 Yeah, good morning guys. I'm Dr. Vidyadhar, consultant and head of the Department of Spine Surgery, Manipal Hospital, Bangalore. I'm here for the next one hour trying to share with you what I have learnt in the last 15-20 years, trying to learn about back pain and related stuff. So if you have any doubts, please do ask me and I'll be happy to answer as many as I can in the next one hour. I've got already a few questions coming in. Do what you want to do and be within pain limits. Basically, pain is only a signal to say that your back is injured or hurt and it needs some time for body to get alright completely. So till such time, if you can, you can pop in a pill, painkiller and go for a movie or take an international flight if it is really necessary. If not, just wait for a couple of days or a couple of weeks till such time that body heals and then you can do everything. I have the next question from Abhishek Malik who is asking, what is degenerative disc disease and what are the best yours for it? See Abhishek, it's a good question but it's more of a theoretical question. Degenerative disc disease, if you ask me is not a disease per se, it is an aging phenomenon. As you go old, your disc that is the cushion between the two bones. Disc is very famous character in today's world especially in an IT crowd like Bangalore. Everybody knows about disc. I think after Modi he gets the maximum TRP rating. Now you can't say that it is a disease to get degenerated. It is only to say that degenerative disc disease is a part of aging like every single disc or the cushion between two bones in the neck and back loses water and protein from the tissue disc and becomes more firm or more harder. And this eventually bulges and then the disc ruptures, the disc fluid inside will come out, the disc gap reduces and once the gap reduces the bones will slip or start toppling one on top of the other and to prevent this the body starts forming bones at the edge of the bones, bridging the two bones together and then eventually the two bones fuse together and this is called as stage of self stabilization. Now if you ask me these are the stages from disc degeneration, disc bulge, disc relapse to spontaneous stage of instability and spontaneous stage of self stabilization. So these are the stages of degenerative disc disease which has to happen in every single disc of us. We have 33 discs and every single disc has to go through all these phases of degenerative disc disease before we die. If you don't have these changes in your disc you are superhuman. Now what are the best cures I guess in today's world as far as I know, I don't think we have a cure to prevent this degenerative disc disease because it is an aging phenomenon and you have to live through it. The next question comes from Babil Kumar, what are the risk factors of back pain? See lot of people have lot of philosophies or theories behind why people get back pain, why some get, why some don't get. The commonest cause is idiopathic. Like every other disease in the planet earth, lot of things we don't know why and we call it as idiopathic. That means you don't know and you get it. At some point of time like 8 out of 10 of us will have some amount of back pain at some point of time in life without doing something, without lifting something, without bending somewhere. So you get back pain without a reason. This is idiopathic low back pain. Now there are other theories like mechanical theories. You are lifting something straining your back or there are nutritional theories. That means you know the disc is actually not a, it is a largest avascular structure in the body. There is no vascularity. In other words see every tissue in the body needs blood supply for its living. Through blood tissues get nutrients like glucose, oxygen and the good blood takes all this. The cells metabolize these glucose, carbohydrate, proteins and fat along with oxygen and carbon dioxide and lactate will be the waste products of metabolism and they come out of the cell or the tissue. Now good blood goes in, gives the nutrients to the tissue and bad blood takes away the products of metabolism. The product of metabolism is causing energy. Energy is ATPs which are required for any living tissue in the body. Now if you take any organ in the body needs blood supply. Like brain needs blood supply, heart needs blood supply, kidneys, lung, liver, everything needs blood to come give the nutrients for its life. But disc being the most peculiar organ it is the largest avascular structure in the body. It has no blood supply but it is living tissue. It has to metabolize, deliver ATPs or energy so that it is having life. Now without blood how can it get nutrients. That is basically by a process of diffusion or capillary action. I think with background of engineering you know that if there are micro pores between a bone and the disc that interface there are micro pores. Like capillary action the nutrients are getting diffused into the disc. Not perfusion it is diffusion into the disc. Disc is nothing but a sponge, you know the kitchen sponge. When you dip it in water it absorbs or imbibes water. That is how the disc gets nutrition by diffusion not by perfusion. Now there are risk factors one of the very commonest and the highly dangerous risk factor is