FAQ's on Spine Surgery

Q- Can further bouts or back pain and/or prolapsed disc be prevented?
Ans- You may be able to avoid back pain by improving your physical condition and learning and practicing proper body mechanics.
How can you keep your back healthy and strong?
Exercise
Regular low-impact aerobic activities - those that don't strain or jolt your back - can increase strength and endurance in your back and allow you muscles to function better. Walking and swimming are good choices. Talk with your doctor about which activities are best for you.
Build muscle strength and flexibility
Abdominal and back muscle exercises (core-strengthening exercises) help condition these muscles so that they work together like a natural corset for your back. Flexibility in your hips and upper legs aligns your pelvic bones to improve how your back feels.
Quit smoking
Smokers have diminished oxygen levels in their spinal tissues, which can hinder the healing process.
Maintain a healthy weight
Being overweight puts strain on your back muscles. If you're overweight, trimming down can prevent back pain.
Use proper body mechanics
Stand smart and Maintain a neutral pelvic position. If you must stand for long periods of time, alternate placing your feet on a low footstool to take some of the load off your lower back.
Sit smart & Choose a seat with good lower back support, armrests and swivel base. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve. Keep your knees and hips level.
Lift smart. & Let your legs do the work. Move straight up and down. Keep your back straight and bend only at the knees. Hold the load close to your body. Avoid lifting and twisting simultaneously. Find a lifting partner if the object is heavy or awkward.
Sleep smart. People with back pain have commonly been told to use a firm mattress, but recent studies indicate that a medium-firm mattress might be better. Use pillows for support, but don't use a pillow that forces your neck up at a severe angle.
(Article written byDr. Sajan K Hegde, Sr. Consultant Spine Surgeon, Apollo Hospitals Chennai)

Q- What is scoliosis? Are there any categories?
Ans- Currently scoliosis is defined as a lateral deviation of the normal vertical spine. But in fact, the curve is three-dimensional resulting in a complex deformity. Scoliosis is broadly classified into three major groups:
Congenital scoliosis - a structural anomaly in the vertebrae.
Neuromuscular - in which there is an imbalance of the function of the muscles leading on to structural deformity of spine.
Idiopathic - in which the cause is not yet known.

Q- Which is most common?
Ans- Idopathic scoliosis is the most common form of spinal deformity seen. By definition, it is lateral curvature of the spine occurring in an otherwise healthy child, for which no recognizable cause exists. It is divided into three categories depending on the age at which the curve is first detected:
Infantile idiopathic scoliosis - when the cure occurs before the age of 3 years.
Juvenile idiopathic scoliosis - first appears between the age 3 and 10 years.
Adolescent idiopathic scoliosis - the most common type and is first detected after puberty i.e. after 11 years.
Adolescent idiopathic scoliosis is the most common type of spinal curvature. It occurs around the onset of puberty in otherwise healthy boys and girls. It is more common in girls.

Q- Can scoliosis by managed without surgery?
Ans- For curves between 20 to 30 degrees in very young skeletally immature patients, it is standard that a non-surgical treatment is instituted. Bracing has proved to be an effective form of treatment to prevent curve progression in about 80% of the patients in this group. The patients on brace treatment also are observed for curve progression as described before. The main disadvantage of bracing is the patients' compliance, as the brace has to be worn almost for the entire day, on all days till skeletal maturity.

Q- What are the surgical options available?
Ans- Surgical treatment of scoliosis is employed if the cure at detection is of greater magnitude (& 40). The aim of surgical correction is to achieve a well-balanced spine in which the patient's head, shoulders and trunk are centered over the pelvis. This is done by using instrumentation to reduce the magnitude of the deformity and obtaining fusion in order to prevent future curve progression. When fusion is done in skeletally immature patients, Crank shafting and flat back syndromes occur producing more severe deformity and these also severely retard growth. A more recent development in the treatment of such patients is the use of staples on the convex side of the curve, which correct and maintain the curve till the patient is skeletally mature. These staples allow differential growth to take place i.e. less growing speed on the stapled side than the conclave side thereby correcting the curve as the child grows. This principle has long been used in the correction of long bone deformity in the skeletally immature.

Q- What are the advantages of the shape memory alloy that has been used for scoliosis correction at Apollo recently?
Ans- Special spinal implants made from Nitinol - a titanium based alloy - have been studied extensively and are being employed clinically in a few centres in USA and Europe. Two well-known spine surgeons from the United States, Dr. Randal Betz and Dr. Ogilvie designed this implant. The staples are in the shape of C' when they are manufactured at room temperature. When the staples are cooled to below freezing point the prongs become straight but clamp down into the bone in a C' shape when the staple returns to body temperature providing secure fixation. These are called Shape Memory Alloy (SMA) staples. As no fusion is done the child grows normally and even the residual deformity tends to improve with growth.
This novel procedure was performed for the first time in India at Apollo Hospitals, Chennai on a 6-year old girl, from a small town near Madurai by our team of surgeons.