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Diagnostic X- Ray
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MRI SCAn report. There is a partial fusion of C5 C6 VERTEBRAL BODIES. C6 C7 BROAD BASED LEFT posture LATERAL DISC PROTRUSION is noted INDENTING the THECAL SAC CAUSING LEFT NEURAL forminal & impinging LEFT C7 Existing NERVE ROOT. What's the cure for this. Will physical therapy help?
Most commonly known as a military neck a straight or forward curve of the neck is abnormal and may cause an unkind progression of symptoms leading ultimately to cervical disk degeneration.
Reversal of cervical lordosis explained
The anatomy of the neck features a lordotic curvature in its typical and healthy state. This means that the cervical region has a gentle curvature with the open end of that curve facing the rear of the body. The base and top of the curve will be further posterior than the mid point, which will be further anterior.
When the lordosis is straightened, the neck becomes more upright and linear. This is more common than the next progression of atypical curvature, which is the subject of this article.
Actual reversal of curvature means that part or all of the cervical spine develops a kyphotic profile, with the open end of the curve facing anteriorly. Usually, this reversal is extremely mild, but is still very abnormal. What we now see is the middle of the curve being positioned posterior to the top and bottom.
In essence, picture the letter c and now turn it backwards: This is the shape of a reversed cervical lordosis.
Reversal of cervical lordosis causes
The spinal curvature in the neck is constantly in flux to some degree.
Congenital conditions and developmental conditions can have lasting effects on the natural degree of curvature typically demonstrated from patient to patient. These circumstances may be explainable due to injury or degeneration, or may be idiopathic:
Scoliosis can affect the normal lordotic curvature in the neck.
Cervical spondylolisthesis is a major source of reversed lordotic curvature.
Severe disc pathologies can facilitate a gradual loss or reversal of cervical lordosis.
Vertebral irregularities, such as wedging, can definitely contribute to lordotic alteration.
Traumatic injury, including vertebral fracture, can create the ideal circumstances for a reversal of lordosis to take place.
Severe neck muscle spasms can actually reshape the spinal curves, although these are usually temporary expressions and not actual structural conditions.
Effects of reversal of cervical lordosis
The neck is designed to curve in order to balance the spine, absorb stress, distribute force and provide proper movement of the head. When this curvature is diminished or reversed, symptoms may result, although this is not an inherent part of any altered lordotic condition.
Patients may experience stiffness and tension in the neck. Pain may be present and may even be severe in rare cases. Neurological dysfunction is possible in extreme cases, since the neuroforamen might not align properly, thereby causing a cervical pinched nerve.
In the worst circumstances, central spinal stenosis in the neck might affect the viability of the spinal cord, possible enacting the most dire of symptoms throughout the body.
Patients will also be more prone to injury, since the normal shock absorption qualities of the typical curvature have been lost.
While all these effects are certainly possible, they are not usual. In fact, a great majority of patients have minor symptoms or even no symptoms at all from mild reversed lordotic curvatures.
The pathology leading to a neck curve reversal (cervical kyphosis shown below right) may be inspired by a multitude of conditions as follows:
Post head injury
Poor sitting/working postures
Congenital spinal curvatures
Degenerative cervical discs (a form of osteoarthritis that can either be the cause of or the result of a cervical kyphosis)
Compression fracture of vertebral body
Infection of the cervical spine
Anatomy: straight vs. Curved
I've always heard that it was good to stand up straight.
stand upright, stick your chest out and hold your shoulders back! otherwise you're going get widows hump.
Are these expressions as familiar to you as they are to me? one might think that having a curved neck goes against what we heard from parents and teachers as we were growing up, but the reality is that there is a little bit a truth in both. Maintaining good posture throughout our lives is crucial to both the health of our spine and vital organs. On the contrary, a special type of curve called a lordosis is a good thing, both in the neck and lower back.
When we look at a person from the back their spine should be truly straight, so that the left and right sides of one's body is symmetrical. However, when we view a person from the side, the front and back of their body is different and this is reflected in a coinciding curvature of the spine. Both the lower back and neck are hollowed out (concave) and the mid or thoracic spine is protrudes (convex). Thus there is an alternation of curves functioning to provide stability, shock absorption and aid in propulsion. A straight spine would be very stiff and not flexible. Imagine the plight of a pole vaulter with an inflexible pole.
Nature's design of our spine and rib cage facilitates breathing and offers protective and supportive framework for vital organs. Spinal disks are shock absorbers and because they are in the front of the spine, lordotic curvatures keep them from having to bear weight. Kyphosis or loss of such curvatures bears weight upon the disks, leading to their ultimate degeneration. This process of deterioration is a form of osteoarthritis and in the spine is known as degenerative spondylosis.
