Question 1

Doctors who don't perform MISS themselves often face a perception battle when counselling patients. How should they address patient fears?

Dr. S. K. Rajan · Accepted Answer

The biggest source of confidence for a patient is seeing or hearing from patients who have undergone the procedure — testimonials describing next-day mobilisation are very powerful, and the Artemis Hospitals website carries many of them. Beyond that, as technology spreads to more centres and results accumulate, outcomes will speak for themselves. The current primary limitation is availability of technology, not the evidence.

Question 2

When we say '99% safe,' patients sometimes read this as '99% chance of a full recovery.' Can you clarify?

Dr. S. K. Rajan · Accepted Answer

Safety and success are entirely separate concepts. When we say 99% safe, we mean that out of 100 patients, 99 will not deteriorate — they will not be made worse by the surgery. Success is different: a patient who arrives already paralysed, no technology anywhere in the world can guarantee that patient will walk. Success depends on the patient's pre-operative condition, the stage of disease on MRI, and their own functional expectations — which is why a one-to-one consultation is essential before anyone is given realistic clarity on likely outcomes.

Question 3

There is often overlap between neurology and spine surgery, with neurologists recommending conservative management until deterioration occurs. How do you decide when surgery is right — for example in a 65-year-old with early disc degeneration and 20 years of quality life ahead?

Dr. S. K. Rajan · Accepted Answer

This is a very large grey zone. In general, a patient with acute pain of short duration, no neurological weakness, and quality of life not severely compromised should get a trial of conservative management first. At the other end, a patient who has tried conservative measures without relief, has developed neurological weakness or significantly impaired quality of life, and has imaging confirming nerve compression, needs an honest conversation about surgery as a genuine option. Individual lifestyle demands matter too — the same imaging findings in a sedentary 70-year-old versus someone who needs to travel and stay professionally active can lead to very different recommendations. Treatment has to be individualised.

Question 4

What hygiene and precautions should be observed after spine surgery?

Dr. S. K. Rajan · Accepted Answer

First, preventing infection: making surgery as minimally invasive as possible, prophylactic antibiotics, and early removal of the urinary catheter, since UTIs are a common source of secondary infection. Second, wound care: dressing changes every second day until suture removal at day ten, sponge bathing rather than full immersion until healed. Third, movement precautions: for three months after discectomy or fusion, no lifting weights, no sitting on the floor, no squatting or forward bending; in the first month, no sitting or travelling continuously for more than 30 minutes without a break. We take follow-up X-rays every month for three months, then every three months up to a year.

Question 5

What is the timeline for an athlete wanting to return to active training after spine surgery?

Dr. S. K. Rajan · Accepted Answer

For a sportsperson or someone with high physical demands, my approach leans towards spinal fixation rather than decompression alone, for greater long-term stability — consistent with how athletes like Tiger Woods have returned to high-level sport after spine surgery. The realistic return-to-full-sport timeline is about one year, with roughly nine months devoted to rehabilitation under sports-specialist physiotherapists focused on core training and back strengthening. The protocol is tailored to the individual, but the principle is the same: build a strong muscular support system before returning to load.

Question 6

What are your recommendations for spine health in office workers with long sedentary hours, and for heavy weightlifters? Is there an age dimension?

Dr. S. K. Rajan · Accepted Answer

For office workers: correct sitting posture throughout, back support maintained, screen at eye level, the angle between thigh and lower leg kept greater than 90 degrees, with regular breaks. I recommend pelvic tilts, leg raises, the Cobra pose and the Superman pose for everyone in this group. For heavy weightlifters with back pain but a largely normal MRI, return to lifting within six to eight weeks is reasonable; but with a prolapsed disc, the annulus tear needs six to nine months, sometimes up to a year, to heal, and early heavy loading risks the prolapse escalating into a full extrusion requiring surgery. For patients beyond 60, protein supplementation and resistance training to maintain paraspinal muscle mass become particularly important, since postural slouching and spinal deterioration are largely consequences of muscular atrophy.

Question 7

For a patient with multiple disc prolapses at both cervical and lumbar levels, is minimally invasive surgery possible, or is open surgery required?

Dr. S. K. Rajan · Accepted Answer

Multi-level thoracic stenosis and multi-level lumbar disc disease can both be managed with MISS, including fixation at two or three levels, and technology now makes MISS technically feasible at four or even five levels — though each patient has to be assessed individually. As a broad guide: one- or two-level lumbar disease, MISS without question; three to four levels, roughly half our patients proceed with MISS and half need open surgery, mainly for anatomical reasons, not because MISS is inferior. For sequencing combined cervical and lumbar disease: if there's cervical cord compression causing weakness, we operate on the cervical spine first; if the cervical issue is just radiating arm pain without cord compression, we address the lumbar spine first.

Question 8

What is the standard treatment for scoliosis with a Cobb angle greater than 10 degrees?

Dr. S. K. Rajan · Accepted Answer

A Cobb angle under 10 degrees isn't classified as scoliosis at all. Between 10 and 30 degrees, observation with serial X-rays is appropriate — the curve is largely safe at this stage. The tipping point for a surgical discussion is a Cobb angle approaching 40 degrees; below that, there's generally no urgent surgical indication. Beyond the angle itself, the second key factor is whether the curve stays within the coronal zone of stability — as long as it does, it's relatively safe, but once vertebral segments shift outside that zone, the curve is at high risk of rapid progression and surgery becomes necessary.

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