A spinal cord injury is a damage to the spinal cord. It s an extremely serious type of physical trauma that s likely to have a lasting and significant impact on most aspects of daily life.

The spinal cord is responsible for sending messages from the brain to all parts of the body. It also sends messages from the body to the brain. We are able to perceive pain and move our limbs because of messages sent through the spinal cord.

If the spinal cord sustains an injury, some or all of these impulses may not be able to  get through . The result is a complete or total loss of sensation and mobility below the injury. A spinal cord injury closer to the neck will typically cause paralysis throughout a larger part of the body than one in the lower back area.

Causes-

A spinal cord injury is often the result of an unpredictable accident or violent event. The following can all result in damage to the spinal cord:

a violent attack such as a stabbing or a gunshot
diving into water that s too shallow and hitting the bottom
trauma during a car accident (specifically, trauma to the face, head and neck region, back, or chest area)
falling from a significant height
head or spinal injuries during sporting events
electrical accidents
severe twisting of the middle portion of the torso
Symptoms-

Some symptoms of a spinal cord injury include:

problems walking
loss of control of the bladder or bowels
inability to move the arms or legs
feelings of spreading numbness or tingling in the extremities
unconsciousness
headache
pain, pressure, stiffness in the back or neck area
signs of shock
unnatural positioning of the head
If you suspect that someone has a back or neck injury:

Don t move the injured person   permanent paralysis and other serious complications may result
Call 911 or your local emergency medical assistance number
Keep the person still
Place heavy towels on both sides of the neck or hold the head and neck to prevent them from moving until emergency care arrives
Provide basic first aid, such as stopping any bleeding and making the person comfortable, without moving the head or neck
Prevention-

Because spinal cord injuries are often due to unpredictable events, the best you can do is reduce your risk.

 Some risk-reducing measures include:

always wearing a seatbelt while in a car
wearing proper protective gear while playing sports
never diving into water unless you ve examined it first to make sure it s deep enough and free of rocks

Spinal Cord Injury - Signs, Causes & Prevention

Spinal fusion is a surgery in which two or more vertebrae in the vertebral column or back are fused or joined to treat a slew of spinal problems and diseases, which cause debilitating back pain. This surgery helps to remove bone and tissue that are narrowing the spinal canal, squeezing the spinal cord and nerves, reducing pain and improving function.

There are many different causes of back pain like injury, poor posture, age, osteoarthritis, herniation of disc between two vertebrae, degenerative disc disease, narrowing of spine called stenosis, and spondylosis or lessening of space between the vertebrae- most of these can be treated using spinal fusion.

All of these causes put tremendous pressure on the vertebrae and pinch spinal nerves that pass through the back and radiate out into the arms, legs and torso. Apart from the pain, patients experience nerve and muscle weakness and irreversible damage affecting normal life.

Spinal fusion started off as just a treatment for fractures but now it has become the surgery of choice for a number of spine problems. Though it can be done anywhere in the spine, it is very effective when done in the lower part of the spine called lumbar spinal fusion or arthrodesis.

Spinal fusion is done by forming a direct bony connection between the vertebrae surrounding the painful discs, the cushioning between the vertebrae. Pain is stopped by stopping the motion of the painful discs.

There are different methods of spinal fusion each with its own advantages and limitations.

Techniques include fusion approached from the front, the back, or both of the vertebral column. Sometimes surgeons decide to use intervertebral cages or metal screws to provide internal structural support while the bone fuses. These cages may be placed between the vertebrae and packed with bone graft material taken from the patient or constructed out of synthetic materials.

What to expect?
Spinal fusion is not a risk-free procedure. It is a major surgery lasting several hours and carrying a number of risks like-

Failure of the vertebral fusion and breaking of metal implants
The vertebrae above and below the fusion can wear away aggravating problems
Blood clots may be formed that can travel to lungs causing embolism
Injury to spinal nerves causing permanent weakness in legs and problem with bladder and bowel function
Infections and blood loss
Heart attack or stroke during surgery
The patient has to be kept in hospital for a couple of days for post-operative care after which he will have to undergo rehabilitation for months. Hence, one should really think before going for spinal fusion. And when it is recommended, seek a second opinion before making a decision. 

