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Dr. Dheeraj Bojwani Your Medical Tour Consultant in India

Dr.DheerajBojwani Consultants Website : www.dheerajbojwani.com


Disc Replacement Surgery India Overview: Spine is an extremely important structure in the body. It not only gives support to the body, but also allows mobility of the back in different directions. In addition to that, it houses the most important connection between brain and the rest of the body - spinal cord. When the discs wear out, spine at that particular level does not function normally and also the back becomes painful. The degeneration of disc leads to a condition called degenerative disc disease. Whereas large majority of such patients can be treated with painkillers, braces, physical therapy, small percentage of such patients do not respond to non-operative treatment and thus need a Disc Replacement.

What is Disc Replacement Surgery? Disc replacement surgery is the most innovative and modern treatment that is now available. In this surgery, the disc (which is a soft material between two vertebrae) is removed and the space is packed with bone graft. In due course of time, the bone creates a solid bony bridge across the two vertebrae. By doing away with movement, previously painful segment is made pain free.

Purpose of Disc Replacement Surgery: The reasons for choosing to replace a disc may vary for each condition. Generally, if the pain caused by the affected disc has not been reduced enough with non-surgical treatments, such as medication, injections, or physical therapy, a doctor may suggest disc replacement surgery. Several conditions that may prevent you from receiving a disc replacement: spondylolisthesis (the slipping of one vertebral body across a lower one), osteoporosis, vertebral body fracture, allergy to the materials in the device, spinal tumor, spinal infection, morbid obesity, significant changes of the facet joints (joints in the back portion of the spine), pregnancy, chronic steroid use or autoimmune problems.

Disc Replacement Surgery Types: There are many artificial disc designs classified into two general types:

 Total disc replacement: As the names imply, with a total disc replacement, all or most of the disc tissue is removed and a replacement device is implanted into the space between the vertebras.

 Disc nucleus replacement: With a disc nucleus replacement, only the center of the disc (the nucleus) is removed and replaced with an implant. The outer part of the disc (the annulus) is not removed.


Artificial discs are usually made of metal or plastic-like (biopolymer) materials, or a combination of the two. These materials have been used in the body for many years. Total disc replacements have been used in Europe since the late 1980s. The most commonly used total disc replacement designs have two plates. One attaches to the vertebrae above the disc being replaced and the other to the vertebrae below. Some devices have a soft, compressible plasticlike piece between these plates. The devices allow motion by smooth, usually curved, surfaces sliding across each other. Most nucleus replacement devices are made of plastic-like (biopolymer) materials. One such material is called hydrogel. This material expands as it absorbs water. The device is placed into the nuclear cavity of the disc and hydrates to expand and fill the cavity The device is compressible and by this means, allows motion, much like a normal disc nucleus. Another design consists of a piece of a plastic-like material that coils around to fill the nuclear cavity. There are also disc replacements designed for use in the cervical spine (the neck). These devices have only been used a relatively short time, and several are currently undergoing evaluation in FDAapproved trials in the United States. Candidate for Disc Replacement Surgery: The best candidates for Disc replacement surgery would be patients who have failed prolonged nonsurgical treatment and who have moderate of severe degenerate disc disease. The ideal candidate for this procedure is someone who fits into the following criteria:            

Is not over the age of 60 Does not have degeneration on multiple levels of the spine Does not have osteoporosis Is it good health? Is not overweight Has not had any previous surgery for this condition such as a spinal fusion Has had at least 3 months of non-surgical treatments such as stretching, exercise and medications which has failed to reduce or eliminate pain in such as way that everyday functions can be returned to as close to normal as possible. Artificial disc replacements have been shown to cause facet joint problems so it is best if you do not have any previous facet joint issues. You do not have scoliosis or any other type of spinal deformity that would make disc replacement not possible. The nerves in your spinal canal are not being compressed in any way. You have never had any sort of spinal infection. You don’t have spinal arthritis

Diagnosis for Disc Replacement Surgery: The indications for disc replacement may vary for each type of implant. Some general indications are pain arising from the disc that has not been adequately reduced with non-operative care such as medication, injections, chiropractic care and/or physical therapy. Typically, you will have had an MRI that shows disc degeneration. Often discography is performed to verify which disc(s), if any, is related to your pain. (Discography is a procedure in which dye is injected into the disc and X-rays and a CT scan are taken. See the NASS Patient Education brochure on Discography for more information.) The surgeon will correlate the results of these tests with findings from your history and physical examination to help determine the source of your pain.


