Dedicated to restoring spinal health and functionality, spine centers are specialized healthcare facilities that concentrate their expertise on diagnosing, treating, and rehabilitating conditions and injuries affecting the intricate spinal column. From precise diagnostic approaches to innovative therapeutic interventions, these centers are meticulously equipped to address a comprehensive array of spinal disorders and traumatic injuries with exceptional efficacy, ultimately empowering patients to reclaim their quality of life.
When it comes to seeking the finest spinal care in India, few healthcare institutions can match the expertise and experience of Kauvery Hospital. This pioneering multi-specialty hospital chain, founded in 1999 and headquartered in Trichy, Tamil Nadu, has emerged as an institution of hope for patients struggling with complex spinal conditions from across the region.
Leading the charge of Kauvery Hospital’s widely acclaimed spine program is Dr. G. Balamurali, Director – Kauvery Spine Institute based at their Chennai facility. With over 26 years of surgical excellence under his belt, Dr. Balamurali has established himself as a luminary in the field of spinal neurosurgery.
Underpinned by an undying commitment to affordability, patient-centricity, and cutting-edge medical services, Kauvery Hospital continues to forge ahead as a torchbearer in the field of spinal healthcare. As the institution expands its footprint across Tamil Nadu and Karnataka, its relentless pursuit of clinical excellence positions it among India’s preeminent spine centers for 2024.
Let’s explore the story behind this leading spine center!
Redefining Spine Care through Multidisciplinary Excellence
A rapidly growing private healthcare institution with 10 hospitals across six cities, Kauvery Hospital has garnered success through its personalized care and cost-conscious approach to treatment. One of the few spine centers in the country that boasts a team of neurosurgeons and orthopaedic surgeons working in tandem, Kauvery Hospital offers a unique and almost unheard-of model, even in many parts of the world. Spine surgery demands the expertise of both neurosurgeons and orthopaedic surgeons, and Dr. Balamurali’s training in both fields has enabled him to lead a team comprising specialists from both disciplines, united by a common goal of delivering the best possible outcomes for patients.
The spine department at Kauvery Hospital stands out as one of the most unique features of the institution. The dedicated team, equipped with advanced equipment, focuses solely on providing comprehensive spine surgery care. They actively engage in academic pursuits, documenting their work and outcomes, publishing data in journals, and conducting academic training programs throughout the year, including lectures, live surgeries, and various practical workshops.
The department offers a comprehensive spectrum of spine surgery services, ranging from treating newborns with neurosurgical problems to adolescents requiring major orthopaedic deformity correction, and elderly patients in need of specialized care. “Everything that is possible to be done in spine surgery is performed at Kauvery Hospital, which is seen in very few hospitals in the country,” asserts Dr. Balamurali. “We are very young and just 10 years old, but we have a very strong base to go further with the addition of more members to form a big group practice.”
A Neurosurgeon’s Journey
In his journey as a trainee neurosurgeon, Dr. Balamurali who trained in the UK and USA for about 14 years, found spine surgery to be one of the most challenging areas, requiring skills that necessitated extensive training and prolonged surgical hours. He realized that to become a successful spine surgeon, one should have a background in both neurosurgery and orthopaedic surgery. Having decided to pursue spine surgery, he underwent training partly in orthopaedic principles and techniques, enabling him to perform 360 degrees of spine surgery, which is typically done separately by neurosurgeons and orthopaedic surgeons.
Among all surgical specialties, neurosurgery is considered one of the most complex and challenging. Spine surgery is an evolving specialty because back and neck pain are increasingly prevalent in the public, affecting individuals from a young age due to lifestyle problems. In spine surgery, Dr. Balamurali found areas that were not receiving sufficient attention, including paediatric spine surgery, pain-related spine surgery, and various functional spine surgical problems.
“Since there was a lack of experts in spine surgery during my period of training, I chose to take up this very challenging field,” he recalls. “Within this, I spent many years doing fellowships in the UK, USA, Canada, Germany, and Switzerland in order for me to get trained in Minimally Invasive, Endoscopic, Paediatric and Complex deformities Spine Surgery.”
Personalized Care—The Cornerstone of Dr. Balamurali’s Practice
One of the crucial factors in Dr. Balamurali’s practice is the personalization of care tailored to each patient’s specific problem. Personalizing care involves the patient’s experience from the moment they enter the hospital until their discharge. This encompasses proper assessment, timely appointments, providing a comfortable environment, effective communication, furnishing printed information, and establishing a proper follow-up plan after discharge.
“When it comes to the treatment plan, patients are given clear information about their procedure, how it is performed, who will be performing it, the timing, and the risks, benefits, and complications of the procedure,” notes Dr. Balamurali.
Most patients are apprehensive about undergoing surgical procedures, especially those involving the brain and spine. Due to negative online and media information, many people perceive spine surgery as unsafe and tend to postpone addressing their issues until they become severe. To alleviate these concerns, patients require reassurance, proper explanation, and clear communication about the risks and benefits involved. Dr. Balamurali’s team also connects patients with consent to former patients who have undergone similar procedures.
