Spinal Deformities in India and its Treatments

A vital skeletal masterpiece by the creator, the spine or the vertebral column comprises 33 vertebras. These vertebras are simple bony structures that are compact and shaped like a marshmallow. It is the vertebral arch and body both are part of this single bone structure. It is the vertebral body that acts as a balance and bears the weight of the spine which in turn bears the weight of the upper body to a great extent. The vertebras are interlinked by a cushion, the intervertebral discs that accord great flexibility to the structure that is responsible for balancing our stance and the biomechanical movements.     

Spinal Structure & Deformities 

Much depends upon the shape of the spinal column not only for composure but also for cosmetics. While the latter does not create problems the former certainly does. A deformity results in bending and stooping and difficulty in standing erect.  

The upper spine with a greater-than-normal curve is deformed and this is called kyphosis and which can cause sagittal imbalance. Other conditions that can cause sagittal imbalance are hyperkyphosis, chin-on-chest syndrome, flatback syndrome, and ankylosing spondylitis. This type of imbalance causes stooping, and difficulty in looking ahead and if it exceeds the limit, it can compress vital organs in the chest. 

Idiopathic scoliosis  

Scoliosis happens due to side-to-side curvature of 100 either on one side (C) or on both sides (S). This is caused by adolescent idiopathic and degenerative scoliosis, neuromuscular imbalances, congenital anomalies, and tumors. Unfortunately, this can impact the heart as well as the lungs but on rare occasions. 

If interference in internal organs occurs surgical intervention may be required.  The surgery is not a cure but rather it is a correction. 

Treatment is provided if surgical intervention is not needed to alleviate pain and other systems associated with the malady.  

Corrections and Stabilization 

The main procedures are: 

• Posterior Column Osteotomy 

• Pedicle Subtraction Osteotomy

• Vertebral Column Resection

• Spinopelvic Fixation

Osteotomy creates 10 to 25 degrees of correction. This procedure removes little bone from the vertebral arch. This is useful in correcting long curves in patients suffering from kyphosis.  This operation can be performed at several levels. Very little removal of bone takes place in the osteotomy. 

More bone is removed in pedicle subtraction osteotomy than in the procedure described above. Here removal of pedicles that connect the vertebral arch to the vertebral body part which itself is removed. This procedure can be combined with osteotomy and the correction achieved is to the extent of 30deg.    

Pedicle Subtraction Osteotomy is used to correct: 

• Ankylosing spondylitis

• Flatback syndrome

• Angular kyphosis 

• C-shaped scoliosis

VCR or Vertebral Column Resection

A large portion of bone is removed in VCR much more than removal in the previous procedures described here. Implants called cages are used to replace the vertebrae. Cages are basically bone grafts used as implants. After the bone grafts heal screws and rods are used to restore stability. This procedure provides a correction of 80deg plus. 

In VCR more vertebrae can be removed to accord a greater degree of correction. 

In this procedure called Spinopelvic Fixation hardware comes into the picture. In this, screws, rods, or other elements are rigidly connecting the base of the spinal column and the bones of the hip. This procedure helps put the strain off healing bone fusion. The stress during bending and rotation betwixt the lumbar spine and the sacrum at the joint. 

Spinal surgical interventions are difficult procedures and are performed in special hospital theatres by expert surgeons. The healthy vertebrae column that is well structured needs no intervention it is when a structural anomaly develops or happens at birth then intervention is required. Surgery may not be the necessary recourse if non-surgical treatments are able to mitigate suffering. 

India has the largest cases of spinal deformities in the World. A nationwide screening takes place in the country to find out the extent every year.  

This surgery is performed in many major hospitals, especially those dealing with neurosurgery. The average cost of kyphosis or hunchback surgery in India is Rs. 374,000.00 while the cost is about USD 140000 in the USA. 

The average cost of surgical interventions in Indian hospitals ranges from Rs.180,000 to Rs.800,000 depending upon the complexity.   The cost in the country also depends upon the medical facility chosen and the city it is based in. In the metros and capital cities cost is higher than in 2-tier towns. But very few hospitals will perform complex operations related to the spine in 2 tier cities in India.  

Each of the kyphosis cases is unique and the treatments or surgical procedure varies as well. A customized plan will include various therapies before and after the operation hence the cost of cumulative procedures would rise. Physiotherapy and chiropractic care may be required in some cases the latter being an alternate healing process used in correcting mechanical disorders in musculoskeletal systems. Often home exercise with corrective bracing is prescribed post-treatment.  

Looking at the gravity of the procedures used for correcting scoliosis surgery should be the last resort. It can alter a patient’s life for good or bad.    

