The intervertebral discs are made-up of two concentric layers, the inner gel-like Nucleus Pulposus and the outer fibrous Annulus fibrosus. As a result of advancing age, the nucleus loses fluid, volume and resiliency and the entire disc structure becomes more susceptible to trauma and compression. This condition is called as degeneration of the disc. The disc then is highly vulnerable to tears and as these occur, the inner nucleus pulposus protrudes through the fibrous layer, producing a bulge in the intervertebral disc. This condition is named as herniated disc. This can then cause compression to the spinal cord or the emerging nerve roots and lead to associated problems of Sciatica radiating pain from back to legs in the distribution of the nerve. Other symptoms could be a weakness, tingling or numbness in the areas corresponding to the affected nerve. Sometimes bladder compromise is also present, which is made evident for urine retention and this need to be taken care as an emergency.
Excessive weight, bad postures, undue movements, improper weight lifting and other kinds of traumas may weaken the intervertebral discs. When this occurs the pulpous nucleus will bulge against the annulus, or even be squeezed through it (extruded disc).

The first steps to deal with a herniated or prolapsed lumbar disc are conservative. These include rest, analgesic and anti-inflammatory medication and in some cases physical therapy. At this point, it is convenient to have some plain X-rays done, in search of some indirect evidence of the disc problem, as well as of degenerative changes on the spine.

If in a few days these measures have failed, the diagnosis has to be confirmed by means of examinations that give better detail over the troubled area, as the MRI, CT which will show the disc, the space behind it and in the first case, the nerves. In some instances, the EMG (electromyography) is also of great value, as this will show the functionality of the nerves and muscles.

Once the diagnosis has been confirmed, one of the best alternatives existing today is the Ozone Discolysis as the results obtained are excellent and practically has no complications. This novel treatment avoids the use of surgery in 80% of those who needed it. In most patients left with painkillers as the only treatment, the symptoms eventually disappear, only that this could take weeks to months. Ozone speeds up these developments, see the same result in a few weeks. The problem has to be seen and approached integrally and frequently the combination of therapies has to be used, most frequently physiotherapy. Also, it has to be known that those who had a herniated disc have 10 times more chances of having another herniation than the rest of the population.

If despite the ozone therapy the symptoms persist, Drill Discectomy/ Laser Discectomy are good alternatives before open surgery (Discectomy) which has to be contemplated in those true emergencies, as mentioned above, this is possibly the first choice.

Once the conservative treatment fails:

Early aggressive treatment plan of pain has to be implemented to prevent peripherally induced CNS changes that may intensify or prolong pain making it a complex pain syndrome. Only 5% of total LBP patients would need surgery & 20% of discal rupture or herniation would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then.

Depending upon the diagnosis one can perform & combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon pt`s pathology & response to treatment.

Using precision diagnostic & therapeutic blocks in chronic LBP, isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of LBP after conservative treatment has failed.

LESI: Lumbar Epidural Steroid Injection

Indicated in   Acute radicular pain due to irritation or inflammation.

Symptomatic herniated disc with failed conservative therapy
Acute exacerbation of discogenic pain or pain of spinal stenosis
Neoplastic infiltration of roots
Epidural fibrosis
Chronic LBP with acute radicular symptoms
Epidural- lumbar injection
ESI Treatment Plan

Compared to interlaminar approach better results are found with a transforaminal approach where drugs (steroid+ LA/saline +/- hyalase) are injected into anterior epidural space & neural foramen area where herniated disc or offending nociceptors are located. Whereas in interlaminar approach most of drug is deposited in posterior epidural space.Drugs are injected total 6-10 ml at lumbar, 3-6 ml at cervical & 20+ ml, if caudal approach is selected. Lumbar ESI is performed close to the level of radiculopathy, often using paramedian approach to target the lateral aspect of the epidural space on involved side. Cervical epidural is performed at C7-T1 level.

SNRB- Selective Nerve Root Block 

Fluoroscopically performed it is a good diagnostic & therapeutic procedure for radiculopathy pain if

There is minimal or no radiological finding.
Multilevel imaging abnormalities
Equivocal neurological examination finding or discrepancy between clinical & radiological signs
Postop patient with unexplainable or recurrent pain
Combined canal & lateral recess stenosis.
To find out the pathological dermatome for more invasive procedures, if needed
Intradiscal Procedures 

Provocative Discography - Coupled with CT

A diagnostic procedure & prognostic indicator for surgical outcome is necessary for the evaluation of patients with suspected discogenic pain, its ability to reproduce pain(even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options & in assessing previously operated spines.

