No worries, with today’s medical technology makes the surgery robotics with a pin hole, painless. But with minimally invasive procedures, which let patients recover much faster, spine surgeries don’t have to be feared anymore.

When 34-year-old Priya (name changed to protect privacy) felt the first twinges of back pain, she didn’t think much of it. There was too much to do, between her IT job and taking care of her two kids. So, she turned to hot packs and pain balms to take the edge off and get through the day. Soon, the pain started radiating towards her entire leg with numbness, and no medication seemed to work.

By the time Priya arrived at the Advanced Centre for Endoscopic Spine Surgery at Gleneagles Global Health, she had exhausted all her non-surgical options for treating her spinal disc prolapse. But she was still wary about going under the knife. It was the thick of the COVID-19 pandemic, and there was only her husband to take care of the house and kids. So, Priya felt she couldn’t spend weeks confined to a hospital bed recovering from complex surgery.

“But she consented to surgery because the pain was too intense,” says Dr S Karunakaran, Director – Institute of Advanced Spine Sciences at Gleneagles Global Health City. Luckily for Priya, Dr Karunakaran specialises in suture-less endoscopic spine surgeries, and she was able return home soon to take care of herself and her children. “By doing a spinal endoscopy, we were able to send Priya home within 24 hours,” he says.

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When spine surgery becomes inevitable?
Priya is part of a rising cohort of patients that Dr Karunakaran is seeing, men and women in their 30s and 40s whose spinal health is deteriorating due to a sedentary lifestyle. “Most of these people spend long hours sitting at the office, which creates musculoskeletal imbalances,” says Dr Karunakaran. He explains that the flexibility and strength of the spine is maintained by an inner core of spongy material called the nucleus pulposus and the outer hard structure called the annulus fibrosus.

“When weight or pressure is evenly distributed, these structures work well together. Good posture is maintained by strong muscles and requires adequate muscle stretching. But due to bad posture, long durations of sitting and muscle tightness due to lack of stretching, force gets unevenly distributed on the spine, and this system gives way fibre by fibre. It is mostly cumulative trauma,” he says.

Importantly, says Dr Karunakaran, this is not a problem restricted to those who are overweight or obese. “Out of all my patients, only 20% are overweight,” he points out.

Another kind of patient that Dr Karunakaran often sees is those who suddenly indulge in bouts of activity that lead to acute problems of the spine. “Some people develop spinal problems because of overactivity in the gym or in physical work.” During the lockdown, the doctor adds, his centre saw a rise in cases as people were suddenly forced to do more domestic work around the home.

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What is endoscopic spine surgery?
There is still a high degree of fear about spine surgery, with patients trying very hard to avoid surgery at all costs, says Dr Karunakaran. Much of this fear, however, is misplaced because it is based on traditional spinal surgery techniques and technology, and skill levels from a couple of decades ago. Today, the level of imaging and surgical technologies, and doctor skill and training have advanced by leaps and bounds, drastically improving surgical outcomes, he says.

In traditional spinal surgery, surgeons are forced to cut a large area of muscles and other tissue in order to gain sufficient access and visibility of the affected region of the spine. Such spinal surgery is painful and requires a long recovery time, as the muscles and other tissues take a long time to recover.

An endoscopic surgery, on the other hand, uses a small incision through which instruments and an endoscope are inserted using tubular systems to access the affected region without damaging any of the surrounding tissue. Such endoscopic procedures can be used for cases of disc prolapse (where a ruptured disc impinges on the spinal nerves), canal stenosis (where the space in the spine for the nerve fibres start reducing), discitis, and facetal arthritis.

Advantages of endoscopic surgery
“Because it is minimally invasive, endoscopic surgery has a number of advantages,” explains Dr Karunakaran. First, because the surgery does not involve cutting a large portion of muscles and soft tissue, it serves to retain greater mobility for the patient. Second, because these surgeries are less invasive and do not compromise stability, the need for spinal fusion (where parts of the spine are fused together to provide stability) is less often necessary.

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All of this means that patients require shorter hospital stays and are able to recover and return to their normal activities much faster. “While traditional spine surgeries require six weeks of post-op rest, many of our patients are able to return to normal activities in about a week,” says Dr Karunakaran.

Moreover, such surgeries result in minimal blood loss and pain, thus also reducing the amount of pain medication needed post-surgery.

Finally, the procedure is also advantageous for patients with conditions increasing the risk of surgical outcomes, as it can even be done using a local anaesthetic. “During the lockdown, we performed such a surgery with local anaesthetic on a COVID-positive patient, in order to reduce the risk of spreading the infection,” reveals Dr Karunakaran.

At the end of the day, says Dr Karunakaran, there is no need to fear spinal surgery at a specialised unit like Global Health City’s advanced endoscopic spine centre. Today, imaging and diagnostic technologies have vastly improved to provide great precision in diagnosing affected areas. Moreover, surgical instrumentation and techniques have also improved, reducing the amount of damage caused by surgery and significantly improving outcomes. And specially trained doctors come with the specific expertise needed to provide patients with the highest quality of surgical care. #KhabarLive #hydnews