spinal fusion procedure


Following is the top ten surgeon in India, in the five most common surgical specialities: heart, orthopaedic, neurosurgery, ophthalmic surgery and reconstructive surgery from HindustanTimes article.

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NEUROSURGERY
Dr Vipul Gupta, 41, Head, Neuro-intervention, Medanta – The Medicity

Vipul Gupta watched his 33-year-old brother die of a malignant tumour in the brain eight years ago. “We knew it was hopeless but we went all the way. He was operated on thrice, at the All India Institute of Medical Sciences in India and Cleveland Clinic in Ohio and Memorial Sloan-Kettering Cancer Center in New York. That’s when I realised that even when the chips are down, the family does not give up, so you have to give it your best,” says the Delhi-based Gupta. He’s a little embarrassed about the emotional outpouring. “Surgeons can’t be emotional, it won’t help the patient on the table. You have to be calm and think clearly,” he says. At 41, Gupta heads neuro-intervention at Medanta – the Medicity, where he moved after doing his MBBS from Delhi’s Maulana Azad Medial College in 1996 and training in neuro-radiology at All India Institute of Medical Sciences (AIIMS) for three years. “I’m out-doorsy and enjoy swimming, rafting and rock-climbing. I broke my knees twice in school. The operation and forced bed-rest for six months slowed me down, forcing me to study which helped me crack the MBBS easily,” he laughs.

Dr Deepak Agrawal, 40, Associate professor, Neurosurgery, AIIMS
He’s the guy at the frontier, treating accident victims at the AIIMS Trauma Centre, best known for treating some of the bloodiest and most bizarre accident cases in the country. “Most accident victims we get are people with severe head or spinal injuries that are often fatal. It does get you down, but nothing can beat the high of seeing a patient everyone including your colleagues had given up on, walk into your clinic for a follow-up. That’s when you know that miracles do happen,” says Dr Agrawal. Agrawal did his MBBS at the University College of Medical Science in 1994 – where he met his onco-surgeon wife Swati – and his training in neurosurgery at AIIMS. “My professional high was being awarded the ‘Young Neurosurgeon of the Year’ Award by the American Congress of Neurosurgeons in 2008. The personal one was my daughter Ayushi, who is five,” he says. His father Dr Ved Prakash was also a neurosurgeon at AIIMS, so Agrawal’s becoming a surgeon was almost pre-determined. “I like to catch up on my emails before breakfast, so I begin work at 5.30 am. I leave home at 7.30, doing rounds of the ward for three hours, which is followed by surgeries that usually go on till 7. Then come the evening rounds, which finish at 9 pm. Add to this administrative work, teaching and writing and correcting research papers, and my day never seems to end,” says Agrawal.

OPHTHALMIC SURGERY
Sri Ganesh, 44, Eye surgeon and chairman, Nethradhama Hospital, Bangalore

Bangalore residents are used to seeing Dr Sri Ganesh zooming down the streets to his farm on his Suzuki Intruder, which he exchanges for his Audi Q7 or BMW 5-Series when he visits the hospitals he set up. “Both my grandmas were blinded with cataract, one because of a botched up surgery. I think seeing them faltering around the house made me decide I wanted to do all I could to help people see,” says the 44-year-old. Eye surgery techniques have become much safer now. “Back then, there were no intraocular lenses (artificial lenses put inside the eye in place of the natural ones) and the failure rate of a simple cataract surgery was 30 per cent, largely due to infection. Now, less than 0.1 per cent cataract and vision-correction surgeries have complications,” he says. Sri Ganesh met his wife Sumanshree at a paratrooping camp in Agra. He was 17, she was 16. “Someone stole my things and she was very sweet,” he says. They married six years later, in 1990, after Sri Ganesh did his MBBS. The couple have three children, Supriya, Sushant and Skanda. Apart from running six hospitals – four in Bangalore, one in Mysore and one in Mangalore – Sri Ganesh runs a 90-bedded charitable hospital in Padmanabhanagar that does 8,000 free cataract surgeries a year.