Percutaneous Disc Decompression (PDD)

After diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed

Ozone Discolysis: Ozone Discectomy a revolutionary least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a daycare setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. The total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no postoperative discomfort or morbidity and low cost.

Dekompressor: A mechanical percutaneous nucleosome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression.

Epidural Adhenolysis or Percutaneous Decompressive Neuroplasty for Epidural Fibrosis or Adhesions in Failed Back Surgery Syndrome (FBSS)

A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ L.A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with epiduroscope.

Procedures That Can Help Treat Slip Disc & Sciatica!

Staying healthy involves a wholesome state of being where the mind and body are in perfect sync. A less than properly functioning body can leave you in a state of potential depression after a certain point of time, while a depressive mind can leave you feeling less than stellar where you end up imagining and experiencing pain. The health of your bones and joints is one such area that requires even more care as you start growing older. Wear and tear is just one of the reasons for degeneration while fractures and injuries can lead to a sudden halt of normal functioning of the bones and joints too. So how can you ensure bone and joint health in the long run? follow our tips!

Eating right: pick calcium rich food like dairy products that have a low fat content, including milk and yogurt. Also, have a daily dose of green, leafy vegetables and plenty of citrus fruit and juices for your fill of calcium. Further, food like eggs and soybeans which have lots of vitamin d can also help in retaining good bone and joint health. Vitamin c rich fruit like watermelon, oranges, squash and tomatoes also help in natural tissue and cartilage repair. And finally, get plenty of vitamin k to retain good bone density for a prolonged period with ingredients like leafy green vegetables, eggs and cheese.

Exercise: this is the key to good bone and joint health. Much like machinery and tools, the bones and joints of your body can also wither with disuse and prolonged inactivity. Make sure that you indulge in exercises like long walks and muscle strengthening exercises which will give your joints and bones good amount of strength as well. Remember to speak with your doctor before you start a new exercise regime so that you avoid anything that may be harmful in case you have any other ailment. Low impact exercises will strengthen the spine, while fat burning and weight loss exercises will ensure that there is less pressure on the knees and lumbar area. Swimming and resistance building exercises can also be practised for these purposes.

Abstinence: a major factor in promoting better bone and joint health is abstinence from all those things that can create problems in the long run, like smoking, drinking excessively and even too much consumption of caffeine and fatty food. All these things can create depletion of the natural bone mass. Also, switching to a lower heel for everyday wear footwear and changing your position during your time at your workstation are a few things that will go a long way.

Take care of your bones and joints the right way today, for a healthier tomorrow.

Bone and Joint Health

Sports injuries are a common problem, where various types of musculoskeletal injuries can occur during the physical activities. These injuries can either be acute or chronic in nature. In athletes, such injuries can pose as a risk to their careers, which makes it essential for the physicians to provide the most appropriate treatment. It is mandatory to provide a prompt, safe and quick treatment that can restore the athlete s preinjury level of participation in sports.

Various treatment approaches are present for treating sports injuries. The use of intra-lesion blood injection is being made for addressing the musculoskeletal injuries. An easy and minimally invasive method of using concentrated autologous growth factors in treating sports injuries is the use of platelet rich plasma (PRP). It is a fraction of the blood plasma that contains a higher concentration of platelets than normal plasma, along with growth factors.

PRP is used in the treatment of both soft tissue and bone injuries. Growth factors have a positively influencing effect on the healing process of connective tissue components.
There is a huge difference between the anatomy and functions of tendons, ligaments, muscles and joint capsules. Hence, the site of injection of PRP also varies.
The cellular tension in the tissue and the collagen structure is affected after the administration of PRP.
Use of PRP is popular in the treatment of an Achilles tendon. For injecting PRP, an ultrasound scan is done, the site of injection is accurately identified and then PRP is administered.
Proper location of the site of injury and deciding the accurate injection zone prior to the injection of PRP makes it easier to facilitate treatment and eliminate discomfort.
Administration of PRP should be considered secondary to physical therapy and other conservative means of treatment.
Enthesopathy is a discomfort in the area where the attachment of tendons, ligaments and the articular capsule is present. The use of PRP is increasing in the treatment of this condition. It has an inflammatory nature and presents as epicondylitis or capsulitis.
Studies have proved that PRP is an effective alternative to injection of steroids for an anti-inflammatory effect. Steroids majorly provide only symptomatic relief, whereas PRP is more definitive.
PRP has also found an increased use in the area of surgical procedures of knees. It is used to increase the efficiency of the healing grafts placed in the knee during reconstructive surgeries.
For treatment of bone injuries, use of PRP has shown an improved quality and rate of bone healing. Even in cases of an infected injury, PRP aids in healing efficiently.
No known side effects or complications after use of PRP have been observed, which makes it a sought after option in management of sports injuries.


