Q: I am 36 years old female suffering from cervical as well as lumbar spondylosis. The MRIs show prolapse and neurosurgeon has advised surgery for both sites. I want to know about the best way of surgery, like replacing the discs with the portion of body part or inert a titanium part. Which are the best hospitals in the country for such operations? What are the surgery costs? What are the post-operative precautions and how long does the post-operative treatment continue? Will my pains go after the surgery? Is there any way of avoiding surgery by other methods of treatment? What could be the effect of delaying surgery and can it be avoided?

A:From your date of birth I see that you are only 36 years old. I am not sure how bad this spondylosis is. Is there any other underlying condition that could modify the picture? For example: fluorosis or any other spondylitis. It is a rare patient that requires surgery at both the levels. Disc surgery is based on symptoms and signs. It is never based on MRI findings alone. I would not recommend that any decision be made on the fact that your spondylosis and disc prolapse are visible on MRI. Are your symptoms worse off in the upper limb or lower limb? What are the signs and symptoms? The type of surgery depends on the levels that are involved and anticipated stability or instability. If it is expected that there is need for some stabilization then that particular segment can be fused by using bone grafting. Artificial discs like titanium discs are not widely prevalent and are more experimental than standard text book protocols. I would not recommend. The cost of surgery varies depending on the hospital and the surgeon you choose. In some of the corporate hospitals these days it may cost upto Rs.1.50 lacs where as in smaller hospitals it may cost Rs.10-20 thousand. Post-operative rehabilitation depends on whether fusion was done or not. If no fusion has been done, then the patient can be up and about in 48 hours time. If fusion is done then mobilization will depend on the type of surgery and the confidence the surgeon has in the stability of fixation. The possibility of deterioration is very unlikely. Maximum relief occurs in the referred pain that occurs in the legs or arms. Local back pain or neck pain may persist to some extent. Normally you should be symptom free. There is no sure-shot way of avoiding surgery. You could try conservative treatment in consultation with the orthopaedic or neurosurgeon. If there are no increasing paralysis or pressure effects on the nerves then there is no risk in delaying surgery. In fact Alf Nachemson the Swedish authority on back pain has found that long term follow-up of operated and un-operated cases were not remarkably different. Whether or not surgery is required depends on the clinical assessment by a competent orthopaedic or neurosurgeon.