Rajesh Kumar Verma

Hi,

I am Dr. Rajesh Verma, Orthopedist, Narayana Super speciality Hospital, Osteon- Narayana Joints & Spine, Gurgaon. Jaise ki pehle bhaag mein humnein dekha ki spine kya hota hai, disc ka structure kya hota hai, aur kya karan hote hain kamar dard ke, unko kaise thik kiya ja sakta hai, kya galat dharnayein hain rest aur surgery ke baare mein. Ab hum baat karenge ki aisi konsi situatiion hai spine ki jismein humein spine surgery karni padti hai. Disc ki vajaha se spine move karta hai. Kuch cases mein spine abnormal movement karne lagta hai. Aage, piche ya side mein jhuk jata hai. Piche ke facet joints arthritis ho jaate hain aur unstable ho jaate hain. Kuch aur situations bhi hoti hain jaise spine mein tumor ho jaaye, spine mein chot lagne se koi fracture ho jaaye ya fir TB jo kafi common hai. In cases mein jab spine ka structure stable nahi hota hai toh humein surgery karni padti hai.

Durbin ya disc ki surgery karne se spine thik nahi hota hai. Sabse common surgery hai spine fusion surgery. Ismein hum 2-20 screw tak fix karte hain. Jab normal disc kharab ho jata hai jiski vajaha se disc spacers hote hain, jismien hum bone graft kar ke cages ko laga dete hain aur piche se titanium rod fit kar dete hain. Isko spine fusion surgery kaha jata hai. Is surgery ke 1-2 days mein hi hum patient ko khada kar sakte hain. Achi baat ye hai ki ab bade chire ki jarurat bhi nahi padti. Minimally invasive surgery se ise thik kiya ja sakta hai. Spine fusion surgery spine ko itna movement nahi de paati hai. Spine fix ho jaat hai. Patient ka pairon ka dard thik ho jaata hai. Kuch saalon ke baad patient ko lagta hai ki patient ka spine stiff ho gaya hai. Spine mein utna movement and mobility nahi hai. Toh spine ko mobility dene ke liya jise hum kehte hain dynamic spine surgery aur motion preservation surgery jismein hum spine ki stability ko khatam karne ke liya, usko stiff toh kar dete hain but bilkul fuse nahi karte hain. Thoda spine ka movement continue rehta hai. Mene pichle 5 saalon mein dynamic spine surgery kafi jyada sucessfully kiya hain.

Spine ke excessive movement ko kam karne ke liya hum ek spacer lagate hain. Is se spine ka movement kam ho jaata hai but bilkul khatam nahi hota. Patient aage jhukega toh thoda movement kar sakta hai. Dusri ek dynasys surgery hoti hain jismein titanium rod ki jagaha hum silicon ki flexible rod lagate hain. Ek surgery hai jo durbin se ki jaati hai use transforaminal endoscopic spine surgery, us case mein bhi hum normal structure ko kharab nahi karte hain. Ye surgery local anasthesia mein ki jaati hai aur patient aagle din hi chal fir sakta hai. Tubes ke through bhi hum surgery karte hain. Chita cut deke like 1-1.5 cm, badi disc ko bhi hum nikal sakte hain. 3rd surgery hai disc replacement. Is se sari movements patient kar sakta hai aur patient bilkul thik ho jata hai. Ab question ye haii ki jitni bhi surgeries hain kya inhein avoid kiya jaa sakta hai?

In selected group of patients by giving laser injections, facet blocks, radiofrequency injections, pain management ke injections hote hain jo OPD mein kiya jaata hai aur jin patients mein surgery avoid ki jaa sakti hai th hum kar sakte hain. Dusra needle procedure hai kyphoplasty jismein jab haddiyan tut jaati hain, bone fracture ho jaati hai aur atient chall fir nahi pata, us case mein hum needle ke through cement ka injection laga dete hain aur patient ko 3-4 months tak intezaar nahi karna padta haddi judne ka balki vo turant thik hoke chal fir sakta hai. Spine surgery ke baad rehabilitation ka procedure kya hai? Pehle ke operations mein bed rest karna padta tha. But ab patient 2 days ke andar hi walk start kar sakta hai. 3-6 weeks mein hi 90% activities start ho jaati hai. Sports mein hum 3-6 months tak body conditioning karte hain, muscles ki exercise karte hain aur jo pain free hota hai vo ye kam kar sakta hai. Aaj humnein jana ki kis tarah ki spine surgeries hoti hain aur kaise spine fusion surgery se hum apne aap ko bacha sakte hain. Sabse jyada jaruri hai weight kam karna Spine surgery ka sabse common karan hai vajan jyada hona, kam exercise karna, bad posture, bed lifestyle hona, smoking. Agar aap in baaton ka dhayan rakhein toh spine surgery se bacha jaa sakta hai. 

