Spine deformity refers to an abnormality of the shape, alignment, or formation of the vertebral column. The spine in the human body is composed of small bones or vertebrae, stacked on top of another. A healthy spine, typically, has gentle curvatures. A displacement or exaggeration of the spine leads to deformities.

Types of spine deformities:

The three major forms of spine curvature deformity are-

  Lordosis - Causes the lower back to turn inward
  Kyphosis - Leads to forward rounding of the back
  Scoliosis - Causes the spine to curve sideways

What are the causes of spine deformity?

The following conditions may cause the spine to be misaligned-

  Achondroplasia - A disorder, which impedes the normal growth of the bones, thereby resulting in short stature or dwarfism
  Spondylolisthesis - When the vertebrae in the lower back slip forward
  Osteoporosis - When the vertebrae become fragile and prone to fractures
  Scheuermann s disease - A developmental disorder of the spine that leads to abnormal growth of the upper back
  Spina bifida - A congenital disorder where the spinal column does not close completely while inside the womb

Symptoms associated with deformed spine:

Signs and symptoms of a deformed spine include-

  Uneven/misalignment of the shoulder and hips
  Uneven shoulder blades (one side is slightly higher than the other)
  Slight bending of the head over the body
  Difficulty in movement
  Discomfort and back pain

How is the condition treated?

The treatment of the condition depends on the severity of your spine deformity. Anti-inflammatory medications and drugs are prescribed to manage pain and discomfort associated with spine deformity/curvature. However, these cannot correct the deformity completely.

Severe cases of spine deformity need another line of treatment.

  Bracing - Back braces are recommended for children and adults alike, depending on the degree of curvature. This can help prevent the condition of your back from worsening.
  Body casting - The doctor places a cast that starts from the shoulders and goes all the way down to the lower trunk. This provides adequate support to the spine and strengthens the back.
  Spinal instrumentation - The surgeon will attach instruments like rods, hooks, and wires to the spine to keep the bones aligned following a spinal fusion.
  Artificial disc replacement - The surgeon replaces degenerated discs in the spine with artificial devices.
  Kyphoplasty - The surgeon inserts a balloon into the spine to stabilize and realign the deformed spine and relieve you from the pain.

Following the treatment, patients with spine deformity are usually advised to go for physiotherapy sessions. Physical therapy and exercise can help you build muscle strength and increase flexibility.

Deformity of the spine is a difficult condition to live with. Not only does it restricts your normal movement but also places you at risk of other musculoskeletal disorders. Therefore, it is imperative that you get the condition treated by a specialist.

Spine Deformity - Everything You Should Know!

Herniated disc, bulged disc, protruded intervertebral disc (PIVD) are the different names of one condition. This is a condition where- disc in between the two vertebral bodies starts peeping out on one side- anterior or posterior. These discs are just like the bags filled with liquid material, which work like shock-absorbent. There are several hard bony vertebrae in the vertebral column and there is plenty of movements with these vertebrae. When we look on one side to other side, we look upwards, downwards or we twist and even we bend forward or backward in each and every condition, there will be a movement in these bones, these discs decide the free movements of the spine. Along with this- when we walk or run there will be shocks and jerks to all these bones and these bags decide that there won't be any kind of jerks in between the bones. So, these discs are of multiple uses.

Our spine is inverted  S  shaped. There are two main curvatures in the spine which are free to move- Cervical and Lumbar curvatures. These curvatures of the spine are maintained due to the spaces in between the two vertebrae. Whenever there is a loss or change (specially reduction) of this space between two vertebrae- pressure will be exerted on the intervertebral discs. This uneven pressure on the disc causes- protrusion/bulge/herniation of the disc- this is the condition known as SLIPPED DISC, in layman language. Why does disc slip

Generally, slipped disc condition is diagnosed by its signs and symptoms. When slipped disc starts exerting pressure on the nerves surround the disc- the nerve will be excited which gives the sensation of- Pain, Burning or Numbness in the related area of the nerve. This sensation can travel long far away to the areas, which are being supplied by the nerve and can be limited to a particular location in neck or back even. Sign & Symptoms of Slipped Disc.

