“India needs a comprehensive approach to healthcare and there is an immediate need to implement holistic policies. We have to take a cue from the US where a sizeable budget is allocated exclusively for the healthcare of the citizens.” This is what Dr. UmeshSrikantha, renowned neurosurgeon and Consultant Head of Spine Services at Aster CMI Hospital, Hebbal, Bengaluruhas to say of India’s healthcare system. In an exclusivetete-e-tete with Karnataka Today’s Denzil Rithesh, Dr. Umesh disseminates his knowledge on spine health in the perspective of a layman apart from emphasizing on the need to conduct awareness camps on the all-pervasive spine related issues.
One of the handful of spine surgeons in India with an expertise in the latest MISS, he expressed a lot of concern on the ignorance and negligence that Indians have with regard to spine issues. An MBBS from Karnataka Institute of Medical Sciences, Hubli and M.Ch (Neurosurgery) from National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, DrUmesh has a Fellowship in Minimally Invasive Spine Surgery (FMISS) from South Korea. His areas of special interest are Minimally Invasive Spine surgery, Endoscopic Spine surgery, Complex Spine Surgery, Stereotactic and Functional Neurosurgery and Neuro-oncology.
Excerpts:
1. How common is Spinal surgery among patients that visit you regularly? And what is the frequency of patients with back pain visiting the hospital?
Spinal problems are one of the most ubiquitous ailments though often ignored. Apart from common cold backache is most common cause for absence from work. An average of 10 patients’ visit me in a day with various indications of spine related aches and pains. 75% of adults have at least one episode of disabling back pain.
Most of the time spine problems are degenerative in nature, i.e.,theyoccur due to wear and tear which is a liability associated with aging and 5 percent because of arthritis. Even trauma, neoplastic growth or a nerve compression can lead to spine problems.
2. Back pain can hamper normal functioning of an individual and can lead to depression – Have you seen any relationship in your practice?
Yes, there is definitely a relationship and it can be directly proportional in a lot of cases. Depression can occur in chronic cases of backache but not in acute cases. However, such cases reported are less in India. But, on the contrary depression can express psychosomatically as back pain. It is now well known that negative mental factors can manifest as physical ailments. Timely diagnosis plays a vital role in the sure shot success of the therapy.
3. With a shift from manufacturing to services, two things have occurred in the way people work. They either sit or stand for long hours. Which is better for the back Sitting or standing? Does either have long term effects?
Anything done in excess is detrimental to health. So is the case with sitting and standing for long hours. There is a need to change the position or stance at regular intervals. In fact, many companies abroad have adopted a corporate protocol to ensure that the staff takes a break from a stationary posture or activity every one hour. Thus the managements have the “backs of their employees” to ensure that they stay healthy. The best example is the policy in IBM, USA where the bell rings every hour to remind the staff their back needs a break. However, there a no such concrete policy in the corporate sector in India. It’s high time the corporate bosses in India got serious about their “backbones.”
4. Which is more ominous and why High Intensity back pain or low intensity back pain over a long period?
Both can be ominous. Whether it is high intensity or low intensity back pain, the cause plays an important role. Neither can be ignored because the root cause could be serious. Timely diagnosis is a must.
5. When should I start to worry about the back pain I have? And what are the possible indicators of a serious problem?
It’s time to hit the hospital the moment you notice the back pain is persistent albeit intermittently in some cases. If there is a persistent pain, no matter how low its intensity is, it is an alarm bell. Even if the pain persists for about four to five days it is advisable to consult a specialist. A backache persistent for more than six weeks is indicative of the ailment turned chronic and negligence can be costly. It is also important to get cautious the moment the normal movements or flexibility are affected. Unfortunately, our country folks carry a “chaltahai” with regard to spinal issues and most often wake up only when the problems aggravate.
6. I’ve heard that Cancer of the spine can be related to low back pain is that true?
Not necessarily. The cancer associated with the spine can be categorized under Primary and Metastasis. Primary cancer is the one which has directly targeted the spine.In metastasis, the cancercells from the primary site in the body escape into the blood stream or lymph system and cause malignant growth in the spine. Though secondary in nature, the chances of therapeutic success are quite uncertain. The tumour can lead to instability due to nerve compression. A surgery is normally recommended in such cases.
7. Is vigorous physical exercise or yoga with its complicated poses good for the back? What are the preventive measures that can be taken to prevent back pain?
