‘India needs more spine centres and spine surgeons’

Dr H S Chhabra, Chief of Spine Service and Additional Medical Director of the Indian Spinal Injuries Centre, has successfully performed triple level cervical disc replacement for cervical mylopathy for the first time in India. Dr Chhabra is also the Secretary of the Spinal Cord Society of India and counsel to Intrenational Spinal Cord Society. Besides, he is actively involved in creating awareness about spine-related ailments and treatment. Dr Chhabra spoke to Sapna Dogra about cervical disc prolapse and disc replacement surgery.

Tell me about the cervical disc replacement surgery that you carried out recently.

The patient was a 41-year-old woman suffering from severe pain in neck radiating to right upper limb (arm, fore arm and hand) and had weakness in upper and lower limbs. Also, she was having difficulty in passing urine.

This was the result of the pressure of the prolapsed disc on the spinal cordand the nerve roots at the three levels. The surgery involved removing the herniated discs and putting three artificial discs (the Bryan Cervical Discs) between four out of the seven vertebrae in the neck.

What are the reasons for the disc prolapse?

Generally, disc dehydrate and shrink over time, producing areas where bone touches bone. Herniation resulting from disc degeneration, injury or heavy lifting, can occur when a portion of the disc is pushed backwards. The pressure on the adjacent nerve results in pain traveling from the neck to the upper limb. If the disc is pushed backward centrally, it causes pressure on the spinal cord, which can result in myelopathy (weakness in both upper and lower limbs along with bladder and bowel involvement).

Is surgery the only option?

We generally avoid going for a surgery as a first step for patients having disc-related problems. However, in this case, the patient was having severe pain and was facing progressive weakness in her upper and lower limbs. We, therefore performed this surgery. Normally, such patients are initially treated conservatively. Cervical disc surgery is normally done for patients with cervical disc herniations that have not responded to non-surgical treatment options and are significantly affecting the individuals’ quality of life and ability to function. Classically, it involves removing the herniated disc, putting bone graft in the disc space and fixing it with a plate. However, this bone graft puts additional stress at adjoining vertebral segments resulting in increased rate of disc degeneration and herniation in the levels adjoining the segment, which has fused. It has been shown that up to 30 per cent of such patients will require an additional surgery for a disc herniation at the adjoining level within 10 years of the first surgery.

And with modern techniques?

With modern techniques, it is now possible to put in an artificial disc instead of bone grafting. An artificial disc replacement reduces the chances of complications associated with bone-grafting. The dics is inserted through a stereotactic technique, which involves putting the disc at the exact angle in the exact place so that it can replicate the normal functioning of the disc for a considerable period of time. The results of such a disc replacement are gratifying since the patient does not require any external support like a collar and can immediately get back to a normal lifestyle.

How old is this technique and what is the cost of surgery?

The cervical disc was introduced only in 2000 after trials over a long period. Even this procedure is being done by a handful of centres across the country in the past one-and-a-half years. However, a triple level cervical disc replacement for cervical mylopathy has been done for the first time in the country at ISIC. The cost of implant (titanium) is about Rs 70,000 and the overall cost comes about to Rs 1,10,000.

Who are susceptible to cervical disc diseases?

More than half of people over 40 years of age have cervical disc diseases, characterised by degenerative changes in the upper spine. Symptoms include pain radiating down the arm and numbness, in addition to neck pain. As a result, many people have difficulty sleeping.

Tell us about fellowship programme at ISIC.

ISIC has a fellowship programme in spine surgery by National Board of Examination. As of now, there are two seats, which will be increased to four. There are a few spine centers in the country. We need more centers along with more spine surgeons. Here, I would like to mention that ISIC is helping the government in setting up four regional level spine centers at Cuttack, Mohali, Jabalpur and Bareilly. We are pressing the government to have 15 such centres across the country.

sapna@expressindia.com