Spine surgeries are complicated and have serious repercussions if the procedure doesn t go as planned. Probing your doctor is therefore very critical to ensure a safe operation and early post-op recovery. Questions can range from the type of treatment chosen for speedy recovery to side effects. Here is a list of questions that you need to ask your spine surgeon:

1. Why is the surgery recommended?
Typically, there could be more than one treatment option for a particular problem. Your doctor should be able to tell you very precisely as to why the surgery is recommended and how it is going to address the problem.

2. Is there any non-surgical option?
Many spine related issues can be treated with medicines and physiotherapy. Ask your doctor if such options exist.

3. Explain the surgical procedure in detail
Your doctor should explain the whole surgical procedure, explaining the minute details and help will help you to understand the implications.

4. What is the duration of the surgery?
Spine surgeries do not take more than 2 hours. It, however, depends on the procedure that is being performed.

5. How will the surgery address the pain?
It is important to know the source of the pain. Exploratory surgeries are not performed on the spine. Ask your doctor how he intends to address the pain through the surgery.

6. What are the risks involved?
Risks and side effects vary from patient to patient. For instance, a person with obesity, spondylitis and smoking has greater chances of complications associated with the operation.

7. Will the doctor perform the whole procedure or he will use practicing surgeons and intern for the job?
Many senior surgeons use interns and junior surgeons to perform a minor procedure. Get a clear understanding of the role of the doctor and his assistants. It is a good idea to know the background if the surgical team who is going to perform the procedure.

8. What is the success rate of the doctor for the procedure he is going to perform?
A successful spine surgeon should be able to give you valid data on his/her success rate and the overall success rate of surgeons all across the country.

9. How many days do you need to spend in hospital?
Your hospital stay is directly related to your insurance. It is essential to get a clear picture on the same.

10. Whether a back brace is necessary after surgery?
Limiting the spine movement speed the process of healing. Most Doctors suggest braces after a spine surgery.

11. What is the time required for recovery?
The recovery greatly varies from patient to patient. What you should ask your Doctor is the expected time required for you to join your job/school.

12. Will there be any physical limitation after the operations?
Many spine surgeries require you to refrain from strenuous jobs for a while. For instance, certain surgeries require you to stay away from driving for a while. Address all these apprehensions from your doctor.

12 Questions You Must Ask Your Spine Surgeon

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!

The bones and joints orchestrate very well with each other for smooth movements of various joints and the spine. However, due to various reasons, some identified and others unknown, there could be inflammation of the areas where the bones join the muscles leading to impaired movement. The range of motion could be reduced or it could be painful, thereby, limiting movement. Spondyloarthritis includes a group of inflammatory diseases that involves the bones and joints and enthuses which are areas where the ligaments and tendons attach to the bones. This causes conditions like plantar fasciitis, ankylosing spondylitis, psoriatic arthritis and reactive arthritis. The term spondyloarthritis is a blanket term to describe any of the above-mentioned conditions.

Read on to know a little more in detail about it:

Causes: While the exact etiology is not identified for sure, most patients with spondyloarthritis have an autosomal dominant gene (HLA-B27). Chronic infections could trigger the onset of the disease too.

Symptoms:

1. In all forms of spondyloarthritis, there is always inflammation of the spine, joints and entheses. If the fingers or toes are involved, there could be swelling leading to what are typically known as 'sausage digits'.

2. There is sacroiliitis which is inflammation of the joint between the pelvis and the spine, and spondylitis which is inflammation of the joints between the spines. 3. Family history and autosomal dominant gene.

Diagnosis:

A detailed medical history and physical examination form the cornerstone of a confirmed diagnosis. In addition, radiographic examination and diagnostic blood tests also could be done to confirm the diagnosis. Radiographs, especially, of the spine and the low back show typical changes including sacroilitis in suspected cases of spondyloarthritis. If the spine does not show these changes, but there is a high likelihood of spondyloarthritis, then MRI (magnetic resonance imaging) can be used to confirm the diagnosis.

