Advantages Endoscopic Micro Discectomy - Spine Surgery Hospital in India

Micro Endoscopic Discectomy (MED) Surgery in India

The Microendoscopic Discectomy (MED) is a minimally invasive surgical technique used to remove a herniated nucleus pulposus (disc). Most people will have back pain sometime during life. And 90% of these people will get better, without treatment or with conservative therapy. Only 5% remain disabled longer than three months and for those, surgery may offer relief.

Procedure

A disc ruptures when there is a tear in the outer lining (annulus) of the disc . When a tear in the annulus occurs, a fragment of disc material may protrude and pinch surrounding nerves. When a nerve is compressed it can cause symptoms such as extremity pain, numbness, weakness, electrical sensations, and bowel and bladder incontinence. If symptoms are not relieved with conservative treatments, a patient may be a candidate for surgical removal of the herniated disc fragment.

Microendoscopic Discectomy differs from the open microdiscectomy. The incision using the microendoscopic technique is smaller (approximately 1cm), causing less trauma to the surrounding tissue. A smaller incision allows for decreased post-operative pain and a faster recovery. A patient is considered a potential candidate for a microendoscopic discectomy if he or she has a large herniated disc fragment extruded to the side of the spinal canal.

Microendoscopic Discectomy is performed by making a small incision in the patient's back and inserting a small endoscopic probe between the vertebrae and into the herniated disc space. A small camera is placed through the probe enabling the surgeon to view the operation on a TV screen in the operating room. Small surgical devices are placed through the probe to remove bone and herniated disc fragments.

The procedure usually takes about one hour; the patient is often able to return home on the same day. It is normal for a patient to experience postoperative pain, such as back pain, spasms, and lower extremity symptoms. These symptoms will usually improve as the nerve heals and inflammation of the nerve decreases. Patients are given pain medications during the healing process.

Who can benefit from Endoscopic Micro Discectomy (MED)?

This procedure is indicated for all those patients who are suffering from severe acute or chronic backache and/or radiating pain in the leg as a result of lumbar disc prolapse/slipped disc/herniated disc.

Quick Recovery – Great Advantage of Endoscopic Micro Discectomy (MED)

Since there is minimal damage to surrounding muscle tissue, the magnitude of post operative surgical pain is much less as compared to conventional open discectomy. The patients can get up and walk around on the post operative day itself making the hospital stay very short.

World Class Technical Expertise for Endoscopic Micro Discectomy

MyMedOpinion affiliated world Best hospitals in India are a benchmark in comprehensive spine care for such complex and sensitive surgeries. The procedure is performed by a highly qualified neurosurgeons who have trained for decades at world’s best spine hospitals and have an excellent track record of successful outcomes.

What are the advantages Endoscopic Micro Discectomy?

• Surgery done under local anesthesia with conscious sedation
• 5 mm skin incision
• Endoscope used for surgery
• No muscle, ligament or normal tissue damage
• Targeted fragmentectomy. (directly prolapsed disc tissue removed.)
• Minimal blood loss
• Patient can be discharged in 24 Hrs.
• No prolonged bed rest required after surgery. Can resume work sooner.
• Even prolapsed, migrated, extra-foraminal, recurrent discs can be removed. Very good technique for old and medically compromised patients.

Treatment of Cervical Herniated Disc in India | Best Spine Surgery Hospital India

Cervical Disc Herniation

The vertebrae that form the spine are cushioned by round, flat intervertebral discs. Each disc contains a tire-like outer band (called the annulus fibrosus) that encases a gel-like substance (called the nucleus pulposus).When these discs are healthy, they act as shock absorbers for the spine and keep the spine flexible. If they become damaged, they may bulge abnormally or break open (rupture), in what is called a herniated or slipped disc. Herniated discs can occur in any part of the spine, but they are most common in the neck (cervical) and lower back (lumbar) spine. The seven vertebrae between the head and the chest make up the cervical spine. Pain develops when the damaged intervertebral disc pushes into the spinal canal or nerve roots. Terminology referred to are herniated disc, prolapsed disc, ruptured disc and slipped disc.

Causes of cervical disc herniation

A herniated disc usually is caused by wear and tear of the disc (also called disc degeneration). Due to age, the discs lose some of the fluid that helps them stay flexible.