Dr Mahipal S Sachdev, 52, Centre for Sight Group of Hospitals

Mahipal S Sachdev, eye surgeon to the rich and powerful, never invests in anything but health. “My last investment was Harshad Mehta and I burnt my fingers there,” says Dr Sachdev. His investments in healthcare – time, energy and money – have shown better results. Sachdev was told he was crazy when he quit as associate professor at the All India Institute of Medical Sciences (AIIMS) to join the newly-opened Indraprastha Apollo Hospital in Delhi in 1996. He was 37. The skeptics got it very, very wrong. Within 15 years of that, he’s running 17 eye hospitals that have become one-stop shops for eye disorders in north India. A year-long fellowship to Georgetown University in Washington DC in ’89-’90 opened his eyes, literally, to the technological imaging and surgical revolution happening in the field of ophthalmology. “I realised less invasive radical surgeries were the way forward, but I needed equipment and trained staff for that. I could not get that in a government set-up. So I set up my own centre, which started in a 8×10 foot room in Safdarjang Enclave in 1996, but we’ve grown a little since then,” he says with obvious pride. Sachdev is arguably the best person to go to for cataract and lasik surgery in India. “This is all I want to do, medicine is in my genes. My mother and brother are doctors, so is my wife Alka and daughters Ritika, 29, and Gitansha, 25,” says Sachdev. Sachdev also has an unexplored, fun side to him. “I did my MBBS from AIIMS, where I was the secretary of the students’ union. We were the ones who threw open Pulse, the students’ festival at AIIMS, to fashion, jam sessions and music. Before that, it was a sporting event. We made it socio-cultural,” he says.

COSMETIC SURGERY
Sunil Choudhary, 42, Aesthetic and Reconstructive surgeon, Max Speciality Hospital, Delhi
Quite like modern day Dr Frankensteins, attaching a hand and replacing chopped fingers with toes is all in a day’s work for reconstructive surgeons. Some, like Sunil Choudhary, who head the aesthetics and reconstruction at Max Speciality Hospital, start a conversation with, “Today, I attached two toes and one finger in the right hand of a 16-year-old who’d lost his fingers in a farming accident. He’ll be able to write now”. This is followed by an MMS of a surgery to fix a congenital defect in which a child’s skull stops expanding naturally, squeezing the brain and making it bulge out of the forehead. Unlike popular perception, silicone implants and other cosmetic procedures make up less than a third of a cosmetic surgeon’s case load. “A lot of what we do is related to reconstruction after cancer surgeries and accident cases, including burns and acid attacks,” he explains. Choudhary grew up in Delhi, went to school in DPS RK Puram and did his MBBS from Maulana Azad Medical College, after which he joined the training programme of the UK’s National Health Service.

Dr Shahin Nooreyezdan, 49, Plastic & reconstructive surgeon, Indraprastha Apollo

He insists on giving you a business card. “I’m the only one in the world with this name, so people often get it wrong,” says Dr Shahin Nooreyezdan. There is, however, a little boy called Shahin Sharma, who was called Golu before his grateful parents renamed him after the surgeon who reattached his finger. “It was deeply touching, but also strange. I guess now there’s another person in the world with a very unusual name,” he says. Nooreyezdan grew up in Mumbai, where he lived with his parents in a flat above Russi J Manekshaw, the granddaddy of plastic surgery in India. “Each day, I’d walk past his door on my way home from school and pass this display box with before- and after-surgery pictures, which kept changing every week. I was hooked and decided this was what I wanted to do,” says the Delhi-based Nooreyezdan. He moved to London in 1996, where he worked at St Andrew’s Hospital for three years and met his wife Neda, a British citizen. “When we decided to move back and I went to the Indian High Commission for a visa for my wife, the clerk there said, why are you going? You have a great future here!” he laughs. Most of his work in India is reconstruction. “Unlike other surgeons who can walk in to do the critical part of the surgery, I have to be there from the first incision to the final stitch because what I do is for everyone to see,” says Nooreyezdan, who gets women as young as 19 who need reconstruction after breast cancer surgery. The deft fingers that reconstruct tissues and reattach blood vessels 1.2-1.5 mm in diameter also help him pursue his hobby: collecting and repairing antique clocks. Nooreyezdan has a collection of over 125 pendulum clocks from all over the world, including grandfather clocks from the UK, clocks from ships and railway stations. “It started when I was 17, when I noticed an old, broken, clock at an Irani dhaba. I bought it for R170, got it home and fixed it. I still do it, though I have to pay a guy to wind them up in rotation once a week,” he says. He clearly knows how to wind down.