Preparing for Disc Replacement Surgery: If you suffer from chronic low back pain caused by degenerative disc disease (DDD) that does not respond to other nonsurgical therapies, you may be eligible for artificial disc replacement surgery. However, this procedure is not recommended for everyone. Based on your symptoms, your doctor will determine the best course of treatment for you. Disc replacement may be recommended for patients between the ages of 18 and 60 with DDD at one or two levels of the spine whose condition has not responded to at least six previous months of non-surgical therapy. Patients who have other spinal abnormalities such as spinal stenosis, spondylolisthesis and scoliosis are usually not candidates for this surgery. Patients with osteoporosis may not have strong enough bone to support a disc replacement. Based on a series of tests, your doctor will determine if artificial disc replacement surgery is an option for surgery and the most effective treatment for your condition. Before artificial disc replacement, your doctor will discuss the procedure with you in detail, answering any questions you may have. Your doctor will also inform you of any special requirements that need to be completed before your surgery. Disc Replacement Surgery Procedure: Artificial disc replacement surgery takes place under a general anesthesia, which means the patient is put to sleep. The procedure takes between one and two hours, followed by a three to four-day hospital stay. The artificial disc is designed as two metal end plates, between which may be found medical grade polyethylene or plastic or gel-like substances, much like a sandwich. After a general anesthesia as the first step, is to remove the diseased disc before installing the replacement. For a total disc replacement in the lower back, a type of disc prosthesis may be used which consists of two metal plates surrounding a mobile core made of plastic. Spikes protruding from the metal pieces fix them into the bone, which eventually grows and fuses with the plates. The plastic core allows gliding movements to occur. A different type of spine arthroplasty device, where two metal pieces articulate by way of a ball and trough, is sometimes used to replace a cervical disc in the neck. An alternative to a total disc replacement is what is known as a disc nucleus replacement, which may be carried out if the outer part of the disc is still quite healthy. In this procedure, only the center, or nucleus, of the original disc is removed. It is replaced by a type of plastic which absorbs water and swells to fill the nucleus cavity. As the material is soft and can be compressed, it allows the disc to continue to function in a relatively It may take up to eight weeks for people to return to normal everyday activities after an artificial disc replacement has been carried out, although it could be longer before more vigorous exercises, such as sports, can be pursued. Artificial disc prosthesis, usually made of a gelatinous or plastic substance, is inserted into the vertebral space to approximate the normal height of the original disc. The patient is often required to wear a back brace support for up to 12 weeks following such a surgical procedure to enable and encourage healing. Possible complications include the artificial disc replacement becoming damaged or dislodged. For this reason, following surgery, patients have regular checkups for life to make sure the prosthesis is functioning normally.

Life after Disc Replacement Surgery: Pain relief, the reduction of further degeneration and resumption of daily activities are typical goals of spine surgery. While both fusion surgery and artificial disk replacement can provide pain relief and stability, with spinal fusion the vertebrae surrounding the disk space are immobilized, and therefore limit flexibility in that area of the spine. Laboratory testing shows that patients who have undergone total disk replacement have more movement in the spine. Nobody can guarantee that after disk replacement surgery you will never feel pain again or that your spine will fully regain its flexibility. If you’re like the majority of spinal surgery patients, you’ll experience a decrease in pain and you’ll gradually be able to increase your level of activity. With your pain minimized or no longer an issue, your concentration level on task will be noticeably better.


Benefits of Disc Replacement Surgery: Most importantly, when fusion surgery is performed, although your pain symptoms may go away, the vertebrae surrounding the disc space are immobilized and therefore typically limit flexibility in that area of the spine. Laboratory testing shows that the Disc replacement design allows your spine to move. In the clinical study, patients were observed to have motion between 0 and 21 degrees while bending forward and backward. Another benefit to disc replacement surgery with the Artificial Disc is that no bone graft is required. Often times with spinal fusion surgery, the bone graft used to pack the disc space is bone that the surgeon has to remove from the patient's hip. This means that the patient ends up having two incisions that must heal, as well as pain in the back and hip during recovery from the surgery.