smoking. Nicotine in the smoke or in tobacco will have a special affinity for these micro pores at the bone and disc junction. Which can block these micro pores and then the disc does not get nutrition and the products of metabolism also will not be taken out of the disc. So it gets to a state wherein it is like a sponge dipped in water for more than say one month. It becomes very brittle and very soft. So piece by piece you can it's so fragile that piece after piece will can be torn from this disc. So this kind of a disc which has no nutrition because of the tobacco or nicotine blocking the micro pores becomes brittle or fragile and then once it starts getting injured small small pieces of disc fragments come and block the nerves which are coming down the back and the legs. And this is one of the first and the worst risk factors that we talk about is smoking. The second risk factor is obvious overweight. If your obese overweight obviously it is a mechanical disadvantage on your back because your whole body weight is pulling your back forward and it is not good for your back. Thirdly, developing stiffness. If your body is flexible like a child like a plant, tender plant, it is always less likely to get injured than a stiff adult. You look more stout, more stiff but you are like a teacher's chalk. You bend it, it breaks. You tend to pick up a mug of water, you have a break of your ligament, disc or muscle or a tear and you go on auto rickshaw, you get a tear and ultimately we keep changing doctors and hospitals for a permanent cure. But the problem remains that it is the loss of flexibility or stiffness that is giving you the risk of increased propensity to get injuring your back. The next question, these are the first two, three common risk factors that I will have to tell. Smoking, obesity and development of stiffness or loss of flexibility. Rupesh Kumar has asked what are the causes of back pain? There are plenty here. The common is being a slip disc or a spondylolisthesis where in slip disc is disc slipping backward and pressing the nerves or there can be a spondylolisthesis where in the bones start wobbling one on top of the other what is called as spondylolisthesis or there can be tumors in the spine, there can be infraction of the spine, there can be injury to the spine, injury to the tissues around the spine like ligaments, muscles or the nerves. What Rupesh is also asking after surgery can the spine be normal for life or do I have to continue to take care of it? Rupesh it is quite understandable that surgery or surgeon is not going to give you a cure. It is a partnership between the patient and the doctor. If you have a mechanical problem in your neck or back we tend to rectify the mechanical problem no matter what whether it is a slip disc or a slip bone or a tumor or an infection we cannot give you a cure. We can only treat the mechanical component of the pain generator where in getting back the flexibility of your back is a lifelong journey and it has to be dealt by you as a patient. It is not whether you had a back pain or not back surgery or not it is your moral duty and responsibility to take care of your body like every other part of your body like your heart you need to take care of it your lung you need to take care of it. Similarly there are 33 bones in our neck and back and every 2 bones have 3 joints. Joints are nothing but bearings like bearings of the motor or engine. They need movement they don't need oiling increasing. They need movement movement is life for a bearing like if you see a house fan it never makes sound whereas you go to a marriage hall 1 out of 10 fans will make karkar noise. Why? Because house fan runs every night whereas marriage hall fan runs once in 2 months in a year. So remaining time it is resting and that is the time bearing gets rusted and that is what is the cause of your problem. For a bearing it needs movement so think of it 96 bearings in our neck and back. How often do we move our neck fully? I know we say yes and no it is shameful to call it as movement. How often do we bend and touch the floor? It is not done every day rather we can count the number of times we have done this from plus 2 days. So if you want to have prevention or looking after your back I think the only the most ideal way is to maintain flexibility move all these bearings every day every day to the full range of movement so that they don't get jammed they don't get rusted. Coming to next person is Rohit Dhyani who is asking how can neck and back pain be prevented? I think I just finished talking about it. I think one of the best exercises to do is yoga because it moves every single joint in the neck and back as well as the limbs. You know there is no other exercise. I think the next closest to yoga is swimming. Other than that say you go for a gym it's only the upper limbs and the cardio or you go to the park for walking. It's only the lower limbs and the heart and lungs which are getting exercise but yoga is a one stop solution and next best is swimming. He also asks Rohit is asking can lifting normal weights also cause spine pain? It is not normal weight or heavy weight or light weight. It is just that if you are stiff you have a propensity to break. Anything can break even I have patients coming with a small mug of water they lift