Spine Surgery


Degenerative Disc Disease (DDD) or Spondylosis refers to the gradual deterioration of the disc between the vertebrae in the backbone. This disease is very common, and affects as much as 40-50% of people over the age of 40. The disorder also becomes increasingly common as we age. It is a disease of wear and tear similar to osteoarthritis. It commonly happens in the lumbar spine (low back), though it can occur at any spinal level.

In DDD, the discs get flattened, losing their normal height. This disc height is what separates the disc above from the one below. Nerve pathways may become narrowed and cause nerve impingement, inflammation, and pain, when the disc height is lost.

Degenerated discs become much thinner and sometimes the vertebrae also develop small, rough areas which irritate the nearby nerves. Severe neck pain and stiffness and pain down the arms and hands can result from this .

Medication and exercises are the first line of management.

Cervical spondylosis is a very common condition where there is chronic degeneration of the bones of the neck (cervical spine) and the cushions between the vertebrae (inter vertebral disc). This is managed by cervical spine surgery where the worn out discs or bone spurs are removed - depending on the underlying problem. Sometimes the gap would be filled by a graft of bone or other implants made of metal combined with bone.

Symptoms of spondylosis may be as mild as occasional backaches or could be chronic low back pain that is severe enough to limit daily activities. The mechanical type of pain increases as more stress or load is placed on the lower back. Bending, lifting, and twisting are the types of movement that may exacerbate it.


Degenerative Disc Disease requires surgery only rarely. The commonly used non-surgical treatments include anti-inflammatory drugs, physiotherapy and exercise programs. Surgery is required when the patient has very severe debilitating symptoms; pain interferes with activities of daily living, and non-surgical treatment has failed after a reasonable period of time, usually at least six months.

Fusion surgery is usually done and this permanently stops the motion of the spine at the level of the degenerated disc. This helps to relieve pain. Fusion surgery works best when limited to one or two discs. As we have five discs in the lumbar spine, the un-fused discs take over to provide adequate function of the lower back.

Sometimes an artificial disc can also be inserted into the disc space after removing the entire degenerated disc. This helps to restore disc height, improve spine function, and ease the debilitating pain.

Slipped Disc

Slipped disc is a common term used to refer to a prolapsed disc. This is a disorder when the inner, softer part of the disc bulges out through a weakness in the outer part of the disc. The bulging disc may then press on nearby nerves and cause discomfort and pain. Back pain, ache in the arm or leg and pinpricks felt in feet, toes and hands are the usual symptoms.


Surgery is considered for disc prolapse if the symptoms of the bulging disc have not settled after about six weeks or so. One may opt for:

Keyhole surgery or microdiscectomy spine surgery, which is typically performed when there is a prolapsed disc in the lumbar (lower back) region which is pressing against a nerve.

Disc replacement - Here, an artificial disc is implanted into the spine to imitate the functions of a normal disc (carry load and allow motion). Artificial discs are usually made of metal or plastic-like (biopolymer) materials, or a combination of the two. The treatment for bulging disc and prolapsed disc is a disc replacement done in the cervical (neck) spine.


The Greek term for slipping of the spine is Spondylolisthesis . The Greek term for slipping of the spine is Spondylolisthesis. This term refers to the abnormal forward movement of one vertebra over the one below. It is in the lumbar spine that this forward slip of the vertebra happens most often. Pressure on the nerve roots associated with the affected vertebrae, as well as pain and dysfunction are caused by the slippage and herniation of the disc. The types of spondylolisthesis include:

Type 1 - Congenital spondylolisthesis
Congenital spondylolisthesis is a condition where a person is born with the abnormality of the posterior bony arch of the spine, which causes the slippage. It happens at the L5-S1 level commonly and is associated with abnormality of the facet joints. Symptoms include back pain during the adolescent growth spurt. CT and MRI scans are required to diagnose the dysplasia (abnormal bone formation).

Type 2 - Isthmic spondylolisthesis
Isthmic spondylolisthesis is a defect in a part of the bone called the pars interarticularis. This bone connects the upper joint of one vertebra to the lower joint. Stress fracture in individuals with a hereditary predisposition (some minor abnormality or weakness of the pars at birth) usually causes this. Sometimes a defect may exist without any forward slip, and this is called spondylolysis. This can also be painful.

Type 3 - Degenerative spondylolisthesis
Forward slippage secondary to arthritis of the spine is known as Degenerative spondylolisthesis. This process is usually also associated with Spinal stenosis. Long standing degenerative disc disease, leading to weak facet joints in the back of the spine is the reason. This is usually seen at L4-L5 level. This is also called Lumbar Spondylolisthesis.


For all the above conditions , surgery is indicated, if the slippage progressively worsens or if back pain does not respond to nonsurgical treatment and begins to interfere with daily life. In the congenital and high dysplastic group, spondylolisthesis surgery is done at early stages to prevent neurological complications.

Spinal Injuries

Damage to the spinal cord from trauma, loss of its normal blood supply, or compression from tumor or infection may lead to spinal cord injury. Spinal cord injuries may be complete or incomplete. Symptoms of a Spinal cord injury depend on the extent and location of the injury. While in complete injuries the body ceases to function below the level of injury, in incomplete injuries there is some function remaining below the level of injury.

Treatment for spinal injuries includes surgery to stabilize the spine. Vertebrae weakened from fracture, tumor or infection cannot support the normal weight from the body or effectively protect the spinal cord. Then, a combination of metal screws, rods and plates may be necessary to help hold the vertebrae together and stabilize them until the bones heal. After surgery it is critical that patients undergo a thorough rehabilitation program.

Methods to help the patient maximize their function through physical and occupational therapy and the use of assistive devices comprise such a programme.

We are experienced in the complete management and rehabilitation of spinal injuries and can help in better outcomes.