Spinal Fusion Surgery - What To Expect?

An orthopaedic fracture is a serious issue that will require lots of care for the bones to heal and re-join. A broken bone is usually plastered so that the tissue may grow back together by fusing eventually, over a period of weeks. When these bones begin to rebuild in an effort to come together, the new bones are called soft callus. This will require lots of energy, which primarily comes from calories. This ensures that essential proteins like amino acids can be taken from the right type of food which would stimulate good blood flow. 

So, let us take a look at the best diet that one can follow in order to recover from a fracture.

Kale: Leafy green vegetables and herbs like kale can help in supplying good amount of protein and iron as well as calcium, which is highly important for good and strong bones. One can also find plenty of calcium in salmon and other kinds of sea food like sardines; consuming these can speed up the process. Sea vegetables like seaweed can also help in the process.
Yogurt: Calcium can be supplied by various other kinds of food including yogurt, which has two kinds of amino acids. These amino acids are lysine and glutamine, which can assist the bones in swift calcium absorption for better recovery of the broken bones.
Spinach: This is a very important ingredient in the bone healing process thanks to its dual elements of calcium and zinc, which come together to cause the appropriate chemical reaction for bone rebuilding. Other zinc heavy food items include pumpkin seeds and wheat germ as well as red meat.
Broccoli: Ingredients like broccoli are rich in Vitamin K1, which is known to very good for the bone recovery process. This vitamin helps in mineralisation of the bone so that they may fuse with each other and form a new mass. One can have up to one cup of this green vegetable per day for a quick and effective fracture recovery process. Other ingredients like cheese and raw dairy products are known to have plenty of this vitamin as well.
Green Bell Peppers: High on vitamin C which helps in producing the skin and tissue structuring element called collagen, green bell peppers are an excellent ingredient that can help you in your fracture healing process. Vitamin C can also be found in citrus fruits like oranges, strawberries as well as tomatoes.
Milk: While milk has plenty of calcium, it also has another important ingredient called vitamin D. When calcium and vitamin D come together, the bones tend to heal much faster as vitamin D helps the bones in absorbing the calcium at a much high rate.

Recovering from Fracture - 6 Foods You Must Consume

As life expectancy is increasing so is the incidence of vertebral body (VB) fractures now being the commonest fracture of the body. PVP is an established interventional technique in which bone cement is injected under local anaesthesia via a needle into a fractured VB with imaging guidance providing instant pain relief, increased bone strength, stability, decreasing analgesic medicines, increased mobility with improved quality of life and early return to work in days.

In this era of minimally access surgery replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression fracture spine.

Morbidity & consequences of spinal fracture:

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory & GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc element
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Results / Outcome

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral.
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Percutaneous Vertebroplasty (PVP) is an emerging interventional technique in which surgical polymethyl methacrylate bone cement is injected under local anaesthesia via a large bore needle into a vertebral body (VB) under imaging guidance providing increased bone strength, stability, pain relief, decreased analgesics, increased mobility with improved QOL and early return to work. Started in 1984 by Galibert PVP is done in host of indications.

Senile osteoporotic compression remains the commonest Indication. Other indications are Metastatic VB, Multiple myeloma VB, VB haemangioma, Vertebral osteonecrosis & for strengthening VB before major spinal surgery. The benefit has been extended to the traumatic stable uncomplicated VB compression (VCF) which is commoner in younger age group with active life profile and prime of their career where strict bed rest and acute or chronic pain are unacceptable and they are more demanding for proactive treatment approach so as to be back to work ASAP.