ORTHOPEDIC SURGERY

Dr Vijay C Bose, 44, Head of orthopaedic surgery, Apollo Chennai
He was part of British orthopaedic surgeon Derek McMinn’s crack team that developed the ‘Birmingham Hip’ – a hip implant that allows people to play contact sports and twist without shouting after a hip transplant – in the late ’90s. Yet what gives Dr Vijay Bose the greatest joy is recognition from his peers. “Three weeks ago, a renowned joint replacement surgeon from the US got his son to our centre for surgery. He’s one of the best in the world and could have done it himself, he could have got it done by the best in his own country, but he still came to India. That’s the quality India offers to the world now,” says Bose. Bose, who joined Apollo Hospital in Chennai in 2000 after six years in Birmingham and Liverpool in the UK, now routinely gets so many patients from overseas that he’s became the face of medical tourism in India for 60 Minutes on CBS News. “I did the first implant in Apollo in 2000 and since then, I have demonstrated the technique across 80 hospitals in India,” says Bose, who did his MBBS from Madras Medical College in 1990. Apart from hip replacement, he does knee and shoulder joint reconstructions.

Dr Suraj Guruv, 36, Orthopaedic surgeon, Asian Heart Institute, Mumbai
Dr Suraj Guruv’s last holiday was spent shooting wildlife at Bandhavgarh National Park in Madhya Pradesh, but he did not break any laws. Guruv is an amateur photographer and rarely leaves home without his Nikon Digital SLR. “I’m crazy about wildlife photography,” he says. When he’s not shooting, Guruv is fixing damaged hips and knees using minimally invasive bone-conserving surgeries in India that make it possible for people to run, drive and work just as they did before, after hip or knee replacements. Guruv is a Mumbai boy, who grew up in Prabhadevi, went to a neighbourhood school, did his MBBS at Mumbai’s Topiwala National Medical College and worked in Bombay Hospital before going to train in Singapore General Hospital. “I belong to a family of chartered accountants, my dad is one, so is my older brother. So when dad said try something else, I thought, why not?” says Guruv, who aced his entrance exam. “Even though I don’t invest in the markets, I still follow financial news very closely, perhaps because that’s what I’ve grown up hearing,” he says. He returned to India because he wanted to be part of the boom in medical care that India is witnessing. “We now have medical facilities at par with any other in the world, with better care,” he says.

HEART SURGERY
Dr Raja Joshi, 40  Paediatric cardiac surgeon, Apollo
He’s called the ‘bandana guy’ because he wears a bandana instead of a surgical cap while operating. Apart from his training as a paediatric heart surgeon during a five-year stint at Cleveland Clinic in the US, what defines Raja Joshi is his bandana collection. “You have to strike a chord with the kids you’re treating, and a bandana with Dalmatians on it sure helps to break the ice,” says the Delhi-based Joshi who, at 36, became one of the youngest surgeons in the country to set up a paediatric cardiac surgery unit in a major hospital. “My dad was in the air force, I grew up wanting to be a fighter pilot. It was after my class 10 boards that my dad told me there were other ways to earn a living,” he recalls. The idea of being a heart surgeon for children came a year later, after a Doordarshan show on a hole-in-the-heart being fixed. “It was so dramatic, the lights and the surgeons in scrubs, this child being immersed in ice to bring the body temperature down. Suddenly, that was the only thing I wanted to do,” says Joshi. He’s had no regrets. “It’s one of the few surgeries where the patients outlive the surgeons. You won’t believe the number of birthday invites I get. Anyone can do adult heart surgery, paediatric is what separates the boys from the men,” said Joshi. His wife Reena Joshi, 36, is a paediatric anaesthetist who’s helped him introduce innovations such as letting the mother stay with the child in the operation room till he sleeps. “Taking away a baby from the mother makes anxiety levels shoot up. Keeping them together till the baby is anaesthetised improves surgery outcomes,” says Joshi.

