Knee is a hinge joint where the lower leg bone tibia meets the thigh bone femur. During osteoarthritis, cartilage or ligament defects and degenerative arthritis, knee replacement surgery is recommended world-wide to get relief from extreme pain. Knee replacement surgery, also known as knee arthroscopy, is a surgical procedure, in which the affected knee joint is replaced with synthetic material. The most likely candidates for total knee replacement are the patients with severe destruction of the knee joint coupled with progressive pain and impaired function.

Modern technological advances have made computer assisted knee replacement surgery extremely popular around the globe. In this surgery, the surgeon is assisted by a computer to remove the optimum amount and angle of the bone, which otherwise is done by inspecting manually. This is an excellent example of surgery through small incision and it eliminates the chances of human error. A perfect alignment and balance is achieved and hence longevity is also increased to 20 - 30 years. Knee replacement surgery is also specific to gender as the anatomy of male and female patients is different.

There are many types of knee replacements, most common being the total knee replacement or Total Knee Arthroplasty. In addition, there is partial knee replacement, bilateral knee replacement, revision knee replacement and knee arthroscopy.

In knee replacement surgery, the worn out surfaces of joints of knee are replaced with artificial implant of plastic and metal. The lower end of the femur bone is removed and replaced with a metal shell. The upper end of the lower leg bone (tibia) is also removed and replaced with a channelled plastic implant with a metal stem. A plastic ball is also added under the kneecap depending on its condition. These artificial components are commonly referred as prosthesis. The design of these highly flexible implants replicate knee, with the rotating knee replacement implants assist in backward and forward swing of the legs.

Patients whose knee joints have been damaged by either trauma or progressive arthritis should consider total knee replacement surgery. Post-surgical hospital stay after knee joint replacement is usually three to five days. The surgery has a very high success rate and shows dramatic improvement after a month. This improvement is most notable one month or more after surgery. The pain caused by the damaged joint is reduced significantly when the new gliding surface is constructed during surgery. Initially, patient will walk with the help of a walking aid until the knee is able to support full body weight. After six weeks, patient can walk comfortably with minimal assistance. Patients with artificial joints are prescribed to take antibiotics during the course of any elective invasive procedures including dental work. Physiotherapy is an essential part of rehabilitation and it will increase the muscle strength and patient can enjoy most activities, except running and jumping.

Knee Replacement

Extramedullary intradural tumours are a rarity. Of all the tumours of the nervous system, fewer than 15% are of the spine. And around 45% of them are intradural. And 40% of intradural tumours are extramedullary.

What are some common Intradural Extramedullary Spinal Tumours? 

Some forms of intradural extramedullary spinal tumours are-

Schwannomas

Meningiomas

Gliomas

Neurofibromas

What are the Symptoms of Intradural Extramedullary Spinal Tumours?

Some symptoms of this condition are-

Back pain

Cramps

Loss of feeling along the back

Loss of spinal flexibility

Weakness of the limbs

Slight degrees of paralysis

Hunched-over spine

If treatment is not sought immediately, the effect of the tumours would penetrate all levels of the spine and may lead to complete paralysis.

How are Intradural Extramedullary Spinal Tumours diagnosed?

A basic physical examination will reveal that there are tumours on the spine. Before treatment commences, the person will have to opt for these tests-

An MRI scan

A CT scan

X-rays

biopsy

Treatment of Intradural Extramedullary Spinal Tumours diagnosed?

Doctors do not usually suggest surgery right away. They will first try to vanquish the tumours with chemotherapy and radiation therapy. Sometimes a combination of both might be required.

If therapy does not work, surgery will be suggested. During the surgery, resection is done with the aim to assuage pain and stabilize the spine. Preoperative embolization is performed. A catheter is inserted into a vessel of the groin and directed to the tumour. Then a glue-like agent is administered to the vessels that carry blood to the tumour. When this supply is cut off, the tumour will shrink.

After the surgery, a person will be required to stay on in the hospital for a couple of weeks after which rehabilitation may be required to help the patient get back to a normal lifestyle.

Spinal tumours can be fatal. That is why it is important to pay heed to the symptoms and consult a doctor right away.

Intradural Extramedullary Spinal Tumour - In Depth!

Back pain is a common source of pain and can be acute, sub-acute or chronic in nature. Back pain is classified along the segments of the spine and can be divided into neck pain, middle back pain, lower back pain and coccydynia or tail bone pain. Back pain can be quite troublesome as it disables a person to move about freely due to constant ache.

Here are some procedures for the treatment of back pain.