Discovering the fact that VB is the commonest of body, its incidence >the hip, it becomes imperative to take it more seriously. With increasing life-span there is more of aged osteoporotic population, more so due to sedentary indoor lifestyle and post menopausal osteoporosis. Diabetics, smokers & alcoholics are at higher risk of developing osteoporosis. I have seen such alcoholic patient developing six spine fractures in just three months time from a single fracture being on complete bed rest.

Quick fix of fracture spine makes patient walk back same day instead of bed rest of months together avoiding morbidity & mortality of prolonged bed rest, making bedridden patient walk, in a way bringing patient back to normal life.

In this era of MAS replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression.

Morbidity & consequenses of spinal 

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly.
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory &
GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc elements.
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics.
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Morbidity and complication of spinal surgery 

Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Preparation & Procedure:
X-ray spine in a/p & lat view. CT is more informative of bone & morphology. MRI is good for soft tissue injuries. Ask for pedicle size in all dimensions and construct a 3D image aiming needle placement and cement filling in scan room itself as rehearsal of PVP. This reduces operative time & gives better results. Conventionally PVP is done by hammering the vertebroplasty needle through the bone. Here we use light weight drill to bore through the vertebra. It is important to set the needle at exact entry site & side with right trajectory aiming the defects.

In lateral view needle should go through middle of the pedicle going up to anterior 1/3 of VB. In P/A view the needle can be in midline or paramedian depending upon & if uni/bipedicular approach is planned. Approach varies as per location of vertebra, anterolateral in cervical, costotransverse/parapedicular in thoracic & transpedicular in lumbar vertebra.

Do bone biopsy if there is any doubt about lession. Do dye test (vertebral venography). Make cement more radiopaque by adding barium /or tungsten. Inject cement with 1or2 ml luerlock syringes strictly under fluoroscope in lateral view & cross checking in P/A view. Stop injecting either there is adequate filling or at the first sight of ectopic cement leak. Keep sample cement to see for hardening. Remove needle with rotational movement before cement hardens.

Pain relief is by virtue of different mechanisms postulated :

Cementing of fragments.
Thermal neurolysis of VB nerve ending due to heat of polymerization.
Washing away of nociceptor chemicals.
Neurolytic action of liquid monomer.
By allowing early ambulation decreasing pains of immobility & bed rest.
Complications 

PVP is generally safe with low risk.
Ectopic cement leak is frequent but generally inconsequential.
Outcome 

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty.
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

Your spine or backbone is composed of 26 bone discs, known as vertebrae. The vertebra shields your spinal cord and allows you to bend forwards and backwards, and stand. However, a number of problems, such as the following can change the structure or cause the vertebrae and its surrounding tissues to become damaged  

  Injuries
  Infections
  Tumours
  Changes in bone formation due to ageing   herniated disks, spinal stenosis
  Conditions like scoliosis and ankylosing spondylitis

Spinal disorders often lead to pain and discomfort when bony projections put pressure on the spinal nerves or cord. Over time, spinal disorders limit movement and reduce flexibility.
Treatment varies depending on the disease, ranging from medications and therapy to bracing and surgery.

Endoscopic Spine Surgery: what is it?

Contradictory to traditional open surgery, the new age endoscopic surgery is a minimally invasive procedure used to detect and treat a disorder. Unlike open surgery, minimally invasive endoscopic surgery does not require the patient to undergo general anaesthesia. The procedure is possible under local anaesthesia, considering the fact that it can be performed without cutting open the portion of the surgery site.

How does surgery work?

During the procedure, the surgeon first administers local anaesthesia to numb the site of the operation. You will be awake during the entire procedure but will not feel any pain. Then, he/she will make a small incision and insert a slender, tubular instrument   known as an endoscope   with a camera attached on one end through the soft tissues and skin, down to the spinal column. This allows the surgeon to get a clear view of the spinal tissues and understand where the problem exists. The endoscope holds the muscles open, allowing the surgeon to remove the damaged tissues or disk.

Endoscopic spine surgery preserves normal mobility, as the spine is not fused with rods and crews. When performed under an experienced surgeon, the procedure takes less than an hour.

