Sample Opinion for Spinal Disc Prolapses with CKD and GERD

Patient with combination of Kidney Failure, GERD and Spinal Disc Prolapse // Case number – OP/2025/2908 // 65 year old male // South Sudan

Case Summary: According to the medical reports shared with us, Mr.GD, a 65-year-old gentleman from South Sudan, has three significant medical conditions:

Condition – 1:  Spinal Disc Prolapses or Lumbo-Sacral Disc Prolapse affecting multiple spinal levels (T11-L5), causing severe nerve compression and widespread radiating pain.

Condition – 2:  Chronic Kidney Disease (CKD) in complete renal failure, requiring dialysis 2-3 times per week and complicating potential surgeries, with a kidney transplant being a critical treatment priority.

Condition – 3: GERD (Gastroesophageal Reflux Disease), which disrupts metabolism and nutrition, further challenges his immune health. His complex condition necessitates further evaluation upon arrival at the hospital to assess severity and determine appropriate treatment.

Evaluations needed to confirm the diagnosis and proceed to treatment: Patient will need to go through detailed physical and clinical investigations, which will include-

• For Spine Disease– Imaging tests like MRI scans, Nerve study, X-ray, etc, along with other routine tests.
• For GERD (Gastroesophageal Reflux Disease)- Upper endoscopy, esophageal pH monitoring,g and esophageal manometry.
• For Chronic Kidney Disease (CKD)- preoperative investigations for donor & recipient, Whole Abdomen Ultrasound, CT scan, CBC, Urine Examinations, and other related investigations to confirm the diagnosis and further treatment Plan.
  
  Treatment Plan:  The final line of treatment can only be decided after the outcome of investigations and after reviewing the patient in India.

• Upon arrival the doctors will need to check whether a spine surgery can be done first because that will give a lot of relief from the pain. But it will largely depend on whether the kidneys with dialysis can handle the surgery. If the kidneys support, Mr. GD will be offered TLIF surgery for the spine at 4 levels with stabilization of the rest of the spine.

• If the Kidneys are found to be in a condition that they cannot support other surgeries, then the Kidneys need to be treated first with a Kidney Transplant.
  

• Gastroesophageal Reflux Disease, depending upon severity, will need a surgery called Fundoplication. Now, if we are doing the kidney transplant first, this surgery may be avoided, keeping the hope that during the post-surgical management of the Kidney transplant, we will be able to manage the GERD also.

TLIF (Transforaminal Lumber Interbody Fusion)- Further the disc will be replaced with spacer instruments and the vertebrae will be fixed with pedicle screws. Technically, this surgery is called TLIF (Transforaminal Lumber Interbody Fusion). 
This surgery will be a Minimally Invasive and Navigation-Guided Surgery. During the surgery, the doctor will remove the bulged discs and replace them with spacer instruments. The vertebrae is fixed with the help of bio friendly very small 2 rods and 4 screws. 

This removes the pressure from the nerves. It allows the spinal cord its natural movement and gives the spine much-needed strength. The surgery is very safe and has a success rate of over 97%.

Kidney Transplant Process: The patient will need a healthy donor from within his family with a matching DNA (the family DNA of patient and donor needs to be same, that is they need to belong to the same family). Upon arrival, the patient & donor will consult the doctor & investigations will be started. During the first week, we will finish all the required diagnostics for the patient/donor and prepare the Renal Transplant file to be presented to the Renal Transplant Approval Committee.
A Renal Transplant file consists of Medical Documents declaring the patient a candidate to receive the transplant, Medical Documents declaring the donor the right candidate for donation with matching HLA, etc., the proofs of relationship and ID proofs, and an affidavit as suggested below in my mail.
This file is then endorsed by the High Commission of the patient’s native country here and presented to the Organ Transplant Approval Committee. This whole process takes 5-7 days after the patient arrives.

Fundoplication – Fundoplication is a surgical procedure, often laparoscopic, used to treat gastroesophageal reflux disease (GERD) by reinforcing the lower esophageal sphincter (LES). The Fundoplication procedure in India involves wrapping the upper part of the stomach (fundus) around the lower end of the esophagus, creating a stronger valve to prevent acid reflux.

Kindly Note: The advised plan is solely based on the reports shared with us. The final line of treatment will be decided post the physical and clinical evaluations of the patient on arrival only. The patient will be investigated in detail towards his candidature towards surgery and the donor will be investigated for his fitment towards the donation. 