    Give your back some rest: Most people who get back pain become obsessed with it and end up getting MRI scans and x-rays done. Some even take injections and other such measures without recognizing the intensity of the pain. It is advised not to rush into the matter immediately and the simplest way to cure the pain is by resting. 90% of pains in the back resolve by themselves in 6 weeks and so you must give your back a break instead of taking medical actions and let time do the healing.
    Pills: While you let time treat your back pain, sometimes the pain increases and gives you a bad time. In this case, you can take anti-inflammatory medicinal pills such as ibuprofen or naproxen. These pills will help you ease the pain. However, using such pills for a continued period of time causes side effects such as gastrointestinal disorders. Hence, you should not take them for more than ten days at a stretch.
    Hot and cold compress: Apply a bag of frozen peas or an ice pack to the affected area for 48 hours after the pain appears. Every session should be about 20 minutes, and you should take more than two sessions each day. After two days, repeat the same procedure using a heat pad instead of ice. The cooling procedure shuts down your blood capillaries and reduces the flow of blood to that area. The swelling is eased as a result. The heating, on the other hand, loosens tight muscles and increases the blood circulation, providing extra oxygen.
    Change your mattress: People who sleep on firm mattresses and cushions on their beds are at a higher risk of having a back pain. According to studies, it has been observed that people sleeping on medium-firm mattresses have healthier backs. In case your mattress in sagging or is over 8 years old, you should replace it.
    Acupuncture: When your back pain is very severe, you can resort to acupuncture, which provides efficient pain relief. The procedure changes the way your nerves react and reduces inflammation.

Back pain arises from various reasons and should always be taken care of. Unattended back pain worsens and makes the affected person suffer.

Suffering From Lower Back Pain - 5 Ways You Can Treat it

The term Sciatica is used to describe leg pain, tingling, numbness or weakness that travels down the low back via the sciatic nerve to the back of leg. Sciatic nerve arises from each side of lower spine and passes deep in the buttock along the back of thigh and legs. The pain of Sciatica may be irregular/ infrequent or persistent causing severe agony to the patients. The pain of Sciatica may be confined to low back or hips or may extend up to toes. The pain of Sciatica can be excruciating and "not relieved by painkillers".

What causes Sciatica?

Pain in Sciatica is due to irritation or pinching of Sciatic nerve within the spine. This occurs most commonly due to prolapsed intervertebral disc (slip disc) causing nerve compression resulting in pain.

Is surgery the only treatment for Sciatica?

Most patients can be managed with medication/exercises. So surgery is not the only way out. Patients who have severe pain can also benefit from "Epidural Steroid Injection". This treatment has proven to be effective in avoiding spine surgery in such patients.

What is Epidural Steroid Injection?

Epidural Steroid Injection is a procedure done by a Specialist (Interventional Pain) in an Operation Theatre using X-Ray (Image Intensifier) to locate exact level of injection. A drug mixture consisting of Steroid with Local Anaesthetic is injected at the epidural space of affected nerve root. The steroid washes away inflammatory mediators from the epidural space which decreases the pain. Steroid also decreases the inflammatory response of body to the prolapsed disc. As a result the pain arising from nerve inflammation is decreased. This is a day care procedure i.e. the patients are discharged the same day.

How is the possibility of surgery ruled out?

Epidural Steroid Injection is a proven, safe and an effective treatment that works on the concept of Interventional pain management - to provide relief from persistent and chronic pain of Sciatica. Generally, a single injection is sufficient to relieve patients of the pain. The procedure can be repeated for a maximum 3 times in a year, depending on the patient's response. With effective pain relief, surgery is negated.

Non-Surgical Treatment For Sciatica

Non-inflammatory pain and tenderness in joints, muscles and ligaments can lead to a chronic condition called Fibromyalgia. It is estimated that it affects 5 % of the population annually. Though there are many conventional medications available to address this situation, none of them focuses on healing the disease from the root. This is precisely where Ayurvedic techniques differ. Let us look at a time tested way to address Fibromyalgia through ancient Ayurveda.

Ayurveda for Fibromyalgia
There are some common symptoms of Fibromyalgia. These include aches and stiffness of the body, generalized fatigue, chronic headaches and migraines, swelling and numbing sensations in the joints. Ayurveda treats a particular disease on the basis of the  vata  imbalance. The condition also affects the central nervous system thus leading to pain and tenderness. Accumulation of Ama or toxins is also the other major factor for Fibromyalgia.