As I said earlier, an excess of anything can be detrimental. A beginner going vigorous with any kind of work out might end up “stabbing his own back” rather than strengthening it. Be it Yoga or any form of exercise, there are levels to gradually touch like you climb a ladder. A scientific approach to workout can yield the desired results and avert the damage. Individual body constitution needs to be understood to design the workout schedule. But unfortunately, most work out freaks fall for the fad of great bodies and tend to overstrain themselves with exercises that may not suit their body types. There are numerous instances with regard to gym workouts wherein the subjects with mere focus on biceps, chest or abs ignore the exercises meant for the rest of muscles and make a disproportionate figure out of their bodies. Lifting excessive loads in a fit of euphoria could lead to pain in back muscles and if ignored, could cause something serious like a slip disc. Even normal loads carried for long periods can lead to back problems depending on the capacity or body constitution of a person. Achieving body flexibility or developing acrobatic skills is a gradual and diligent process. A hasty approach for quick results can really harm the spine.
Meanwhile, I would also like to advise here that a sedentary lifestyle can weaken the back. Basic amount of planned workouts including long brisk walks and jogging can help a person maintain a healthy spine. So don’t laze, work out.
Maintaining the right posture in normal activities like sitting, standing or walking also plays a vital role in keeping the spine healthy. So always be conscious of your posture and put efforts to keep it right always.
8. What is percentage of cases of back pain that require spinal surgery and what is the complete recovery rate and time required?
Roughly five percent of the cases of back pain require spinal surgery. The recovery rate purely depends on cause rather than symptom. For instance, a problem that may have arisen due to heavy manual labor for six months to one year may need a systematic and long duration therapy. Here it is the extent of damage caused that decides the accuracy and duration of the treatment. However, by applying modern therapeutic technologies like MISS (Minimal Invasive Spine Surgery) the recovery rate in majority of the cases is 90 percent.
9. Spinal Surgery as I understand it as a layman, is very complicated and there will be unsatisfactory outcomes – As a doctor how do you handle such outcomes and how do patients reconcile to the same?
The worst case scenario in spine treatment could be Failed Back Surgery Syndrome (FBSS), i.e., recurrence of the symptom or complications post treatment. A lot of psychosocial factors are involved in this. All that is required is a proper diagnosis and results vary from case to case. For instance, in case of recurrent slip disc, a fusion procedure is conducted. Here also the recovery rates vary from 50 to 80 percent.
10. What are the latest developments in the field internationally and are they all available in India?
As I said earlier, MISS (Minimal Invasive Spine Surgery) is one the most reliable technologies available worldwide albeit scarcely in India. The procedure involves making a small incision hence making it less laborious for the patients. Others include
Robotics: Though a high-end methodology, it has its limitations-it can be used only for setting screws.
Navigation System: It is a guiding mechanism for the surgeon to accurately get the route tothe target part in the body.
Neuro-monitoring System: This system averts the side effects or damage associated with the surgery. In a typical spinal surgery there is always an impending risk of exerting pressure or damaging the spinal cord or nerve. The Neuro-monitoring System beeps instantly when the instrument loses track or gets closer to the nerve or spinal cord thus ensuring absolute safety.
11. What is the average cost of Spinal surgery in India and how can it be made affordable?
The cost purely depends on the facilities availed by the patient. There definitely would be difference in the cost incurred by a patient in general ward and special ward. However, the patients won’t be charged for the technology employed on surgery. A doctor may prefer traditional or older modes of surgery and another might employ modern techniques like MISS. But this won’t be charged on the patients.
ABOUT ASTER CMI HOSPITAL
Aster CMI Hospitals, Bangalore is DM Healthcare’s continuation of its endeavor to create world-class,patient-centric hospitals driven by medicalinnovation and a culture of excellence. The AsterCMI Hospital has contemporary state-of-the-artfacilities accommodating over 500 beds. It offerscomprehensive primary care to quaternarycare services with Centers of Excellence in CardiacSciences, Neurosciences, GastroenterologySciences, Surgery and Allied Specialties,Integrated Liver Care, Organ Transplant, Urologyand Nephrology, Orthopedics’, Women’s Health,and Child & Adolescent Health. The sereneenvironment, spacious interiors and advancedfacilities create a positive ambience that isconducive to healing.