Platelet Rich Plasma In Sports Injuries

Spondylosis is a disease of the bone which involves wear and tear of the discs. The latter is the cushion between the joints of the neck and the neck bone. While it is mostly observed in aged people, it is not too uncommon among the youth as well. It can present with symptoms such as numbness, neck pain, headache, stiffness near the shoulder area etc. Ayurvedic treatment has been extremely promising in treating both cervical and lumbar spondylosis.

The food connection: Ayurveda states that there is a close connection between Spondylosis and food. In Ayurvedic terms, an increase of Vata Dosha can lead to the problem of Spondylosis. For instance, consumption of frozen or processed food, sodas, junk food, low consumption of water, excess consumption of curried food heighten the chances of Spondylosis.

Habits matter: As per the books of the Ayurveda, a reckless lifestyle increases the chances of Spondylosis. Habits such as day sleep, regular walking for a long distance, urging the suppression, rigorous exercise daily, work that involves bearing of weight on the neck, head and shoulder, night awakening etc. can wreak havoc and result in Spondylosis. On the other hand, healthy lifestyle changes can help a person refrain from this condition.

Psychological Factors: Ayurveda states that even psychological factors can go a long way in making a person suffer from Spondylosis. Certain factors such as excess stress, loss of interest in day to day work, fear of failure, feeling of frustration, too much anger, grief resulting from personal loss etc. play a major role in Spondylosis.

Visible Symptoms of Spondylosis:
Some medical symptoms that can be easily identified as the signs of Spondylosis include fatigue, pain in the arm, shoulder, and forearm, difficulty in functions pertaining to neck rotation, extension, joint stiffness, muscular spasm, headache, weakness in the arm, difficulty in movement, difficulty in muscle coordination etc.

Some ayurvedic treatments to deal with Spondylosis

Treatment: 

Home Remedies For Cervical Spondylosis:

Use Cow's ghee in your food. It is a best natural "Vata" reliever and gives nourishment to the nerves and other body parts.

1 tablespoonful of Turmeric should be consumed once every day, after boiling it in milk for half an hour. It is a very useful herbal treatment for cervical Spondylosis.

Constipation must be avoided at all costs. Constipation may increase pain in Cervical Spondylosis.

Herbs have divine healing powers and they have the ability to cure any type of disease from the root. They were gifted to us by God when he created life. So believe in God if you want to get rid of your problems!

Ayurvedic herbs are unique natural remedies for Cervical Spondylosis. Ayurvedic principles are different in many ways from modern medicine for example - Drinking water from a copper pan after keeping it overnight is also very useful in Rheumatoid arthritis and Cervical Spondylosis.

Consuming castor oil at night with milk or alone is a very useful herbal remedy for arthritis, especially rheumatoid arthritis and Cervical Spondylosis.

Improve your nutrition as the first step.It plays an important role to fight diseases. When nothing works, nutrition does!

Use herbal juices like Aloe vera juice (Kumari Saar) and Amla Juice (Amla Saar) in routine. Amla is the richest source of natural Vitamin C. Vitamin C improves the natural immunity of the body. 100 gm of Amla juice contains 30 times more vitamin C than 100 gm of oranges.

Greeva Basti- A compound created with Bala Ashwagandhadi oil, Medicated oil and black gram paste is applied on the affected area. Regular application of this can regenerate the muscle bone and reverse Spondylosis to a considerable extent.

Ayurvedic Herbs For Spondylosis
Some ayurvedic herbs are known to be extremely beneficial for treating Spondylosis. When these are consumed or applied on the affected area, they can fetch surprising result for a Spondylosis patient. Some of these herbs include Prishniparni (Uraria picta), Ashwagandha (Withania somnifera), Guggulu (Commiphora mukul), Shunthi (Ginger), Bala (Sida cardifolia), Amalaki (Emblica officinalis), Gambhari (Gmelina arborea), Shallaki (Boswelia serrata), Rasna (Pluchea lanceolata), Castor root (Ricinus communis) etc.

Spondylosis - Is Ayurveda The Best Form Of Treatment?

Dysmenorrhea is a condition marked by severe menstrual cramps. This is caused due to contractions in the pelvic area during the menstrual cycle. While most women go through some degree of cramping, when the cramps become too serious and severe, it should be reported to a doctor to find out if there are any other related problems like Endometriosis, Fibroids, Adenomyosis or some infections.

