Lumbar spine

The lumbar spine is made up of five vertebral bodies in the lower back, where the spine curves inward toward the abdomen. It starts about five or six inches below the shoulder blades, and connects with the thoracic spine at the top and extends downward to the sacral spine. These nerves transmit sensations from the buttocks and lower extremities through the spinal cord to the brain and transmit motor signals from the brain to the lower extremities to produce movement of the legs, toes, and joints of the lower extremities.
Lumbar stenosis
Lumbar spinal stenosis is a condition caused by narrowing of the spinal canal. This narrowing occurs when the growth of bone or tissue or both reduces the size of the openings in the spinal bones. This narrowing can squeeze and irritate the nerves that branch out from the spinal cord.
Lumbar spine

Main Causes

  • Herniated discs  / Disc Bulge / Disc Protrusion– As the discs in the back deteriorate they can herniate, meaning the disc swells, bulges, or ruptures. When this occurs some of the disc material can protrude into the spinal canal. A herniated disc, while painful, doesn’t always cause lumbar spinal stenosis.
  • Spondylolisthesis – Refers to the forward slippage of one vertebra over another in the spine. This can cause narrowing of the spinal canal and result in pinching of the nerves. Learn more about spondylolisthesis.
  • Slip Disc – When a spinal disc moves from its place due to injury or sudden shock

Other Causes:

  • Back injuries – Can both cause spinal stenosis or can worsen already existing low-level symptoms.
  • Tumor growth – Can narrow the spinal canal, but the occurrence of spinal tumors is rare.
  • Bone spurs – As cartilage deteriorates between the joints of the back, small bone growths, called bone spurs, or osteophytes, can develop. Bone spurs sometimes develop due to arthritis in the spine.
  • Changes to ligaments – Changes can occur, especially to the ligamentum flavum, the ligament that runs along the inside of the spinal canal. This ligament can become thickened, taking up more space in the spinal canal. Or, as deteriorating discs lose some of their height, this ligament can buckle.
  • Enlarged facet joints – Enlargement of the facet joints in the spine can also cause narrowing of the spinal canal.
Lumber Spine Surgery /Treatment in India:
  • Laminectomy Spine Surgery In India : This procedure involves removing the bone, bone spurs, and ligaments that are compressing the nerves. This procedure may also be called a “decompression.” Laminectomy is a surgical procedure to remove a portion of the vertebral bone called the lamina. The minimal form of the procedure requires only small skin incisions, the back muscles are pushed aside rather than cut, and the parts of the vertebra adjacent to the lamina are left intact. Recovery from the minimal procedure can occur within a few days.
  • Microscopic Decompression of the nerve roots In India : Spinal/microscopic decompression is a surgical procedure performed to relieve pressure and alleviate pain caused by the impingement of bone and/or disc material on the spinal cord or nerves. This will be done using minimally invasive spine surgery. 
  • Decompression and Spine fusion surgery in India:  Here pressure over nerves is released with the help of microscope. Disc is excised and is replaced. Pedicle screws and rods are attached to the back of the vertebra and an interbody fusion spacer is inserted into the disc space from one side of the spine. The surgery is known as TLIF/ Spinal fusion surgery. 
  • Spinal fusion Surgery in India : If arthritis has progressed to spinal instability, a combination of decompression and stabilization or spinal fusion may be recommended. Spinal fusion is a surgical procedure used to correct problems with the small bones of the spine (vertebrae). It is essentially a “welding” process. The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone.
  • Steroid injections for Spine Treatment In India: Cortisone is a powerful anti-inflammatory. Cortisone injections around the nerves or in the “epidural space” can decrease swelling, as well as pain. It is not recommended to receive these, however, more than 3 times per year. These injections are more likely to decrease pain and numbness but not weakness of the legs.
Lumber Spine Surgery
Lumbar spine 2

Spinal Tumors Surgery In India:

