The aim is to limit the skin incision and muscle injury during surgery. A precision planning allows the surgery to be targeted. This is done using precision tools (Microscope/ endoscopes). Magnification with these tools help to protect neurological structures and minimize complications. Patient can helped out of bed on the day of surgery or coming morning. Technological advancements (3D c-arm / Neuro-navigation / robotics) allow ease of implant (screw) placement while protecting the vital structures. This is significantly improved the outcome of spine surgery and improved patient confidence.

A condition where in the spinal nerve is compressed by a herniated intervertebral disc. A patient complains of radicular pain and/or numbness. Muscle weakness can ensue. A Microscopic discectomy surgery aims to free the compressed nerve via a 20 mm mini-incision. This key-hole procedure provides instant relief of patient’s symptoms. Patients are typically discharged on the same or next day.

A condition associated with narrowing of the space for the nerves in lumbar spine due to degenerative changes. The patient complains of pain and/or heaviness in the legs while walking after few steps (claudication) and requires sit/stand to get relief of symptoms. The symptoms progress over time. The degree of disability worsens as the walking/ standing time reduces with time. Surgery entails microscopic decompression. Instrumentation is decided as per instability.

It is a condition where in one vertebra slips over the other. This may in the forward direction (antero-listhesis) or backward direction (retrolisthesis). The spinal nerves are thus compressed due to this mal alignment of the spinal vertebrae. A fusion surgery re-aligns the spine with help of screws/rods and decompresses the nerves. A minimal invasive technique allows the patient to resume out of bed activities on the next day after surgery. A return to normal functions is faster.

Cervical nerves can get compressed due to variety of causes. Slipped (herniated) disc, injury, degenerative stenosis, infection and Ossified ligament are common. The patient complains of severe or intractable disabling pain. A progressive weakness in the hand and legs (myelopathy) that eventually causes paralysis is common. Surgery from the front (anterior approach) involves removal of the oending disc. This is replaced with a fusion device (cage/ plate) or in select cases a mobile device (disc replacement). When many levels in the neck are involved, the surgery is done from behind (posterior approach). A laminectomy is the gold standard procedure.

The scoliosis is a sideway (coronal) curvature of the spine, while Kyphosis is a forward bending (sagittal plane) of the spine. Most deformities are seen during growth spurt before puberty (idiopathic). Non-idopathic curves (congenital / syndromic /neuromuscular) can present at early age and progress rapidly.

Curves less than 60 degrees are a cosmetic problem due to unacceptable shape of the trunk (rib hump). Mechanical fatigue pain and breathlessness due to pressure on the heart and lungs can occur when curves are more than 60 degrees.

Conservative treatment with bracing is reserved for mild curves or early onset curves. Surgical correction aims to correct the deformity and create a more pleasing shape of the trunk by reducing the rib hump. A careful counselling of the child and the parents is of paramount importance. Neuro-monitoring is used to monitor the spinal cord function during surgical correction. This has helped to reduce the incidence of spinal cord injury. Advanced radiological (3D-Carm) and computerised navigation technologies help to accurately position the screws in a deformed spine.

Spine is the next common site of TB infection after lungs (chest). The commonest presentation is disabling pain. This is treated early with anti-tuberculosis medications. If treatment is delayed, a progressive destruction of the spine can result in instability, deformity (bending) and paralysis (weakness of spinal cord). The surgery then aims at decompression of the spinal cord and complex reconstruction of the spinal column with rods, screws and inter-body cage

Primary spine tumors (originating in the spine) are rare. Most common types are giant cell tumor, aneurysmal bone cyst, chordoma, osteoid osteoma and osteoblastoma. The surgery for primary tumor aims at resection when possible. This is combined with adjuvant therapy (chemotherapy / radiotherapy)

Secondary tumors (metastasis) originate in some other site. Common sites are prostate, thyroid, breast, lungs, kidneys, GI tract and uterus. Surgical treatment for spinal metastasis aims at palliation of pain, decompression of spinal cord to prevent paralysis and instrumentation for instability of the spinal column. A team approach including medical oncologist, radiotherapist & spine surgical team would require for planning the treatment as per the tumor type.

The upper part of the neck that supports the head called as a cranio-vertebral junction. It controls the head movements. The critical nerves and blood vessels to the brain pass through this complex. Injury to the spinal cord due to instability of the joints commonly occurs at C1 and C2 joints (atlantoaxial dislocation). A progressive paralysis ensues. Stability can be restored by surgery. The C1-C2 or Occiput-Cervical fixation is the procedure of choice. It is done from the back side of the neck with due care to safeguard the vital nerves and blood vessels.

Vehicular accidents and work place injuries constitute most of the spine fractures. A fall from a height can result in one or more injuries to the spine together with other limbs and other organs. The spinal injury becomes serious when the fractured bone compresses the spinal nerves causing pain and paralysis. The aim of surgery is to restore the spine stability and shape, decompress the nerves and start early rehabilitation. This helps in early return to activity. Modern physiotherapy techniques are important in achieving these goals.

Reduction is bone mass occurs with age. When severe it results in fractures after a trivial exertion or injury. Most osteoporotic fractures heal with rest , bracing and medications. When the healing is delayed, these fractures can collapse further causing prolonged pain and even paralysis due to compression of nerves.

In complicated fractures, a vertebroplasty or kyphoplasty (cement injection) significantly controls pain and allows early restoration of function. This is vital in frail and elderly patients to avoid medical complications due to pain and bed rest. When the nerves are compressed, a complex spine reconstruction procedure is performed as per merit. A significant advancement is the use of minimally invasive surgery to achieve these goals in these frail patients.

Introduction of a 5-6 mm diameter needle in to the spine to acquire a bone or soft tissue sample using fluoroscopy is called biopsy. This provides a diagnosis (Infection/ tumor) to plan correct treatment strategy. Spinal biopsy is done as a day care procedure under local anaesthesia through a suture less technique.

A non-surgical approach for managing a nerve root pain with spinal injection is offered to the patient who is not responding to medical treatment. It is a Day-care or OPD procedure done under local anaesthesia in C-arm guidance. The involved nerve is desensitised with steroid and local anaesthetic agent to block the source of pain. The procedure is relatively risk free with no side effects.