Spine surgery has evolved from its humble beginnings.
From surgeries that involved laminectomies for all back pains to a more precise well thought of process.
We no longer see all back aches as slipped discs and all radicular pains as sciatica. Spine surgery now involves looking at different pathologies affecting different areas of the vertebral column. We realise that there are different diseases that affect the vertebral column.
Degenerative: still forms the major bulk of patients complaints
Traumatic: unavoidable
Congenital: you are simply born with it
Inflammatory: part of a general disease process
Infective: pyogenic or tubercular
Neoplastic: tumours or metastatic diseases
Scoliosis and Kyphosis: deformities seen in the spine
Unlike other fields of orthopaedics wherein imaging modalities are used to establish diagnosis in spine surgery we have these modalities to confirm and substantiate our diagnosis. “Never judge a book by its cover” was just the right phrase for determining the “usefulness” of judging the value of an MRI without adequate clinical examination. Patient education is also as important in spine pathologies as patient awareness dispels anxiety and the fear of paralysis if they know the cause of their problems and the possible solutions. Often the options available are patient dependent — they have the right to know the various options available and select the right treatment.
My endeavour in this field of spine surgery is to do precisely this — educate the patient, offer them the diagnosis and possible treatment options and let them decide what option they want to follow — ultimately they best know their level of pain and the way it limits their functioning on a day to day basis. Having said this I would however tell them to allay fears and old wife tales about spine surgery.
Today with modern technology, minimal access to the spine is possible in select cases. Appropriate instrumentation is available to help us stabilise and correct deformities when needed. This allows patients to be up on their feet faster than what was done earlier.
Patients are in general not encouraged to rest beyond what is required but motion is strongly emphasized |