Risks of Disc Replacement Surgery: As with any surgery, there are risks associated with disc replacement. The complications when using artificial discs are similar to those associated with anterior spinal fusion. Possible complications include but are not limited to: infection, injury to blood vessels, nerve injury, dislodgement or breakage of the device, wear of the device materials, continued or increasing pain, development of new pain, sexual dysfunction, injury to urologic structures and death. Discuss these risks with your surgeon before deciding to have an artificial disc implanted.

Recovery after Disc Replacement Surgery: Most people spend one or two nights in the hospital. You may require an extra day or two if for some reason you're having extra pain or unexpected difficulty. Patients generally recover quickly after an artificial disc replacement. You should be able to get out of bed and walk within a few days. Some people wear a corset or brace for support. As you recover in the hospital, a physical therapist may see you to start you on a few gentle exercises. You'll also start a walking program that you are encouraged to continue when you get back home. When you leave the hospital, you should be safe to sit, and walk. Your surgeon will see you within a month to do an X-ray to make sure the disc is in place and holding steady. However, you should avoid lifting things for at least four weeks. You can often return to work after your surgeon has evaluated you, as long as your job does not include heavy lifting. It should be noted that a successful result of the disc replacement means that back symptoms are better but not necessarily perfect. Most studies show that 60 to 70 percent of patients have significantly less back pain and greatly improved function with the operation.

Disc Replacement Surgery in India: Disc Replacement surgery in India is getting these days an overwhelming response for best medical facilities which come at economical budget. In the last few years medical tourism in India has grown considerably. Various Indian hospitals where Disc Replacements are performed are available with state-of-art facilities abreast with latest technology. It is not only because of the cost factor but also the English language is widely spoken here, which makes the communication easy for the international patients coming from all corners of the world. There is a pool of world class spine surgeons and competent orthopedic team in India, with most of them has been trained abroad in countries like UK, US and Australia. Thus the medical team performing the Disc Replacement in India is excellent and world class. They are qualified from prestigious medical institutions and universities of the world which are popular for quality education, while, they also have ample of experience in handling complex problems with excellent solutions. And besides having the medical in India, the patients have the opportunity to avail a leisure package wherein they can rejuvenate and take home pleasant. The hospitals and clinics catering Disc replacement surgery procedures in India are spread all over the country with presence of more than five thousand healthcare professionals treating with the most advanced medical amenities in the world.


These are available at hospitals in the following cities with latest amenities and state-of-art-facilities.

Mumbai

Hyderabad

Kerala

Delhi

Pune

Goa

Bangalore

Nagpur

Jaipur

Chennai

Gurgaon

Chandigarh

The additional warmth and care rendered to the global patients during their medical treatment or surgery surpasses all the value added services they avail at their respective places.

Cost of Disc Replacement Surgery in India: The global patients traveling to India for Disc replacement can enjoy savings of tens of thousands of dollars. They may save between 60 and 80% on costs found in the United States. Lower costs do not equate to lower quality, but lower operating costs, lower medical malpractice costs, and different healthcare systems in place in foreign destinations. The following table can give you a fair idea of the cost difference which is evident in India.

Procedure Cost (US$) United States 55,000 77,000 58,000 20,000

Medical Treatment Disc Replacement Surgery Spinal Fusion Cervical Disc Replacement Orthopedic Surgery

Some of the common countries from which patients travel to India for surgery are: USA

