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Frequently asked questions - Spine Surgery(For Disc Disease)

# Why surgery is needed?

Surgery of spine is required only and only when non surgical methods like rest, medications, physiotherapy fail and patient continues to have severe pain, weakness, paralysis or progressive bending or slippage. Sometimes it is done without waiting if there something called as "cauda equina syndrome".

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# What are the options?

When there are no "red flags" as assessed by a spine surgeon then options like painkillers, pain injections, accupressure, accupuncture etc are there

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# What is the risk with Spine surgery?

Spine surgery if selected carefully and performed by an experienced as well as skilled surgeon, possesses, very minimal risks. At our centre, the risks are even minimised due to the adoption of keyhole minimally invasive approach(endoscopic/microscopic).

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# Will I get paralysed? Or Bed ridded?

When the indications are clear cut, reasonable treatment goals are set preoperatively, skill set and technology is used efficiently/effectively and patient related factors are favorable, then, the chances of having such a catastrophic complications are extremely small. On the otherhand, not undergoing surgery or delaying it further, MAY end up, having, same complications that are being scrutinized and afraid of!

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# Who is better Neurosurgeon or Ortho/spine Surgeon?

Both are trained in doing surgeries of the spine. However, spinal cord problems are better handled by Neurosurgeons, while, complex large bony curvature deformities/bony tumors are dealt better by ortho spine surgeons. However, more than 90 percent of cases with spine issues can be operated by both with good results.

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# Will it be done by Laser or keyhole?

Laser technology is not popular in Spine sugery unlike plastic surgery, ENT surgery etc. There are better tools such as O arm, minimally invasive surgery that has the potential to make Spine surgery a Day Care Procedure(In selected cases)

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# Whether screws, rods, fusion surgery is required?

This is determined by the type of symptoms, patient factors and pre surgical evaluation. Large majority of patients do not require additonal screws etc

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# If used which implants are better - Indian or Imported?

Indian implants are more price friendly. No long term data exists comparing foreign and indian implants in rigorous clinical trials providing Class 1 evidence. However it is my experience that till the native bone is fused, both are equally efficacious.

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# What is the cost?

Surgical cost varies from hospital to hospital and region to region. The very basic spine surgery (without implants) in Mumbai region at a NABH accredited corporate hospital in general ward is approximately 2.0 Lakhs INR and it increases depending on the facilities and bed status chosen and complexity of surgery. The cost may be lower for certain procedures such as vertebroplasty etc. There is no package deal and most of the insurance companies cover spine surgeries.Do mail at hrishikesh.sarkar@hotmail.com for more.

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# How many days in the hospital

From the day of surgery, for an uncomplicated case, you may need to stay for about 5-7 days. Some cases have been discharged the next day too. Every attempt is made to minimize the no of days in the hospital.

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# When can I resume work normally?

There is a period of about month following surgery during restriction of activites limited to house are required. Followed by that, progressively level of activity is increased, so as to goal of normalizing activites by three months is achieved. However it will depend on pain threshold, type of activities, healing and strenth(mind and body) of the patient. Physiotherapists and rehablitation experts play significant role in this phase.

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# What are general dos and dont's following surgery?

Do's

- Maintain walking and short strolls. Leg exercises as demonstated by physio only for first three months followed by spine physiotherapy under supervision

- Maintain healthy diet, avoid constipation

- Take medications as prescribed

- Visit for follow up visits as adviced

- Keep wound dry and clean

Dont's

-Sitting, bending, lifting weights, travelling on bumpy roads, long distance travel

- Yoga, chiropractice, manipulation therapy unless cleared by Surgeon


# How do I take care of the wound?

- Keep the area clean

- Do not put any ointments, oil, lotions

- Do not scratch. If the scratching is intense contact

- Watch for fever, redness, pain, discharge or any visible area of thread jutting out

- The time for removal of staplers/ sutures will be informed to you

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# What is the sequence of events once I decide to get operated?

1. Meet the secretary for estimate letter and proposed date of admission and surgery. For those who wish to avail Insurance - Get the documentation ready for insurance(TPA form) - Handled by TPA department

2. Visit Admission counter and book bed/ward/room/category

3. Visit Neuroanaesthetist(coordinated by Secretary) regarding evaluation of fitness for surgery and other relevant consultations

4. Once OK from fitness point and the finances/Insurance - Confirm date of Admission and Surgery

5. Once Admitted - Relevant technical scan and relevant consultations if required

6. Signing of informed consent and obtaining Clearance form from the finance department

7. Anaesthesia review in the ward, Time to OR notification, Nil by mouth notification

8. OR shift the next day, Anaesthesia Induction process begins

9. Surgery starts. Relatives in waiting area. Duration of procedure intimated and timely notification provided. Surgery ends

10. Patient is shifted to the ward unless indicated then to ICU. Standard ward visitors rule apply.

13. Observed in ward for 3-4 days minimum and then discharged if all parameters appears fine

14. Discharge summary and advice regarding follow up

15. Billing clearance

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