Injuries to the spine might also cause a herniated disc, which may cause tiny tears or cracks in the outer layer (annulus or capsule) of the disc. The jellylike material (nucleus) inside the disc may be forced out through the tears or cracks in the capsule, which causes the disc to bulge, break open (rupture), or break into fragments.

Symptoms of Cervical Disc Herniation

Herniated discs in the neck or cervical spine can cause pain, numbness, or weakness in the neck, shoulders, chest, arms, and hands. In some cases a very large herniated disc in the neck may cause weakness or slight prickling which affects different body parts. The arm pain from a cervical herniated disc results because the herniated disc material presses on a cervical nerve, causing pain to radiate along the nerve pathway down the arm. Along with the arm pain, numbness can be present down the arm and fingertips.

A cervical herniated disc will typically cause pain patterns as follows:

• C4 - C5 (C5 nerve root) - Can cause weakness in the deltoid muscle in the upper arm. Can cause shoulder pain.
• C5 - C6 (C6 nerve root) - Can cause weakness in the biceps (front upper arms muscles) and wrist extensor muscles. Numbness and tingling along with pain can radiate to the thumb side of the hand. This is one of the most common levels for a cervical disc herniation to occur.
• C6 - C7 (C7 nerve root) - Can cause weakness in the triceps (back upper arm muscles and extending to the forearm) and the finger extensor muscles. Numbness and tingling along with pain can radiate down the triceps and into the middle finger. This is also one of the most common levels for a cervical disc herniation .
• C7 - T1 (C8 nerve root) - Can cause weakness with handgrip. Numbness and tingling and pain can radiate down the arm to the little finger side of hand.

Stages of a Cervical Herniated Disc

The 4 stages to a cervical herniated disc are:

1. Disc Degeneration: Due to chemical changes associated with aging, intervertebral discs weaken. As part of the aging process, it can cause the disc to dry out, making it less able to absorb the shock. Disc can also become thinner in this stage.
2. Prolapse: The position of the disc changes with some slight impingement into the spinal canal or spinal nerves. This stage is also called a bulging disc or protruding disc.
3. Extrusion: The gel-like nucleus pulposus (inner part of the intervertebral disc) breaks through the tire-like wall (annulus fibrosus) but remains within the disc.
4. Sequestration or Sequestered Disc: The nucleus pulposus breaks through the annulus fibrosus and can move outside the interverterbral disc and into the spinal canal.

Most Advanced Slip Disc Treatment in India | Best Spine Hospital India

Slip Disc Treatment in India

The spine is made up of many bones called vertebrae. These are roughly circular and between each vertebra is a 'disc'. The discs are made of strong 'rubber-like' tissue which allows the spine to be fairly flexible. A disc has a stronger fibrous outer part, and a softer jelly-like middle part called the nucleus pulposus. 

The spinal cord, which contains the nerves that come from the brain, is protected by the spine. Nerves from the spinal cord come out from between the vertebrae to take and receive messages to various parts of the body. 

Strong ligaments attach to the vertebrae. These give extra support and strength to the spine. Various muscles also surround, and are attached to, various parts of the spine. (The muscles and ligaments are not shown in the diagram below for clarity.) 

At what age can a slipped disc occur? 
A slipped disc in the lower back is most often seen between the ages of 30 and 50. In the cervical vertebrae around the neck, slipped discs are most often seen between the ages of 40 and 60. 

Who Gets A Slipped Disc? 
  

What Are The Symptoms Of A Slipped Disc? 

Back pain

The pain is often severe, and usually comes on suddenly. The pain is usually eased by lying down flat, and is often made worse if you move your back, cough, or sneeze. 

Nerve root pain (usually 'sciatica')

Nerve root pain is pain that occurs because a nerve coming from the spinal cord is pressed on ('trapped') by a prolapsed disc, or is irritated by the inflammation caused by the prolapsed disc. Although the problem is in the back, you feel pain along the course of the nerve in addition to back pain. Therefore, you may feel pain down a leg to the calf or foot. Nerve root pain can range from mild to severe, but it is often worse than the back pain. With a prolapsed disc, the sciatic nerve is the most commonly affected nerve. (The term 'sciatica' means nerve root pain of the sciatic nerve.) The sciatic nerve is a large nerve that is made up from several smaller nerves that come out from the spinal cord in the lower back. It travels deep inside the buttock and down the back of the leg. There is a sciatic nerve for each leg. 

