ASTRA Ortho N Spine Center

As with any surgery, spinal surgery can be a significant undertaking. But if you are considering the option, you ought to know that people who had undergone a spine surgery not only get to move around a lot better than before but also becomes more physically fit. So, if your doctor recommends it, you can very well opt for it. And with proper care and following specific dos and don'ts such as those mentioned below can ensure a speedy recovery.

Phase I: One-week Post operation
Right after the spine surgery, it is very normal to have pain. However, in the majority of spine surgery cases, the patients can get up and walk, but only if advised by the doctor. During the stay in the hospital, which generally is around a week, the rehabilitation process consists of managing pain, wound care and getting out of and in the bed without twisting the spine.

Phase II: First month after discharge
Once, you are discharged from the hospital, the rehabilitation process at home typically include various movements and stretching exercises, prescribed by your doctor, and wound care again to prevent the risk of an infection. This first month at home can help you both recover as well as to prepare your body for getting back to daily activities slowly.

Phase III: Resuming daily activities
Patients are often suggested to opt for physical therapy for a speedy recovery which should be continued for around three months once released from the hospital. In this phase, after consulting with your orthopedic, you can start resuming your regular activities, starting with taking short walks, doing back strengthening exercises and doing light works. Remember, don’t try to lift heavy object until unless your doctor allows you to.

Some posture precautions to follow:
Certain posture precautions can play a crucial role, at least for the first six weeks. Sitting on a sturdy chair is highly recommended as it can ensure a good posture and spending too much time in any particular position such as sitting or standing for long is a strict no-no. Plus, when sitting make sure your knees stay below the height of your hips.

Forcing your body for performing any extreme motion, such as twisting the spine too much for turning or bending forward at the waist should also be avoided. Instead, make it a practice to turn your entire body when turning back at something and bend your knees and hips but not your waist when lifting something.

Depending on one’s general health, musculoskeletal status and the type of spine surgery undergone, the recovery time may vary from person to person. However, following the necessary health care tips and precautions suggested by your orthopedic can undoubtedly ensure a fast and complete recovery.

Awareness is the key to catch it early and reduce the risks associated.

• Scoliosis is an abnormal sideways curve in the spine. Normally the spine has a straight alignment when seen from the front or back. A sideways curve in the spine can develop due to a various reasons at different stages of growth. As the spine grows taller, there is a tendency for the curves to worsen and can become severe by the time the kid reaches skeletal maturity.
• The curve in the spine is associated with rotation of the spinal column to one side. As the ribs attached to the spine rotate along with it, it leads to a rib hump in the back on one side and prominence of chest wall in the front on the other side. A curve in the lower spine leads to asymmetry in the waist lines. It is usually the rib hump or asymmetrical waist line that brings the problem to notice, usually at a time when the kid is growing rapidly.
• Severe curves distort the chest cavity and reduce the space available for the lungs, thereby reducing the breathing capacity, especially if the scoliosis starts before 5 years of age (early onset scoliosis). This is known to significantly reduce life expectancy due to failure of lung and heart function over the years. In some with severe curves, the spinal cord function may get affected leading to progressive weakness in lower limbs and eventually loss of ability to walk. But the most common and important complaint with scoliosis is the cosmetic appearance and related problems. The social stigma and misconceptions associated with these deformities  is often the reason for the parents not seeking medical opinion earlier. The child may suffer low confidence due to self perceived defective body image, affecting their performance in studies and sports.
• Common cause of scoliosis in infants and toddlers is a bony defect in the spine resulting in asymmetrical growth in both sides of the spine leading to a rapidly worsening curve (known as Congenital scoliosis). A bony defect during development of skeleton in the womb or during growth after birth is usually associated with birth defects in other systems like heart, kidneys and other bones and can be detected at or soon after birth. In some, it is a nerve or muscle disorder leading to muscle imbalance resulting in a curve in the spine (known as Neuromuscular scoliosis, for example: Poliomyelitis, cerebral palsy). But majority of scoliosis that is noticed in second decade of life has no known cause and is called Idiopathic scoliosis.
• Treatment options include serial observations, spinal braces, and surgical correction of the deformity depending on various factors in each individual patient.
• But the most important factor that may help reduce the severity of the problem is early detection and treatment. The risks involved in surgical correction of a severe curve are much more than in a smaller curve detected much earlier. Newer techniques like growing rods can be used in those with early onset scoliosis to prevent compromise of lung and heart function while allowing the spine to grow in a better alignment. Consult a Spine specialist if you notice any suspicious curve / asymmetry in the back in your kid.

