FAQ

Frequently Asked Questions

What is spine? How is it designed?

Our spine is made up of multiple blocks called vertebrae placed on top of each other. Humans have 7 cervical vertebrae in the neck (C1-C7), 12 thoracic vertebrae in the back (T1-T12), 5 lumbar vertebrae in the low back (L1-L5) and 5 sacral (S1-S5) and 3 coccygeal vertebrae (Cx1-Cx3) between buttocks and are named accordingly. So, first cervical vertebra is C1 and second is C2.  8thvertebra is 1stthoracic vertebra and so is called as T1.

These vertebrae have intervening disc for cushioning called intervertebral disc (IVD).

These vertebra encircle and protect the spinal cord which acts as a electrical conduits for the brain to the legs, urine bladder and stool motion.

So main purpose of spine is to protect the spinal cord. From this spinal cord, multiple nerve rootlets come out at each level and supply respective muscles. For example, nerve roots at L2-L3 control thigh muscles and carry sensation of thighs to the brain. L4-L5 controls the calf muscles and carries sensation of the calf back to the brain. So nerves do movement and carry sensation back to the brain.

When there is disturbance in these nerves, they either over-function or under-function. So symptoms such as leg pain, tingling, numbness, loss of urine control, urgency in urination, constipation manifest.

What is slip disc?

Slip disc is simplified was of explaining prolapsed intervertebral disc (PIVD).

The disc is made up of tough fibrous annulus surrounding the soft gelatinousnucleus.  Sometimes, this disc herniates into the spinal canal which contains spinal cord and nerve roots and causes compression of these elements. That causes severe pain along with other symptoms.

There are 4 grades of PIVD:

  • Prolapse
  • Herniation
  • Extrusion
  • Sequestration

Symptoms may vary according to severity of herniation.

Why do we have slipped disc?

The cause cannot be ascertained. Scientist have found few associations which may explain why we have back pain.

Back pain is the bane of our erect posture. When we were quadrupeds, ie walked on all 4 limbs, the weight was distributed in all 4 limbs. Eventual shifting to bipeds ie walking on 2 legs has shifted the centre of gravity and caused increased stress on the back and pelvis. This issue along with change in lifestyle of less exercise, less agility, central obesity, long hours of sitting job have made us even more vulnerable to back pain and disc herniation.

Plus factors such as smoking, obesity, high BP, diabetes have been found to be associated with spinal ailments.

What are symptoms of slipped disc?

Usually, severe excruciating pain going down one or both legs. It can be associated with tingling, numbness, urine urgency as well. It may cause to tilt while walking.

Why do I have back pain?

Back pain is thought to affect more than 80% of all people at some point in their life. Multiple factors can cause back pain. Sitting at desk for long hours, bad car, bad posture, bad roads, lifting heavy weight can cause muscle pull and lead to severe back pain.

I have back pain. Do I need surgery?

Back pain is usually self-limiting and can improve on its own with some rest.

Some patient with back pain will eventually need surgery to correct the spinal problem. Your doctor can guide you better if you can be given conservative therapy (rest, medication, physiotherapy) or surgical therapy.

What are common spine problems?

As discussed earlier, mechanical back pain is common. It is self-limiting and can be controlled with rest and medicines alone.

Slipped disc is herniation of disc into spinal canal and compressing the nerves.

Spondylolysisis breaking of vertebrae at pars interartecularis.

Spondylolisthesisis slipping of one vertebra over the other.

Compression fractureis collapse of vertebral body.

OPLLis calcification of a ligament in the cervical spine.

How do you operate the spine?

Once a person has developed slipped disc and is not relieved with medicine, doctor and patient both should opt for surgery. Patient should be convinced that medicines and rest are not adequate for his relief and doctor should ensure that he has given adequate medication and that right surgery will relieve the patient of his symptoms.

The surgery involves putting the patient under general anesthesia, placing him on his stomach (prone position), and making an incision on the back to reach the bone, removing part of the bone to reach the disc and excising the abnormal, herniated disc. Then closing back till skin and dressing the wound. The size of incision depends on the problem and can be 1-6 inch in size.

What is Minimal Invasive Spinal Surgery (MISS)?