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Ancient India Now a Modern Land of Healing & Wellness

India’s progression in modern medicines has been exponential, a phenomenon recognized all over the World. Thanks to the rising popularity of medical tourism in India, the World has come to comprehend the unique health ecosystem that the country has created in modern times.

The country is home to the finest medical institutions dealing with a wide spectrum of therapeutics, surgery, and wellness treatments. Patients suffering from serious illnesses arrive here for tertiary treatment related to terminal cancers, liver and kidney transplants, and heart ailments to name a few. The country also attracts people for secondary health care related to cosmetics, hair transplants, and dentistry to name a few.     

India boasts one of the finest and largest platforms for education in modern medicine. But in spite of extreme reliance on allopathy, the inclusion of traditional pathways of healing has not been shunned. The ancient healing systems have been absorbed along with the rising tide of modern medicine in a syncretistic approach.      

Ancient Healing Systems

Healing as a science is an age-old phenomenon in India dating back more than 5000 years. The Hindu sages although born with a religious bent were explorers of spiritual mind and body as well. They created a society with a propensity towards research and development, as did few other civilizations flourishing in the World in ancient times.

In the centuries that followed, they developed numerous sciences not only those associated with healing but also with civics, art, and cultural aspects.  As a human entity, India was a conglomeration of robust cultures with an inclination toward science.

Ayurveda

Yoga and Transcendental Meditation are recognized globally for the immense health benefits they promote. Ayurveda too is slowly being accepted with greater result-based research being carried out. The benefits of herbs used in Ayurvedic practice are being understood far better now. The country exported 330.18 million USD worth of herbs in the period 2017 – 2018. The trade holds greater potential due to a projected growth rate of 14 % CAGR.  

Herbal cosmetic and value-added extracts were shipped overseas to the tune of 456.12 million USD in the same period.  With the standardization of organic agricultural practices, the demand for herbs and value-added herbal products will increase exponentially in the near future.  To prevent biopiracy, the Government of India has set up Traditional Knowledge Digital Library which serves as the repository for Indian formulations.

Yoga Tourism

Major centers of Yoga Tourism include Rishikesh and Mysore. Yoga holidays have become a mainstream tourism activity not only in India but in many countries due to the rising popularity of science which deals both with the physical and mental aspects of the human body. The ashrams or Yogi ashrams were the ones to popularize Yoga. The activity became commercialized with the spawning of a number of centers pan India in form of spa and wildlife resorts and five-star hotels. Experts teach yoga in private schools as well and certify learners. TM is delivered side by side in most of these centers. The AYUSH Ministry plays a vital role in the promotion within.

Yoga tourism is secondary to medical tourism, and it generates revenue according to health to the of overseas visitors. A drop-in class fee in Rishikesh ranges from INR 200 to 500. The classes are well organized and headed by a Guru, and most of the followers are overseas visitors from the UK, EU, and the USA.     

Wellness resorts are flourishing all over the country promoting therapy based on diet, Naturopathy, Yoga, and Ayurvedic treatments the latter including the most sought-after massages. There is no fine line that segregates indigenous healing therapies, as a matter of fact, the delivery is often mixed in these resorts.   

Towards Syncretism

Most practitioners of modern medicine or allopathy tolerate patients undergoing alternate healing. As a matter of fact, some doctors prescribe innocuous Ayurvedic herbal formulations along with their treatments.   The rate of patients using indigenous formulations along with allopathic drugs is 3.5 % percent but this does not include habitual users of the formulations. Ayurvedic herbal formulations are used in every Indian household. This is evident from the growing exports and mushrooming of small units manufacturing the formulations. The popularity of herbal cosmetics and therapeutics that line the stores all over the country is another indicator of the increasing demand.    

Across the World, around 80 percent of 6 billion people use herbal medicine for primary healthcare. Although describes as pseudoscientific, a good number of Ayurvedic products have proven their efficacy abroad, but a lot of studies proving the efficacy of many other formulations need to be carried out. 

Herbal medicine is culturally accepted throughout the World as part of traditional healing that promotes a healthier living besides offering a moderate approach to healthcare. 

With a robust healthcare infrastructure, India is attracting international patients from many countries. Reach and the cost has been the criteria upon which to base the visit for international patients everywhere. This applies to India as well, but the alternative healing and wellness holidays act as additional criteria upon which the patients base their visits. Hence it is not only neighborhood visitors that arrive from Bangladesh, Pakistan, Afghanistan, and Nepal traveling to India for medical treatments. Yoga, TM, and Ayurveda are proving as additional determinants that are attracting people from developed countries as well as propelling health tourism in India.