and they get a catch in their back. So it is the stiffness which gives you a propensity to breaking your back muscles ligaments or discs. Next Samaraj is asking when should I see a doctor for pain? I really can tell you that you don't have to rush to a doctor just because you have first episode of back pain today morning. I think you wait have patients have faith on your body that nature heals. Nature heals. Nature used to heal even when there were no doctors and nature will heal even today and it will heal even in the days to come. So after all the scientific advances we today conclude that it is the nature which heals not the doctor, not the physiotherapist, not the massager. And the main problems that we have today for nature to heal is we are impatient because nature would take maybe three days if it is a small injury, three weeks if it is a medium scale injury or three months up to three months if it is a major injury to your back. Now how often have we patients to wait for three months? Of course not. We would have changed 30 doctors in three months. So we keep changing doctors and hospitals trying to get a faster remedy and honestly speaking trust me when I say that the last doctor would get the credit nothing that he needs to do. So I pray God every day that let me get patients who have almost come to the fag end of natural healing and let me get the credit. So I really feel that it is better if you wait for seeing the doctor as much as you can unless there are specific things like you are involved in a road traffic accident and having a back pain. Please do see a doctor because you need to rule out some fractures because it's a high energy injury or if you have elders in your house, old people who are having osteoporosis and they have a slip and fall in the bathroom, you see a doctor or if there are patients with cancer or patients on steroids for some other reason. You know that their bones are not as strong as a young individual's bones and if they have a small trivial fall also I think you need to take them to the hospital or a doctor to make sure that there are no fractures being missed. Now the other aspect is talking about children. Children if they complain of back pain I guess it needs to be taken too seriously because children always complain only when they have either infection or tumor in their spine. And we do all the tests possible as doctors, all the tests possible to rule out infection or malignancy. Rest all can wait at least for three weeks before they go and see a doctor and before they even go to do an x-ray. Forget about MRI, we are talking about only x-ray and if after three weeks the protocol that we follow rather I follow and most of these spine specialists across the world would follow is three weeks of back pain we would do an x-ray in a normal man. I am telling you all the exceptions excluded that is old people, people with known cancer, people on steroids or people on our children. So all the rest of the people can wait for three weeks and if they have still got back pain they get to do one x-ray. It mainly excludes some gross pathology in the bones but that's good enough and then you don't need MRI till six weeks of back pain unless you have developed weakness in the limbs or problems in holding on urine or passing urine or motion. Now these are the specific things which really are very important to know if you have weakness in your limbs or if you have lost control over your urine and motion. I guess you need to see a doctor at the earliest, it may be one day with weakness of limbs I think you need to see a doctor because there may be a chance that a nerve is pressed and you need to release that nerve by surgery or injection or whatever it is. Sawik is asking how females can get rid of spinal problems especially housewives. I don't know whether we have to call them as housewives nowadays they are also homemakers but anyway not getting into controversy. Females are also human beings like men. I don't think there is a different treatment for females rather I would say that they have, first of all you know most female homemakers would be very stressed out because they are working 24 by 7 without a break. The working men may be having Saturdays and day off but these ladies are working all through the week, 7 days a week and 365 days a year. I think they deserve a break, a selfish break wherein the husband should take care of the child and wife should do what she wants out of her life, her personal interest rather than all the time looking after the house and the household work and the family. I think I would say they need a break once in 6 months at least a week husband has to take off from work and give wife a break from her daily routine which may be very frustrating for her and she may not be able to cope up and stress building up also causes small little aches and pains in the body to be perceived as too much of pain. You know we always feel that okay I have injured my back but you know so many injuries we neglect if we are on vacation, if we are on a party, if we are on a good company. But the same pain if you are totally having a bad time in life, bad time of the day, if you have a small injury you will literally get tears in your eyes and looking at you crying people may think my God such a strong person