All spinal surgeries done with minimal tissue damage is called MISS. The basic requirement for MISS is that the tissue damage should be as minimum as possible so that recovery is faster. Some open surgeries have incision of 10- 15 cm, thus skin incision, muscle separation, bony removal is leading to patient having more pain and longer time to recover than with smaller surgery. Key hole approach is having smaller skin opening, minimal muscle damage, opening just enough bone and then doing the main surgery.

MISS can be done using a microscope or an endoscope. There are many variations in the techniques and your surgeon will guide you the best which technique suits you the best.

What is endoscopic surgery?

Endoscopic surgery uses a camera scope, which goes inside the skin to help surgeon see inside the spine clearly on a television screen. Due to this high definition cameras, an incision as small as 8 mm can be used to go inside, remove disc fragment and come out. It ensures less muscle damage, less, bleeding, less time of surgery, better pain control post surgery, early mobilization. Endoscopy is doing same surgery using an endoscope so tissue damage is less and patient is much more comfortable in post operative phase. Patient is comfortable enough to be sent home within 24 hours from surgery!

Also, surgery can be done under local anesthesia instead of general anesthesia.

What is the length on incision in MISS?

Length of incision, number of stitches are least important aspects of MISS. Main focus is less tissue damage while reaching the pathology.

 

System used Usual size of incision
Tubular system with microscope 18 mm
Tubular system with endoscope 15, 19 or 23 mm
Destandau’s approach 21 mm
Transforaminal approach fully endoscopic system 8 mm
Interlaminar fully endoscopic system 8 mm

 

Your pathology, symptoms, clinical examination and MRI findings determine which system will be used for you.

Why should I choose Dr Sumeet Pawar for my surgery?

Dr Sumeet Pawar is trained in all modalities of MISS and hence an appropriate decision will be taken as per your need and not based on what is available. He has been trained in these surgeries from Mumbai, Japan, South Korea and has an experience of more than 2300 cases in spine. He is trained micro-neurosurgeon and performs surgeries on brain as well as spine with his special interest being in Minimal Invasive Spine Surgery. Being in this field for more than 8 years, he has received accolades from India and abroad for his innovative techniques and approaches in spine surgery.

Is same surgery performed in open and endoscopic surgery?

Yes. Decompression of spinal elements, bony overgrowth, ligamentum hypertrophy, discectomy is same. Approach is smaller and thereby better for recovery.

How long does the endoscopic surgery take?

A simple discectomy takes about 1 to 1.5 hours. It may get prolonged in case of multi level disease or if bone fusion is needed.

What are advantages of Endoscopic surgery over open surgery?

  • Shorter hospital stay
  • Less pain and pain medication
  • Less blood loss and transfusions
  • Less scarring
  • Quicker return to normal activities

How long do I have to stay in the hospital post surgery?

Typical single level endoscopic surgery is done under local anesthesia so discharge is within 24 hours. In case of multi level surgery or co morbid conditions like diabetes etc, you may need to stay for 2-3 days.

Will I have a urinary catheter inserted?

Usually not. If expected time of surgery is more than 3 hours, then a catheter will be inserted.

Endoscopic surgery is newer than open surgery. Is it safe?

Endoscopic surgeries are being done since 1970s and not a very recent trend. Over time, endoscopes have better optics and have become smaller in size. If anything, it has become safer than open surgery!

What are symptoms of spondylolisthesis?

As discussed earlier, it is slipping of one vertebra over the other. It causes severe back pain and if the bone causes, neural compression, it may cause pain going down the leg, tingling, numbness or claudication.

Is it a major surgery?

Earlier, it used to be a major surgery lasting 8-10 hours with patient needing bed rest for about 3 months! Now, the surgery can be done within 2-3 hours, with minimal incision and patient is mobilized next day!

Can fusion be done by MISS techniques?

Yes! Today, we have percutaneous screw insertion techniques and MIS TLIF cages, which can be inserted through small opening in skin and entry is by muscle splitting approach instead of subperiosteal dissection. End-point – less pain, earlier recovery, faster mobilization, better surgical outcome.

What test do I need before surgery?

From spine point of view, MRI of the spine and Xray of spine is a must. In few cases, a CT scan is necessary to study bones as well.