Benefits of the Procedure

The advantages of going for an endoscopic surgery are the following  
  Local anaesthesia
  Surgery and discharge on the same day
  Microscopic incisions
  No removal of bone or muscles
  Zero or minimal blood loss
  Preserves spinal mobility
  Immediate recovery
  Reduced intake of pain medicines
  The high rate of success
  Improved quality of life

Minimally invasive endoscopic surgery has made it possible to rectify spinal problems and disorders without having to go under the knife. With less pain and quicker recovery, you can improve your spine health and get back to your usual activities in a day or two.

Consult a specialist and discuss the procedure in detail before opting for the same.


Endoscopic Spine Surgery Under Local Anaesthesia!

Spinal fractures are extremely painful and usually happen when an external force applied to the spine exceeds the vertebral column s ability to bear the load. Many times, the bone fragments pinch and damage the spinal cord, which leads to an injury or dislocation of the bony vertebra. Although spinal fractures can develop anywhere along the spine, the most common site is the lower back.

What causes spinal fractures?

Spinal fractures can occur due to both minor trauma/falls and major accidents. The following are the probable causes of such fractures-

  Injuries sustained while playing a sport
  A traumatic injury
  Spinal instability
  Injuries sustained after falling from a height
  A whiplash
  Injuries sustained in an accident
  An underlying condition such as Osteoporosis, which causes the spinal bones to weaken

Symptoms observed:

Spinal fractures are characterized by the following symptoms-

  Muscle spasm and swelling
  Numbness
  Acute pain that worsens when you walk or stand for a long time
  A tingling sensation
  Restricted mobility of the spinal column
  Spinal deformity/disability
  Sudden onset of pain in the lower back region

What are the various types of spinal fractures?

Spinal fractures primarily fall into four categories, namely the following-

  Compression - Compression fractures are quite common in people with osteoporosis or bone cancer. The bones become fragile and brittle. If sudden force is applied with extreme pressure, the vertebra may not be able to support the load and that may result in a fracture.

  Burst - Severe trauma, such as a car accident can cause burst fractures. The external pressure is so much that the vertebra gets crushed. As a result, the bony fragments spread out and cause spinal cord injury. Unlike a compression fracture, where only a part of the vertebra is damaged, a burst fracture leads to multiple fractures in the vertebra.

  Flexion-distraction - This type of fracture is likely to happen if you are involved in a car accident. Normally, the spine is made to flex forward. However, a sudden jerk that pushes your body forward can put a lot of pressure on the spine and cause the vertebrae to break.

  Fracture-dislocation - This debilitating condition results from a torn ligament and broken bone.

What is the treatment for spinal fractures?

Treatment options for spinal fractures include both non-surgical and surgical methods.

  Non-surgical treatment - Most cases of spinal fractures can be treated with immobilization in a corset or brace for up to 10-12 weeks. Bracing will help prevent deformity and reduce pain.

  Surgical treatment - The doctor may recommend surgery in severe cases. The two standard surgical procedures are-

Vertebroplasty - The surgeon will insert a tube, known as a catheter, into the compressed vertebra. Through the catheter, he/she will inject bone cement into the fracture site. This will harden and stabilize the vertebral column. Vertebroplasty has proved to be an effective procedure to reduce pain. The surgery restores mobility and prevents loss of bone due to bed rest.

Kyphoplasty - During this procedure, the surgeon inserts a catheter into the spinal column under the guidance of an X-ray. Next, he/she makes small incisions along the back and inserts an inflatable bone stamp. The tamp, once inflated, bring back the vertebral body to its original height. It also creates a cavity to be filled with bone cement, which seals the cracks. The bone cement stops the vertebra from collapsing again. After the whole procedure, the surgeon will remove the catheter and stitch the incisions.

Following surgery, you will need to wear a brace for about 6-12 weeks. Physical therapy is strongly recommended initially to help you get back to your daily activities in a week or two.

Spinal Fractures - All You Should Know!

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