Lumbar Spine Surgery in India

Lumbago, or what is more commonly known to people as lower back pain , is one of the most widespread and prevalent spinal problems. The reason for such persistent back pain is any kind of pathological problem in the lumbar region of the spine, which is made up of the last five vertebrae.

Lumbar spine problems are most often caused by herniated inter-vertebral discs, anomalous developments on the vertebral bodies (osteophytes), which apply pressure on the spinal nerves that leads to narrowing of the spinal column around the spinal cord. The most important procedures followed in a lumbar Spine Surgery are decompression and fusion.

Decompression : Lumbar Decompression spine surgery in India is performed to assuage pain caused by pinched nerves. The surgery is generally recommended in cases of spinal stenosis caused by thickened joints, loosened ligaments, bony growths, or disc herniation.

The various procedures used for Decompressing Lumbar spine are:•  Discectomy•  Laminotomy or Laminectomy•  Port Hole Decompression•  Foraminotomy or Foraminectomy•  Osteophyte removal•  Corpectomy

Fusion : Lumbar fusion surgeryin India has two individual approaches. The most common process used is the posterior approach, where the surgery is done from the back. The three main Posterior fusion techniques are:

•  Postero lateral gutter fusion surgery•  Posterior lumbar interbody fusion (PLIF) surgery•  Transforaminal lumbar interbody fusion (TLIF) surgeryThe anterior approach involves placing the bone directly into the section between the vertebrae where the shock-absorption disc had been situated.

Candidates

Lumbarspine surgery in India is indicated for people who have pain that extends (radiates) from the back to the buttocks or back of thigh, pain that interferes with daily activities, weakness of legs or feet, numbness of legs, feet, or toes, loss of bowel of bladder control, had physiotherapeutic & medication input, but that hasn't helped.

Expected ResultsMost patients can expect a dramatic and lasting improvement in their back and leg pain after the lumbar spinal surgery . Though the success rates are excellent in Lumbar surgery , it can be lower in patients who smoke, are overweight, have diabetes or other significant medical illnesses, have osteoporosis, or who have had radiation treatments that included the lower back. Good nutrition and slowly increasing activity (as recommended by your physician) in the recovery period can help achieve success.

RecoveryYou are likely to experience pain and discomfort after the surgery which will be controlled with pain killers prescribed by your surgeon. You would be advised to walk the same day or the next after the surgery to prevent any clot formation. You would also be advised to do breathing exercises after the lumbar surgery for better circulation of blood and decrease the risk of any lung problem. You would need to stay at the hospital for about 5-6 days after the surgery and can go back home with specific instructions to follow. Many people return to work in 3-4 weeks after the surgery. But you may or may not be allowed to do heavy work depending upon your specific condition.

Most Advanced Lower Back Pain Treatment - Best Spine Hospital India

Pain or discomfort in the lower portion of our back and the spinal column is a common phenomenon and can be largely attributed to our changing lifestyles.

Wrong posture or inadequate exercise is most often the cause of the pain in the lower spinal column. The treatment of such a pain can vary from a simple over the counter medicine to surgery depending on the severity and the cause.

The pain is generally felt in the lumbar and the sacral region and can also affect other areas. A sprain in the muscles or the ligaments constituting the lower portion of the spine can be the most common cause of backache. Some of the other problems that involve pain in the lower back are disc degeneration due to arthritis or ageing, spondylitis, infections and tumors.

In most of the cases the pain is localized in the lower back and vanishes after some time. However, it may even extend to the buttock or the leg on the affected side. In cases wherein the pain is persistent and increases with time or results in weakness in the foot or loss of bladder control- proper medical check up becomes essential.

In some cases stiffness or persistent pain around the spine can disturb your sleep resulting in further problems like tiredness. Such problems can be rectified by the used of pillows designed to maintain our body posture and thus ensure proper sleep. The use of the wrong type of mattresses can also affect the body posture and result in back pain.

