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Most people have at some point in their life experienced back and neck pain from mild pain to excruciating pain that leaves you in bed. From bad posture to injuries and neglect, the causes are manifold. Most people avoid seeing a doctor and self treat which can actually worsen the situation. Being told that you have a spinal disorder is also a worrying and stressful experience. The best way to reduce your fears and concerns is to gain a better understanding of your condition. Below we have spoken with Dr Gaurav Raj Dhakal to address the most common spine conditions and provide an informative explanation of the condition, symptoms and possible treatment options.

Dr Gaurav Raj Dhakal completed his clinical spine fellowship from India and advanced spine training from Columbia University, New York Presbyterian Allen Spine Hospital; Miami Children’s Hospital, Florida; Riley’s Hospital for Children, Indiana. He is a Spine Surgeon and Associate Professor at National Trauma Center, Bir Hospital, National Academy of Medical Sciences, Kathmandu.

gaurav-raj-dhakalWhat are the common spine problems patients present to you with?
The commonest problem is back and neck Pain.

Back and Neck Pain seems to be endemic in our patient population. What do you think may be the reason?
A majority of the pain is lifestyle and work related. Improper posture, long office hours, sedentary lifestyle, maximum time in front of the computer, work that require bending, lifting weights and students carrying heavy bags, studying in bed rather than at a desk.

Is it necessary that patients with back and neck pain present to a spine surgeon early?
80% of back and neck pain are benign in nature and are treated with a course of medications, physiotherapy and counselling on lifestyle and work modifications. However, in 20% of patients the pain maybe pathological and of serious reasons. Therefore, it is important that patients are investigated early and proper treatment is initiated.

What are the other spine problems?
Deformity of the spine, in which, the spine is bent, crooked, deformed which is called scoliosis or kyphosis. Degenerative disorders such as spinal stenosis, disc herniation. Slipped vertebrae called spondylolisthesis, spinal tumors, spinal injuries and spinal infection.

What are the symptoms of spine problems?
Patients present with back and neck pain. The pain can radiate to the leg or arm and hand. There may be numbness or paresthesias of the hands and feet with or without weakness. In infective cases, fever maybe present and in spinal tumors, patients present with severe back pain, loss of weight and weakness of the limbs.

Gaurav-dhakalWhat should a patient do?
It is important to visit a spine surgeon in the early stage rather than ignore the pain and present late.

Can you tell us about the Spine Unit at National Trauma Center, Kathmandu?
The Spine Unit has been created at National Trauma Center to provide specialised spine care to patients with spine problems. Over the last calendar year, we have performed 100 major spine surgeries, which is a milestone! The spine unit provides optimum spine care irrespective of financial status. Being a government institution, spine surgery is being performed at one-fourth the price than what private centers are charging and in special circumstances, the costs are highly subsidised.

Isn’t spine surgery a highly sensitive specialty with plenty of risks?
Every surgery is associated with a risk. The same exists in spine surgery also, however, with the support of our skilled anesthetists, nursing staff and equipment at our disposal, risk is minimised.

Technology wise, is National Trauma Center at par with other centers abroad?
Yes, we now have the latest neuromonitoring system. It is a computer based software program that warns us of nerve or neurological injury during spine surgery and based on it we can take precautionary measures. This technology helps us minimise risk of neurological injury. We are the first hospital in the country to acquire this technology. We also, have the facility to take X ray of the whole spine in a single film. In addition to these, we now have the equipment to perform minimally invasive spine surgery. In summary, we are the pioneer in the country to acquire and use the latest spinal equipment.

The future of Spine Surgery in Nepal
Personally, I strongly feel that the nation’s health is reflected by the status of the government health institutions. As of today, we have established ourselves as the premier spine center in the country catering to an ever increasing spine patient population, performing the highest number of spine surgeries, providing the best spine care at a nominal price. The future looks promising and we, with the support of the vice-chancellor, hospital director, nursing and administrative staff aim to be the best spine center in the South Asia!