BRAIN AND SPINE CARE

(http://www.armancare.com/brain_spine_care.html) Brain surgeries Microsurgery for Brain Tumors Endoscopic Brain Surgery Trans Nasal Endoscopic Brain Tumor Removal Skull Base Surgery Brain Trauma Surgery Congenital Cranial Deformity Stereotactic Brain Surgery for Tumor and Functional Neurosurgery Craniofacial Surgery with FMS (Facio-Maxillary Surgery) Brain Surgery for Abnormal Blood Vessels, epilepsy, removal of blood clots Interventional/ Neuro-endovascular Therapy for Cerebro-vascular Diseases and Tumor Spinal surgeries Spinal Decompression microdiscectomy and laminectomy Endoscopic spinal fusion Percutaneous Endoscopic Lumbar Discectomy Total disc replacement surgery Spine Tumor Surgery Spine Trauma Vertebroplasty Kyphoplasty Spondylolisthesis

Spinal Decompression Two general types of lumbar spine surgery comprise the most common surgical procedures for the lower back: Decompression and Spinal fusion Decompression surgery involves removing a small portion of the bone over the nerve root and/or disc material from under the nerve root to relieve pinching of the nerve and provide more room for the nerve to heal (a MICRODISCECTOMY or LAMINECTOMY) Lumbar spinal fusion involves using a bone graft to stop the motion at a painful vertebral segment, which in turn should decrease pain generated from the joint. Spine surgery instrumentation (medical devices), bone graft procedures, and the bone stimulator are sometimes used along with spinal fusion surgery. Lumbar Decompression Surgery Decompression is a surgical procedure that is performed to alleviate pain caused by pinched nerves (neural impingement). During a lumbar decompression back surgery, a small portion of the bone over the nerve root and/or disc material from under the nerve root is removed to give the nerve root more space and provide a better healing environment. There are two common types of spine surgery decompression procedures: MICRODISCECTOMY (or MICRODECOMPRESSION) or a LUMBAR LAMINECTOMY (OPEN DECOMPRESSION). Several conditions may cause neural impingement and necessitate these surgeries, including spinal stenosis, a herniated disc, isthmic or degenerative spondylolisthesis, or a spinal tumor (rarely).

How decompression surgery is performed With modern spine surgery techniques, both a microdiscectomy and laminectomy can usually be done with a minimum amount of morbidity (e.g. postoperative discomfort) and a high degree of success in alleviating lower back pain and/or leg pain. Sometimes in addition to the decompression procedure, a spine fusion surgery is also necessary in order to achieve adequate decompression of a nerve root. This is especially true if the nerve root is compressed as it leaves the spine (in the foramen), known as foraminal stenosis.

Foraminal stenosis is difficult to decompress simply by removing bone because if the bone is fully removed in the location of the foramen it is generally necessary to also remove the facet joint. Removing the facet joint leads to instability, so a spinal fusion is necessary to provide stability.

The foramen can be opened either through an anterior approach (by "jacking" open the disc space in the front of the spine) or by distracting between two pedicle screws inserted posteriorly (through the back of the spine). After the foramen is opened up, a spine fusion is also done to keep it open so the instrumentation does not fail and the stenosis does not return later. As an alternative to spinal fusion, interspinous process spacers may be implanted to open the central canal and foramen, and address motion restrictions and pain from spinal stenosis. Microdiscectomy (microdecompression) spine surgery In a microdiscectomy or microdecompression spine surgery, a small portion of the bone over the nerve root and/or disc material from under the nerve root is removed to relieve neural impingement and provide more room for the nerve to heal. A microdiscectomy is typically performed for a herniated lumbar disc and is actually more effective for treating leg pain (also known as radiculopathy) than lower back pain. Impingement on the nerve root (compression) can cause substantial leg pain. While it may take weeks or months for the nerve root to fully heal and any numbness or weakness to get better, patients normally feel relief from leg pain almost immediately after a microdiscectomy spine surgery. How microdiscectomy is performed A microdiscectomy is performed through a small (1 inch to 1 1/2 inch) incision in the midline of the low back. First, the back muscles (erector spinae) are lifted off the bony arch (lamina) of the spine. Since these back muscles run vertically, they can be moved out of the way rather than cut The surgeon is then able to enter the spine by removing a membrane over the nerve roots (ligamentumflavum), and uses either operating glasses (loupes) or an operating microscope to visualize the nerve root. Often, a small portion of the inside facet joint is removed both to facilitate access to the nerve root and to relieve pressure over the nerve.

