Cervical Spine Surgery in India

What is Cervical Spine Surgery ?

Cervical spine surgery is conducted in the neck region to cure herniated disc or overgrown bone that exerts pressure over spinal cord or nerve roots.
Cervical spine surgery usually lasts for approximately 3 hours and the patient is required to stay in the hospital for at least one night post surgery. During their stay in the hospital, recovery of patients is closely monitored by neurosurgeons, doctors and nurses. Blood loss is minimum but it’s still a good idea to make prior arrangements for blood transfusion. The pain and discomfort associated with the surgery reduces with every passing day and it takes around a few months for the bones to heal.

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WHAT ARE THE SIDE EFFECTS OF CERVICAL SPINE SURGERY?

Negative side effects are relatively minimal in cervical spine surgeries. But with any procedure, there come a number of inherent risks. For this procedure in particular, patients may want to consider the following:

• A cervical fusion will limit some ability to look straight up or down by extending or flexing the neck.
  (Rotation of the head to the right or left is not affected by this surgery.)
• A bone stimulator may also need to be worn after surgery to assist with this bone regeneration.
  Patients may experience a sore throat or difficulty swallowing immediately after the procedure.

WHAT IS RECOVERY LIKE FOR CERVICAL SPINAL FUSION?

With a fusion, a collar may need to be worn for 4-6 weeks. Many people notice an early improvement in their arm pain; however there may be persistent neck pain or headaches until the collar is completely discontinued.
The healing process is different for every patient. Generally speaking, postoperative pain is minimal, although perhaps uncomfortable. In most cases, patients heal within 3-6 months with professional supervision.
It is important for patients to talk to Dr. Ahuja or their physical therapist about correct posture and movements. Activity should be increased slowly every day, but patients should only do what they are comfortable with. Cervical spine surgery patients should be sure to attend their follow-up appointments and stick with their postoperative plans.

Why is Cervical Spine Surgery Required?

Cervical spine surgery is conducted only if medications, physiotherapy sessions and other treatments fail to produce desired outcome. The surgery is necessary in case of a herniated disc. It can also be done to cure cervical degenerative disc disease. The surgery is also a good option to treat symptoms associated with cervical spinal stenosis (pain, numbness, stiffness or weakness in the neck, shoulder, arm or leg) and bone spurs (osteophytes) The ultimate goal of cervical spine surgery is to reduce or relieve pressure on nerve roots or on spinal cord by removing the damaged or degenerated disc. The surgery provides immense relief to patients suffering from chronic neck pain or from other disorders that are concerned with cervical spine.

Pre-Operative Procedure

In the pre-operative preparation phase, you need to visit your doctor several times to undergo some screening tests. These tests reveal the status of spine injury or any development in herniated disc to the surgeon.
You also need to let the doctor know about your past medical history and current medications. Non-steroidal anti-inflammatory drugs may be discontinued for a week or so prior to surgery.
Anticoagulants may also be stopped for five days before the surgery. Doctor will tell you to undergo a blood test to determine if there is any active infection, high blood sugar or clotting disorder of the blood. Additionally, urine tests and even ECG (Heart analysis) is advised to evaluate your overall health status. If a blood test shows any abnormality, then the doctor will prescribe you medications accordingly so that you get better before the surgery.
Smoking, tobacco and alcohol consumption should also be completely stopped a few weeks prior to surgery.
Also, you need to take care of your financial requirements before the surgery. If you have medical insurance, then you need to consult with the insurance agency to sort out the formalities so that they can take care of your bills while you are at the hospital.

Day Before Cervical Spine Surgery:

Since cervical spine surgery is intensive, patients will be recommended to get admitted to the hospital a day before surgery. Patients will be advised to undergo complete physical examination . Also, arrangements for blood transfusion are made the day before the surgery in case the emergency situation calls for it. Fasting for a minimum eight hours prior to the surgery is mandatory.
Patients should not take a lot of stress about the surgery. He/she needs to relax and not worry about the surgical procedure. Support from family members and close ones will also help patients to prepare emotionally and mentally for the surgery.

Procedure Day:

The patient is required to change into a sterilized hospital gown.
An intravenous line is inserted into a vein in the arm or back of the wrist through which antibiotics will be administered in order to decrease chances of infection. Doctor will also check blood pressure level, pulse rate and body temperature before starting the operation. In the operating theater, anesthesiologists will be present to inject the correct and precise amount of general anesthesia in your body.

Methods/Techniques of Cervical Spine Surgery:

Cervical spine surgery can be approached in two different ways – anterior approach (from front of the neck) and posterior approach (from back). Some spine disorders require anterior approach while some require posterior approach. Let us understand these two approaches and get an idea about how the surgery is conducted.