Tuberculosis is widely known as a disease that affects the lungs. Tuberculosis is an infection caused by a bacteria called Mycobacterium tuberculosis. Although most commonly the lungs and bowel are affected, it can affect any organ in the body including the bones and joints .

How and who:

Tubercular bacteria usually enter the body through the airway into lungs or through the gut and spread out to different areas of the body through the blood stream, spine being the most common area. They can stay dormant in the body for many years and start multiplying when the immunity goes down due to any reason. So those with reduced immunity like young kids, old age group, diabetics, those on steroid medication or other immune-suppressive medication are at a high risk of developing tuberculosis of various organs. Patients affected with HIV are also at high risk of developing tubercular infection. But it is not uncommon to see a healthy young person affected with tuberculosis of spine.

Disease manifestations:

Spine is one of the very common structures affected by tuberculosis, leading to significant disability and high risk of paralysis if undetected in the early stages. As the bones in the spine get destroyed by the disease, the spine bends abnormally at the affected level and a deformity develops. There is pus formation at the affected area which can cause compression on the spinal cord and nerves in the spinal canal and lead to paralysis of limbs and loss of bowel and bladder control. Tuberculosis of spine can affect all age groups from infancy to old age.

Spine tuberculosis initially causes pain in the back/neck, which gets worse on movements and while changing posture. Night pains that wake the patient up from sleep is another characteristic feature. Fever, weight loss and loss of appetite are usually associated. Weakness of limb muscles can lead to unstable gait and tendency to fall and the patient usually seeks a support to hold on to while walking.

Diagnosis and treatment:

With MRI being available widely, spinal tuberculosis is being detected at early stages now as compared to X-rays. Most of them can be cured well by anti-tubercular medication (ATT). The medication needs to be taken for a long duration (minimum of 6 months - upto 18 months). Drug resistance is a serious problem needing second line medicines and is more difficult to treat. There are special tests like Gene Xpert available now to detect multiple drug resistant tuberculosis.

In some patients with deformity in spine or those with spinal cord compression causing paralysis, surgery to stabilise the spine and decompress the spinal cord/nerves is required. Surgical treatment in right time can prevent spinal deformity/paralysis and help in faster and better recovery of muscle power in those who have developed paralysis.

So, any persistent back pain needs an evaluation by a Spine physician. 

Unique problem in dealing with age related spinal disorders is that degenerative changes (age related wear and tear) are very common and can exist without causing pain, while at the same time, some of them can be the cause of significant pain and disability in some patients.

• These changes can exist in multiple levels in the spine making it difficult to identify clinically, despite a thorough clinical examination, the exact level or structure that is the main cause of the spinal pain. The fact that they can exist without causing pain in many people compounds the situation. So, seeing an x-ray or mri of the spine is not enough to exactly identify the pain generator in the spine.
• In situations where there is spinal pain and there are multiple level degenerative changes seen on the mri, spinal injections are used as a test to temporarily block the pain from some structures in order to help identify the most likely cause of pain and help deciding further treatment plan accordingly.
• These injections are also used as treatmentof spinal pain (back/neck pain, sciatica) caused by a specific structural problem for relieving pain, while we wait for the problem to settle down naturally; and in those who are not responding to medication and physiotherapy. Another situation where injections are used is in patients who need surgery but cannot be operated for other reasons or want to postpone the surgery temporarily.
• Typically the injections are done under local anaesthesia, with the patient lying in an operation theatre with x-ray facility or in a ct scan console to help pass the needle to the exact desired location in the spine. A local anaesthetic alone or in combination with a steroid medication is injected. The target location may be the facet joints, si joints, disc or a near the nerve root.
• Many spine surgeons use these injections as a tool to help in accurate diagnosis as well as treatment of spinal pain world over.