Pranav Kandachar, 37, Paediatric heart surgeon, Asian Heart Institute, Mumbai
Heart surgery is one of the cleanest surgeries there is, it’s like mathematics. The result is directly related to what you do, there are few surprises,” says Pranav Kandachar, the newest heart surgeon to join Asian Heart Institute’s team of surgeons. “Of course, there are some conditions in which you cannot play god, but in most cases, children can lead active, normal lives after surgery,” he says. After doing his MBBS from Bangalore Medical College in 1997, Kandachar worked at Sion in Mumbai, Apollo Chennai and Colombo, did a year long stint in New Zealand, returned to Bangalore to work at Shirdi Sai Baba Charitable Hospital, and joined the Asian Heart Institute, Mumbai, in January this year. “When you’re training, one institute can’t offer you everything. I’ve trained with the best,” he says. Kandachar describes himself as a nature kind of guy, being big time into hydroponics, a scientific method of growing plants in water – without soil – using mineral nutrient solutions. “I have a virtual vegetable garden in my little balcony, where I grow spinach, beans, cauliflower, coriander and mint. I’m planning to grow strawberries next,” he says. He’s also into ornithology and is part of a nature club that goes birdwatching to sanctuaries at least once a month.

Source: HindustanTimes, April 10

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WHAT MAKES YOUR BACK?

Anatomy of the human spine
Have you ever wondered what makes your back and neck bend, stretch and even rotate so swiftly and smoothly? These movements are possible due to the spinal column or vertebral column in your body which extends from the skull to the pelvis and is made up of 33 individual bones termed vertebrae. The vertebral column is not actually a column but is sort of a spiral spring in the form of the letter S.

The following figure illustrates the human spinal column:

Human Vertebral Column or Spinal Column

Human Vertebral Column or Spinal Column

Between each vertebra are strong connective tissues which hold one vertebra to the next, and acts as a cushion between the vertebrae. The disc allows for movements of the vertebrae and lets you bend and rotate your neck and back. The type and degree of motion varies between the different levels of the spine: cervical (neck), thoracic (chest) or lumbar (low back).

The cervical spine is a highly mobile region that permits movement in all directions. The thoracic spine is much more rigid due to the presence of ribs and is designed to protect the heart and lungs. The lumbar spine allows mostly forward and backward bending movements (flexion and extension).

 

WHAT BREAKS YOUR BACK?

Spinal osteoarthritis

Back pain

Back pain

Spinal arthritis or osteoarthritis of the spine is a common cause of back pain. It is the mechanical breakdown of the cartilage between the vertebral joints in the back portion of the spine leading to mechanically induced pain. The joints become inflamed and pain may be felt when performing even the simplest of activities like standing, sitting or walking. Over time, bone spurs – small irregular growths on the bone, also called osteophytes – typicaly form on the vertebral joints and around the spinal vertebrae which may become so large as to cause irritation or entrapment of nerves passing through spinal structures and result in spinal stenosis (diminished room for the nerves to pass).

Classification of spinal osteoarthritis

– Lower back (lumbar spine) osteoarthritis or lumbosacral arthritis, which produces stiffness and pain in the lower spine and sacroiliac joint (between the spine and the pelvis)

– Neck (cervical spine) osteoarthritis or cervical spondylosis, which causes stiffness and pain in the upper spine, neck, shoulders, arms and head.

Causes of spinal osteoarthritis

The most common causes are repetitive trauma to the spine from repetitive strains caused by accidents, surgery, sports injuries and poor posture. Other risk factors include aging, gender (more common in post-menopausal women), excess body weight, genetics, and associated diseases (like infections, diabetes, rheumatoid arthritis, etc.)

 

WHAT REMAKES A BROKEN BACK?