Although most physiotherapists or conservative orthopedists can recognize a cervical curve reversal upon viewing the patient's posture, a definitive diagnosis may be obtained via a standing lateral (side view) x-ray of the neck. Cause can often be determined by corroborating a comprehensive history, a thorough examination, x-rays and questions about sleep, work and lifestyle.
In my professional career I found that the majority of young adults presenting with cervical kyphosis either had a whiplash or were stomach sleepers from an early age. For desk jockeys 40-60 years of age, many hours of sitting with their head flexed forward almost dictates the fate of developing kyphosis. In prior years I considered cervical kyphosis a job hazard for the careers of accountants, attorneys and often teachers because of years spent with their head in a book or paperwork. However, the digital age offers some relief in that respect. A well-planned, ergonomically-friendly office can do wonders for protecting the spine in the sedentary worker.
Treatment for cervical curve reversal (kyphosis)
During my chiropractic practice I had the opportunity to note a good percentage of correction toward a more normal lordosis (noted on x-ray) for 70% of patients under my care. This was almost always consistent with those patients that followed all recommendations and were model participants in their own care. Here is the recommended treat plan:
Spinal manipulation of stiff and fixated spinal segments by a qualified physio
Flexibility exercises for flexion and extension of cervical spine
Resistance exercises for flexors and extensors of the neck
Learn the Alexander technique for maintaining good posture (hint: the basic philosophy is to sit and stand like you were hanging by a string from the vertex of your skull. Liken it to a puppet on a string).
Elimination of stomach sleeping
Avoid standing on your head, although some yoga postures may be beneficial
Use of orthopedic neck pillow while sleeping.
Can disc stenosis be cured permanently? And can the compressed disc become as it was earlier with Pranayam?
1. What are the symptoms of liver disease? When to see a doctor?
Most of the liver diseases present with similar symptoms with some variations. Some of the common symptoms can be loss of appetite, nausea and vomiting, vomiting of blood, jaundice(yellowish discoloration of the eye), abdominal pain, itching, distension of abdomen( accumulation of fluid- ascites), swelling of lower limbs, weight loss, altered sensorium, confusion, and in a late stage- coma.
2. Can liver disease be prevented?
Liver is a crucial body organ which is responsible for processing essential nutrients from the food you eat, synthesizing bile and most importantly removing harmful toxins from the system. To ensure that your liver keeps performing its functions, you need to follow a healthy lifestyle.
Some of the liver diseases are metabolic and hence inherent at the time of birth and manifest later. However, some of the more common liver diseases are preventable like alcohol induced liver disease, fatty liver induced liver disease (NAFLD), Hepatitis A, B and C.
3. What is liver transplantation? What is the average cost of liver transplantation?
Liver transplantation is the treatment for end stage liver disease in both adults and children. In this operation, the diseased liver is removed and replaced by a healthy one. The success rate for the operation is high and terminally ill patient can return to normal lives.
The average cost of liver transplantation is Rs 18 to 20 Lakhs at Sahyadri specialty hospital, Pune Maharashtra. The cost of investigations of the donor and recipient is Rs 90,000. When patients are too sick and require prolonged stay following liver transplantation, the cost of treatment can escalate; hence it is advisable to patients to have the liver transplantation before they develop complications secondary to the liver disease (Cirrhosis).
Most of the patients seek help at a very late stage or referred late to a Surgeon. It is advisable for patients to seek the opinion of a Surgeon at a very early stage of the disease. The patient needs to take medicines for the rest of his life to prevent rejection of the new liver. The cost of medicines and the investigations in the first year is approximately Rs 10-15000/-. The number of medicines and the frequency of blood investigations are much less after the first year of liver transplantation.
The cost of liver transplantation in India is one-twentieth when compared to USA, UK and other European Countries.
4. When should a liver transplant be performed?
When a person’s liver is severely damaged and cannot function properly or complications may develop and liver transplantation should be considered. Conditions like hepatic coma, massive upper gastrointestinal bleeding, and liver cancer is the best treated by complete removal of the liver (cirrhotic liver).
In general, when a patient needs a new liver, the earlier the operation, the higher the success rate is.
Urgent liver transplantation is recommended in patients who have acute liver failure and this could be due to many reasons. The common conditions are Hepatitis B, Hepatitis A, Hepatitis E and drug induced. In such patients, liver transplantation is urgently needed in order to save the life of the individual.
5. What are the advantages/benefits to the recipient of getting a living donation vs cadaver?
A new liver can come from either of the two sources: A living donor or a brain-dead deceased donor.
Living donor transplantation:
It is technically feasible to remove part of the liver from a living person and transplant it to a patient who needs a new liver. The operation has now been done since 1989. Depending on the size matching of the donor and recipient, either the left side (about 35-40%) or the right side (60-65%) of the liver will have to be removed. The liver remnant in the donor will grow to its original size in 6-8 weeks time.