A spinal tumor, also termed as neoplasm’s that is seen to be a cancerous or a non cancerous growth which develops within or near the spinal cord area or within the bones of the spine. The common areas where these tumors occur are cervical, thoracic, lumbar and sacrum.Tumors that start in the spinal tissue are termed as primary spinal tumors. On the other hand the tumors that spread in the spine through some other body organ are termed as secondary spinal tumors.Back pain is seen to be the most common symptom of a spinal tumor. Such sort of a tumor or an unaccepted growth of tissues that can affect the nerves where the tumor has developed. Such growth can be very critical and can cause permanent disability or sometimes even death.
Symptoms of Spinal Tumors:
The symptoms that any patient can face depend on the location, type and the general health condition of the patient. Secondary tumors also known as (Metastatic Tumors)have been seen progressing quickly. Primary tumors on the other hand might take months or may be years to grow and develop.
Patients suffering from spinal tumors are seen to have certain complications that
are:
1. Abnormal sensations or loss of sensation:
a. Causes usually in the legs which includes knee and ankle
b. Cold sensation in the legs, cold fingers and hands
2. Back pain:
a. Middle and lower back are most common pints of pain
b. Usually the pain isn’t relieved even after taking medications.
c. Patients suffer strain, cold, cough and continuous sneezing
3. Fecal incontinence
a. Leads to inability of keeping oneself from holding urine.
4. Muscle contractions:
a. Leads to complications like twitches and spasms
5. Muscle weakening
a. Leads to difficulty in walking
b. Causes falls
c. Severe sprains
Treatments:
To diagnose the problems of the patients the normal series of tests may include a neurological examination, spinal tumor X-rays, MRI, CT scans and a closed biopsy may be considered as necessary in order to plan a definitive treatment.
The three most common treatments that are usually undertaken to treat the patients are:
1. Corticosteroids (Dexametasone) / Drug Treatment for Spinal Tumor in India:
This treatment is given in order to reduce inflammation along with swelling in the spinal cord region
2. Spine Surgeries for Spinal Tumours in India :
A surgery can be done in order to reduce the compression over the spinal cord. Some tumors are completely
removed using surgeries whereas others are partially removed in order to relieve the pressure on the spine.
3. Radiation therapy for Spine Tumour in India:
May be used on its own or in a combination with the surgery in order to treat the complication.
4. Chemotherapy for Spine Tumours in India:
Though this procedure has not seen many successes but still depending from case to case, it is still
recommended by the doctors.

Spine Specialist Doctors in India

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HBG case study for Lumbar Spinal stenosis with disc bulge

Case of Ms. Lucy, 49 year old lady from Kenya

Greetings from HBG Medical Assistance, India!!!

The reports sent suggest that the patient is suffering from 1 level disc disease at L5-S1 with spinal Stenosis which is a narrowing of the open spaces within the spine, which put pressure on the spinal cord and the nerves that travel through the spine.

In this case, the patient required Detailed Clinical Investigations which will includedMRI Spine, Blood Monitoring and spine X-rays before the treatment.

Post Investigations, the patient could benefit from either Micro Endoscopic Discectomy Or TLIF Spine Surgery (Decompression, instrumentation and Fusion surgery), depending upon the investigative outcome.

If the patient is having minimal back pain, then the Micro Endoscopic Discectomy is a very good option to get complete cure from the disease. Micro Endoscopic Discectomy is a surgical procedure in which the pressure over nerves is released with the help of microscope. In this surgical procedure no implants will be needed.

OR

If the back pain is very severe, then TLIF Spine surgery would be required.

(TLIF Spine Surgery)- The patient would benefit fromDecompression, Instrumentation and Fusion Surgery (TLIF) at L5-S1 Level in which a diseased discs would be excised and replaced with spacer device. Thus the pressure over spinal cord is released and the two bones are fused together with anterior plate.

The Surgery is done using latest state of the art minimally invasive techniques using US FDA approved implants. Doctor’s use Neuro-Monitoring during surgery which helps to continuously monitor nerves and muscles during surgery which greatly reduces the risk of damage to nerves and muscles during surgery and thus making this surgery very safe.

After the completion of the Surgery, the patient is recommended to undergo Physical Rehabilitation as it is very much beneficial and it will also improve the movement and reduce the pain.

The implants are titanium pedicle screw sourced from the United States.

Prognosis: Very Good. The Success rate of the Surgery is 99%.

We recommend following hospitals, having acclaimed doctors:

  1. Fortis Healthcare, Mumbai is a leading integrated healthcare delivery provider, present in 11 countries, in the Asia Pacific region. The healthcare verticals of the company span diagnostics,   primary care, day care specialty and hospitals. Fortis Healthcare is driven by the vision of saving and enriching lives through clinical excellence. Currently, the company operates its healthcare delivery network in India, Mauritius, Singapore, Sri Lanka and UAE with 75 hospitals, over 12,000 beds, 600 primary care centers, 191 day care specialty centers, 230 diagnostic centers and a talent pool of 23,000 people. To know more kindly visit https://hbgmedicalassistance.com/fortis-hospitals/  on our website.

Dr. VikasGupte: Dr.Gupte has undergone  Clinical Fellowship training in Minimal Invasive and Endoscopic Spine Surgery at Wooridul Spine Hospital, Seoul, Korea. It is a renowned world-class dedicated hospital for spinal disorders and a recognized training center for American Board for Minimal Invasive Spine Surgery. To know more about this doctor kindly click on the link: https://hbgmedicalassistance.com/dr-vikas-gupte/

  1. Paras Hospital Gurgaon,  – Paras Healthcare initiated with the inception of Paras Hospitals, Gurgaon in the year 2006, with the vision of providing specialized super specialty tertiary care services to the community at large. To know more about hospital kindly visit https://hbgmedicalassistance.com/paras-hospitals/   on our website.