The word “stenosis” means a narrowing or constriction of the diameter of a bodily passage/canal/tubular structure. “spinal stenosis” refers to narrowing of the spinal canal inside the spine, leading to constriction of the spinal cord and nerve roots passing through the spine. It usually occurs in the middle and old age. Main reason for stenosis is age related degeneration of the structures in the spine that gradually encroach into the spinal canal and start compressing the spinal cord or the nerve roots.

• Reduced space for the spinal cord or nerve roots affects their function and can lead to pain/numbness/weakness in the limbs and trunk. When severe, it can affect the standing or walking balance, urine control and bowel control.
• Symptoms depend on the region of the spine involved and the severity and duration of the narrowing. Initial symptoms are mild and usually there is a gradual worsening of symptoms over several months or years, leading to significant limitation of daily activities and lifestyle. If the stenosis is in the lumbar spine, it affects the lower limbs. If it is in the cervical spine, all four limbs and trunk as well can get affected. Dorsal spine stenosis is less common but often very disabling. Examination by a spine specialist will help in diagnosing the condition. Usually and mri and x rays are done to see the severity and level of stenosis.
• Those with mild to moderate stenosis in lumbar spine are managed with medication, physiotherapy and exercises. Limitation of certain activities may also be advised.
• Severe stenosis causing significant symptoms and disability needs surgical treatment. Surgery is more likely to be required if the stenosis is in the cervical or dorsal spine where the spinal cord itself is compressed.
• Spinal stenosis is one of the most common reasons for which spine surgery is performed and surgical treatment gives an excellent relief of symptoms and improvement in those with severe stenosis. There are minimally invasive procedures that have been developed to minimise the muscle damage and pain due to the surgical procedure itself.

Osteoporosis is a condition wherein the bones become brittle and weak; so much so that even mildly stressful activities such as coughing, bending over or even a slight fall (such as the one from a high rise chair) can result in fractures. Osteoporosis-related fractures commonly occur in the spine, hip or the wrist. The human body has a continuous mechanism of bone absorption and removal. In case of osteoporosis, the creation of new bones doesn’t happen in accordance with the removal of old bones.

Spinal Fractures:

The bones of the spine get extremely vulnerable to breakage and even cracking open. The fractures in the spine, also known as vertebral compression fractures can cause a sharp stinging pain in the back that may make sitting, standing, or even walking a very tardy task.

Risk Factors:

1. Increasing age
2. Abnormally less or high body weight
3. Smoking
4. Menopause or low levels of sex hormones
5. Gender: This disorder is more likely to affect women as compared to men. Also, women, who are above 50 are more likely to suffer from this debilitating disorder.
6. Race is a significant risk factor of osteoporosis. If you are of Asian descent, you are more likely to be affected by it.
7. Having a family history of osteoporosis will put you at a greater risk of this disorder.

The pain typically happens with a slight back strain during an everyday activity like:

• Lifting a bag of groceries
• Bending to the floor to pick something up
• Slipping on a rug or making a misstep
• Lifting a suitcase out of the trunk of a car
• Lifting the corner of a mattress when changing bed linens

Symptoms  of Spine Fracture:

1. Fractured or collapsed vertebra causing back pain
2. A stooped posture
3. A shrunken appearance (as if one has had loss of height)
4. Very fragile bones, thus increasing risks of fractures
5. Severe and sudden pain in the back
6. Difficulty in twisting or bending the body

Lower spine fractures are way more troublesome as compared to fractures in the upper spine. Fracturing more than a bone in the spine also remains a huge possibility.

Who’s Most Likely to Get Spine Fractures?

Women, especially those older than 50, are most likely to get spine fractures. By age 80, about 40% of women have had one.

Your age makes a difference, too. As you get older, your bones become thinner and weaker, and you’re more likely to have osteoporosis. Women and men who have osteoporosis have much higher chances of getting spine fractures.

Diagnosis and Treatment:

Firstly, an X-ray or a computerized tomography (CT scan) will be done to have a closer look at the bones. A bone density test is another commonly used method of diagnosing osteoporosis.