Ayurveda focuses mainly on these two factors and creates a balance in suppressing them. The famed panchakarma therapy and the herbal oil massage can help in reducing the toxin levels. They also work additionally as a detox thus helping in eradicating the harmful by-products. Along with it, a diet plan should also be followed for stimulating the growth naturally. These include vegetables, fibers, and juices of carrot, cucumber, beetroot, spices like cumin, coriander, ginger asafetida and coconut milk.

Also, some limitations are needed, and a person should avoid spicy foods and reduce the intake of caffeine products. Alcohol should be curbed when a person is under the treatment plan. Few herbs like "Dashamula quath" and 'Triphala choorna' are recommended for cleansing the colon. Mental stress is also one of the major factors, and hence a relaxed attitude should be followed along with certain lifestyle changes. Ayurveda wants the body to get the necessary sleep and rest in its treatment plan. In the treatment of Fibromyalgia too, it is no different. The Ayurvedic physician would lay out the entire cycle of the treatment procedure, and they have to be followed religiously. A person can see the reduction in the pain within a few weeks of following the treatment.

Ayurveda is safe
The biggest advantage of an Ayurvedic treatment is that it is extremely safe and that there are no side effects. They effectively act as a detox thus getting rid of the harmful substances from the body along with curing of the symptoms. Ayurveda not only takes care of the pain but identifies the problem from the root. Hence it effectively curbs the chances of Fibromyalgia from reoccurring.

Fibromyalgia - How Ayurveda Is Safe For It?

Back pain is one of the most common debilitating disorder in the world today. The pain affects 90% of people at some point of their lives. Human back comprises of various structures (see figure) which are nerves, bones, muscles, ligaments, and tendons, any or all of which can be a source of pain. Once back pain occurs, it may become chronic (more than 4 weeks) and you shall need to consult a pain physician for relief and accurate diagnosis.
Since prevention is always better than cure,  you can save yourself from having back pain if you follow these basic tips.
Regular Exercise in Correct Form: Regular exercise is important to maintain proper muscular strength of the back. Human back is supported by several big muscle groups (see figure). They serve two functions - one is to facilitate the posture and movements of the back itself and the other is to help movements of the rest of the body appendages (arms, head, pelvis and legs).The health of these muscle group is important to take stress off the spinal bones and maintain proper function. Most of these muscles are red muscle fibers as they need to maintain their activity for prolonged periods of time. Just to give you an idea - your biceps (arm muscles) have to work only when you bend your arm. But your back muscles have to function all the time - whether you sit, walk, stand or even sleep. But the point is what kind of exercises are good for your back? The best exercises for back include body weight low impact aerobics like brisk walking, swimming, stationary bicycling, extension exercises and yoga. What is important to remember while doing these exercises if that you need to be gentle in your movements and achieve correct "form" - this is possible if you can ask someone (preferably a trainer) to observe and point out whether the back stays straight during the exercise. It has been seen that arching and excessive bending is associated with injury to the back while exercising.
Stay Hydrated and Eat Natural Nutritious diet:The inter vertebral discs contain 70 - 80% water. The muscles and tissues have 60% water content. Therefore, it is important to stay hydrated. In addition, you must eat a nutritious diet consisting of green leafy vegetables, good protein source and just enough carbohydrates. Deficiencies of essential nutrients like Vitamin D can result in diseases like osteoporosis. Another important aspect is to maintain body weight within healthy limits. This is very important as increased belly fat is linked to increased back pain due to mechanical factors.
Lift objects correctly and maintain proper posture:While lifting objects, keep them as close to body as possible. Do not slouch or bend excessively while lifting. Just keep your back straight at all times. You may bend your knees a little if required (see figure). Think before you lift and get help if needed.
While working, you must not sit for more than 45 minutes at a stretch. Walk for two minutes, go to a colleague's desk and say hi or even just drink some water or visit the washroom. Humans evolved as hunter - gatherers and our bodies are more adapted to walking / standing than to sitting for prolonged periods. Those of you who travel more and have to sit for long periods of time also need to follow above tips - avoid prolonged sitting in same posture.While exercising, improper position can do more harm than good. Therefore, proper form and posture is a must.
Bonus tip: Avoid cigarette smoking and those who smoke cigarettes to decrease your chances of having degenerative disc diseases leading to chronic back pain early in life.
Word of caution to prevent permanent damage: In case of back pain, which is not responding to home remedies or over the counter painkillers, please contact a Pain Physician to pinpoint the diagnosis and appropriate management.

3 Essential Tips to Prevent Back Pain

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