Thanks!

Hi,

I am Dr. Rajesh Verma, Orthopedist. Today I will talk about spine. Aaj hum apna discussion 2 bhagon mein rakhenge. First part is how our spine works, uske kya components hote hain aur kya kya dharnayein and myths hain like spine surgery, rest karna chahiyai ya nahi karna chahiyai aur kya aisi technique hai jo without surgery spine ko thik kiya ja sakta hai. Toh pehle samjhate hain ki kamar mein kya kya hota hai. Spine mein 2 bones hoti hain and bich meien ek disc hota hai. Disc 2 parts ka bana hot hai. outer structure and bich mein jelly structure hota hai. Jelly shock absorber ka kam karti hai. Jab bhi disc prolapse hota hai jisko commonly slip disc kaha jaata hai, agar ye bahar aa jata hai toh ye nerves ko press karta hai jis se pairon mein taklif hoti hai, jhanjhnahat, sunapan, glut region mein pain, pairon mein weakness and chalne mein kafi dikkat aati hai.

Aisi talklif mein patient ko bed rest karna padta hai. Bed rest ke liya bhi myths hai ki besd rest hi best treatment hai? But mai aap ko btana chaunga ki bed rest worst treatment bhi nahi hai aur na hi acha treatment hai. Iske kayi karan hain. Agar hum aaj se 10-20 years pehle ki baat karein toh bed rest ko ek acha ilaj mante the. Agar hum 3-4 weeks se jyada bed rest karte hain toh usmein pneumonia, muscles weakness bhi aa jata hai. Humari abdominal muscles and back muscles integral part hai spine stability ka . Ye humein sidha khade rehne, aage jhukne and mudne mein help karti hain. Is se patient ka dard jaldi thik nahi hota hai. Toh bed rest unhi cases mein karna chahiyai jismien spine fracture ho jaye, ya koi spine mein infection hai, ya fir tumor se instability ho jaati hai toh un cases mein bed rest acha hota hai.

Otherwise, 1-3 days se jyada bed rest spine and disc problem ke liya thik nahi hai. 2nd question hai ki sare disc problem mein kya surgery ki requirement hoti hai? Ye bhi bilkul thik nahi hai. Mai ye manta hun and research bhi manti hai ki 90% patients kamar dard ke rest, physiotherapy, exercises and with time bhi apne aap thik ho jaate hain and disc mein jo water hota hai vo bhi improve ho jaata hai. 90% patients surgery ke bina thik ho sakte hain. Fir sabse badi dharna hai ki agar spine surgery karni padti hai toh uske baad patient nomal nahi ho pata aur apna time thik se spend nahi kar sakta. Aisa bhi bilkul thik nahi hai. 98% tak success rate hai aaj kal ki modern techniques hain spine surgery ka.

Bus aap ko surgery ka indication thik se choose karna chahiyai. Aise cases mein surgery ke 98% ache results hain. Uske baad pucha jaata hai ki spine surgery ke baad kya bed ridden ho jaate hain. Nahi, ye ek myth hai. Only 1% cases mein aisi taklif ho sakti hai. Vo bhi tab jab spine mein instability hai ya tumors ki surgery hai ya revision cases mein spine surgery ke results itne ache nahi hain jitne ki primary cases mein hain. Fir sabse pehle kaha jata hai ki dharna galat hai. Spine surgery mein bahut bada cut lagta hai, bahut sari muscles damage ho jaati hai. Patient vo activity kabhi bhi nahi kar pata jo normally karta hai. Ye bhi galat hai. Aaj kal ki spine surgery usmein hum 5mm ka cut dete hain durbin se aur 1 inch tak ka cut deke hum spine surgery karte hain. Humare paas computer navigation hai, latest techniques hain and chote chote durbin ke through jaise laparoscopic colectomy, usi tarah hum spine surgery ke liya chote se durbin se jaate hain aur disc ke tukade ko nikal dete hain.

Ismein bich ki bone ko koi bhi destruction nahi hota hai. So, without destroying the normal structure hum spine ki surgery karte hain. Local anesthesia mein hi hum patient ko walk kara sakte hain. Th ye kehena bilkul sahi nahi hai ki patient apni normal activity nahi kar sakta hai surgery ke baad. Ye baat sahi hai ki kuch spine surgery is type ki hoti hain jismein humein spine ko fuse karna padta hai. Humein screw laga kar spine ko fuse karna padta hai. Uske baad patient apna normal activity kar sakta hai. Dusre bhaag mein hum baat karenge ki spine surgery kyun jaruri hai? Kab jaruri hai, uske kya indications hain, iske kya nuksan ho sakte hain and kaise bacha jaa sakta hai?

Thank You!