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Middle East Health speaks to Dr. Vidyadhara S, HOD & Senior Consultant Spine Surgeon, Manipal Spine Care Centre, at Manipal Hospitals, Bangalore, India – about the evolution of spinal surgeries from being very unsafe to the status of being as safe as they can be today.
Question: Why were Spinal Surgeries considered Unsafe until Very Recently?
Dr. Vidyadhara S: The spine is the most complex organ wherein the spinal cord is protected in a bony canal made of 33 bones and discs as well as 96 facet joints which give movement to the neck and back. The bony canal is about 10-15mm in diameter and working in such a small space has always been a challenge. In the past, there were not many training programmes. Surgeons attempting to do spinal surgeries were trying to help the patients get relieved of their problems by getting in there with their best knowledge of anatomy. Mistakes did happen and lots of patients became para-/quadri-plugins. Even 20-30 years back, spinal surgeries were fraught with a very high risk of 50-80% in various centres across the world.
In the last 2 decades, we have seen the evolution of a lot of training centres in spine surgery and the technological advantage with the use of microscopes, endoscopes, navigation etc. has made spine surgery as safe as it can be. We now can easily achieve 99% safety and success in almost all the spinal surgeries at Manipal Spine Care Centre. Today, our results are at par with the best centres of Spine Surgery across the world. You must visit Manipal, the best spine hospital in Bangalore for spinal surgeries. This can be attributed to the right choice of the patient and matching the correct surgical procedure. Even if you take my example, I have had 6-years of training exclusively in Spine Surgery in various reputed centres across the globe before joining Manipal Hospitals as a Consultant Spine Surgeon more than 12 years back.
Question: When does one decide on surgery for a problem in the spine?
VS: About 90% of patients with back and neck pain do not need surgery. More than 95% of spinal surgeries are done for one of the following 3 indications.
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The gross weakness of limbs,
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Urine/motion incontinence/inability to pass, and
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Functionally disabling pain for longer than 3 consecutive months.
The first two indications are absolute (as they mean cry of the dying nerve and delay in surgery means more damage) and the third indication is relative (as the pain is subjective). However, the exceptions are congenital/developmental spinal deformities, spinal tumours, spinal fractures, spinal infections etc. Indications for surgery in all of these conditions are very highly individualized and need to be decided by a spine specialist in Bangalore.
Question: What are the latest developments in back/neck pain surgery?
VS: Whenever indicated, most age-related degenerative conditions can be treated by minimally invasive surgeries with the use of operating microscopes, endoscopes, image intensifiers, etc. The patient’s hospitalization would be restricted to 2-3 days and the patient would be on his feet in 4-8 hours after surgery. This is possible because of better techniques of smaller incisions, better vision, improved soft tissue handling techniques, and lesser blood loss. In many people suffering from back/neck pain, we do try injection techniques / radiofrequency ablations before making a decision favouring surgery as the last resort.
Question: Please explain the progress done in motion preservation spinal surgery.
VS: Most spinal surgeries are directed towards two major problems in the spine, namely neural compression and spinal instability/deformity. The principles of surgeries are neural decompression and spinal stabilization respectively. These goals can be achieved using open/minimally invasive spine surgery techniques. However, following the neural decompression or Discectomy, normal spinal mobility can be preserved using Artificial Disc Replacements in the neck and Interspinous Process Spacers or Posterior Dynamic Stabilization Devices in the lower back.
Question: What is your opinion on the advances in Osteoporotic Wedge Fracture management?
VS: Fractures are common causes of morbidity and mortality in elderly post-menopausal ladies especially. They can happen even without much impact or injury. The patient finds instability back pain which is worse than any change of position that the patient attempts such as turning on the bed, getting up from sitting and lying down position. Today, we perform vertebra/Kyphoplasty for these fractures which aim to fill the fractured bone with bone cement which gives instant pain relief, enabling them to regain the activities of daily living. These are day-care procedures and are done through needles (no incisions/stitches). These procedures are increasingly being used in spinal tumour surgeries as well. Younger patients with fractures of the spine can get Percutaneous Spinal Stabilization using minimally invasive gadgets.
Question: What are the spinal deformity surgeries possible at Manipal Hospitals?
VS: We do all spinal deformity surgeries using Multi-Modal Neuromonitoring to reduce the risk of neurological injury while deformity reduction to a least. In complex bony deformities, we have the Neuro-Navigation system to help us use the corrective spinal instrumentation safely. We treat a wide range of spinal deformities ranging from pediatric to adult, congenital to neuromuscular or syndromic, etc. We have performed various spinal osteotomies, Spino-pelvic fusions and vertebral column resections safely and successfully. We have been affiliated with the Scoliosis Research Society (USA) and are submitting our M&M data to their registry.
Question: What are the advantages of Manipal Spine Care Centre?
VS: Manipal Spine Care Centre is a COMPREHENSIVE unit consisting of dedicated fellowship-trained Spine Surgeons, Pain Physicians, Interventional Radiologists, Physiotherapists, Rehabilitation Specialists, Neuropsychologists, and support staff. We aim to treat patients suffering from spinal problems with a holistic approach incorporating protocols and ethics. We have the state of the art pre-, intra- and post-operative care facilities and infrastructure so that the patient gets the best of care with a personal touch. We have been training surgeons with 2-year National Board of Examinations fellowship in Spine surgery as well as a one-year structured fellowship programme accredited by the Manipal University. We are an academically oriented unit with an evidence-based approach to the management of spinal problems. At MSCC, we see around 12500 outpatients and perform about 1,000 spinal surgeries in a year.