 The nerve root is then gently moved to the side and the disc material is removed from under the nerve root. Importantly, since almost all of the joints, ligaments and muscles are left intact, a microdiscectomy does not change the mechanical structure of the patient's lower spine (lumbar spine).

Indications for microdiscectomy surgery In general, if a patient's leg pain due to a disc herniation is going to get better, it will do so in about six to twelve weeks. As long as the pain is tolerable and the patient can function adequately, it is usually advisable to postpone back surgery for a short period of time to see if the pain will resolve with non-surgical treatment alone. If the leg pain does not get better with nonsurgical treatments, then a microdiscectomy surgery is a reasonable option to relieve pressure on the nerve root and speed the healing. Immediate spine surgery is only necessary in cases of bowel/bladder incontinence (caudaequina syndrome) or progressive neurological deficits. It may also be reasonable to consider back surgery acutely if the leg pain is severe. A microdiscectomy is typically recommended for patients who have: Experienced leg pain for at least six weeks

Not found sufficient pain relief with conservative treatment (such as oral steroids, NSAID's, and physical therapy). However, after three to six months, the results of the spine surgery are not quite as favorable, so it is not generally advisable to postpone microdiscectomy surgery for a prolonged period of time (more than three to six months). Lumbar laminectomy surgery for spinal stenosis (open decompression) A lumbar laminectomy is also known as an open decompression and typically performed to alleviate pain caused by neural impingement that can result from lumbar spinal stenosis. A condition that primarily afflicts elderly patients, spinal stenosis is caused by degenerative changes that result in enlargement of the facet joints. The enlarged

joints then place pressure on the nerves, and this pressure may be effectively relieved with the laminectomy. The lumbar laminectomy is designed to remove a small portion of the bone over the nerve root and/or disc material from under the nerve root to give the nerve root more space and a better healing environment Laminectomy surgery The lumbar laminectomy (open decompression) differs from a microdiscectomy in that the incision is longer and there is more muscle stripping. First, the back is approached through a two-inch to five-inch long incision in the midline of the back, and the left and right back muscles (erector spinae) are dissected off the lamina on both sides and at multiple levels. After the spine is approached, the lamina is removed (laminectomy), allowing visualization of the nerve roots. The facet joints, which are directly over the nerve roots, may then be undercut (trimmed) to give the nerve roots more room. Post laminectomy, patients are in the hospital for one to three days, and the individual patient's mobilization (return to normal activity) is largely dependent on his/her pre-operative condition and age. Patients are encouraged to walk directly following a laminectomy for lumbar stenosis. However, it is recommended that patients avoid excessive bending, lifting or twisting for six weeks after this stenosis surgery in order to avoid pulling on the suture line before it heals. What is medical tourism? Medical tourism, also known as health tourism or health travel, is a term that describes travelling to a foreign country for medical, dental, or cosmetic treatment. It involves the benefit of cost effective treatment, private medical care, in collaboration with the tourism industry. The concept of medical tourism is fast growing in India and people from different part of the world are choosing India as their desired destination. Why Choose India? Medical tourism is a rapidly growing sector in India and millions of medical tourists from all over the world have come here to experience a world-class healthcare service. In 2010, about 600,000 patients travelled to India from over 30 countries for treatment, including the USA, Canada, UK, Russia, the Middle East and Africa.

