Treatment and surgeries

A. Spondylosis:

Degenerative Disc Disease (DDD) or Spondylosis refers to the gradual deterioration of the disc between the vertebrae in the backbone. This disease is very common, and affects as much as 40-50% of people over the age of 40. The disorder also becomes increasingly common as we age. It is a disease of wear and tear similar to osteoarthritis. It commonly happens in the lumbar spine (low back), though it can occur at any spinal level.

In DDD, the discs get flattened, losing their normal height. This disc height is what separates the disc above from the one below. Nerve pathways may become narrowed and cause nerve impingement, inflammation, and pain, when the disc height is lost.

Degenerated discs become much thinner and sometimes the vertebrae also develop small, rough areas which irritate the nearby nerves. Severe neck pain and stiffness and pain down the arms and hands can result from this.

• Medication and exercises are the first line of management.
• Cervical spondylosis is a very common condition where there is chronic degeneration of the bones of the neck (cervical spine) and the cushions between the vertebrae (inter vertebral disc). This is managed by cervical spine surgery where the worn out discs or bone spurs are removed – depending on the underlying problem. Sometimes the gap would be filled by a graft of bone or other implants made of metal combined with bone.
• Symptoms of spondylosis may be as mild as occasional backaches or could be chronic low back pain that is severe enough to limit daily activities. The mechanical type of pain increases as more stress or load is placed on the lower back. Bending, lifting, and twisting are the types of movement that may exacerbate it.

• Degenerative Disc Disease requires surgery only rarely. The commonly used non-surgical treatments include anti-inflammatory drugs, physiotherapy and exercise programs. Surgery is required when the patient has very severe debilitating symptoms; pain interferes with activities of daily living, and non-surgical treatment has failed after a reasonable period of time, usually at least six months.
• Fusion surgery is usually done and this permanently stops the motion of the spine at the level of the degenerated disc. This helps to relieve pain. Fusion surgery works best when limited to one or two discs. As we have five discs in the lumbar spine, the un-fused discs take over to provide adequate function of the lower back.
• Sometimes an artificial disc can also be inserted into the disc space after removing the entire degenerated disc. This helps to restore disc height, improve spine function, and ease the debilitating pain.

B. Slipped Disc:

Slipped disc is a common term used to refer to a prolapsed disc. This is a disorder when the inner, softer part of the disc bulges out through a weakness in the outer part of the disc. The bulging disc may then press on nearby nerves and cause discomfort and pain. Back pain, ache in the arm or leg and pinpricks felt in feet, toes and hands are the usual symptoms.

• Surgery is considered for disc prolapse if the symptoms of the bulging disc have not settled after about six weeks or so. One may opt for:
• Keyhole surgery or microdiscectomy spine surgery, which is typically performed when there is a prolapsed disc in the lumbar (lower back) region which is pressing against a nerve.
• Sometimes an artificial disc can also be inserted into the disc space after removing the entire degenerated disc. This helps to restore disc height, improve spine function, and ease the debilitating pain.
• Disc replacement - Here, an artificial disc is implanted into the spine to imitate the functions of a normal disc (carry load and allow motion). Artificial discs are usually made of metal or plastic-like (biopolymer) materials, or a combination of the two. The treatment for bulging disc and prolapsed disc is a disc replacement done in the cervical (neck) spine.

C. Spondylolisthesis

The Greek term for slipping of the spine is Spondylolisthesis . The Greek term for slipping of the spine is Spondylolisthesis. This term refers to the abnormal forward movement of one vertebra over the one below. It is in the lumbar spine that this forward slip of the vertebra happens most often. Pressure on the nerve roots associated with the affected vertebrae, as well as pain and dysfunction are caused by the slippage and herniation of the disc. The types of spondylolisthesis include:

Type 1 – Congenital Spondylolisthesis:-Congenital spondylolisthesis is a condition where a person is born with the abnormality of the posterior bony arch of the spine, which causes the slippage. It happens at the L5-S1 level commonly and is associated with abnormality of the facet joints. Symptoms include back pain during the adolescent growth spurt. CT and MRI scans are required to diagnose the dysplasia (abnormal bone formation).

Type 2 – Isthmic Spondylolisthesis:-Isthmic spondylolisthesis is a defect in a part of the bone called the pars interarticularis. This bone connects the upper joint of one vertebra to the lower joint. Stress fracture in individuals with a hereditary predisposition (some minor abnormality or weakness of the pars at birth) usually causes this. Sometimes a defect may exist without any forward slip, and this is called spondylolysis. This can also be painful.

Type 3 – Degenerative Spondylolisthesis:- Forward slippage secondary to arthritis of the spine is known as Degenerative spondylolisthesis. This process is usually also associated with Spinal stenosis. Long standing degenerative disc disease, leading to weak facet joints in the back of the spine is the reason. This is usually seen at L4-L5 level. This is also called Lumbar Spondylolisthesis.

• For all the above conditions , surgery is indicated, if the slippage progressively worsens or if back pain does not respond to nonsurgical treatment and begins to interfere with daily life. In the congenital and high dysplastic group, spondylolisthesis surgery is done at early stages to prevent neurological complications.

