication etc. whereas the same surgery would cost as less as $ 5-6000 in India, with equally good surgeons, at surgical facilities which are JCI accredited and thus at par with their counterparts in US.

If you are also suffering from Low back pain and are not sure, if you need a spinal surgery, write to us at We have few of the best spinal surgeons in the world on our panel who can give you unbiased opinion about the best options for you.

You can also call us at +91-932-003-6777 (India number) or +1-877-270-2448 (US Toll Free) or talk to us at Skype @ IndiCure