if he has to cry there should be an injury. And you will also be wondering that may be this kind of injury has never hurt me so bad but today it has hurt me so bad. So it may be the stress which is multiplying or amplifying your pain perception and also not letting you understand that it is because of the stress that you are feeling the pain more than normal. So there is nothing specific about house wise other than maybe you need to give them a break maybe once in 3 to 6 months. How is back pain diagnosed? You asked me you have to come and sit with me on a Saturday morning till evening you will get hundreds of people with back pain with different descriptions. So we don't neglect them but you know each one's pain is unique and diagnosis is most often based on what they speak, how they speak, what is the distribution of pain. It is purely clinical in the sense a doctor should have a reasonable understanding of the patient's pain distribution, pain pattern and pain duration and we can actually come to a diagnosis. In 90% of the diagnosis is made in just listening to the patient how they talk about the pain from where to where, how long and other things. And remaining 5% is on examination quickly we ask them to bend and touch the floor, bend backwards, bend sideways, twist on both the sides. We ask them to heal walk to walk to see if there is a weakness in the limbs. So all this done quickly I think you have a reasonable 95% of your mind is set on one particular diagnosis and the investigations like X-ray and MRI are only adding up to the last 4 to 5% we are never sure 100% in any case. So we are only nearing 100% we may be 99% correct by whatever tests or whatever investigations that we have but you don't need investigations in 90% you just have to listen to the patient. 5% you need to examine the patient and remaining 4 to 5% you need to investigate by X-ray and MRI. MRI is a very sensitive tool it picks up all that you need to necessarily see or not see. It will show you more than necessary things so it can actually scare you to a large extent but it is also the gold standard. Like if I have to do a surgery I can't do it without a MRI showing me which surgery to do, which direction to go, whether it's anterior, posterior, whether it's only a decompression, whether it's a dyskectomy, whether it is a fusion or whether it is a micro dyskectomy or a laser surgery. So everything can be planned depending on what the MRI shows me and whether it correlates with the patient's symptoms. So that's how we diagnose back pain. What's the difference between acute and chronic back pain? Acute pain is acute less than 3 months is the cut off that we give usually. So anybody having less than 3 months of back pain is acute back pain which wherein we say that there is a good 90% chance that nature can heal it without doctors. Where in chronic pain is wherein somebody has suffered for more than 3 months wherein he's not become alright with or without doctors, with or without physio, without massages. And we feel that they need treatment, they need diagnosis, they need maybe intervention. Interventions can vary with respect to back pain. It can be an epidural steroid injection or a facet joint block or a transforaminate nerve root block or sacroiliac joint block. There are a lot of pain generators and you can direct your injections to the particular pain generator wherein you numb that area so that the pain is taken care of. Although this may be a short lived glory but you know it may give a ray of hope to somebody who is suffering for more than 3 months. You know pain is something that you cannot neglect and you need to get pain out of the body because if you don't, if you let it become really chronic like say 1 year, 2 year, it is like a bad marriage. Neither can you live with your wife nor can you leave her. So it is better that you don't let any acute back pain become chronic that is 3 months is the cut off. How is back pain treated? So like I said we have options of just waiting and watching how it behaves. If there are indications for surgery, surgeries are available but the indications are only 3 for surgery. One is if you have weakness of limbs or if you have bowel and bladder involvement or if you have functionally disabling pain for more than 3 consecutive months. These 3 are the common as maybe 95% of the time back pain is treated by surgery with these 3 indications for surgery. I have a patient a person by name Vinay Agarwal asking me this question about I have a L5S1 disc relapse, walking, driving, cycling makes me makes my pain worse, living a restrictive life what should I do. It depends on the duration of back pain. I don't know why you already are talking about disc relapse because once it is driven into your head it is very difficult to get it out of your head. Because it is a visual picture wherein you see that your disc has come out and it is pressing on your spinal cord or the nerve roots. How do you know your grandfather didn't have a slip disc or a disc relapse? He didn't have. He also used to have back pain, leg pain on and off but he used to wait it out and once things are... It used to go off on its own because he didn't have time, he didn't have money, he didn't have doctors like Vidyadhar, he didn't have hospitals like Manipali, he didn't