Best Spine Surgeon in India – Dr. (Prof.) Sumiet Snha

A spine operation that does not deliver the expected relief is deeply discouraging. Patients may have spent months in pain, taken time off work and invested savings in treatment, only to find that symptoms persist or return. The term "failed back surgery syndrome" is often used, but it is a description rather than a diagnosis. The essential task is to find out why the result was disappointing, because the answer determines whether another operation will help at all.

Common reasons for a disappointing result

• Recurrent disc herniation at the same level, sometimes months or years after a successful first operation.
• Incomplete decompression - a narrowed area or a trapped nerve that was not fully released.
• Adjacent segment disease - wear and narrowing at the level next to a previous fusion.
• Instability that developed after decompression, or a fusion that did not heal (pseudarthrosis).
• Implant problems such as screw loosening, breakage or malposition.
• Wrong or incomplete diagnosis, where the pain was never coming from the level that was operated on.
• Nerve damage or scarring, which may cause pain that surgery cannot correct but other therapies can ease.

How a revision case is evaluated

Evaluation begins with the full history - the original symptoms, what was done, how the patient felt immediately afterwards and when the problem returned. Old operative notes and pre-surgery scans are very helpful. Imaging usually includes an MRI with contrast to distinguish scar from recurrent disc, a CT scan to assess bone and implants, and standing or flexion-extension X-rays to look for instability or imbalance. Blood tests may be needed to rule out a low-grade infection. Only when the findings clearly explain the symptoms is revision surgery recommended.

Options when surgery is needed again

Depending on the cause, revision may involve removing a recurrent disc fragment - sometimes endoscopically, which avoids dissecting through old scar - extending a decompression, replacing loose implants, extending a fusion to an adjacent level, or correcting an alignment problem. When the main issue is persistent nerve pain rather than ongoing compression, further surgery on the bones may not help, and treatments such as spinal cord stimulation may be worth considering.

Tumours affecting the spine are classified by where they arise, and this classification guides treatment. Some grow from the bones of the spine, others lie inside the dura (the covering of the cord) but outside the cord, and a smaller group grow within the spinal cord itself.

Many benign intradural tumours can be removed through small openings, and selected cases are suitable for endoscopic or minimally invasive tumour removal. Tumours arising from nerve roots overlap with Dr. Snha's work in nerve sheath tumour surgery. For malignant disease, surgery is one part of a plan that may include radiotherapy and systemic therapy, and the goals - pain relief, protecting neurological function and stability - are agreed with the patient and family in advance.

A deformed spine may curve sideways (scoliosis), tilt too far forward (kyphosis), or combine both. In children and teenagers, curves may be idiopathic or linked to congenital vertebral anomalies or neuromuscular conditions. In adults, deformity more often results from degeneration, old fractures, healed tuberculosis or previous surgery. Adults typically complain less of the curve itself and more of back pain, leg pain from associated stenosis, fatigue, and difficulty standing upright.

When is surgery considered?

• A curve that is progressing, particularly in a growing child
• Pain or nerve symptoms not controlled by non-surgical care
• Loss of balance, where the patient cannot stand upright without bending the knees or leaning forward
• Neurological deficit or spinal cord compression, as in some post-tubercular kyphosis

Deformity correction is major surgery. Planning uses full-length standing X-rays to measure global balance, CT for bone anatomy and MRI for the neural structures. Intra-operative neuromonitoring helps protect the cord during correction. Because older patients often have osteoporosis, diabetes or heart disease, medical optimisation before surgery is as important as the operation itself. In some adults, a limited decompression of the most troublesome level may offer substantial relief with far less risk than a long correction, and this option is always considered.

Being told that you need spine surgery can be frightening, and it is natural to want another expert to confirm the advice. A second opinion is not a sign of distrust towards your doctor; it is a standard part of careful decision-making for any major operation. It may confirm that surgery is the right step, suggest a smaller or different procedure, or show that further non-surgical treatment is reasonable first. In each case, you proceed with greater confidence.

When a second opinion is especially worthwhile

• You have been advised a fusion, a multi-level operation or a deformity correction.
• The proposed surgery does not seem to match your symptoms, or the explanation left you unsure.
• You have already had spine surgery and are now advised a revision.
• You have been told that your condition, such as a spinal cord tumour or CVJ anomaly, carries a high surgical risk.
• You have been told nothing more can be done, but symptoms continue to affect your life.

How to make the most of a second opinion

The quality of an opinion depends on the information available. Send the actual images, not only the written reports, because the surgeon needs to see the scans personally. Include the dates of your symptoms, the treatments you have already tried and how you responded, and the exact procedure that has been proposed. Write down your questions beforehand - for example, what happens if you wait, what the realistic benefits are, what the main risks are and how long recovery will take.

Dr. Snha offers preliminary opinions on reports shared by WhatsApp or email, and more detailed video consultations for patients across India and abroad. Where the case is complex, he may recommend an in-person visit, additional imaging or specific tests before giving a definite view. His aim is to give an independent, clearly explained assessment - never to criticise another doctor, but to help you understand your options.

High-energy injuries from highway accidents, falls from rooftops and trees, and diving into shallow water can fracture or dislocate the spine and injure the spinal cord. Many such patients are first treated at a local hospital and later transferred, or referred for definitive care once they are stable. As President of the Neurotrauma Society of India, certified ATLS faculty and a former Professor at AIIMS, Dr. Snha has long experience of both the emergency and the reconstructive phases of spinal trauma care.

Priorities after a serious spinal injury

• Protecting the spine - careful immobilisation and handling from the scene of injury onwards to avoid further damage.
• Early imaging - CT to define the fracture and MRI to assess the cord, ligaments and any disc fragments.
• Timely decompression and fixation - where the cord is compressed or the spine is unstable, surgery restores alignment and allows early mobilisation.
• Preventing complications - pressure sores, chest infections, blood clots and bladder problems are major threats that need attention from the first day.

The extent of recovery depends mainly on the severity of the original cord injury, which surgery cannot reverse. What surgery can do is remove ongoing compression, stabilise the spine and create the best conditions for whatever recovery is possible. For selected patients with injuries of the cervical cord, nerve transfer surgery performed at the right time may help restore some hand and arm function - an area that draws on Dr. Snha's work in peripheral nerve surgery. Associated limb nerve injuries are managed through his peripheral nerve injury service, and stiffness after cord injury may be addressed through spasticity treatment.