Lower back pain is one of the commonest problems afflicting people around the world at some point of time in their life.

In the initial stages of pain, stretching exercises work effectively as Lower Back Pain Treatment.

The lower back supports the upper body and allows the body to turn, twist, bend, lift and walk. It plays a very important role in mobility. The lower back takes a lot punishment, as we tend to overuse or misuse it.

There are many options available for Lower Back Pain Treatment, depending upon the problem.

Surgery is usually the last resort in the treatment of back pain. It is usually only recommended if all other treatment options have been tried or in an emergency situation. The main procedures used in back pain surgery are discectomies, spinal fusions, laminectomies, removal of tumors and Vertebroplasty.

There are different types of surgical procedures that are used in treating various conditions causing back pain. Nerve decompression, fusion of body segments and deformity correction surgeries are examples. The first type of surgery is primarily performed in older patients who suffer from conditions causing nerve irritation or nerve damage. Fusion of bony segments is also referred to as a spinal fusion and it is a procedure used to fuse together two or more bony fragments with the help of metalwork. The latter type of surgery is normally performed to correct congenital deformities or those that were caused by a traumatic fracture. In some cases, correction of deformities involves removing bony fragments or providing stability provision for the spine. A time-tested procedure to repair common intervertebral disc lesions which offers rapid recovery (just a few days) involves the simple removal of the fibrous nucleus of the affected intervertebral disc.

A discectomy is performed when the intervertebral disc have herniated or torn. It involves removing the protruding disc, either a portion of it or all of it by placing pressure on the nerve root. The disc material which is putting pressure on the nerve is removed through a small incision that is made over that particular disc. This is one of the most popular types of back surgeries and which also has a high rate of success. The recovery period after this procedure does not last longer than 6 weeks. The type of procedure in which the bony fragments are removed through an endoscope is called percutaneous disc removal.

Microdiscectomy may be performed as a variation of standard discectomies in which a magnifier is used to provide the advantage of a smaller incision, thus a shorter recovery process.

Spinal fusions are performed in cases in which the patient has had the entire disc removed or when another condition has caused the vertebrae to become unstable. The procedure consists in uniting two or more vertebrae by using bone grafts and metalwork to provide more strength for the healing bone. Recovery after spinal fusion may take up to one year, depending greatly on the age of the patient, the reason why surgery has been performed and how many bony segments needed to be fused.

In cases of spinal stenosis or disc herniation, laminectomies can be performed to relieve the pressure on the nerves. During such a procedure, the surgeon enlarges the spinal canal by removing or trimming away the lamina which will provide more space for the nerves. The severity of the condition as well as the general health status of the patient are key factors in establishing the recovery time, which may be range from 8 weeks to 6 months.

Back surgery can be performed to prevent the growth of benign and malignant tumors. In the first case, surgery has the goal of relieving the pressure from the nerves which is caused by a benign growth, whereas in the latter the procedure is aimed to prevent the spread of cancer to other areas of the body. Recovery depends on the type of tumor that is being removed, the health status of the patient and the size of the tumor.

Cervical Disc Replacement Vs Spinal Fusion Surgery | Best Spine Hospital India

CervicalDisc Replacement Vs  Spinal Fusion

Fusing a disc inevitably transfers work to the adjacent discs. So, unless there is a good reason to fuse the spine, the usual course is a disc replacement as this offers to restore and or preserve movement at the affected level.

Disc replacement is therefore now more common than fusion after disc removal though the evidence that it is actually better is not as tight as you might think. Both operations are good. Your big decision is whether to have surgery or not. If you have spent more time thinking about replacement vs fusion your mind has been focused on the wrong issue - though this is an important decision too. Fusion is needed if there is significant instability at the operated level – spondylolisthesis or if there is a fracture as well as a prolapse.

Fusion is also used if the disc space is already very narrow when the movement has already been lost. If the facet joints are also worn and painful then disc replacement can make this worse. Finally, if there are a lot of osteophytes then these have to be drilled away. As a result of this bone work, the two vertebrae can fuse around the replacement – this happens more often with some discs than others and may occur as many as one in ten times.

Disc replacement is not a guarantee of no more trouble nor does it prevent all disease in the adjacent levels. You wore out the first disc without having had a fusion so you may also wear out another. That said, our philosophy is to preserve and restore function where possible.