have technology like MRI to prove that it is a disc relapse. So it used to go off in 3 days, 3 weeks or 3 months and he was a happy man till 80 or 90 years of age. Today we have these 4-5 bad things, time, money, doctors, hospitals and technology. We go searching for problems the more we search the more we get. So we have labelled ourselves as having slip disc, spondylolisthesis, 50% block of coronary arteries. You know we need not know all these things and I feel sad when people label themselves and walk around saying that I have a slip disc, I have a slip disc. I think you should get it out of your body, keep the MRI in the locker. Unless it is really troubling you, then you get it out, sort out the problem by whatever is the intervention that is required. If you have weakness of limbs, you get a surgery done and get rid of the problem. If you have functionally disabling pain, you try some interventional injections, pain targeted injections of steroids into epidural space of acid joint block or sacroiliac joint block so that you can do what you want to do like walking, driving, cycling without pain or even a surgery for that matter. Or there is no question of in today's world living a restrictive life. I would say first 3 months, don't do something that hurts you more, hurting is equal to increasing the injury before it has healed. Rather than after 3 months I think you need to go aggressively, take the help of science and technology, pinpoint the problem, get rid of the problem so that you can lead a carefree life. I don't think you have to give up anything. Priyanka is asking, I am 7 months pregnant and my back is very sore. I can't walk or sit or sleep without it hurting. Will it go away? Priyanka, it's very clear today that there is no indication for bed rest on pregnant ladies. Although in India I always believe that bed rest has become the 5th largest religion. After Hindu, Muslim, Christian, Sikh is bed rest. Anything and everything, lagao bed rest and I, both patient and doctor is happy. Whether somebody is pregnant, normal delivery or caesarean, people love taking bed rest because they feel cared. But what happens over a period of time is we put on more than necessary weight and we are so stiff that everything starts hurting. Whole body and then whole back, everything hurts and ultimately we are deconditioning our body. So today the recommendation is whether you are pregnant or not, whether you are delivered recently or not, you need to take up exercises. You need to be looking after yourself, looking after movement of every single joint and yoga is very strongly recommended even in pregnant ladies. So don't get up from your bed, do exercises, I think your soreness of back would go. And there is no indication to take pain killers because they are just killing pain, not the underlying problem. I hope I have answered your question. Sushmita is asking, my mother fell and cracked a vertebra. She has osteoporosis. She was given a brace but it doesn't seem to be helping. Is there any treatment for this? Priyanka, the bed rest for a fractured spine was a historical treatment. Today we have a lot of interventions where in not surgeries per se, under local anesthesia you can inject bone cement into the fractured bones. And it's a daycare procedure wherein you inject the bone cement and instantly following the procedure, two hours later patient walks with 75-90% of pain relief. And it is such a relief that patient will thank you for the rest of their life. Now older school of thought was brazing and vitamin supplementation and waiting it out for three months. But now with these interventions in place and these approved stuff, I guess the vertebroplasty and kyphoplasty procedures which you can read up in Google are the in things and they are game changes with respect to treatment of osteoporotic fractures in true sense. Putting somebody on bed because of a vertebral fracture can cause severe osteoporosis because person who is vertical the gravity works and the body forms bone. Whereas if you eliminate gravity by putting somebody on bed, the bones become weaker at double the pace. So it is not good to be on bed or restrict your activities when there is a fracture. I would strongly suggest you to take up your mother for a vertebroplasty or kyphoplasty procedure in trained hands. Of course this is not to say that you should not treat osteoporosis. Osteoporosis needs treatment but fracture treatment takes a priority and then you follow it up with osteoporosis treatment. Subarna Biswas is asking what causes spinal stenosis. Spinal stenosis is a chronic condition which comes with age. Here patients will not have much of back pain. It is more to do with leg pain, leg numbness, leg tiredness, feeling in your legs, either one leg or two legs or whatever. So you feel your and this is typically more on standing and walking and patient is very comfortable if he sits for two minutes. Again he can walk for another 100 meters. Again he has to sit. So this keeps going on. This is called as spinal canal stenosis. Wherein there is a concentric reduction in the space available for the spinal cord and the nerves going down the legs. And this is age-related phenomenon. If it comes in the way of day-to-day activities of people, I think they need to get treated by a