DR. S. KARUNAKARAN, Director- Global Spine Institute & Senior Consultant Spinal Surgery Gleneagles Global Hospital, Chennai

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The Bone Identity

What are the risks pertaining to conducting Spine Surgery? How can we minimize the risks?
Today patients are coming in after already taking an MRI test; more so, pondering and worrying about the results of the MRI. It’s integral to understand that patients first need to come in and state their problems – is there pain? Where do they feel the pain is originating from? How long have they been suffering from this issue? Once we know the complaint, we can correlate with the investigation. The key to success in surgery is the clinical symptoms, investigation and the following treatment designed for the stated problem. Hence, the surgery today is of Safe Spine surgery.

What are the prevailing Spinal problems present in the 21st century?
One of the common problems is back pain. See, back pain itself is not a disease but can be the result of a more serious complication such as a disc prolapse, degenerative disk, arthritis, inflammatory problems, spine structure problems such as stiffness, bending, weakening and so on. Additionally, with age there can osteoporosis issues where the bones are not of their normal quality, soft or squishy; thus, they can easily break.

Can you give us a brief account of cervical spine pathologies? What are the three types of scoliosis?
Cervical problems most common would be spondylitis. Without compressing the nerve, it can just be as neck pain. It can get compressed because of the disc or general wear and tear. Even at a young age, a patient can suffer from a disk collapse or infections such as TB, which can be seen to be prevailing in Asian countries. The TB of lungs is the most spoken about, however, TB of the bones is the next commonest prevailing disease and equally, if not more, deadly. The three types of scoliosis are the conjunctival, adolescent idiopathic scoliosis and traumatic.

Give us an account of your experience in Key-hole spine surgery?
Key-hole spine surgery is a big boon. It’s not because of the small incision required by this procedure, rather the boon is from the tissue which is preserved which is vital for spine functions. Tissue preserved is a function preserved. Hence, the key-hole spine surgery brings down the overall discomfort and need for medications at post-op and risk during the pre-op planning and execution.

What are some key pain management techniques for the spine? How far does the techniques/physiotherapy come in pain alleviation?
Usually, it’s a multi-pronged approach. Giving one shot of painkiller alone or substituting with just medication alone may not be as effective. Combined simultaneously, with physiotherapy and modification activities will better help them in their own pain management and also their need for further pain medication for pain alleviation.

The key to success in surgery is the clinical symptoms, investigation and the following treatment designed for the stated problem.

How has the field evolved in the past 20 years? (Innovations, patents, etc.)
It has developed tremendously. One of them would be the preliminary investigation as we are now better at understanding what the problem is and thus have a stronger understanding of the subsequent treatment plan. The clarity in diagnosis has grown massively, we know what the problem is and its origin accurately; no need to keep searching. Before we would operate in search of the problem. Nowadays, we don’t rely on one single modality, rather adopt multiple modalities. For instance, general practice is to go forward with the treatment using MRI. However, it needs to be substituted with X-rays and CT scans. The reason being, MRI is a static picture but we also require dynamic results. The patients have been seen to state no pain at rest but pain in movement; this knowledge is provided by dynamic tests. X-rays and CT scans can be investigated for these and thus cannot be discarded because you have an MRI.

Can spinal injury lead to full/partial paralysis? What are the recovery techniques, if any?
There are situations where the spinal cord can be completely transected – the neural structures from one end to the other, loses its continuity. Thus, no nerve continuity and loss of function. Once they lose their function, it’s the early intervention; we cannot predict then what the future will hold for the patient. Therefore, we need to maintain the environment for the nerves to recover. Starting from maintaining the blood pressure, adequate pulse rate, oxygenation and remove any compression of the chords, if present. Once they have the injury, they should not discontinue their treatment on the idea of no recovery is happening. The main aim for these patients is rehabilitation, where we prevent issues of joint stiffness, contractures and so on. Nowadays, there are inventions emerging which allow us to externally control the joints through EMG movement. Hence, if you become stiff, the technology won’t work as well, making it more important to maintain joint health and thus the potential of being able to walk again through assistive external devices.

Please share your interests in the specialities of Stitchless Spine Surgery and Safe Spine Surgery?
Stitchless spine surgery, you have all the anatomy preserved, while the pathology (disease) is still targeted. This allows for the normal functioning again while the preservation of tissues, this is the beauty of this endoscopic stitchless spine surgery. I have about 20 years of experience with this and currently, this method is becoming more established.
Safe spine surgeries provide many things, the main aim being to not lose any nerve functions. For instance for Scoliosis surgery, we monitor the spine functions during the entire procedure to ensure its operational consistency.

What’s one piece of advice you would give to your patients?
Keep fit. The simplest thing to be aware of is that the best economic exercise for the spine is walking. Irrespective of pain, some form of functioning is imperative for bone health. You sit way too much, everything will start to go out of order. Sitting is the new smoking so keep moving.

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