According to a study by the Confederation of Indian Industry (CII) on healthcare, after software, the medical tourism industry is poised to be the next big success story in India. It has predicted that the industry will grow to earn additional revenue of $2.3 billion by 2012 and will soon account for a major share of the countrys revenue. There are several reasons behind this tremendous growth: Patients come to India to get specialized treatments not available in their home country. Indian hospitals excel in performing complex cardiac surgeries, kidney transplants, bone marrow transplants, orthopedic surgeries, infertility treatments amongst their wide repertoire. India provides world-class quality treatments at a fraction of the priceof developed countries. The cost of medical treatment in India is generally one tenth of western countries and among the cheapest in Asia. India has state of the art medical institutes and hospitals of international standards with highly qualified medical professionals. These centers are backed by high quality equipment and technology. This fusion of highly qualifiedstaff assisted by the latest equipment gives India the edge over other countries. With hospitals and clinics in every region including urban, semi-urban, or rural parts of the country, India has ample choice in terms of preferred destinations. In countries such as Canada and the UK, patients almost always have to wait weeks and sometimes months to avail of medical treatments. In India the consultations with the doctors are prompt and patients receive a turnaround to their treatment plan at a quicker pace.

As English is a commonly spoken language in India, the patient will be comfortable communicating with the doctors. Medical tourists find that the cost of their treatment (including the return airfare, holiday and accommodation) leaves them with a total bill substantially less than they would have spent just on having the procedure in the UK. Why Arman There are several concerns that flicker in the minds of the foreigners who come for treatment to India, particularly for first time fliers. The first among them is which hospital to choose for their treatment.

India is flooded with hospitals, medical centers and hotels which have their websites that attract the foreign patients. This makes them even more confused and the complexity of decision making becomes a challenging task. We, at Arman can address all these concerns and issues by acting as intermediary with hospitals, clinics, surgeons, hotels. Arman is a healthcare facilitator that has painstakingly brought together highly qualified professionals and hospitals of repute and health care providers. We take the responsibility of screening the hospitals by checking their track record, accreditations, associations and have partnered with the best internationally accredited hospitals in India. Arman update and monitor our network of hospitals on a regular basis and maintain a database on the hospitals certifications, type of facilities and other factors critical in choosing a medical center. Arman also negotiate a lower price from the hospital which foreign patients would not get by directly approaching the hospitals This helps the patient to save a lot on the medical procedure costs We provide assistance with logistics, documentations, permits and other travel arrangements required for medical tourism.

Our coordinators are highly trained to foresee every need of the patient and make the entire process hassle free from start to finish. They help the patient plan his medical procedures before leaving home, and schedules all his appointments, surgery, treatments and plans for recuperation. This in turn helps the patient to choose the hospital according to his convenience and also get a clear picture of the cost of treatment, accommodation beforehand that helps them to arrange their finance. We are aware that a lot of trust is put in our hands and ensure that this trust is well placed by serving each patient individually with care and comfort. How We Work Patient query received by the patient himself or his doctor/ hospital. This query along with medical reports is forwarded to the concerned hospitals to get expert opinions After the hospitals respond, we create a package for the patient which includes recommendation on the treatments, duration of stay, and the costs involved.

The patient reviews the various options presented to him and makes a decision based on budget and the line of treatment recommended by the doctors. Occasionally, a patient may clarify his concerns or questions he may have regarding the treatment with the doctor by telephone. In liaison with the patients, Arman representatives will make prior bookings with the hospital, airlines, hotels. Patient travels and checks into hospital to start the treatment. We provide assistance through out your stay in the hospital which include pre and post opeartive care. Once fit and able to travel, the patient if wishes can enjoy the vast tourist destinations within India before returning to their home country fully rejuvenated. (at an additional cost)(ebranding/mum/ts/19) Arman Health Care Facilitators OUR OFFICE IN INDIA 422, Bonanza, 'B' Wing,Sahar Plaza Complex, Next to Kohinoor Hotel, Andheri Kurla Road, Andheri East Mumbai India 4000059. Contact: land line No: ( 022-28387433 ) Email :enquiry@armancare.com OUR OFFICE IN CONGO Arman Health care Facilitators,Gallery Saint-Pierre, 36 local UtexAfrica Advanced ,AV 374 VolonelMondjiba,Kinshasa / Ngaliema,DRC Mobile : +243998290384 OUR OFFICE IN KENYA Arman Health Care Facilitators C/O Doctor Pharma Kenya Limited Vision Tower, Muthithi Road, Westlands, Nairobi,Kenya.Contact: Telefax:(+254)722330329 Email : doctorpharmamt@gmail.com Web:- http://www.armancare.com/brain_spine_care.html
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