He further emphasizes, “I think proper clear communication and personalized care are the keys to success in our practice. We provide a lot of information in digital and print formats in different languages for patient awareness and post-operative care.”
Cutting-Edge Technology for Safer Spine Surgeries
As one of the premier hospitals in the country, Kauvery Hospital is equipped with all the necessary equipment to perform safe spine surgery. Most surgical specialties have evolved due to advancements in technology coupled with the expertise of the surgical team. Dr. Balamurali shares, “In Kauvery Hospital, we perform Minimally Invasive Spine Surgery, Navigation-assisted Spine Surgery, and Endoscopic Spine Surgery in patients ranging from newborn babies to individuals in their nineties.”
In spine surgery, one of the key features is safety because most patients present with pain, disability, and loss of function. To achieve safe procedures, accuracy is required in locating the problem area, placing various implants like screws and rods, and performing corrections without causing harm to the patient’s function. Visualization and elimination are also crucial, as surgeries are performed through small endoscopes and tubes to reach the problem area within the spine.
To meet these demands, Kauvery Hospital has specialized equipment such as Navigation systems, Minimally Invasive equipment, endoscopes, CUSA (Cavitational Ultrasonic Surgical Aspiration), microscopes, high-speed burrs, neuromonitoring, “O” arm and various other micro-instruments and gadgets.
Mastering Complexity
Spine surgery is a highly complex field, and the team at Kauvery takes several key steps to approach these challenges. One crucial aspect is discussing complex cases as a group, where joint meetings are held involving the surgeon, radiologist, and neurologist to arrive at a clear diagnosis. Advanced investigative opportunities, such as CT, MRI, angiography, and neuroelectrophysiology, are utilized to identify the exact problem.
Preoperative planning is meticulously carried out with the anesthesia team for complex cases, and no surgery is refused due to its complexity or the patient’s comorbidities. Intraoperatively, during surgery, all safety monitoring mechanisms are in place to perform safe spine surgery, forming a key part of their best outcome approach. The surgeries are performed by an entire team comprising orthopedic and neurosurgeons, with neurophysiologists monitoring the spinal cord and excellent neuroanesthesiologists.
When complex surgeries are performed, the operative team not only includes advanced gadgets but also highly skilled and well-trained theater technicians and nurses who have been trained by the team over an extended period. Postoperatively, a separate ward dedicated to spine surgery ensures that nurses and the team provide specialized care. This comprehensive approach, encompassing preoperative, intraoperative, and postoperative care, contributes to the success of providing excellent outcomes in complex surgeries.
A Collaborative Teamwork for Comprehensive Care
The success of any healthcare system hinges on the effective collaboration of multidisciplinary and intradisciplinary teams. Dr. Balamurali shares, “At Kauvery Hospital, we have both intradisciplinary and multidisciplinary teams.” The intradisciplinary team consists of surgeons, spine specialist nurses, spine physician assistants, spine team secretaries, and managers for academic and clinical work. The theater team comprises scrub nurses, technicians, and an excellent spine rehabilitation team consisting of physiotherapists, occupational therapists, speech therapists, and psychologists.
Moreover, Kauvery Hospital has a strong multidisciplinary team, with regular meetings involving neurologists, radiologists, interventional specialists, spine surgeons, orthopaedic, and other surgical teams when necessary. Dr. Balamurali believes this forms a key to the success of their practice, as they have established international standards and standard operating procedures (SOPs) for collaboration within these teams.
By fostering seamless coordination between intradisciplinary specialists and leveraging the expertise of a multidisciplinary team, Kauvery Hospital exemplifies collaborative excellence in delivering comprehensive and patient-centric care. This approach not only enhances the quality of care but also ensures that patients receive the best possible outcomes through a well-orchestrated effort by various healthcare professionals.
Embracing Evidence-Based Practice and Continuous Learning
Kauvery Hospital places a strong emphasis on documenting all patients’ surgical outcomes and measuring their improvement through various metrics. The team performs very rare operations in children and for pain procedures, which are then documented, published, and disseminated at various conferences, both national and international, as well as regularly published in journals. Kauvery Hospital strongly positions itself as an academic institute, conducting monthly teaching and training programs both internally and externally through lectures, workshops, and live surgeries.
“Through an International Spine Academy (iSpine) founded by us, we run regular academic programs throughout the country. We have fellowship programs with more than 40 fellows who have been trained by us through short-term fellowships, both from India and abroad,” highlights Dr. Balamurali.
Regular teaching programs are conducted for the hospital’s paramedical staff within the team. Kauvery Hospital embraces evidence-based practice and develops Standard Operating Protocols (SOPs) for all common and rare surgeries. It is through this continued learning exercise that the team stays updated with their knowledge and skills, as the entire team attends various workshops to upskill in new techniques, new technologies, and current best practices around the world. Dr. Balamurali believes that this commitment to continuous learning and evidence-based practice is one of the biggest contributors to their successful surgical outcomes.
Leading the Way in Advanced Spine Surgery Techniques
As the field of spine surgery continues to evolve, Kauvery Hospital remains at the forefront of adopting the latest advancements. Dr. Balamurali shares, “Currently, the most advanced techniques we have are minimally invasive spine surgery, including surgery through small tubes, and endoscopic spine surgery.” Robotic spine surgery is an emerging field that is currently quite expensive, but Kauvery Hospital is in the process of acquiring one of the most advanced intraoperative navigation systems for the future.