This process helps in an earlier transplantation before the recipients’ conditions deteriorates. It is a planned procedure whilst cadaver liver transplantation is an emergency procedure. It avoids the risk of death while waiting for a deceased donor liver graft(40% overall and 75% for patients in Intensive care units). The survival rate of a living donor transplant is over 90%.
There are risks like complications of the investigations and surgical procedures but the possibility of donor death rate is of 0.2-0.5%. Seventeen donor deaths have been reported in Brazil, France, Germany, Egypt, Hong Kong, Japan, USA and India.
This is well established in the Europe and USA. Unfortunately, the availability of deceased donor liver is not very often in India. Depending on your blood group, you may have to wait for 0 to 6 months before you get a new liver.
During this waiting period, you may develop complications like spontaneous bacterial peritonitis (infection of the fluid in the abdomen) which, if repetitive may produce severe adhesions in your abdomen rendering liver transplantation difficult if not impossible.
It is important for everyone to register for organ donation, so that when we die, this noble act will help many people to lead normal lives. In the Western world the organ donation rate is between 15-18/million population where as in Indi it is less than 1/million.
6. Who can be a suitable living donor?
The most important criteria is that the donation of portion of the liver is done voluntarily. The donor has to be less than 50 years of age, body mass index of less than 25 and is a near relative of the recipient. Both the donor and the patient should have the same Blood group or O Blood group.
Besides, the potential donor should understand clearly that
- The donor operation carries complication rate of 10-15%.
- The recipient is successful in 90-95%, which means that there is 5-10% chance of dying.
- The donation is done out of his/her own wish and without any coercion.
- There is no financial gain related to the act of donation.
- The donor has the right to withdraw at any time without the need of giving any reasons to do so.
7. Which patients are excluded from liver transplantation procedure?
Patients who have cancer in another part of the body, active alcohol or illegal drug abuse, active or severe infection in any part of the body, serious heart, lung or neurological conditions or those who are unable to follow doctors’ instructions are excluded generally.
8. What are the risks to the recipient from the surgery?
The overall success rate of liver transplant is over 94% and the majority of recipients can return to normal activities and achieve 95% of their quality of life which they had prior to liver disease. Since the recipients’ body may reject the new liver, it is essential for them to take immunosuppressive medications and continue follow up at the liver transplant clinic. They will need to continue these medications for life, at a reducing dosage.
The risk for the recipient is the return of the original problem that necessitated the liver transplant in the first place, e.g. hepatitis C, recidivism (return to alcoholism), noncompliance of medications. The other complications that can arise are thrombosis of blood vessels going into or out of the liver, primary or delayed graft non-function, bile duct complications, renal failure and other infections.
9. What are the side effects of having a liver transplant?
After a successful liver transplantation (95% of patients) – the patient is advised to take care of infections and to take anti-rejection medicines for life. The patient can return to normal quality of life and can return back to work in three months time. The patient has to regularly follow up with the surgeon in the first year and later at regular intervals as advised by his doctor. He will require blood tests to determine that his liver functions and to adjust his medications in the beginning and later the tests are infrequent. The patient is advised not to take any herbal or alternative drug treatment.
The transplant patient is assessed regularly for various complications like rejection, infection, narrowing of blood vessels etc., and appropriate treatment is initiated. Post transplantation, he is under the guidance of his doctor throughout his life. Any health problems that do come up have to be investigated and treated, though they are infrequent.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Is there any other possible cure for herniated disc except operation when the patient has started losing power in one leg while other leg is having radiative pain.
The most powerful and amazing organ in our body is the brain. It differs from many other organs of our body not only by its shape, but also by its special type of cell called neurons. When these cells gets affected or dead it can never be reverted or regenerated which is the most exclusive nature found only in brain cells. The cells in other parts of our body has the capacity to regenerate (can be replaced or new one can be grown or produced), but brain cells are exception. Hence any damage to the brain, injury or trauma is really a crucial thing to be considered with utmost care.
Brain surgeries really need skill, proper training, confidence and intelligence to perform this highly complicated and risky surgery.
Brain surgeries are performed to:
- Remove the brain tissues that are grown abnormally
- Aneurysm is clipped to prevent flow of blood cliff off an aneurysm
- Biopsy purpose or to remove the tumour
- Make a nerve free
- Drain the abnormal blood or clot collection or to drain any excessive fluid collection caused by infection.
- To implant artificial electronic device as a treatment for conditions like Parkinson’s disease
- Biopsy: A part of brain tissue is removed for the brain or whole tumour is removed.
- Craniotomy: The skull bone is opened to remove tumour, an aneurysm and drain fluid or blood from infection.
- Minimally invasive endonasal endoscopic surgery: Endoscopic devices are inserted through the nose to remove the lesions or tumour.