Dr. ArunBhanot- He is a Chief – Department of Spine Surgery. You can visit our website https://hbgmedicalassistance.com for more information about this doctor.

 

  1. 3. Artemis Hospital, Gurgaon- Artemis Health Institute (AHI), at Gurgaon is 300-bed tertiary care super-specialty flagship hospital established by Artemis Health Sciences (AHS). Artemis Hospital is the first JCI and NABH accredited hospital in Gurgaon. Artemis aims at creating an integrated world-class healthcare system by leveraging the best medical practices backed by cutting-edge technology. To know more about the Hospital, please click on the link: https://hbgmedicalassistance.com/artemis-health-institute/

Dr. Hitesh Garg- He is senior consultant for Spine surgeries.To know more about the Doctor, Please click on the link: https://hbgmedicalassistance.com/dr-hitesh-garg/

  1. BLK Super Specialty Hospital, New Delhi – BLK Hospital possibly has the best of the mix of doctors in the country today. They have a star studded Cancer Team, one of the finest managed Critical Care Units and best trained Neurologists and Cardiologists. Given the technological back up, they are most well placed to take care of this case. You can visit our website https://hbgmedicalassistance.com/blk-super-specialty/

Dr. Puneet Girdhar- He specializes in the surgical and non-surgical management of spinal disorders involving neck and back, utilizing turn of the century minimally invasive techniques. He also specializes in minimally invasive hip, knee and shoulder surgery. To know more about him kindly click on the link: https://hbgmedicalassistance.com/dr-puneet-girdhar/

  1. Apollo Spectra Hospitals, Mumbai(erstwhile Nova Specialty Surgery taken over by Apollo Hospitals Group) – As a specialty hospital, Apollo Spectra gives you the advantage of expert and quality healthcare with all the benefits of a large hospital but in a friendlier, more accessible facility. This is what makes them unique. With 10 centers across 7 cities – Bengaluru, Chennai, Delhi, Jaipur, Kanpur, Mumbai and Pune, over 50,000 successful surgeries with excellent clinical outcomes, and over 700 leading doctors, Apollo Spectra Hospitals continue to set new standards in healthcare services.

Dr. AnandKavi- He is an orthopedic surgeon who has developed a keen interest and expertise in endoscopic spine surgery.  Dr. Kavi has special interest in research related to advanced endoscopic and laser techniques for lumbar and cervical spine surgery. Dr. Kavi brings a wealth of orthopedic surgery experience to Prime. Having graduated with top honours in his Master of Surgery program, he has worked in the UK in the NHS system. As a orthopedic surgeon in the UK, Dr. Kavi received extensive training and experience in joint replacement, pediatric orthopedics, limb reconstruction, trauma and micro vascular surgery. Upon returning to India, DrKavi developed an extensive practice in joint replacement and endoscopic spine surgery.

Estimated Cost– Evaluations + Micro Endoscopic Discectomy Surgery or One Level Spine Surgery.

HOSPITALS LOCATION EVALUATIONS COSTS: Micro Endoscopic Discectomy- Twin Sharing Surgery- Spine One Level- Twin Sharing
FORTIS Mumbai USD 1000 USD 3200 USD 5600
PARAS HOSPITAL NCR-New Delhi USD 1000 USD 4500 USD 5000
ARTEMIS HOSPITAL NCR- New Delhi USD 1000 USD 4000 USD 5500
BLK Hospital New Delhi USD 1000 USD 4300 USD 5200
APOLLO SPECTRA Mumbai USD 1000 USD 4500 USD 6000

The package will include:

  1. The cost of all investigations
  2. The cost of the treatment
  3. The doctor’s fee and surgery charges
  4. The stay of patient and 1 attendant in hospital while surgery.
  5. All meals for the patient and the attendant as per the available menu while in hospital.
  6. Medical Consumables and Medicines while in hospital.
  7. The fee for dietician and nursing while in hospital.
  8. It also includes complementary Airport Transfers, Forex Services and assistance.

Total Stay:

If Micro Endoscopic Discectomy is required-

The patient will require a stay of 3 days in the hospital and another stay will be 5 days in the guest house for follow-up.

If TLIF Spine surgery is required-

The patient will require a stay of 6 days in the hospital and another stay will be 5 days in the guest house for follow-up.

Post Discharge, we will help them find a decent guest house near the hospital. They may prepare for approx. USD 50 per day for the accommodation for two.