Spinal Frontier

According to doctors, MISS developed out of the desire to effectively treat disorders of the spinal discs with minimal muscle-related injury, and with rapid recovery.

But isn’t spine surgery a drastic step?
That’s very true, says Dr Yash Gulati, senior consultant in spine surgery at Indraprastha Apollo, New Delhi. ‘‘Though back and neck pains are the commonest problems encountered in clinical practice, most are caused by bad posture and degenerative changes with advancing age. Measures such as physiotherapy can take care of most problems. But for a significant minority, diseases are responsible for the conditions. That’s when surgery is necessary.’’

So who needs MISS?
According to Gulati, the beneficiaries could be people suffering from:
• Disc prolapse: A common condition causing severe leg pain or arm pain. About 10 per cent of cases require surgery. Microdiscectomy decompresses the spine through a small incision, allowing the patient to walk on the first post-op day.
• Disfiguring deformities: Depending on the type and severity of the case, MISS can correct anterior, posterior, or a combination of anterior and posterior, deformities. Severe cases may call for the procedures to be staggered, but it’s still an improvement on the braces commonly used to correct spinal deformities in children.
• Skeletal tuberculosis: The spine is the commonest site of the disease, which continues to be the biggest killer in our country. A significant number of patients suffering from spinal TB develop weakness or paraplegia. MISS can tackle the diseased area very effectively from the front of the spine. It avoids large open incisions and cuts back morbidity, leading to early rehabilitation and faster recovery.

Are the increased costs worth it?
MISS costs more or less the same as regular surgery, between Rs 50,000 and Rs 70,000; the benefits lie elsewhere. ‘‘Traditionally,’’ says Gulati, ‘‘surgical approaches to the spine have necessitated prolonged recovery time, besides producing the majority of of the perioperative (during the operation) pain.

Such pain necessitates the use of medication, with its inherent side effects. Also, the degree of the pain delays the return to normal daily activities and non-physical work.’’

Doctors also factor in scars and loss of innervation, which is the supply of nerve stimulation to the muscles. This leads to muscle atrophy, triggering permanent weakness of the back muscles.