- Minimally invasive neuroendoscopy: Similar to endonasal surgery but small incision is made.
- Anaesthesia risks like breathing difficulty, allergic reaction to medications, excessive bleeding or clots and infection.
- Risk related to the brain surgeries are seizures, coma, swelling of brain, infection to brain or meanings, surgical wound infection that intrudes to the brain structures, abnormal clot formation and bleeding.
- General risks include muscle weakness, disturbances in memory, speech, vision, coordination, balance and other functions that are controlled by the brain. If you wish to discuss about any specific problem, you can consult a neurosurgeon.
Extracorporeal Shock Wave Therapy (ESWT) is a highly effective and innovative treatment option in a variety of fields, from urology to cosmetology including orthopedics. This is a non-invasive method that employs high-energy shockwaves to bring about the healing of the affected tissues. It has been found to provide good results for recalcitrant orthopaedic problems like frozen shoulder to certain chronic degenerative or tendon conditions such as Achilles tendinitis (injury of the Achilles' tendon due to overuse) and plantar fasciitis in heel pain.
How does it work?
The procedure is basically an outpatient/ daycare job. It involves the application of a non-invasive probe to the affected tissue. This is followed by the external generation of shockwaves focused on the target area. The shockwaves cause a force to be created that brings about healing. Although it's still not clear as to why this kind of therapy works, the dominant understanding is that shockwaves render an improvement in the flow of blood so as to promote the body to fix and heal itself.
Depending on individual cases, high or low energy waves may be employed. While pain may occur during the transmission of high energy waves and would require short general anaesthesia, low-energy ESWT is carried out without anesthesia.
What problems can this form of therapy effectively tackle?
ESWT can be used to treat a number of musculoskeletal disorders. From plantar fasciitis (heel pain), tennis elbow, shoulder rotator cuff, degenerated tendons (Achilles' tendon) to hip and knee pain, the therapy has been found to reduce pain as well as accelerate healing in individuals.
Complications are very few and far between with this therapy. Individuals who suffer from hypersensitivity or poor sensation in the affected area are usually not recommended this procedure. Even individuals with heart conditions, seizures and open sores need to consult a doctor before going forward with the therapy.
The therapy has also been found to be very effective in bone healing as well as treatment of bone necrosis (a disease that occurs due to permanent or temporary loss of blood flow to the bones). Additionally in place of surgery, ESWT may also be a valuable option for non-healing fractures. In case you have a concern or query you can always consult an expert & get answers to your questions!
Uterine fibroids, also known as leiomyoma or myoma, are benign growths on the uterus, occurring mostly during the years of childbearing. Few of the common symptoms of fibroids are leg pain or backache, constipation, difficulty in emptying the bladder, frequent urination, pain or pressure in the pelvic region, menstrual periods stretching over a week and excessive menstrual bleeding.
Certain genetic changes of the uterus which are different from the ones normally present in the muscle cells of the uterus can cause this disorder.
Substances which help the body maintain its tissues trigger fibroid growth as well.
Family history, excessive consumption of alcohol and red meat while going low on foods such as dairy products, fruits, green vegetables and vitamin D, obesity, usage of birth control pills and early onset of the menstruation cycle are other factors that may escalate the risks of one suffering from fibroids.
Be careful and take a closer look: Fibroids are fundamentally non-cancerous and they hardly interfere with pregnancy. Often, they do not exhibit notable symptoms and are prone to shrinkage after menopause. Hence giving them and yourself some time might be the best option.
Medications generally aim at the hormones controlling the menstrual cycle and treating symptoms such as pelvic pressure and excessive menstrual bleeding. However, they do not treat fibroids completely but work towards contracting them. They include-
Gonadotropin-releasing hormone (Gn-RH) agonists to block estrogen and progesterone production
Progestin-releasing intrauterine device (IUD) to alleviate severe bleeding caused due to fibroids
Tranexamic acid to ease excessive menstrual periods
Progestins or oral contraceptives to regulate menstrual bleeding
Nonsteroidal anti-inflammatory drugs (NSAIDs) to ease pain associated with fibroids
Surgeries to Treat Fibroids:
Depending on symptoms and whether medical therapy has failed, the patient may have to undergo surgery. The following surgical procedures may be considered:
Hysterectomy: removing the uterus. This is only considered if the fibroids are very large, or if the patient is bleeding too much. Hysterectomies are sometimes an option to prevent fibroids coming back.
Endometrial ablation: removing the lining of the uterus. This procedure may be used if the patient's fibroids are near the inner surface of the uterus; it is considered an effective alternative to a hysterectomy.
UAE (Uterine artery embolization): this treatment cuts off the fibroid's blood supply, effectively shrinking the fibroid.
Magnetic-resonance-guided focused ultrasound surgery: an MRI scan locates the fibroids, and sound waves are used to shrink the fibroids.