What is Scoliosis?

When is Surgery Considered?
Surgery is typically recommended when the curve is severe, progressive, or causing significant symptoms. Criteria include:

• Curve Magnitude: A Cobb angle (measurement of curvature) greater than 40-50 degrees in a growing child or adolescent. For adults, surgery is considered for curves over 50 degrees that are causing pain or functional issues.
• Documented Progression: The curve is worsening over time, despite bracing or other conservative treatments.
• Pain: Severe, debilitating pain that does not respond to non-surgical treatments (physical therapy, medication, injections).
• Cosmetic Concerns: Significant visible deformity (e.g., rib hump, uneven shoulders or hips) that affects the patient’s quality of life.
• Neurological Symptoms: Signs of nerve compression, such as numbness, weakness, or tingling in the limbs.
• Cardiopulmonary Function: In very severe cases (curves >70-90 degrees), the curvature can reduce space for the heart and lungs, impairing function.

Part 2: Common Types of Spine & Scoliosis Surgery

The goals of surgery are to correct the deformity as much as safely possible, prevent further progression, restore spinal balance, and alleviate pain.

1. Spinal Fusion

This is the most common surgical treatment for scoliosis. The goal is to straighten the curved vertebrae and fuse them together into a single, solid bone.

• How it works:
  1. Access: The surgeon accesses the spine from the back (posterior approach), front (anterior approach), or side (lateral approach). The posterior approach is most common.
  2. Correction: Surgeons use a system of rods, screws, and hooks attached to the vertebrae to carefully maneuver the spine into a straighter position.
  3. Fusion: Bone graft material (from the patient’s hip, a donor, or synthetic) is placed along the prepared spine. This material stimulates new bone growth, which permanently fuses the vertebrae together over time.
• The rods and screws (implants) act as an internal cast, holding the spine in place while the fusion occurs, which can take several months to a year.

2. Minimally Invasive Surgery (MIS)

This technique uses smaller incisions and specialized instruments to perform spinal fusion or other procedures. It aims to reduce muscle damage, blood loss, and recovery time. It is more commonly used for degenerative conditions and certain types of adult scoliosis but is less common for complex pediatric deformities.

3. Vertebral Body Tethering (VBT)

An emerging, non-fusion option for specific pediatric patients who are still growing.

• How it works: The surgeon places screws on the outside of the spinal curve and connects them with a strong, flexible cord (tether).
• The Concept: As the child grows, the tether applies pressure on the convex (outer) side of the curve, guiding the spine to straighten naturally. It allows for more motion than a fusion.
• Limitations: Only suitable for a specific subset of patients (typically adolescents with curves between 35-60 degrees who have significant growth remaining).

4. Osteotomies

For very rigid or severe curves, a spinal fusion alone may not be sufficient. Surgeons may perform osteotomies—procedures where they cut and reshape bones to achieve better correction. Examples include:

• Pedicle Subtraction Osteotomy (PSO): Removing a wedge-shaped piece of bone, including the pedicles, to correct a sharp angle.
• Vertebral Column Resection (VCR): Removing an entire vertebra to allow for major realignment. This is a highly complex procedure reserved for the most severe deformities.

Part 3: The Surgical Journey

1. Preoperative Planning: This involves detailed imaging (X-rays, CT scans, MRI), medical evaluations, and often, blood donation for anticipated transfusion.
2. The Surgery:
   • Duration: Typically lasts 4-8 hours, depending on the complexity.
   • Team: Performed by a specialized orthopedic or neurospinal surgeon with a full team, including an anesthesiologist and neurophysiologists who monitor nerve function throughout the surgery (Intraoperative Neuromonitoring).
3. Recovery in the Hospital:
   • ICU/Step-down unit: 1-2 days for close monitoring.
   • Mobilization: Patients are usually encouraged to sit up and walk within 1-3 days post-surgery.
   • Pain Management: Carefully controlled with various medications (IV, then oral).
   • Length of Stay: Typically 4-7 days.
4. Recovery at Home:
   • Activity Restrictions: No bending, lifting, or twisting (BLT) for several months. Sports and heavy activities are restricted for 6-12 months.
   • Return to School/Work: Usually within 4-8 weeks for sedentary activities.
   • Physical Therapy: Crucial for rebuilding core strength, flexibility, and learning proper movement mechanics.

Part 4: Risks and Considerations

All surgeries carry risks. It’s crucial to discuss these with your surgeon.