What tests are required for anesthesia fitness?

Usually,

  • Complete Blood Count
  • Sr Blood Urea Nitrogen
  • Sr Creatinine
  • Triple viral markers
  • Coagulation profile
  • Xray Chest PA
  • ECG
  • 2D Echo (if age more than 50 years)

Anesthesia team may decide for more test as per preexisting comorbidities.

  • Our spine is made up of multiple blocks called vertebrae placed on top of each other. Humans have 7 cervical vertebrae in the neck (C1-C7), 12 thoracic vertebrae in the back (T1-T12), 5 lumbar vertebrae in the low back (L1-L5) and 5 sacral (S1-S5) and 3 coccygeal vertebrae (Cx1-Cx3) between buttocks and are named accordingly. So, first cervical vertebra is C1 and second is C2.  8thvertebra is 1stthoracic vertebra and so is called as T1.

    These vertebrae have intervening disc for cushioning called intervertebral disc (IVD).
    These vertebra encircle and protect the spinal cord which acts as a electrical conduits for the brain to the legs, urine bladder and stool motion.

    So main purpose of spine is to protect the spinal cord. From this spinal cord, multiple nerve rootlets come out at each level and supply respective muscles. For example, nerve roots at L2-L3 control thigh muscles and carry sensation of thighs to the brain. L4-L5 controls the calf muscles and carries sensation of the calf back to the brain. So nerves do movement and carry sensation back to the brain.

    When there is disturbance in these nerves, they either over-function or under-function. So symptoms such as leg pain, tingling, numbness, loss of urine control, urgency in urination, constipation manifest.

  • Slip disc is simplified was of explaining prolapsed intervertebral disc (PIVD).

    The disc is made up of tough fibrous annulus surrounding the soft gelatinousnucleus.  Sometimes, this disc herniates into the spinal canal which contains spinal cord and nerve roots and causes compression of these elements. That causes severe pain along with other symptoms.
    There are 4 grades of PIVD:

    • Prolapse
    • Herniation
    • Extrusion
    • Sequestration
    Symptoms may vary according to severity of herniation.

  • The cause cannot be ascertained. Scientist have found few associations which may explain why we have back pain.

    Back pain is the bane of our erect posture. When we were quadrupeds, ie walked on all 4 limbs, the weight was distributed in all 4 limbs. Eventual shifting to bipeds ie walking on 2 legs has shifted the centre of gravity and caused increased stress on the back and pelvis. This issue along with change in lifestyle of less exercise, less agility, central obesity, long hours of sitting job have made us even more vulnerable to back pain and disc herniation.

    Plus factors such as smoking, obesity, high BP, diabetes have been found to be associated with spinal ailments.

  • Usually, severe excruciating pain going down one or both legs. It can be associated with tingling, numbness, urine urgency as well. It may cause to tilt while walking.

  • Back pain is thought to affect more than 80% of all people at some point in their life. Multiple factors can cause back pain. Sitting at desk for long hours, bad car, bad posture, bad roads, lifting heavy weight can cause muscle pull and lead to severe back pain.

  • Back pain is usually self-limiting and can improve on its own with some rest. Some patient with back pain will eventually need surgery to correct the spinal problem. Your doctor can guide you better if you can be given conservative therapy (rest, medication, physiotherapy) or surgical therapy.

  • As discussed earlier, mechanical back pain is common. It is self-limiting and can be controlled with rest and medicines alone. Slipped disc is herniation of disc into spinal canal and compressing the nerves. Spondylolysisis breaking of vertebrae at pars interartecularis.Spondylolisthesisis slipping of one vertebra over the other. Compression fractureis collapse of vertebral body. OPLLis calcification of a ligament in the cervical spine.

  • Once a person has developed slipped disc and is not relieved with medicine, doctor and patient both should opt for surgery. Patient should be convinced that medicines and rest are not adequate for his relief and doctor should ensure that he has given adequate medication and that right surgery will relieve the patient of his symptoms.

    The surgery involves putting the patient under general anesthesia, placing him on his stomach (prone position), and making an incision on the back to reach the bone, removing part of the bone to reach the disc and excising the abnormal, herniated disc. Then closing back till skin and dressing the wound. The size of incision depends on the problem and can be 1-6 inch in size.