Surgical treatment of spinal arthritis

For spinal arthritis, the only effective surgical treatment is spine fusion surgery, to stop motion at the painful joint. In fusion, one or more of the vertebrae of the spine are united (fused together) using bone grafts so that motion no longer occurs between them.

Interbody Spine Fusion System

Interbody Spine Fusion System

Uses of spinal fusion surgery

Spinal fusion surgery is used to treat:

– a fractured (broken) vertebra e.g. spondylolisthesis

– deformity e.g. scoliosis or kyphosis (spinal curves or slippages)

– pain from painful motion

– instability

– some cervical disc herniations (fusion together with discectomy)

– weak or unstable spine caused by infections or tumors

For more information about spine fusion surgery, check out medical tourism for spine fusion surgery through Healthbase.

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Spinal Fusion Surgery

Anatomy of the human spine
The spinal column (or vertebral column) extends from the skull to the pelvis and is made up of 33 individual bones termed vertebrae. The following figure shows the lateral and posterior views of the spinal column:
Anatomy of the Human Spine

Between each vertebra are strong connective tissues which hold one vertebra to the next, and acts as a cushion between the vertebrae. The disc allows for movements of the vertebrae and lets people bend and rotate their neck and back. The type and degree of motion varies between the different levels of the spine: cervical (neck), thoracic (chest) or lumbar (low back). The cervical spine is a highly mobile region that permits movement in all directions. The thoracic spine is much more rigid due to the presence of ribs and is designed to protect the heart and lungs. The lumbar spine allows mostly forward and backward bending movements (flexion and extension).

What is a spinal fusion surgery?
Fusion is a surgical technique in which one or more of the vertebrae of the spine are united together (“fused”) so that motion no longer occurs between them. Bone grafts are placed around the spine during surgery. The body then heals the grafts over several months – similar to healing a fracture – which joins, or “welds,” the vertebrae together.

When is a spinal fusion surgery necessary?
Spinal fusion surgery is used to treat:
• a fractured (broken) vertebra e.g. spondylolisthesis
• deformity e.g. scoliosis or kyphosis (spinal curves or slippages)
• pain from painful motion
• instability
• some cervical disc herniations (fusion together with discectomy)
• weak or unstable spine caused by infections or tumors

Details of the procedure

What do I need to do before the surgery?
• Follow your health care provider’s instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery.
• Take a shower and wash your hair the night before surgery.
• Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the m morning before the procedure. Do not even drink coffee, tea, or water.
• Follow any instructions your health care provider may give you.

What type of anesthesia will be used?
You will be given a regional or general anesthetic. A regional anesthetic numbs part of your body while you remain awake. It should keep you from feeling pain during the operation. A general anesthetic relaxes your muscles, puts you to sleep, and also prevents you from feeling pain.

What happens during the surgery?
The surgical procedure involves placement of a bone graft between the vertebrae. The surgery can be done either from the front or back of the body. The surgeon will decide which approach is the best depending on the problem. In the neck, the anterior approach is more common; lumbar and thoracic fusion is usually performed posteriorly.

The vertebrae are joined together by adding bone in the space between the vertebrae. The soft discs between the bones are sometimes removed if they are causing pain. The pieces of bone are usually taken from the outer pelvic bone (autograft). Bone from a bone bank (allograft) may also be used. There is research being done with synthetic (man-made) bone rather than using real bone.

With some of the newer “minimally invasive” surgical techniques currently available, fusion may sometimes be done through smaller incisions. The indications for minimally invasive surgery (MIS) are identical to those for traditional large incision surgery; however, it is important to realize that a smaller incision does not necessarily mean less risk involved in the surgery.

After surgery the bone heals and fuses together with the vertebrae. The bone will heal better if the spine does not move. Spinal instrumentation, such as rods, plates, wires, or screws, may be put in the back at the same time as the spinal fusion to keep the spine from moving while it heals.

How long will I be in the hospital?
Patients generally stay in the hospital for three or four days, but a longer stay after more extensive surgery is not uncommon. A short stay in a rehabilitation unit after release from the hospital is often recommended for patients who had extensive surgery, or for elderly or debilitated patients.