We would recommend the following top hospitals having acclaimed Doctors as below:

1. Artemis Hospital, Gurgaon //Surgeon for Spine –Dr. Hitesh Garg // Surgeon for Kidney Transplant-Dr. Varun Mittal 

2. BGS Gleneagles Global Hospital Bangalore, // Surgeon for Spine –Dr. Keshav // Surgeon for Kidney Transplant-Dr. Anil Kumar

3. Amrita Hospitals, Faridabad // Surgeon for For Spine –Dr. Anandh Balasubramanium // Surgeon for Kidney Transplant- Dr. Kunal Raj Gandhi 

4. Sarvodaya Hospital and Research Centre, Faridabad // Surgeon for Spine –Dr. Ashish Tomar // Surgeon for Kidney Transplant-Dr. Rahul Gupta 

5. Medanta’s Hospital, Gurgaon // Surgeon for Spine –Dr. Sudhir Dubey // Surgeon for Kidney Transplant- Dr. Prasun Ghosh 

6. BLK-MAX Super Specialty Hospital, New Delhi // Surgeon for Spine- Dr. Puneet Girdhar Surgeon for Kidney Transplant- Dr. Shafiq Ahmed 

Estimated cost:

For TLIF Surgery-

The estimated cost of evaluations will be approximately. USD 1000-1500 on OPD basis.

The Estimated Cost of TLIF Surgery at the various hospitals will be approx.: 

For Kidney Transplant-

The Estimated cost of Initial Evaluations for patient and donor both will be approx. USD 2000-2500 on OPD basis for patient and donor both.

The Estimated Cost of Kidney Transplant at various hospitals: 

*The cost of Fundoplication may range between $3800 and $4800.

**If the patient needs additional sessions of Dialysis apart from the included, the cost for that will approximately USD 80-90 for each session.

**If the patient requires extra Anti-rejection injection apart from the above included, the cost for each anti-rejection injection would be approximately USD 700-900.The number of Anti-Rejection Injections used in Transplant depends on the relationship of donor with the recipient. One may need 1-2 injections.

Kindly Note: The given cost is a tentative cost based on the sheared information. If the investigations shed a new picture, the cost may vary accordingly.

Stay in India-

FOR TLIF- The patient will require 2-3 days for initial evaluations on an OPD basis. The patient will require 3-5 days of hospitalization for surgery. Post-Discharge patient may require 10-15 days for follow up and recuperation. Total Length Stay in India will be approx. 3-4 weeks.

KIDNEY TRANSPLANT- In hospital for surgery – Patient will need to be in the hospital for 10 +/- 5 days for the Transplant. Out of these, patient will be in an isolation room for 8-10 days post-surgery. The donor will need to be in the hospital for 6 days. Outside the hospital stay – Patient will need to be in India for 6-8 weeks in the vicinity of the hospital in preparation for the surgery and after the surgery.  

Inclusions of the package:  

1. Doctor’s Consultation (related to KTP or TLIF).
2. All Investigations of the patient and donor for KTP.
3. The cost of surgery.(KTP or TLIF)
4. The stay of patient and 1 attendant in the hospital during the surgery procedure. The attendant may not be allowed to stay in the hospital during the ICU stay of patient.
5. All expenses related to the surgery for patient and donor.
6. Drugs and Medical Consumables used during surgery (related to KTP or TLIF).
7. Stay of the patient while in ICU and in ward.
8. Stay of donor for 10 days & recipient in 7 days in ward.
9. All meals for the patient and the attendant as per the available menu while in the hospital.
10. 10 sessions of Dialysis.
11. 1 Anti-Rejection injection.

Exclusions:
1.      Any consultation other than in discussion
2.      Extended stay.
3.      Treatment for any other illness.
4.      Covid Tests
5.      If & when the patient is shifted to ICU (Intensive Care Unit) then attendant has to vacate the room and shift to a Guest House near the Hospital

On Arrival: 

Patient and the attendants will be received at the airport by our Representative. Apart from the medical and nursing team, one Case Manager will take care of all the needs. We shall also assist them with the reasonably charged accommodation near the hospital. Patient and attendant may arrange USD 30-50 per day toward accommodation at the Guest House. Apart from the medical and nursing team, one Case Manager will take care of all the needs. 

Additional Information of Kidney Transplant -The hospital will need a few documents that need to be prepared before they start from there. These are:
 
1. Affidavit from donor’s relative (consent from spouse / father to go ahead with the procedure and donor relative has no objection for the donation). 
2. Affidavit from patient for acceptance of Transplant – Attested by court / Superintendent of police or above. 
3. ID proof (any one)
a. Driving License
b. PAN card
c. Passport
d. Others {Bank account} 
4. Proof of relationship (any one)
a. Family photograph
b. Birth certificate of patient and donor/school certificate. 
5. 15-16 photograph each of donor and recipient

Note: The Renal (Kidney) Transplant is to be done on the basis of the transplant protocol to be followed and completed as laid by the Ethic Committee.

Disclaimer – This is a sample opinion for better understanding of non-medicals and patients. The above is an opinion which has been accumulated from the many good but different opinions received from multiple doctors. The treating doctor is the best person to give you accurate information. The actual Treatment Plan may vary from case to case.