UK

Canada

Australia

New Zealand

Nigeria

Kenya

Ethiopia

Uganda

Tanzania

Zambia

Congo

Sri Lanka

Bangladesh

Pakistan

Afghanistan

Nepal

Uzbekhistan

India 11,000 10,000 10,000 5,000


ABOUT INDIA Located in South Asia, bordered by Pakistan, Nepal, China and Bangladesh, India is South Asia's largest, sovereign, democratic republic. India has an edge over other countries when it comes to offering comprehensive, cost-effective and timely medical care: it also offers an exotic, adventure-filled or cultural -if you wish array of destinations to discover and revel in for the travelers. Indian cities like Mumbai, Hyderabad, Goa, Bangalore, Nagpur, Kerala, Delhi, Pune, Jaipur, Chennai, Gurgaon, and Chandigarh offers best medical tourism service. Mumbai - Formerly known as Bombay, is the commercial & financial capital city of India. Mumbai is famous for many things, including its thriving Bollywood film industry, teeming bazaars, colonial-style buildings, Art Deco structures and a superb choice of restaurants, often being rated as the dining capital of India. The tourist district of Colaba in Mumbai is a great place to start exploring this great city. Hyderabad – Hyderabad city is a great place to visit in the state of Andhra Pradesh. The place has witnessed a continuous growth for last many years. Hyderabad has become a tourist hotspot following ever increasing number of tourists during past few years. Hyderabad has a well-founded reputation as one of the safest cities in the world. Goa - The country's smallest state and famed for its colonial Portuguese and Catholic past, most tourists visit Goa for its endless selection of sandy beaches and coastal attractions. Standing proudly next to the Arabian Sea, Goa is a particularly compact state and often feels like a large town, being easy to travel. Around Goa, tourists will soon realize that the state has much more to offer than simply stunning beaches, fishing, water scooters, windsurfing and scuba diving. Bangalore - Beauty lies in the eyes of beholder and if you want to see one of the most beautiful places in India then Bangalore is the word for it. Bangalore has earned sobriquets like 'Silicon Valley of India', 'Pub Capital of India', and 'City of Gardens'. Pleasant climate with colorful gardens with lakes and glittering nightlife, Bangalore has made its own attraction for travelers as one of the most charming cities in India, Nagpur - Nagpur is the largest city in central India, but with its friendly atmosphere and dependable transportation, you’ll instantly feel at home. The city of Nagpur has a well-built infrastructure, is a clean and affluent city which makes a good jumping-off point for a series of trips into the far eastern corner of Maharashtra. Kerala - Natural beauty, clean air and primordial greenery amidst the vast expanse of water and sky, typifies the state of Kerala – better known as God's own country. Kerala is famous for its alternative medical therapies such as Ayurveda, which help to rejuvenate and revitalize the body. The region is also home to India’s only virgin tropical rain forest – the Silent Valley National Park, supporting an overwhelming range of life forms, many of which are highly endangered, and endemic to this part of the planet. Delhi - "Welcome to The Capital City of India - New Delhi" Delhi is famous as Capital city of India is located in North India. Delhi is truly a symbol of the old and the new; a blend of ancient well preserved monuments and temples along with jam-packed burger joints and up market shopping malls. Delhi has state of the art Hospitals and the best qualified doctors. Pune - Once referred to as the Oxford of the east, Pune continues to be a stronghold for academics and culture. An array of factors like availability of efficient and experienced doctors, comparatively low treatment costs, hospital facilities of international standards and many more have made Pune one of the top destinations for medical tourism. Jaipur - Jaipur is one of the most popular destinations on a tourist's itinerary. The magnificent forts, beautiful havelis and colourful bazaars make Jaipur a popular tourist destination among tourists. Jaipur has pioneered health and medical tourism in India. Chennai - Chennai is one of the most developed urban centers in the Indian subcontinent. The city forms the capital of Tamil Nadu state and is the fourth largest metropolitan city in India. They have some of the very best hospitals and treatment centers in the world. Each hospital is equipped with state of the art facilities. The technology brought into practice is the very latest, including robotic surgery. Gurgaon – It is one of the four important satellite cities of the National Capital Region and is often referred to as the 'Millennium


Patients Testimonial:

Mrs. Joan, Canada Disc Replacement Surgery in India

I am Joan Ference from Canada. I came to India for my Artificial Disk Implant surgery in India. I was looking forward for getting an Artificial Disk Implant surgery from a long time. I contacted two disc replacement surgeons in Canada for my surgery and I was told that there was a long waiting list for my surgery and the price was also very expensive. Then I decided to take the matter in my own hands and then I started looking on the internet to say if I can find any reasonable alternative abroad for my surgery and nowadays we are very much familiar with the concept of medical tourism in India. So I started researching for Artificial Disk Implant surgery in India. Then I found Dr Dheeraj Bojwani’s company Dr Dheeraj Bojwani Consultants. I want to thank Dr Dheeraj Bojwani and the whole team of Dr Dheeraj Bojwani Consultants for their help and assistance in arranging my Artificial Disk Implant surgery in India with the best medical facilities in India and the best medical treatment for my Artificial Disk Implant surgery in India.