  • All spinal surgeries done with minimal tissue damage is called MISS. The basic requirement for MISS is that the tissue damage should be as minimum as possible so that recovery is faster. Some open surgeries have incision of 10- 15 cm, thus skin incision, muscle separation, bony removal is leading to patient having more pain and longer time to recover than with smaller surgery. Key hole approach is having smaller skin opening, minimal muscle damage, opening just enough bone and then doing the main surgery.

    MISS can be done using a microscope or an endoscope. There are many variations in the techniques and your surgeon will guide you the best which technique suits you the best.

  • Endoscopic surgery uses a camera scope, which goes inside the skin to help surgeon see inside the spine clearly on a television screen. Due to this high definition cameras, an incision as small as 8 mm can be used to go inside, remove disc fragment and come out. It ensures less muscle damage, less, bleeding, less time of surgery, better pain control post surgery, early mobilization. Endoscopy is doing same surgery using an endoscope so tissue damage is less and patient is much more comfortable in post operative phase. Patient is comfortable enough to be sent home within 24 hours from surgery!

    Also, surgery can be done under local anesthesia instead of general anesthesia.

  • Length of incision, number of stitches are least important aspects of MISS. Main focus is less tissue damage while reaching the pathology.

    System used Usual size of incision
    Tubular system with microscope 18 mm
    Tubular system with endoscope 15, 19 or 23 mm
    Destandau’s approach 21 mm
    Transforaminal approach fully endoscopic system 8 mm
    Interlaminar fully endoscopic system 8 mm

    Your pathology, symptoms, clinical examination and MRI findings determine which system will be used for you.

  • Dr Sumeet Pawar is trained in all modalities of MISS and hence an appropriate decision will be taken as per your need and not based on what is available. He has been trained in these surgeries from Mumbai, Japan, South Korea and has an experience of more than 2300 cases in spine. He is trained micro-neurosurgeon and performs surgeries on brain as well as spine with his special interest being in Minimal Invasive Spine Surgery. Being in this field for more than 8 years, he has received accolades from India and abroad for his innovative techniques and approaches in spine surgery.

  • Yes. Decompression of spinal elements, bony overgrowth, ligamentum hypertrophy, discectomy is same. Approach is smaller and thereby better for recovery.

  • A simple discectomy takes about 1 to 1.5 hours. It may get prolonged in case of multi level disease or if bone fusion is needed.

    • Shorter hospital stay
    • Less pain and pain medication
    • Less blood loss and transfusions
    • Less scarring
    • Quicker return to normal activities
  • Typical single level endoscopic surgery is done under local anesthesia so discharge is within 24 hours. In case of multi level surgery or co morbid conditions like diabetes etc, you may need to stay for 2-3 days.

  • Usually not. If expected time of surgery is more than 3 hours, then a catheter will be inserted.

  • Endoscopic surgeries are being done since 1970s and not a very recent trend. Over time, endoscopes have better optics and have become smaller in size. If anything, it has become safer than open surgery!

  • As discussed earlier, it is slipping of one vertebra over the other. It causes severe back pain and if the bone causes, neural compression, it may cause pain going down the leg, tingling, numbness or claudication.

  • Earlier, it used to be a major surgery lasting 8-10 hours with patient needing bed rest for about 3 months! Now, the surgery can be done within 2-3 hours, with minimal incision and patient is mobilized next day!

  • Yes! Today, we have percutaneous screw insertion techniques and MIS TLIF cages, which can be inserted through small opening in skin and entry is by muscle splitting approach instead of subperiosteal dissection. End-point – less pain, earlier recovery, faster mobilization, better surgical outcome.

  • From spine point of view, MRI of the spine and Xray of spine is a must. In few cases, a CT scan is necessary to study bones as well.

  • Usually,

    • Complete Blood Count
    • Sr Blood Urea Nitrogen
    • Sr Creatinine
    • Triple viral markers
    • Coagulation profile
    • Xray Chest PA
    • ECG
    • 2D Echo (if age more than 50 years)
    Anesthesia team may decide for more test as per preexisting comorbidities.