As a final step, a blood test for the HLA-B27 gene can also be confirmatory. However, it is not true that a person with the gene will definitely develop the disease.

Treatment:

The most important aspect of treatment is the use of pain medications and anti-inflammatory drugs (NSAIDs) which help manage pain and inflammation.
Corticosteroid injections may sometimes be given directly into the joint spaces or the membranes to provide quick relief of these symptoms.
ESWT / RSWT has a definite role to cure enthesopathy. Plantar fasciitis, and achillodynia can be cured with ESWT. Even small joints of hand and feet are amenable to treatment with RSWT. It is nonoperative and noninvasive treatment and has no side effects.
Very rarely, stronger drugs such as methotrexate or sulfasalazine may be used.
Another set of drugs known as TNF-blockers (tumor necrotizing factor blockers) are also shown to be highly effective in controlling the pain of the spine and joints.
In very severe cases, surgery may be required to correct joint damages or correct severe degenerative changes.
Exercise plays a very vital role in controlling the issue and improving range of motion.

What You Should Know About Spondyloarthritis?

Weakness of the muscles due to a genetically inherited condition is known as muscular dystrophy. This condition prevents the body from producing the required protein that can help in building muscles. This protein is also responsible for making the muscles strong and stable. This is most commonly seen in children who may seem clumsy as they begin to grow up and indulge in varied kinds of movements. Let us learn more about this condition and the ways in which it may be treated.

1. Symptoms: In order to better understand the ways of treating this condition, it is important to take stock of the varied signs and symptoms that are associated with the same. The main symptom of this condition includes difficulty in walking as well as constant slips and falls that may be endured by the child. Also, the children suffering from this condition will have trouble in lifting the leg and foot in a normal way.

2. Other Complications: This condition can also affect the heart and lungs by making the muscles in these regions weak. Also, this condition can lead to a number of serious breathing problems that will need immediate medical intervention so that it does not become fatal. It may also lead to accelerated heart beats and affect the hands and feet of the patient in an adverse manner. This condition can be found in different types, each of which will affect the patient in a different manner.

3. Physical and Occupational Therapy: One of the most effective ways of dealing with condition in the long run is to indulge in physical and occupational therapy. With the help of a physiotherapist and other specialists, the patient will be taught to move in a more deliberate and normal manner without falling too often. Also, the patient will be eventually trained to go about life and various functions with certain kinds of movements that will be limited to the issues that the patient may be facing. Bracing will also be required so as to help the child cope better in the physical sense.

4. Prednisone: This medicine may be prescribed by the Pediatrician to ensure that the progression of the heart issues may be slowed down. This will ensure that the heart may function in a more normal manner despite the muscle issues that it may be facing. The doctor will usually recommend that the medicine should be started when the child is around five or six years old.

5. Spinal Fusion: This surgery can lessen the pain and reduce the severity of the symptoms, which can lead to better chances of moving in a normal manner. This will also give the child better posture so that the child may breathe normally.

How Can Muscular Dystrophy Be Treated in Children?

If you are suffering from arthritis, it is important for you to know about how it affects your knee and other joints. Arthritis is a chronic, systematic inflammatory disease which damages your joints and connective tissues. Your knee is commonly affected by arthritis and there are three primary types of arthritis that occur in the knees. They include osteoarthritis, rheumatoid arthritis and post-traumatic arthritis.

Types of arthritis 
The different types of arthritis affecting the knees occur due to different reasons. Osteoarthritis is a progressive condition, which wears away the joint cartilage over time. Rheumatoid arthritis is an inflammatory condition, which may occur at any age. Post-traumatic arthritis occurs after an injury is inflicted to the knee and may occur several years after a ligament injury or knee fracture.

