2. (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

3. 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

4. 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

5. • 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.

6. 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).

7. 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
microdiscecto my and laminectomy can usually be done with a
minimum amount of morbidity (e.g. post-operative 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.

8. 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.

9. 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 microdiscecto my spine surgery.

10. 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.

11. • 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.

12. 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).

13. 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.

14. 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.

15. • 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.

16. 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.

17. 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
country’s 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

18. 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.

19. 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.

20. 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 hospital’s certifications, type
of facilities and other factors critical in choosing a medical center.

21. 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.

22. 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.

23. 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.

24. 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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