• Abnormal curvatures if the spine are referred to as scoliosis and kyphosis. In the normal spine, there are normal curves if seen from the sides, but the spine is seen as a straight column from the front. In scoliosis, the spine shows curvatures from the front. In kyphosis, there is abnormal forward bending of the spine.
• Scoliosis is a Greek word meaning curvature. Ancient physicians thought poor posture was the primary cause of scoliosis. Today it is clear that scoliosis is either congenital (present at birth) or developmental and may be hereditary. The spine curves to the side in the shape of an “S” or “C”. The curvature is measured in degrees.
• Types Of Scoliosis:-Scoliosis is classified according to the affected age groups:

Infantile scoliosis: from birth to 3 years old

Juvenile scoliosis: from 3 to 9 years old

Adolescent scoliosis: from 10 to 18 years old

We can also classify according to the direction of the curve. A spinal curve to the right is called Dextroscoliosis (“dextro” = right). This is the most common type, usually occurring in the thoracic spine.

It can occur on its own (forming a “C” shape) or with another curve bending the opposite way in the lower spine (forming an “S”).

A spinal curve to the left is called Levoscoliosis (“levo” = left). This is quite common in the lumbar spine, but when this rarely occurs in the thoracic spine it indicates a higher probability that the scoliosis may be secondary to a spinal cord tumor.

Scoliosis may also be classified according to location. Thoracic scoliosis is curvature in the middle (thoracic) part of the spine. This is the most common location for spinal curvature. Lumbar scoliosis is curvature in the lower (lumbar) portion of the spine. A curvature that includes vertebrae in both the lower thoracic portion and the upper lumbar portion of the spine is called a Thoracolumbar scoliosis.

Adolescent Idiopathic Scoliosis is yet another condition that starts around the onset of puberty in otherwise healthy boys and girls. It is more common in girls. Physical signs may include uneven shoulders, one hip lower than the other, a rib hump when bent over at the waist and leaning to one side.

Symptoms:-The obvious symptom of scoliosis is an abnormal curve of the spine. In some cases, the head may appear off center or one hip or shoulder may seem higher than the opposite side. In severe scoliosis the heart and lungs may dysfunction leading to breathlessness and chest pain. Back pain, rib pain, and abdominal pain are the other symptoms.

• Treatment goal is to stabilize the spine to prevent additional curvatur and to free from pain. Most of time, it is done through medication and physiotherapy with excises. In severity case, patient may require surgery.

• For curvature of greater magnitude, surgery is needed. The goal of scoliosis surgery is to achieve a well-balanced spine in which the patient’s head, shoulders and trunk are centered correctly over the pelvis. Instrumentation to reduce the magnitude of the deformity and fusion to prevent future curve progression are the steps involved.
• Use of staples on the convex side of the curve, to correct and maintain the curve till the patient is skeletally mature, is a recent development in the treatment of Scoliosis. These staples allow differential growth to take place i.e. less growing speed on the stapled side than the concave side thereby correcting the curve as the child grows.
• Nitinol is a titanium based alloy. Spinal implants made from Nitinol are also now being used. The C shaped staples are in the shape of ‘C’ when they are manufactured at room temperature. When the staples are cooled to below freezing point the prongs become straight but clamp down into the bone in a ‘C’ shape when the staple returns to body temperature providing secure fixation. These are called Shape Memory Alloy (SMA) staples. As no fusion is done the child grows normally and even the residual deformity tends to improve with growth.

D. Spinal Tumors

Any tumor or growth on the spine whether cancerous or not, can press upon the nerves, causing pain, neurological defects and sometimes paralysis. Loss of sensation or muscle weakness, especially in the legs, difficulty in walking, sometimes leading to falls and loss of bowel or bladder function are some other symptoms of such tumors.

They are classified according to their location, as follows:

• Extradural – outside the dura mater lining (most common)
• Intradural – part of the dura mater lining
• Intramedullary – inside the spinal cord
• Extramedullary – inside the dura, but outside the spinal cord
• Surgeons at PP Maniya Hospital Private Limited, Surat treat spinal tumors even in the most inaccessible areas. High-powered microscopes that are used in surgery help remove even delicately placed intradural tumors. Total Spondylectomy – removal of the entire vertebra is done as a definitive cure is also done for some spinal tumors.

E. Spinal Injuries

Damage to the spinal cord from trauma, loss of its normal blood supply, or compression from tumor or infection may lead to spinal cord injury. Spinal cord injuries may be complete or incomplete. Symptoms of a Spinal cord injury depend on the extent and location of the injury. While in complete injuries the body ceases to function below the level of injury, in incomplete injuries there is some function remaining below the level of injury.

Treatment for spinal injuries includes surgery to stabilize the spine. Vertebrae weakened from fracture, tumor or infection cannot support the normal weight from the body or effectively protect the spinal cord. Then, a combination of metal screws, rods and plates may be necessary to help hold the vertebrae together and stabilize them until the bones heal. After surgery it is critical that patients undergo a thorough rehabilitation program. Methods to help the patient maximize their function through physical and occupational therapy and the use of assistive devices comprise such a programme. A hospital that is experienced in the complete management and rehabilitation of spinal injuries can help a great deal in better outcomes.

F. Prevention of spine prolapsed of disc: -

Health life style:-You may be able to avoid back pain by improving your physical condition and learning and practicing proper body mechanics.

Exercise:-Regular low-impact aerobic activities – those that don’t strain or jolt your back with walking and swimming.

Build Muscle Strength And Flexibility :- Abdominal and back muscle exercises (core-strengthening exercises)

Quit Smoking

Maintain A Healthy Weight

Use Proper Body Mechanics

Stand smart: Maintain a neutral pelvic position.

Sit smart: Choose a seat with good lower back support, armrests and swivel base.