Here are the ways in which this condition may be treated effectively:

Medication: One of the main ways of dealing with this condition includes taking pain relievers that must be prescribed by your doctor. Also, one can take over the counter drugs to relieve the pain. These include ibuprofen as well as aspirin and non-steroidal anti-inflammatory drugs. Acetaminophen can also help in most cases. Some women may need antibiotics to take care of pelvic infections that cause pain in the pelvic region.

Hormonal Birth Control: if your symptoms are too severe and debilitating, then the doctor can also put you on hormonal birth control treatment to bring down the pain and severity of the cramps. These are usually prescribed in the form of oral tablets which need to be consumed daily as advised by the Gynaecologist . Sometimes, some women may be unsuitable / unwilling for oral medications and in such cases, other routes for hormonal administration may be followed. This can be administered in the form of an injection. Also, you may wear the dose as a patch on the skin. A surgical procedure can also implant the same under your skin. This also comes as a flexible ring that the doctor can insert into your vagina with the help of an intrauterine device (IUD).

Surgery: In very extreme cases, the doctor may recommend surgery. This is usually conducted in case there is an underlying condition like endometriosis or fibroids, which can create severe complications for the patient as well. The doctor may also carry out surgical removal of the patient's uterus in case there are many complications.

Home remedies: One can exercise on a regular basis in a moderate manner so as to ensure that the cramps are not too severe. Also, you can use heat therapy in order to bring down the pain. This can be done by taking a hot bath and soaking in a tub of hot water. Also, you can use a heat compress so as to relieve the pain. Other dietary supplements can also be taken in order to reduce the cramps. For this purpose, one should regularly indulge in fish and flax seeds as well as other ingredients that are rich in omega three fatty acids. Also, vitamin B1 is an important ingredient that can be found in leafy green vegetables. Magnesium supplements can also be taken by the patient for such cramps.

Stress: one will need to take care of the stress levels by staying away from stressful situations and also cutting back on the consumption of alcohol. One should also avoid smoking completely. Meditation & Yoga have been known to help in relieving stress and you can practise a little bit of these on a daily basis. Also, devoting time to your hobbies and listening to good music can be a stress-buster when incorporated in your daily routine.

So eat right, exercise right, think right and have a positive attitude- That helps take care of most non-pathological cases of dysmenorrhoea.

Ways to Treat Dysmenorrhea Effectively

The carpal tunnel is the passageway for the median nerve to pass through on the inner side of your hand, when your palms are facing down. For example, while typing, there is a lot of movement of the fingers and this puts a lot of pressure on this tunnel. In fact, people who are involved in a lot of typing are one of the most prone people for carpal tunnel syndrome (CTS). Other causes would include trauma, fractures, etc., where the tunnel is injured.

Conventional measures to treat CTS included a combination of exercise and pain killers in mild to moderate cases. In moderate (sometimes) to severe cases, surgery was also done. However, with advancements in medical technology, endoscopic surgical procedure is gaining popularity.

What is done?
In endoscopic surgery, a small incision is made in the wrist or one each in the palm and the wrist. Through this, a flexible tube with a camera and minute cutting tools are inserted into the wrist. Another ligament known as transverse carpal ligament is cut. This reduces the pressure on the median nerve, which provides relief from the CTS symptoms.

What to expect as benefits?
The intention behind the surgery remains the same in both traditional and endoscopic procedures. The pressure on the median nerve is released, restoring movement and reducing pain in the joints. In addition, the endoscopic procedure has the following benefits.

Less invasive: Needless to say, there are only one or two small incisions done for this procedure, so less surrounding tissue is damaged.
Same day surgery: No hospitalization is required, and unless required, the patient can return home on the same day of surgery.
Reduced recovery time: The recovery period is usually substantially less compared to the traditional surgical approach.
Back to work: Depending on which is your dominant hand, you would be able to return to your regular work earlier than with regular surgery. If your non-dominant hand is involved, a day or two of rest is required. If your dominant hand was involved, give it up to four weeks for complete recovery.
Reduced chances of nerve injury: The area of operation has many nerves and blood vessels, and endoscopic surgery reduces the chances of damaging adjacent nerves.
Anesthesia: This is done under local anesthesia. Therefore, complications arising out of general anesthesia are completely avoided.
Indications
While these sound promising, your doctor will decide if you are a candidate for endoscopic procedure depending on the following:

Nonsurgical treatment including exercise and pain killers have not provided relief, even after several months.
Severe symptoms including those of nerve damage, like loss of sensation, altered coordination, etc., is affecting your normal daily routine.
Person requiring bilateral surgery like severe trauma, wheelchair dependent, etc.

Carpal Tunnel - How Endoscopic Surgery is Beneficial?

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