specialist. And this is age-related stuff. It has nothing to do with what you did in your childhood or what you didn't do. Reshma is asking what are the precautions required immediately after spine surgery. Reshma, the main thing is if your surgery is well done, I think there is no reason to be very cautious. Although first one or two weeks we always advise the patient not to bend forwards, not do lift weights because it hurts your back, wherein we have put these stitches. Whether they are absorbable stitches or not, but ultimately they all hurt. So we ask them to avoid things that hurt them more. Rather once the wound heals, the muscles may still be hurting for a month or two or up to three months. But after three months we really don't have any restrictions. Rather we want people to do more. We want them to do Surya Namaskar so that they get back the flexibility that is required for every human being. Sushant is asking what are the symptoms of spinal stenosis? I just answered this. Basically it is the tingling numbness in the lower limbs, tiredness, fatigability in the lower limbs, less of back pain. Preeti Menon is asking how is spinal stenosis diagnosed? Spinal stenosis is a diagnosis by listening to the patient. They say what I was talking to you about, you know that there is a spinal canal stenosis and if the patient has suffered for more than three months, we always get an X-ray to prove that there is no bony instability like spondylolisthesis, which is causing the spinal canal stenosis. Or we do MRI to see whether it's a central spinal canal stenosis or a lateral spinal canal stenosis. This is diagnosed by combination of clinical history, examination and X-ray and MRI. Jayashankar is asking what are some of the non-surgical treatments of spinal stenosis. One of the most important things are if it is acute setting, I think people can take help of nerve root blocks, transferaminal nerve root blocks or even the epidural steroid injections or facet joint blocks if it is coming from the facet. If things don't improve and their walking capacity has not improved to an acceptable limit, I guess there are minimally invasive surgeries which can be either a micro-diskectomy or a micro-decompression, limited internal decompression, bilateral foramenotomy depending on the case, depending on patient symptoms and the MRI correlation we decide on which surgery to do. These are all very minimal invasive surgeries wherein they also are like you need to stay in the hospital for two nights and one day and four hours after the procedure you can walk on your own. And a typical one-level decompression, micro decompression, would have a scar of around two and a half to three centimeters. Mukesh is asking when should surgery be considered and what is it involved? Mukesh, like I said earlier, indications for surgery even in lumbar canal stenosis are the same. One, if the patient has got weakness of limbs. Two, if they have lost control over urine and motion, either passing or holding the urine and motion. Or three, if they have functionally disabling pain or numbness or weakness for more than three consecutive months. It is because three months is the cut-off for nature to heal and if body has not healed, I guess you have to resort to surgical intervention. And I have talked about surgeries like micro decompression. Basically spinal stenosis is compression on the neural elements. So the surgery's principle is revolving around decompression. If it is central canal that is compressed, you remember the ligament and phlegm and digum, if it is the lateral foraminal compression, then you do a opening up of the foramine by undercutting the facet joints. So these are technical, I don't know whether you will be able to understand me when I say this. What is the technical advancement or recent research being conducted on spinal stenosis? This is Amit Bhandari. Research is plenty and lot, but there is nothing path-breaking or revolutionary as of now other than what is the standard of care in patients with lumbar canal stenosis. Basically surgery is, one of my teachers used to say, when you want to give up, it is surgery. If you can heal it with one injection forever, I think that will be a path-breaking or a mind-blowing research outcome, which is yet to come, we don't have it as of now. What are the long-term outcomes of surgical treatment for spinal stenosis? Rupesh Kumar is asking me this question. Rupesh long-term depends on less dependent on surgeon, more dependent on the patient, because surgeon can be doing the best of his jobs, but if patient doesn't understand that he has to also contribute in the well-being of his back in the long-term, it is not going to work out. So you need to exercise so as to get a long-term outcome which you can lead a normal life, not mere normal, you can be as normal as anybody else. People are getting into professional careers even after spinal surgeries without much of hassles. In fact, after a major surgery like scoliosis, today we have the brand ambassador of scoliosis research society, Ms. Stacy Lewis is the world number one golfer. So she is the brand ambassador having undergone a major spinal deformity surgery. So if she can be world number one, I don't think you need to restrict yourself with any sporting activity after a spinal