Is there good evidence to prove disc replacement is better? Not in the form of randomised trials. Such trials are difficult to do, they have been flawed and to some degree inconclusive. In our view, this reflects the difficulty of doing this kind of study. For most patients, a logical choice can be made and where there is doubt we would opt for disc replacement – you can fuse after if it does not work but you cannot reverse a fusion.

Cervical Disc Replacement

 

Cervical disc is a piece of specialized tissue that separates the vertebral bones of the spinal column in the neck. Cervical disc disease is caused by an abnormality in one or more discs. When a disc is damaged due to arthritis or an unknown cause it can lead to neck pain from inflammation or muscle spasm. Severe pain and numbness can occur in the arms from pressure on the cervical nerve roots. The disc space is jacked up to its prior normal disc height to help decompress (relieve pressure) on the nerves. In severe cases, when the patient is not benefited from non-surgical treatments like medication or physiotherapy then they are advised Cervical Disc Replacement Surgery.

The Center of the disc, which is called the nucleus, is soft, springy and receives the shock of standing, walking, running, etc. The outer ring of the disc, which is called the annulus (Latin for ring), provides structure and strength to the disc. Patients with cervical disc herniations are advised cervical disc replacement, if they have not responded to non-surgical treatments like medication or physiotherapy.In the surgery, an artificial disc replaces the worn out or affected one and the disc space is jacked up to the normal height.

SpinalFusion

Once you have had your offending disc removed, a simple fusion procedure can be performed as the cervical spine reconstruction. 

This is usually performed with a plate and integrated cage (PCB). This is filled with recycled bone collected during the decompresion of the spine in addition to some synthetic bone supplement. Usually no additional bone needs to be taken from the pelvis. Profesional athletes involved in heavy contact sport such as rugby may wish to utilise their own pelvic bone as it is still probaly provides for the fastest and most secure fusion. Return to play is often possible at three months. 

the device, filled here with synthetic bone, is ready for insertion. This technique obliviates the need for a separate incision and the harvesting of the patient’s bone from elsewhere, e.g. the pelvis.

After Surgery

Patients are usually able to get out of bed within an hour or two after surgery. Your surgeon may have you wear a hard or soft neck collar. If not, you will be instructed to move your neck only carefully and comfortably. Most patients leave the hospital the day after surgery and are safe to drive within a week or two. People generally get back to light work by four weeks and can do heavier work and sports within two to three months.

Outpatient physical therapy is usually prescribed only for patients who have extra pain or show significant muscle weakness and deconditioning.

Rehabilitation

Patients usually don't require formal rehabilitation after routine cervical discectomy surgery. Surgeons may prescribe a short period of physical therapy when patients have lost muscle tone in the shoulder or arm, when they have problems controlling pain, or when they need guidance about returning to heavier types of work. If you require outpatient physical therapy, you will probably only need to attend therapy sessions for two to four weeks. You should expect full recovery to take up to three months.

At first, therapy treatments are used to help control pain and inflammation. Ice and electrical stimulation treatments are commonly used to help with these goals. Your therapist may also use massage and other hands-on treatments to ease muscle spasm and pain.

Active treatments are added slowly. These include exercises for improving heart and lung function. Walking, stationary cycling, and arm cycling are ideal cardiovascular exercises. Therapists also teach specific exercises to help tone and control the muscles that stabilize the neck and upper back.

Your therapist works with you on how to move and do activities. This form of treatment, called body mechanics, is used to help you develop new movement habits. This training helps you keep your neck in safe positions as you go about your work and daily activities. You'll learn how to keep your neck safe while you lift and carry items and as you begin to do other heavier activities

Minimally Invasive Spine Surgery in India | Best Spine Hospital India

Minimally Invasive Spine Surgery in India

Spine surgery is traditionally done as "open surgery," meaning the area being operated on is opened with a long incision to allow the surgeon to view and access the anatomy. In recent years, however, technological advances have allowed more back and neck conditions to be treated with a minimally invasive surgical technique.Because minimally invasive spine surgery (MISS), does not involve a long incision, it avoids significant damage to the muscles surrounding the spine. In most cases, this results in less pain after surgery and a faster recovery.

