Spine Surgery - Treatment and Services
Spine Disorders and their Treatment
SpondylosisThe gradual deterioration of the disc between the vertebrae is referred to as Degenerative Disc Disease (DDD) or Spondylosis. Degenerative Disc Disease is very common affecting 40-50% of people over the age of 40 and becomes increasingly common as we age. It is a kind of wear and tear disease similar to osteoarthritis. Although it can occur at any spinal level, it is most common in the lumbar spine (low back). DDD can cause the discs to flatten losing their normal height. This disc height is important as it separates the disc above from the one below. When disc height is lost, the nerve pathways may become narrowed and cause nerve impingement, inflammation, and pain. As the 'discs' degenerate, they become thinner. Sometimes the vertebrae develop small, rough areas which may irritate the nearby nerves. This causes troublesome symptoms like severe neck pain and stiffness and pain down the arms and hands. Most patients tend to get better with medication and exercises. However occasionally the spondylotic changes can lead to compression of the spinal cord or the nerve roots and this may result in pain, numbness and weakness in the upper limbs (radiculopathy). Cervical spondylosis is chronic degeneration of the bones of the neck (cervical spine) and the cushions between the vertebrae (inter vertebral disc). The treatment involves removal of worn out discs or bone spurs - depending on the underlying problem. If required the surgeon will fill the gap with a graft of bone or other implants made of metal combined with bone. Patients have reported their symptoms as being as mild occasional backaches to chronic low back pain that is severe enough to limit their activities at work and play. The pain is typically mechanical in nature. This means the pain increases as more stress or load is placed on the low back. Bending, lifting, and twisting are the types of movement that may exacerbate DDD.ManagementRarely does DDD require surgery. There are several non-surgical treatments including anti-inflammatory medication, physical therapy and exercise programs. Surgery is only considered when the patient's symptoms are debilitating; interfere with activities of daily living, and non-surgical treatment has failed after a reasonable period of time, usually at least six months. Fusion permanently stops the motion of the spine at the level of the degenerated disc. This helps to relieve pain. Fusion for DDD is best when limited to one or two discs. Fortunately we have five discs in the lumbar spine. The un-fused discs take over to provide adequate function of the lower back. An artificial disc can also be inserted into the space after removing the entire degenerated disc. This surgery is done from the front. This restores disc height, improves spine function, and helps to eliminate debilitating pain.
Slipped DiscA prolapsed disc is a condition when the inner, softer part of the disc bulges out through a weakness in the outer part of the disc. This bulging disc may then press on nearby nerves which in turn causes discomfort and pain. The symptoms include - back pain, ache in the arm or leg and pinpricks felt in feet, toes and hands.ManagementAs a rule, surgery may be considered if the symptoms have not settled after about six weeks or so. At Apollo Hospitals, the spine surgeons may opt for: Keyhole surgery - Also known as microdiscectomy spine surgery, it is typically performed when there is a prolapsed disc in the lumbar (lower back) region which is pressing against a nerve. Disc replacement - An artificial disc is a device that is implanted into the spine to imitate the functions of a normal disc (carry load and allow motion). Artificial discs are usually made of metal or plastic-like (biopolymer) materials, or a combination of the two. The disc replacement for prolapsed disc is done in the cervical (neck) spine.
SpondylolisthesisSpondylolisthesis is a Greek term meaning slipping of the spine. It is the abnormal forward movement of one vertebra over the vertebra below. Most often, this forward slip of the vertebra occurs in the lumbar area of the spine. This slippage and herniation of the disc causes pressure on the nerve roots associated with the affected vertebrae, causing pain and dysfunction. There are various types of spondylolisthesis.
Type 1 - Congenital spondylolisthesisAn individual is born with the abnormality of the posterior bony arch of the spine, which causes the slippage. This is usually seen at the L5-S1 level and often associated with abnormality of the facet joints. Patients usually present with back pain during the adolescent growth spurt. CT and MRI scans are required to diagnose the dysplasia (abnormal bone formation).
Type 2 - Isthmic spondylolisthesisIsthmic spondylolisthesis is caused by a defect in a part of the bone called the pars interarticularis. The pars bone connects the upper joint of one vertebra to the lower joint. The defect is usually caused by a stress fracture in individuals with a hereditary predisposition (some minor abnormality or weakness of the pars at birth). In certain individuals a defect may exist without any forward slip, referred to as spondylolysis. This condition can be painful.
Type 3 - Degenerative spondylolisthesisDegenerative spondylolisthesis is a forward slippage secondary to arthritis of the spine. Spinal stenosis is usually associated with this process. This is due to a long standing degenerative disc leading to weak facet joints in the back of the spine. This is usually seen at L4-L5 level.