surgery provided the surgery has been well done by qualified people. Shoaib Shaikh is asking what are the side effects, potential risks and potential complications of surgery? Shoaib surgery has two components, one is the anesthetic risk, the surgical risk. The anesthetic risk is dependent on the preoperative comorbidities that the patient has, whether patient is a diabetic, hypertensive, whether patient had a thyroid problem, patient has a cardiac surgery or a cardiac arrhythmia or so many things, whether his liver is abnormal, whether he is in sepsis, whether somebody is having normal mentation or psychological illnesses. So a lot of stuff depends on the medical aspects based on which the anesthetic risk of surgery will become more or less. But having said that, today most of the medical risk can be optimized and if not, we can take extra precautions so that it is optimized and safety levels are nearing 99%. Now the surgical risks are obviously surgeon dependent and also technology driven. With today's technology and a decently qualified and trained and experienced spine surgeon, the surgical risks become less than 1%. Although the commonest for any surgeon, the nightmare is an infection, wound infection can be a dreaded complication and if it happens, you need to take IV antibiotics for six weeks and oral antibiotics for six weeks more. But in rare circumstances with florid infection, you may have to reopen and clean up the wound again so that patient gets a faster recovery. The second complication with respect to spine surgery is neural damage. This may be inadvertent and it is common with people who are not trained in spine surgery and it may be lesser and lesser as the person gets more and more experience in spinal surgeries. Spinal surgeries are quite demanding and if technology is by your side like use of microscope, loops or image intensifiers or navigation or neuro monitoring tools, I guess the safety limit can be as close to 100% as possible. Now you can have lot of other complications which I cannot be able to enumerate here or discuss because it is beyond the purview of this one hour that I am spending with you. Alka is asking, my son is a tennis player and is always busy in training. He often complains of lower back pain. Is it normal for athletes to have a lower back pain? Alka, it depends on the age of the child. If your son is very small, I guess you need to see a spinal specialist. It is not normal for a child to complain of back pain. Even as an adult if he is complaining for more than three months, I guess you need to investigate and see what is the problem so that you have a genuine diagnosis saying that either there is a problem that needs to be fixed or there is no problem. Krithika Rai is asking, what is the best treatment for spinal tumor? Now it depends on the tumors. There are so many tumors which are incidental findings like hemangioma or vertebra is a common finding in MRIs. If you do an MRI, 10 out of 100 people's report will say that there is a hemangioma in L1 vertebra or L3 vertebra or whatever. These can be just left alone and can be watched over a period of years. It doesn't do anything. You will be born with it and you will die with it. But there are some which are benign like osteoid osteoma which can be a very small tumor inside. You can just drill hole and take out the nidus and patient may get completely alright. Or there may be a big tumor like a giant cell tumor which needs complete excision by front and back spine surgery or there may be metastatic bone tumors wherein you may have tumor coming from lung, breast or cervical cancer going into the spine. Now here it depends on whether what stage of the disease it is. If somebody is in stage 4, we may do less so that patient leads a good quality life and the life expectancy may be 6 months to 2 years and we don't want to do too much for this patient. But if it comes to patient's ambulatory status, if he is getting bedridden because of the metastatic disease in stage 4, still we offer surgical help for them because everybody has a right to live independent with dignity till the end. Doesn't matter whether you are going to live for 6 months or 2 years. I guess that's how we decide treatment of tumors and there are some primary malignancies of bone like lymphoma or myeloma or leukemia wherein most of the tumor can be cured with just chemotherapy and you don't need to operate unless there is a pressure on the nerves. I hope I have answered you Krithika. Khushbu is asking, I have a lower back pain for the past one month as I fell down and was told to have a slip disc. Can I sit for long hours in one place like watching movies or going for road trips? Khushbu, human beings are made, custom made by God to work like farmers. We are not custom made by God to sit and watch movies for hours together. You have a right to get up and stretch yourself and sit again if you really want to have a good time for the movie because otherwise you sit for 3 continuous hours and when you get up you will be like, oh my God, my back is hurting. Or if you are going for a road trip, you need to take a break, have some coffee and get going rather than sitting and driving for continuously for 6 hours or 8 hours. So you need to understand that you are not custom made by God for sitting work.