Anterior Cervical Surgery Approach:

In most of the cases, along with anterior cervical surgery, fusion surgery is also conducted to stabilize the cervical segment. The surgery in combination is called Anterior Cervical Discectomy and Fusion (ACDF). ACDF is generally performed to remove damaged discs to alleviate spinal cord or nerve root pressure and thereby reduce corresponding weakness, pain and numbness.

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The surgery is carried out in two parts – anterior cervical discectomy and then fusion. The surgery is approached through the front of the neck and the damaged disc is then taken out from between two vertebral bones. Fusion surgery is then carried out during discectomy operation to hold the cervical segment in place. Fusion surgery consists of placing implants or bone grafts in place of the original disc that used to perform the function of providing strength and stability to that particular area.

General procedure of ACDF surgery comprises the following steps:

Anterior Surgical Approach:

• One to two inches long incision is made; either on the right or left side of the neck.
• Underlying muscle skin is then split in synchronization with incision and the area between sternocleidomastoid muscle and the strap muscles is accessed.
• Blood vessels or flat layers of fibrous tissues which cover the spine are dissected away from the disc space.

Disc Removal:

• During the surgery, fluoroscopy is conducted to provide an X-ray image of the spinal cord so that the surgeon is able to understand whether he is at the correct disc level of the spine.
• Once the correct disc space is located, the disc is removed. It is done by first cutting the fibrous tissue ring which surrounds the disc and then removing the soft inner core of the disc.

Cervical Spine Canal Decompression:

• Posterior longitudinal ligament which lies between spinal cord and disc is removed so that the surgeon can gain access to the spinal canal in order to remove any disc material that might have got extruded through the ligament and it may result in spinal stenosis.
• Lower portion of vertebral bone on either side which helps in forming boundaries of the disc are also partially removed. This is called an uncinate process. The process is usually carried out to remove bone spurs (osteophytes) and the result is relieved compression of spinal cord or nerve root.
• The process of dissection is usually carried out using an operating microscope or magnifying loupes. The instruments provide a larger view of small anatomical structures and help doctors to visualize and correctly locate these anatomical structures.

Cervical Fusion:

• Once cervical discectomy is done, it is followed by anterior cervical fusion surgery. This is done in order to prevent disc space collapse and is carried out by insertion of bone graft or implant into the evacuated disc space area. The process of fusion is carried out by combining two vertebrae in a single unit. Thus, the nerve roots and spinal cord get enough room to maintain decompression. Fusion surgery also helps in preventing local deformity called kyphosis.
• To provide additional stability across the disc space, a small plate is often joined to the front portion of the spine by fitting screws into each of the vertebral bones. This also helps in promoting healing of bones which have undergone a fusion process.
• Due to the occurrence of cervical fusion, bone is formed in the space from where the disc had been removed and vertebral bones (both above and below located ones) unite into one solid bone.

Posterior Cervical Decompression Surgery:

Some spine surgeons prefer to access the spine via a posterior approach in case of large soft disc herniations that occur on the side of the spinal cord. Posterior cervical decompression surgery is also called microdiscectomy.

The general procedure for microdiscectomy is as follows:

Surgical Approach:

• A small incision; approximately one or two inches, is made in the midline of the back of the neck.
• The paraspinal muscles that are attached to the spinal cord are elevated off the spinal level in order to access the spinal cord.

Disc Removal:

• To confirm whether the spine surgeon is operating at the correct level of spine, X-ray is taken. Through X-ray images, a spine surgeon is able to clearly understand at which spine level he is operating.
• To remove some of the facet joints, a high speed burr (instrument) is used. Once the facet joint is removed, the underlying nerve root is accessed.
• For better visualization, an operating microscope is used. A network of veins called plexus which lie over the disc can obstruct visualization if they bleed during the surgery.
• To cure disc herniation, the affected disc located under the nerve root will be gently moved or mobilized to the side.

Both the procedures of anterior approach and posterior spine surgery approach have been mentioned above. However, please note that there will be some changes in the procedure steps as every patient’s needs and requirements are unique.

Success Rate

The success rate of cervical spine surgery is as high as 97 to 98%.
Cervical Spine Surgery Treatment Cost in India

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Fortis Memorial Research Institute

Number of beds:    1000
ICU Beds:                  298
Airport Distance:  17 KMs

Brief About:

• Fortis Memorial Research Institute was established in 2001.
• It is an outstanding multi-speciality quaternary care hospital,having the top-notch infrastructure, advanced equipment, highly qualified and experienced medical professionals and super sub-specialists.
• Fortis Hosptial Gurgaon is an advanced centre of excellence in Robotic Surgery, Neurosciences, Oncology, Renal Sciences, BMT, Organ Transplants, Orthopaedics, Cardiac Sciences and Obstetrics & Gynaecology.