Mr. Lew Heskewich, Canada Disc Replacement Surgery in India

Hi. I am Lew from Calgary, Canada. Last month, I got my Disc Replacement Surgery in India. I would like to thank the Dheeraj Bojwani Group for their coordination. Without your support, my medical tour to India couldn’t have been so easy. I came to know about Dheeraj Bojwani Group from the internet and I immediately contacted them to arrange my Disc Replacement Surgery in India. They asked for my relevant medical reports, MRI and X-Ray reports. They were studied by thee senior spine surgeons. After going through my medical reports they, considered me a perfect candidate of Disc Replacement Surgery in India. I was suffering form severe neck pain. I also experienced shooting pain in my arm. My doctor had suggested that I should go for a Disc Replacement Surgery. I chose India for my surgery was mainly because of the low cost. If I was getting the same quality at a much lower price then why not consider it. When I entered the hospital where I got my Disc Replacement Surgery in India, I was stunned to see the medical facilities around me. My hospital room was very cozy and comfortable. It seemed more like a 5 star hotel room rather than a hospital room. My Disc Replacement Surgery in India was carried out by expert surgeons. My surgery was performed successfully and ever since then, I am not experiencing pain at all. I am very grateful to my doctor for doing an excellent job. Thank you, Lew


Knee Replacement Surgery in India Knee replacement surgery also known as knee arthroplasty is procedure to replace the weight-bearing surfaces of the knee joint to relieve the pain and disability of osteoarthritis. It may be performed for other knee diseases such as rheumatoid arthritis and psoriatic arthritis. The procedure has been proven to help individuals return back to moderately challenging activities such as golf, bicycling, and swimming. Total knees are not designed for jogging, or sports like tennis and skiing (although there certainly are people with total knee replacements that participate in such sports). Knee replacement is a routine surgery performed on over 600,000 people worldwide each year. Over 90% of people who have had Total Knee Replacement experience an improvement in knee pain and function.

Knee Replacement Surgery Candidates A person would be considered a candidate for knee replacement if there is: • • • • • •

Daily pain The pain is severe enough to restrict work, recreation and ordinary activities of daily living Significant stiffness in the knee Significant instability (constant giving way) of the knee Significant deformity (knock-knees or bow-legs) that hinders normal function of the knee Damage from arthritic conditions, such as osteoarthritis, rheumatoid arthritis or post-traumatic arthritis

Success Rate of Knee Replacement Surgery: Knee replacement surgery is recognized as a miracle of modern surgery. Most orthopedic experts consider replacement to be the best method of handling arthritis in the knee. Knee replacements have literally put hundreds of thousands of Americans back on their feet and allowed them to enjoy their golden years.

Knee Replacement Surgery Preparations: • • • •

• • •

If you smoke, cut down or quit. Smoking changes blood flow patterns, delays healing and slows recovery. If you drink, don't have any alcohol for at least 48 hours before surgery. Ask your doctor for pre-surgical exercises. If you are having hip or knee replacement surgery, doing exercises to strengthen your upper body will help you cope with crutches or a walker after surgery. Your primary care physician or an internist will conduct a general medical evaluation several weeks before surgery. This examination will assess your health and your risk for anesthesia. The results of this examination should be forwarded to your orthopaedic surgeon, along with a surgical clearance. Shortly before your scheduled surgery, you will probably have an orthopedic examination to review the procedure and answer any last-minute questions. You may need to take several types of tests, including blood tests, a cardiogram, a urine sample and a chest X-ray. Advice your surgeon of any medical conditions you have and of all the medications you are taking. You may need to stop taking certain medications or your surgeon may recommend substitute medications until your surgery. Medications such as corticosteroids, insulin or anti-coagulants will need to be managed before and after surgery.


Disc replacement surgery india