• General Surgical Risks: Infection, blood loss (requiring transfusion), blood clots, adverse reaction to anesthesia.
• Procedure-Specific Risks:
  • Nerve Damage: The most serious risk, which could lead to weakness, numbness, paralysis, or bowel/bladder dysfunction. This is why intraoperative monitoring is critical.
  • Pseudoarthrosis: When the fusion fails to form solidly, which may require additional surgery.
  • Instrumentation Failure: Rods or screws can break or loosen, though modern implants are very strong.
  • Adjacent Segment Disease: The spinal segments above and below the fusion can degenerate faster due to increased stress.
• Long-term Considerations: The fused portion of the spine is permanently stiff. Most patients adapt extremely well and have full, active lives, but some may notice a loss of flexibility.

The cost for Scoliosis and complex Spinal Fusion surgery in India is significantly lower than in Western countries, often just a fraction of the price.

• Approximate Cost Range: ₹4,00,000 to ₹12,00,000+ (approximately $5,000 to $15,000+ USD).
• For Comparison: The same surgery can cost between $100,000 and $250,000+ in the United States.

This is a wide range because the final cost depends heavily on numerous variables.

Factors Drastically Influencing the Cost

1. Type and Complexity of Surgery:
   • Simple Spinal Fusion (short segment): Less expensive.
   • Complex Scoliosis Correction (long segment fusion): More expensive due to more implants (rods, screws), longer OR time, and higher technical skill required.
   • Use of Advanced Techniques: Procedures like Vertebral Column Resection (VCR) or Osteotomies are at the highest end of the cost spectrum.
   • Minimally Invasive Surgery (MIS): Can sometimes be more expensive due to the cost of specialized equipment.
2. Implants Used:
   This is often the biggest cost component. The type, material, and brand of screws, rods, and cages make a huge difference.
   • Indian-made Implants: Most affordable.
   • Imported Implants (US/European brands): Can be 2-3 times more expensive than Indian implants. Many surgeons and patients prefer these for their proven track record.
3. Hospital Category:
   • Public Government Hospitals: Lowest cost, but with long waiting lists and not typically an option for medical tourists.
   • Private Hospitals (Tier 2 Cities): More affordable.
   • Premium Corporate Hospitals in Metro Cities (e.g., Apollo, Fortis, Max, Medanta, Artemis in Delhi/NCR; Manipal, Columbia Asia in Bangalore; Global in Chennai): Higher cost, but offer world-class infrastructure, latest technology, and internationally trained surgeons.
4. Surgeon’s Experience and Fee:
   A highly reputed and specialized senior spine surgeon will command a higher fee, which is often justified by their expertise and outcomes.
5. Patient’s Condition:
   • Severity of the Curve: A 50-degree curve will be less complex and costly than a 90-degree, rigid curve.
   • Underlying Cause: Idiopathic scoliosis is more straightforward than correcting deformities from syndromes or previous failed surgeries.
   • Age: Adult scoliosis surgery can be more complex due to pre-existing degeneration, osteoporosis, and other health factors, potentially increasing cost.
6. Length of Hospital Stay:
   A standard stay is 7-10 days. Any complications (e.g., infection) that extend the stay will increase the cost.
7. Pre-operative and Post-operative Care:
   Costs include diagnostics (X-rays, MRI, CT scans, blood tests), consultations, physiotherapy, and any specialized bracing required after surgery.

Breakdown of Cost Components

Cost in Major Cities (Approximate Estimates)

• Delhi NCR: ₹5,00,000 – ₹15,00,000+ (Home to some of the best spine institutes in India)
• Mumbai: ₹5,50,000 – ₹14,00,000+
• Bangalore: ₹5,00,000 – ₹13,00,000+
• Chennai: ₹4,50,000 – ₹12,00,000+
• Hyderabad: ₹4,50,000 – ₹12,00,000+

Note: These are indicative figures for complex surgeries. Less invasive procedures will be on the lower end.

Tips for Managing Cost

1. Get a Detailed Quote: Contact the hospital’s international patient desk with your medical reports (X-rays, MRI) for a transparent, itemized cost estimate.
2. Discuss Implant Options: Talk to your surgeon about the pros and cons of different implant brands. Understand why they are recommending a specific type.
3. Insurance: Check if your international health insurance covers treatment in India. Indian citizens should check their policy’s coverage for such major surgeries.
4. Medical Tourism Packages: Many hospitals offer all-inclusive packages for international patients that cover surgery, hospital stay, hotel for a relative, local transportation, and sometimes even a city tour. This helps in budgeting.

Conclusion

Spine and scoliosis surgery is a major undertaking, but for those with severe curves, it is a life-changing procedure that can halt progression, improve appearance, alleviate pain, and enhance overall quality of life. The field is continually advancing with better techniques, materials, and safety protocols.