Spine surgery is typically recommended only when a period of nonsurgical treatment — such as medications and physical therapy — has not relieved the painful symptoms caused by your back problem. In addition, surgery is only considered if your doctor can pinpoint the exact source of your pain, such as a herniated disk or spinal stenosis. Minimally invasive techniques are beginning to be used for a wider range of spine procedures, and have been used for common procedures like decompression and spinal fusion since the 1990s. Decompression relieves pressure put on spinal nerves by removing portions of bone or a herniated disk. Spinal fusion corrects problems with the small bones of the spine (vertebrae). The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone. This article focuses on decompression and fusion with a minimally invasive technique.

Minimally Invasive Spine Procedures

There is a rapid increase in technology that allows the MIS physician to treat patients with minimally invasive spine surgery procedures. Some of these techniques are now well established, while others remain new and continue to evolve. The best MIS (Minimally Invasive Spine Surgery) technique will depend on the specific character of the problem. While the list of MIS (Minimally Invasive Spine Surgery) techniques continues to expand, the most commonly employed today include:

• Minimally Invasive Tubular Microdiscetomy
• Minimally Invasive Lumbar Laminectomy
• Cervical laminoforaminotomy
• Endoscopic Discectomy
• Minimally Invasive Transforaminal Interbody Lumbar Fusion (TILF)
• Minimally Invasive eXtreme Lateral Interbody Fusion (XLIF)
• Microsurgical Discectomy
• Posterior Lumbar Interbody Fusion (PLIF)
• Kyphoplasty
• Nucleoplasty or Percutaneous Discectomy

Comparing Minimal type of Invasive pine surgery to Invasive Spine Surgery:

Minimal Invasive Spine surgery comes with more benefice than invasive spine surgery.

• Less scar tissue is created thereby not leaving the patient to recover with huge and ugly scar marks.
• Pain associated with this procedure is effectively less severe as small incisions are made. Also less soft tissues are damaged.
• Less blood is lost and therefore the patients don’t have to be at a medication for long periods of time
• Procedure is more accurate and leaves the patient with better results.
• The cost for such a surgery is quite lesser as compared to an Invasive Spinal surgery.

Candidates

People with back pain, numbness or weakness in upper or lower limbs who are not responding to non surgical treatments like pain killers, non steroidal anti inflammatory drugs and physiotherapy can consider surgery. They need further investigations like X-ray/ CT scan/ MRI to confirm bulging or protruding disc which can be corrected by surgery.

Surgery for herniated disc should be considered emergency if there are symptoms of pressure on the spinal cord or on the cauda equine or cases involving serious or increasing paralysis

Expected Results

The results of herniated disc surgery are good. A successful surgery relieves the symptoms of herniated or slipped disc in up to about 90% of the patients.

Recovery

Recovery is different for each patient. However, it is normal to feel pain at the site of surgery for the first few days which can be controlled with medication. You would be advised to start physical therapy after a week of the surgery for rehabilitation. You would be able to return to normal activities in about two weeks while full recovery may take few weeks to months. Your treating surgeon would advise you about the rehabilitation and when to start rigorous activities.

Lower Back Pain Treatment and Surgery in India

Back pain is a common reason for absence from work and doctor visits. Although back pain may be painful and uncomfortable, it is not usually serious.

Even though back pain can affect people of any age, it is significantly more common among adults aged between 35 and 55 years. Experts say that back pain is associated with the way our bones, muscles and ligaments in our backs work together.

Pain in the lower back may be linked to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, lower back muscles, abdomen and pelvic internal organs, and the skin around the lumbar area. Pain in the upper back may be due to disorders of the aorta, tumors in the chest, and spine inflammation.

How Is Back Pain Diagnosed?

Before a doctor can begin treating back pain, he or she may do tests to diagnose what is causing your problem. Unless you are totally immobilized from a back injury, your doctor probably will test your range of motion and nerve function and press on your back to locate the area of discomfort.