Pediatric spine surgery is also an emerging area, and Kauvery Hospital regularly performs these procedures on children with low birth weights as low as 1.2 kg. The hospital also boasts advanced neuromonitoring systems, where a specialized team of neurophysiologists monitors the spinal cord to prevent any damage during surgery. This level of monitoring is not commonly available in most hospitals in the country, but Kauvery Hospital routinely employs it for all complex operations.
Furthermore, Kauvery Hospital performs pain procedures such as spinal cord stimulators, baclofen pumps, selective dorsal rhizotomy, dorsal root entry zone rhizotomy, and various other pain procedures that are not routinely performed in the private sector. These complex and challenging surgeries require the most advanced technical skills and equipment, which Kauvery Hospital is well-equipped to handle on a routine basis.
Achieving Exceptional Success Rates through Expertise and Transparency
Spine surgery has undergone a remarkable evolution over the past two to three decades, emerging as a rapidly advancing field. However, in India, it remains an area with immense potential for growth and development. Due to suboptimal outcomes in the past, a lingering myth persists among the public and medical community alike, casting doubt on the safety and efficacy of spinal procedures. This misconception often leads patients to delay seeking surgical intervention until their condition becomes critically severe, a perilous approach that only compounds the complexity of the required treatment.
Transparency regarding success rates is crucial for the public and patients to make informed decisions. With a sense of pride, Dr. Balamurali shares, “We are very proud and happy to say that our success rate is more than 98%. We are very clear and realistic in setting goals for the patients for their surgical procedures.”
At Kauvery Hospital, they understand that surgery carries potential risks and complications. They believe in clearly explaining these risks to patients and providing realistic expectations about the possible outcomes. While the majority of surgeries have low risks, even for complex procedures, due to the expertise and training of the team, as well as the availability of advanced equipment and gadgets that enable safe spine surgery, there are certain high-risk procedures that may have complications.
Dr. Balamurali emphasizes, “Until the patient is very clear about such risks, we do not operate on them. I would say that in our practice, the risks of paralysis or any major complications are less than 1%, and in 99% of cases, we have good to excellent results in our patients. This is because of our patient selection process, expert team, advanced equipment, safety protocols during procedures, low infection rates in our hospital, and the excellent administrative team that ensures patient satisfaction.”
Choosing the Best Spine Surgery Care
For those considering spine surgery and seeking the best hospital, surgeon, or surgical team, Dr. Balamurali shares some crucial aspects to consider:
- The surgical team should have dedicated specialists who operate solely on spine surgeries. At Kauvery Hospital, they have been performing only spine surgeries in their department for the past 10 years, and Dr. Balamurali has over 25 years of experience performing solely spine operations.
- The team should consist of both neurosurgeons and orthopedic surgeons who can manage the entire spectrum of spine surgeries, from orthopedic to neurological problems. This combination of orthopedics and neurosurgeons brings together different skill sets, training, and expertise. At Kauvery Hospital, apart from Dr. Balamurali, the team includes Dr. Keerthivasan P (Orthopedic & Spine Surgeon), Dr. Soma Sundar S (Orthopedic & Spine Surgeon), Dr. Dilip Chand (Spine & Orthopedic Surgeon), and Dr. Arun (Neurosurgeon).
- A dedicated spine team has a clear focus on the problem, planning during surgery, and post-operative care. The entire team understands all the medical and non-medical problems faced by patients with spine issues. Excellent post-operative rehabilitation is essential, and Kauvery Hospital works closely with HAMSA Rehabilitation, which is part of the spine team and provides post-operative rehabilitation for patients requiring surgery and specialized programs for back and neck pain rehabilitation for those who do not require surgery. Home therapy is provided for local discharged patients, and online therapy is available for those from out of town.
- Clear standard operating procedures (SOPs) and guidelines following international standards are essential for any upcoming spine team to stay updated with current knowledge and evidence. Kauvery Hospital has an excellent academic program with weekly and monthly meetings where they discuss complex cases, problems, and challenging scenarios.
- It is important to understand the safety mechanisms in place during surgery. At Kauvery Hospital, they have all the necessary safety mechanisms, including accurate gadgets like navigation systems, O-Arm, and ultrasonic curators, as well as neuromonitoring with the help of a neurophysiologist present in the operating theater.
- Excellent post-operative care with an ICU and neuroanesthesiologists is essential for achieving good outcomes in complex operations. Lastly, the entire team focuses solely on spine operations, and their experience grows day by day by operating on the same problems rather than having someone who performs spine surgery occasionally.
- A dedicated team of nurses, physician assistants, physiotherapists, and administrative managers is necessary to arrange appointments, admissions, and follow-ups, as well as to answer all queries before and after surgery.
- Paediatric Spine Surgery needs a special team involving Paediatric anesthetist, Neonatologist, Paediatrician, Neonatal & Paediatric ICU. Our team manages children with low birth weight who need spine surgery.