Major symptoms

Arthritis pain may occur all of a sudden but develops slowly. In the early stages, the pain is observed in the morning after you have been inactive over the night. Pain is likely when you want to move around. Pain may be experienced even when immobile.
Periodic inflammation is a common symptom of arthritis of the knee. This happens because of the formation of bone spurs or excess fluids in your knee. The swelling gets pronounced after being inactive for a long period. The skin on your knee may look red and feel warm while you touch it. This may lead to chronic inflammation, which is very difficult to manage.
Treatment
There are several ways of treating knee arthritis. The mode of treatment depends on the severity and cause of knee arthritis. NSAIDS or nonsteroidal anti-inflammatory drugs are commonly prescribed for dealing with arthritis pain temporarily. Other medicines used for knee arthritis treatment are as follows:

Analgesics, which help in pain reduction act as good alternatives to NSAIDS.
Corticosteroids are used for reducing inflammation.
Certain DMARDs or disease-modifying antirheumatic drugs are used.
Certain injections that are used for helping with knee arthritis. They include:

Hyaluronic acid supplements, which ease the pain and inflammation by lubricating your knee joints.
Corticosteroid injections also soothe inflammation and pain.
You may also require a surgery for dealing with knee arthritis when other modes of treatment fail. The most common surgeries are as follows:

Total joint replacement, where your knee is replaced with a prosthetic made of metal, plastic or ceramic.
Osteotomy, where the knee bones are modified for controlling pressure and damage in the knees.
Arthroscopy, where an incision is made in the knee for removing damaged parts.
It is recommended for you to consult a doctor, if you experience any symptom of knee arthritis. Early treatment will prevent the condition from worsening.

Know if You Have Arthritis in the Knee

Your knee is guarded and cushioned by a cartilage known as meniscus. A meniscus tear, therefore, is an extremely painful and discomforting situation. It occurs very frequently and has emerged as one of the most commonly occurring cartilage injuries. What makes a meniscus tear an extremely common phenomenon is the way it can tear that is all it takes is a twist of the knee for it to happen.

People involved in sports mostly face the brunt of this form of injury. The risk of getting meniscus torn increases with age and tends to occur at the slightest change of direction of movement. 

Symptoms 
Some of the symptoms of a torn meniscus are:
1. Pain and inflammation: it goes without saying that an internal injury of the cartilage or tearing away of it would inevitably result in extreme pain and inflammation near the knee.
2. Immobility: the extreme pain and inflammation, which follows will inevitably make it difficult to move. Since the pain occurs in the joint, you will have difficulty in walking and any forceful movement will only aggravate the pain.
3. Locking of the knee: locking of the knee refers to a situation when you are unable to move your knee. This occurs most commonly after you have your meniscus torn.

Treatment
Notwithstanding its frequency of occurrence, there are several ways, by which you can treat a torn meniscus. Some of the ways are:
1. Apply ice: in order to get some relief, applying ice is a suitable option. If you apply ice every day for some time, it wonders in reducing swelling and the consequent pain.
2. Use a bandage: in order to control the swelling, it is important that you cover your knee with an elastic bandage.
3. Change the posture: it is important that you keep the affected knee in an elevated plane, in order to ensure an efficient blood supply and a consequent relief from pain.

Some medical treatments
There are many things to consider when deciding how to treat your torn meniscus, including the extent and location of the tear, your pain level, your age and activity level, your doctor's preference, and when the injury occurred. Your medical treatment choices are:
1. Nonsurgical treatment with compression, elevation, and physical therapy. This may include wearing a temporary shoulder brace.
2. Surgical repair to sew the tear together.
3. Partial meniscectomy, which is surgery to remove the torn section.
4. Total meniscectomy, which is surgery to remove the entire meniscus. This is generally avoided, because this option increases the risk for osteoarthritis in the shoulder.
5. Whenever possible, meniscus surgery is done using arthroscopy, rather than through a large cut in the shoulder.

Symptoms and Treatment of Torn Meniscus

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