Blood and urine tests may be done to be sure the pain is not caused by an infection or other systemic problem. X-rays are useful in pinpointing broken bones or other skeletal defects. To analyze soft-tissue damage such as disk herniation, magnetic resonance imaging (MRI) scans may be needed. A CT scan can be done instead for those who cannot have an MRI. X-rays and imaging studies are not usually indicated for first-time back pain caused by an overuse type injury and are generally used only for checking out ongoing pain, direct trauma to the back, back pain with fever, or nerve problems such as weakness or numbness in the arms or legs. To determine possible nerve or muscle damage, an electromyogram (EMG) can be useful.

Unfortunately, there is not always a direct correlation between the findings on imaging studies and the amount of back pain. Many people have findings on CT scans and MRI, yet do not have back pain.

Causes of back pain

Strain - the most common causes of back pain are:
Lifting something in an improper manner is a common cause of back pain.
Treatments for back pain
Usually back pain is categorized into two types:
Injecting cells to regenerate spine discs - scientists from Duke University, North Carolina, developed new biomaterials that can deliver a booster shot of reparative cells to the nucleus pulposus, effective eliminating pain caused by degenerative disc disease.
If home treatments do not give the desired results, a doctor may recommend the following: 

Surgery - surgery for back pain is very rare. If a patient has a herniated disk surgery may be an option, especially if there is persistent pain and nerve compression which can lead to muscle weakness. Examples of surgical procedures include:

The human back is composed of a complex structure of muscles, ligaments, tendons, disks and bones - the segments of our spine are cushioned with cartilage-like pads. Problems with any of these components can lead to back pain. In some cases of back pain, its cause is never found. 

•     Strained muscles
•     Strained ligaments
•     Lifting something improperly
•     Lifting something that is too heavy
•     The result of an abrupt and awkward movement
•     A muscle spasm.

• Structural problems - the following structural problems may also result in back pain:

 Ruptured disks - each vertebra in our spine is cushioned by disks. If the disk ruptures there will be more pressure on a nerve, resulting in back pain. 

 Bulging disks - in much the same way as ruptured disks, a bulging disk can result in more pressure on a nerve. 

 Sciatica - a sharp and shooting pain that travels through the buttock and down the back of the leg, caused by a bulging or herniated disk pressing on a nerve. 

 Arthritis - patients with osteoarthritis commonly experience problems with the joints in the hips, lower back, knees and hands. In some cases spinal stenosis can develop - the space around the spinal cord narrows. 

 Abnormal curvature of the spine - if the spine curves in an unusual way the patient is more likely to experience back pain. An example is scoliosis, when the spine curves to the side. 

 Osteoporosis - bones, including the vertebrae of the spine, become brittle and porous, making compression fractures more likely.

In the vast majority of cases back pain resolves itself without medical help - just with careful attention and home treatment. Pain can usually be addressed with OTC (over-the-counter, no prescription required) painkillers. Resting is helpful, but should not usually last more than a couple of days - too much rest may actually be counterproductive.

  Acute - back pain comes on suddenly and persists for a maximum of three months. 

  Chronic - the pain gradually develops over a longer period, lasts for over three months, and causes long-term problems.

A considerable percentage of patients with back pain experience both occasional bouts of more intense pain as well as more-or-less continuous mild back pain, making it harder for the doctor to determine whether they have acute or chronic back pain. 

  Fusion - two vertebrae are joined together, with a gone graft inserted between them. The vertebrae are splinted together with metal plates, screws or cages. There is a significantly greater risk for arthritis to subsequently develop in the adjoining vertebrae. 

 Artificial disk - an artificial disk is inserted; it replaces the cushion between two vertebrae. 

 Discectomy (partially removing a disk) - a portion of a disk may be removed if it is irritating or pressing against a nerve. 

  Partially removing a vertebra - a small section of a vertebra may be removed if it is pinching the spinal cord or nerves.

Most Advanced Cervical Discectomy Surgery in India - Best Spine Surgery Hospital India

Cervical Discectomy Surgery in India

Cervical discectomy is surgery to remove one or more discs from the neck. The disc is the pad that separates the neck vertebrae; ectomy means to take out. Usually a discectomy is combined with a fusion of the two vertebrae that are separated by the disc. In some cases, this procedure is done without a fusion. A cervical discectomy without a fusion may be suggested for younger patients between 20 and 45 years old who have symptoms due to a herniated disc.

Who is a possible candidate for Cervical Disectomy?