Indraprastha Apollo Hospital

No. of beds: 900
ICU Beds:     262
Airport:  20kms

About Hospital:

• Indraprastha Apollo Hospital is a flagship hospital of India’s foremost healthcare groups,the Apollo Group. It is a highly renowned multi-speciality facility that offers tertiary and quaternary care services to domestic and international patients.
• The 900 bedded hospital is outfitted with the most modern technology for diagnostics as well as therapeutic purposes.
• A team of highly trained medical professionals work under all the 52 specialities at the hospital.

Artemis Hospital Gurgaon

Number of beds:  600
ICU Beds:                185
Airport Distance: 19 Km

Brief About:

• Artemis Hospital, established in 2007, spread across 9 acres, is a 600plus bed; state-of-the-art multi-speciality hospital located in Gurgaon, India.
• Artemis Hospital is the first JCI and NABH accredited hospital in Gurgaon.
• Designed as one of the most advanced hospitals in India, Artemis provides a depth of expertise in the spectrum of advanced medical & surgical interventions, a comprehensive mix of inpatient and outpatient services.

BLK-Max Hospital

Number of beds: 700
ICU Beds:               175
Airport Distance: 13 Km

Brief About:

• BLK Super Speciality Hospital was established by Dr. B.L. Kapur  in 1959. It was inaugurated by the then Prime Minister of India, Pandit Jawahar Lal Nehru.
  
• BLK Super Speciality Hospital was established by Dr. B.L. Kapur  in 1959. It was inaugurated by the then Prime Minister of India, Pandit Jawahar Lal Nehru.
• BLK has a unique combination of the best in class technology, put to use by the best names in the professional circles to ensure world-class health care to all patients.

Max Hospital Saket

Number of beds:   500
ICU Beds:                 267
Airport Distance: 13 KM

Brief About:

• Max Super Speciality Hospital at Saket is one of the topmost healthcare service
• Providers in India. The multi-super speciality hospital has a capacity of over 500 beds, 250 functional beds. It is equipped with state-of-the-art facilities, advanced technologies.
• With the help of over 300 leading specialist Doctors, strong nursing staff, and state-of-the-art innovative medical tools.

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Medanta The Medicity Hospital

Number of beds:  1250
ICU Beds:                300
Airport Distance: 18 KMs

Brief About:

• Medanta – The Medicity is amongst India’s largest and most renowned multi-super speciality healthcare centre with 1250 beds, 29 super speciality units and more than 800 accomplished doctors.
• Supported by state-of-art infrastructure, all the departments in the hospital are fully equipped with cutting-edge technology, modular Operation Theatre and modernized monitoring systems in ICUs.
• The panel of doctors from Medanta, headed by A.S.Soin performed the first successful intestinal transplant in India.

Sanar International Hospital

Number of beds:   130
ICU Beds:                  35
Airport Distance:  20 Km

About Hospital:

• Sanar International Hospital was established in 2018.
• Sanar International Hospital founded by Mr. Naresh Kapoor.
• Sanar International Hospital offers comprehensive advanced surgical care in specialties like Cancer, Heart, Blood and Marrow Transplant, Lung, Liver, and Neurosciences along with other major departments with advanced state-of-the-art facilities.

Jaypee Hospital, Noida

Number of beds:   525
ICU Beds :               150
Airport Distance: 32 KMs

About Hospital:

• The Jaypee Hospital was conceptualized by a revered Founder Chairman, Shri Jai Prakash Gaur in 2014, with the vision of promoting world-class healthcare amongst the masses by providing quality and affordable medical care with commitment.
• Jaypee Hospital at Noida is the flagship hospital of the Jaypee Group, which heralds the group’s noble intention to enter the healthcare space.
• This hospital has been planned and designed as a 1200 bedded tertiary care multi-speciality facility and has commissioned 525 beds in the first phase.

W Pratiksha Hospital Gurgaon

Number of beds: 110
ICU Beds:                 31
Airport Distance: 19 KMs

About Hospital:

• Established in 1995, W Pratiksha Hospital is a 110+ bedded flagship hospital of the Pratiksha group.
• W Pratiksha Hospital in Gurgaon, the flagship hospital of Pratiksha Group is a one-of-its-kind facility in Gurgaon that brings to you 30 years of experience.
• The hospital has treated more than 25,000 people In 2018.
  

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