What are the risks associated with spinal fusion?
Risks for any surgery include bleeding and infection. Additional risks for spinal fusion surgery include urinary difficulties (retention) and temporary decreased or absent intestinal function.

How long will it take to recover?
The immediate discomfort following spinal fusion is generally greater than with other types of spinal surgeries. Postoperative pain control methods including oral pain medications and intravenous injections help control pain. Another method is a patient-controlled postoperative pain control pump that delivers a predetermined amount of narcotic pain medication through an intravenous line.

What should I watch out for?
Call your provider right away if:
• The wound is bleeding or oozing fluid.
• You develop a fever.
• You become short of breath.
• You are in a lot of pain.
• You develop numbness or weakness.

What rehabilitation program is recommended after the procedure?
Following spinal fusion surgery, a postoperative rehabilitation program may be recommended by your surgeon. The rehabilitation program may include back strengthening exercises and possibly a cardiovascular (aerobic) conditioning program, and a comprehensive program custom-designed for the patient’s work environment in order to safely get the patient back to work. The decision to proceed with a postoperative rehabilitation program depends upon many factors. These include factors related to the surgery (such as the type and extent of the surgery) as well as factors related to the patient (age, health and anticipated activity level.) Active rehabilitation may begin as early as 4 weeks postoperatively for a young patient with a single level fusion.

When can I expect to return to work and/or resume normal activities?
Recovery following fusion surgery is generally longer than for other types of spinal surgery. It also takes longer to return to a normal active lifestyle after spinal fusion than many other types of surgery. This is because you must wait until your surgeon sees evidence of bone healing. The fusion process varies in each patient as the body heals and incorporates the bone graft to solidly fuse the vertebrae together. The healing process after fusion surgery is very similar to that after a bone fracture. In general, the earliest evidence of bone healing is not apparent on X-ray until at least six weeks following surgery. During this time, the patient’s activity is generally restricted. Substantial bone healing does not usually take place until three or four months after surgery. At that time activities may be increased, although continued evidence of bone healing and remodeling may continue for up to a year after surgery.

In addition to some restrictions in activity, a brace is sometimes used for the early post-operative period. There are many types of braces that might be used. Some are very restrictive and are designed to severely limit motion, while others are intended mainly for comfort and to provide some support. The decision to use a brace or not, and the optimal type of brace, depends upon your surgeon’s preference and other factors related to the type of surgery.

What can I expect in the long run?
Although fusion can be a very good treatment for some spinal conditions, it does not return your spine to “normal.” The normal spine has some degree of motion between vertebrae. Fusion surgery eliminates the ability to move between the fused vertebrae, which can put added strain on the vertebrae above and below the fusion. Fortunately, once a fusion has healed, it rarely, if ever, breaks down. However, it does place more stress on the vertebrae next to the fusion. This has some potential to accelerate degeneration of those segments, but this risk varies between individuals. Many surgeons therefore recommend that spinal fusion patients avoid repetitive strenuous activities that involve combined lifting and twisting maneuvers to minimize the stress on the areas around the fusion.

Cost and availability

How much does it cost?
Click here for details.

Which countries/hospitals is it available in?
Click here to check the availability of spinal fusion surgery with our partner hospitals.

Healthbase is a medical and dental tourism facilitator that connects patients to leading JCI/JCAHO/ISO accredited hospitals and dental offices overseas through a secure, high-tech, information-rich web portal. Healthbase provides a wide range of medical procedures through its partner hospital network. Over two hundred medical procedures are available in various categories: cosmetic and plastic, orthopedic, dental, cardiac, and many more. The savings are up to 80 percent from typical US prices even after adding up the travel costs, hospital stay and other related expenses. Healthbase offers more than just procedural availability; we also provide customers with extensive information on medical treatments, hospital and doctor profiles to help them make an educated decision regarding their treatment; travel planning and booking; applying for medical/dental loan and much more.

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Note: All information presented here has been obtained from publicly available medical resources and is here for reference purposes only. Healthbase does not claim to be a medical professional and does not provide any advice on any issues relating to medical treatment.

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