Neck pain is usually due to problems with a disc or facet joint. Disc pain tends to be worse when bending forwards. Facet joint problems tend to be worse with neck extension (arching backwards) and occur more often in the older population.

Disc and facet disease can cause neck pain directly, or may cause "referred" pain, meaning pain from the cervical spine which is felt elsewhere - into the neck, shoulders or shoulder blades. It is uncommon for disc or facet joint pain to radiate down beyond the elbow, but it does occur. Facet joint pain rarely radiates down past the shoulder.

Who may require Cervical Discectomy?

Those patients who suffer from persistent neck pain, one or both arm pain and weakness, instability while walking and lack of bowel and bladder control in spite of taking conservative treatment methods such as rest, medication, physical therapy are ideal candidates for this procedure.

The disc may herniate backwards to compress upon the cord or it may bulge sideways to compress upon the nerve. Cord compression may lead to numbness and weakness of both arms and in severe case may affect the bowel and bladder function. This procedure aims to remove the complete disc or its fragments in order to relieve compression of the cord or nerve and restore their function.

In Cervical Discectomy, disc can be accessed via Anterior or Posterior approach.

The Anterior approach is more popular with the surgeons as the access to disc is very easy with little muscle tissue on the way and complete disc removal is possible with no recurrence of disc herniation. This approach also provides a good exposure to all cervical vertebrae from C2 to cervicothoracic junction. The limited amount of muscle division or dissection helps to limit postoperative pain following the spine surgery. The main postoperative problem most patients face is difficulty swallowing for 2-5 days due to retraction of the esophagus.

Posterior approach is slightly complicated as too many tissues have to be traversed to reach the disc. There are chances of injury to spinal cord and nerve roots while accessing the disc. Also since complete removal of disc is not possible, re-herniation can occur. But the positive aspect of this approach is that spinal fusion is not required so natural spine movement is preserved.

• Anterior Approach: The patient is made to lie down on his back under general anesthesia. A horizontal incision is made just 2 inches above the clavicle on either left or right side. The thin muscle layer is cut and the trachea and esophagus are shifted to one side along with the nerves and vessels. The surgeon has a clear view of the cervical vertebrae. An X-ray is done to confirm the involved disc. An operating microscope can also be used to get a better picture of the operating field. The anterior longitudinal ligament is gently removed to reach the osteophytes and the disc fragments. The osteophytes are scraped off and the intervertebral disc is dissected. Once the disc is removed the vertebral bodies are gently distracted to their original distance to fill the space with bone graft. This helps to relieve the compression from the nerves as the diameter of the intervertebral foramen is enlarged. Sometimes cervical discectomy is followed by spinal stabilization using screws and plates.
• Posterior Approach: The patient is sedated under general anaesthesia and made to lie on his abdomen. The neck is slightly bent and head is supported on the head rest. An incision is made on the back of the neck in the midline. The skin, fascia and muscles are retraced to reach the vertebrae. An X-ray is done to confirm the level of affected disc. Edges of the lamina are shaved off to give a clearer vision. Incase of central herniation, both lamina may have to be removed in order to get full view of the fragmented disc. The posterior longitudinal ligament is incised and a small hole is made in the ligamentum flavum. The surgeon now uses a surgical microscope to magnify the operating area and the disc fragments and bony spurs are carefully removed. The muscles fascia and skin are stitched back together.

What happens after surgery?

Patients are usually able to get out of bed within an hour or two after surgery. Your surgeon may have you wear a hard or soft neck collar. If not, you will be instructed to move your neck only carefully and comfortably.

Most patients leave the hospital the day after surgery and are safe to drive within a week or two. People generally get back to light work by four weeks and can do heavier work and sports within two to three months. Outpatient physical therapy is usually prescribed only for patients who have extra pain or show significant muscle weakness and deconditioning.

Rehabilitation

Patients usually don't require formal rehabilitation after routine cervical discectomy surgery. Surgeons may prescribe a short period of physical therapy when patients have lost muscle tone in the shoulder or arm, when they have problems controlling pain, or when they need guidance about returning to heavier types of work.

  If you require outpatient physical therapy, you will probably only need to attend therapy      sessions for two to four weeks. You should expect full recovery to take up to three months.

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