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Future Belongs to Minimally Invasive Spine Surgery

Lifestyle changes have made even the young generation prone to spine problems such as slip disc, back pain, recurring neck pain, spasm, says Dr Arun Bhanot, Chief of Spine Service at Paras Hospitals. In conversation with Sharmila Das, ENN.

What is the role of spine surgery in treating a patient?
Spine surgery is currently an emerging sector. A few decades ago, Orthopedics and Neurosurgical fields were a part of general surgery and the same surgeon would perform abdominal, neurosurgical and orthopedic operations. However, with advancements in these fields, these specialties got separated and became independent subspecialties of medicine. Similarly, spine surgery is now evolving from neuro and orthopedic surgery.
However, confusion and myths regarding management of spinal problems still persist among people. Many are clueless about whom to consult (whether ortho or neuro) for their spine problems. Others are scared of spine operations, if advised, assuming that they will get paralysed, which is far from reality. There is hardly any chance of paralysis (less than one percent) with modern spinal operations for routine indications, whereas success rate of spinal interventions is more than 90 percent.


The unique feature of our spine department is Keyhole Endoscopic Spine Surgery, which is basically a day care spine surgery 


What kind of spine department you have created at Paras Hospitals and what are its goals?
At Paras Hospitals, we have a very good team of trained and highly skilled spine specialists and a research associate. With such a team, we are building one of the best spine departments in Northern India. Lifestyle changes have made even the young generation prone to spine problems such as slip disc, back pain, recurring neck pain,spasm, etc. I personally feel that spine being an emerging field and people having various misconceptions about it, with proper infrastructure and staff in place we should start spreading awareness about modern spine treatments and their high safety and success rates. We need to make people realise that despite having spinal problems one can actually lead a good quality life by timely intervention by a trained and dedicated spine doctor.

Case in point
Today technology and training of the doctors have enhanced the safety standards to an extent where we can operate a 90 year-old patient with more than 90 percent safety margins. We have had patients who were lying in bed for four-five months due to spinal fracture before they were brought to us. We gave minimally invasive treatment to them that involved treating the patients spine through five to six small holes in back and placing supportive screws and bone cement through those holes. Within a day or two the patient was able to stand on his feet

What is the percentage of patients who need to undergo spine surgery?
Not everybody suffering from a spinal problem requires a spine surgery.In fact, 80-90 percent patients do not require the surgery. In a majority of cases, proper counseling, timely medical intervention and therapies help.The timeframe for improvement may range from a few weeks to months.Prolonged medication is not advisable either, as this may risk damage to kidneys, liver, or stomach, leading to bigger problems. In case medical treatment and rehabilitation fail, the spine doctor has to take a call whether surgery is needed or not.
Today technology and training of the doctors have enhanced the safety standards to an extent where we can operate a 90 year-old patient with more than 90 percent safety margins .We have had patients who were lying in bed for four-five months due to spinal fracture before they were brought to us. We gave minimally invasive treatment to them that involved treating the patients spine through five to six small holes in back and placing supportive screws and bone cement through those holes. Within a day or two the patient was able to stand on his feet.

Which minimally invasive procedures are available in your spine surgery department?
The unique feature for our spine service is the Keyhole Endoscopic Surgery for slip disc which is the main procedure to treat slip disc these days and most of the big hospitals do not have this facility in North India. Its basically a day care spine surgery, whereby a small eight millimeter keyhole is created in the patients back and the patient can even watch the entire procedure on screen as it is done under local anesthesia. We put high resolution cameras inside the body to keep a track and also talk to the patient continuously which keeps us informed if we have touched any sensitive nerve or not. Post operative recovery is fast with little pain as the cut is very small and the patient can get back to routine life within a few days.
Then we have the procedure of cementing, known as Kyphoplasty, for old age patients with fracture in their spine. We put bone cement to heal the spine by creating small keyholes to reconstruct the fracture area. Sometimes we need to place screws and rods in the affected area, which can also be done through minimally invasive procedure. In addition, we perform all types of complex microscopic and open spine surgeries to correct spinal stenosis, spinal deformity and infections as well as run a spine pain clinic where we treat spine patients with image guided injections.

What kind of setting is required to perform spine surgery?
Usually, we need a rehabilitation team to support us. Whether we give medication or perform surgery, the patient needs exercise therapy anyway.This apart, we need high-resolution cameras, endoscope, specialised instruments and equipments in the hospital to facilitate excellent results that we are talking about.

What kinds of advancements have happened in spine surgery in India in terms of technology and manpower?
We are witnessing the emergence of big hospitals, like ours, where we can have state-of-the-art infrastructural facilities to support advanced treatments. The advanced diagnostic facilities are also important and go hand in hand in improving the outcomes.

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