1. Steroids and medications: Some medications may be used to prevent or combat osteoporosis. These include alendronate, ibandronate, risedronate and zoledronic acid.
2. Physical therapy: Just like muscles, bones get stronger too when you exercise. Weight-bearing and muscle- strengthening exercises are the most helpful in this regard and are considered best for the treatment of osteoporosis. Cardiovascular exercises such as walking, jogging or even swimming can prove to be immensely beneficial.
3. Diet: Make a diet chart that includes high-calcium food items, dairy products such as yogurt, cheese, and low-fat milk, tofu, green vegetables such as collard greens and broccoli, sea fish such as salmon and sardines.
4. Salt: Limit salt intake
5. Therapy: Hormone replacement therapy (treatment method consisting of estrogens to alleviate and treat symptoms of osteoporosis) is another method of treatment that can be recommended by the doctor.

Prevent Spine Fractures:

The best way to prevent them is to prevent osteoporosis. Even if you already have it, you can take steps to keep it from getting worse. Eat a diet rich in calcium and vitamin D, and get regular exercise, especially the weight-bearing and muscle strengthening kinds. Ask your doctor if you need a bone mineral density test to see how strong your bones are. It is never too early -- or too late -- to prevent bone loss.

In case you have a concern or query you can always consult an expert & get answers to your questions!

As a kid grows older, the calcium content in the bones increases. It reaches a peak in early adult age, around 25-28 years and then there is a gradual reduction of calcium from the bones at a slow pace during the rest of the life. The loss of calcium from bones accelerates after menopause in ladies. That means their bones loose calcium at a much faster rate and become weaker and weaker, leading to porous bones. That is called Osteoporosis. Weak bones fracture easily and affect the lifestyle in old age.

So, it is clear that the lower the peak bone mass one attains, the higher are the chances of developing osteoporosis and fractures in old age. That is why it is important to try and reach a higher peak bone mass during growing years of your life. 

That can be achieved by calcium and vitamin D rich diet, adequate exposure to sunlight and regular exercises. Ladies after their menopause should check their bone density by DEXA scan atleast once in two years. Discuss with your doctor the risks of developing osteoporosis and fractures, and prevention tips. 

Spinal surgery becomes inevitable when back pain cannot be managed with medications and/or exercise. This is a major decision and requires planning for many things before, during, and after the surgery.

Before a spinal surgery- This preparation will help in smooth recovery, especially if you do not have a full-time caretaker.

1. Discontinue pain killers: Discontinue pain killers at least 10 to 14 days before surgery. These are blood thinners and can prolong bleeding during the surgery.

2. Prepare for blood loss: Most people experience some blood loss, but not excessive.

3. Use a toilet seat raiser: Sitting and getting up from the toilet seat may be difficult. The seat raiser is used to increase the height, making this movement easy.

4. Enable easy access to common items: Before heading for the surgery, keep things which are commonly used within easy reach. This will help reduce movement and avoid searching (especially if someone else is going to be doing it).

5. Stock it up: Cooking may not be feasible during the initial postop period, and so it is advisable to stock up food items (ready to eats, fruits, soups, etc.) which will come in handy.

6. Slip-ons: Bending down and tying shoes may not be easy, so slip-ons can be used.

7. Caregiving: It is always advisable to have someone stay over with you during the initial postop days. They could help with regular household chores, cooking, etc.

8. Lifestyle changes: Ensure you eat well in the days before surgery, quit smoking, quit/use moderate amounts of alcohol, and exercise as advised by your surgeon.

After Surgery- Post surgery, there will be some pain and limitation of movement. It is important to understand that adherence to post-op instructions will improve the success rate of the surgery. 

1. Postoperative medications: These will be given to control infection and pain in the immediate postop period, and should be taken without fail

2. Rehab: The surgeon will recommend physical therapy and rehab exercises which need to be followed. Complete recovery may take anywhere between 3 to 12 months. During this time, care should be taken to avoid repeat injury.

3. Support: Adequate back support should be provided using lumbar support and ergonomic chairs, and the right posture should be maintained. Ensure there is no undue strain on the back muscles.

4. Weight management: With excess weight, there is too much strain on the lower disks. Therefore, weight should be managed to reduce this strain.

5. Smoking and alcohol should be completely stopped, as healing can be hampered.

With some preparation, spinal surgery can be sailed through smoothly.

In case you have a concern or query you can always consult an expert & get answers to your questions!