Ayurveda about Slipped Disc

Where modern medical (Surgical) sciences believes that this is a problem of just bones and joints of the vertebral disc besides this Ayurveda takes a  Wholistic  (Complete and wholesome) approach towards this and tells that this is a problem at three levels-

Mamsa Dhatu, Asthi Dhatu, Majja Dhatu!!
These are different tissue levels according to Ayurveda- Mamsa is muscles, Asthi represents bones and the Majja denotes everything which is in between and in the bones.
Mamsa (the muscles) starts stiffening due to the dryness   improper diet and imbalanced lifestyle and deteriorate the curvature of the spine- which leads to the deterioration of the intervertebral discs.
Asthi (the bony tissue) is affected due to the muscles.
Majja (the disc and the neural tissue- spine) is compressed due to the pressure and all effects.
So, we need to treat the condition, wisely and in a wholesome manner, rather just to removal of the protruded tissues (Laminotomy) and this is the basic reason- there are risks associated with the surgery of the spine and in almost more than 45% cases patients had to go for a second surgery to stay pain free. Why Surgery for spine doesn t succeed. Secondly, this is a mechanical problem so medicines alone can give you temporary relief rather than the cure-  So better you save your money and invest it on complete cure for the problem, rather than just taking the pain killers and medicines which were indicated in epilepsy to just reduce the signs and symptoms.



Slipped Disc - How Can Ayurveda Avert It?

Also known as Median Nerve Compression, Carpal Tunnel Syndrome is characterized by a sensation of tingling and numbness in the hands or the arm caused due to a strained nerve of the wrist. This condition occurs due to stress which affects the functioning of the part of median nerve, situated along the wrist.

Various Causes of Carpal Tunnel Syndrome:
Constant movement of the hands in activities such as typing on the computer
Pregnancy
Arthritis

Various Symptoms of Carpal Tunnel Syndrome:
The symptoms of this syndrome start to show up when there is excessive pressure build up in the median nerve of the wrist. You may experience-

A sensation of numbness
A sensation akin to the pain experienced when needles are inserted into the skin
Pain (mostly at night)
The build- up of pressure can occur due to a number of reasons. They are-

Painful injury
Fracture
Tenosynovitis (a condition that affects the tendons along the sides of the thumb)
The compression of the nerve may develop anywhere, and not necessarily the wrist only.
Diagnosis of Carpal Tunnel Syndrome:
Doctors base their diagnosis of the condition on the symptoms and certain tests. These include-

Phalen s test (a test that is carried out to determine any pain or numbness in the fingers within one minute of this activity)
Wrist flexion/median nerve compression test
Tinel s test (a test that is used to diagnose irritated nerves)
Few nerve enlargements may be revealed by an ultrasound, X-Ray, MRI scan, CT scans etc. The doctor generally recommends any of the above tests to determine carpal tunnel syndrome.
Important measures that help treat the condition are

Getting ample rest
Educating yourself on the various symptoms
Knowing certain activities or movements that trigger symptoms
Attending physiotherapy sessions
Physiotherapy as an important form of treatment for Carpal tunnel syndrome
Extensibility of muscle as well as soft tissue
Strengthening the forearms and the ability to grip things and pinch too
Maintaining posture and performing hand agility exercises can improve the hand movement
Mobilization of the Carpal bone and stretching of the flexor retinaculum (a fibrous band near one s wrist) so as to widen the carpal tunnel
Gliding training for nerves/ tendons for unrestricted motion
Endurance training for strengthening the upper limb as well as the wrist

Carpal Tunnel Syndrome - Measures That Can Help Treat It!

Muscle contusion is a condition that is characterized by bruising in the muscles. It generally tends to occur in athletes who play a lot of contact sports. Repetitive blows in any part of the body may cause damage to the underlying muscle tissues. These blows may lead to internal bleeding, resulting in blood clot formation. The most common site where it occurs are the quadriceps.


The various causes of this condition are:
1. Direct repetitive blows to a part of the muscle in contact sports such as football
2. If you fall on a hard surface 
3. It may also occur if the muscle comes in contact real hard with sports equipments like soccer balls

The symptoms of a muscle contusion are:
1. You may experience swelling of the muscle
2. Excessive pain
3. Decrease in range of motion in the concerned body part
4. It may lead to leaking of blood vessels
5. You may also experience hematoma where a lump is formed over the affected spot
6. Symptoms of broken bones, dislocations and fractures may also occur

Complications
This disorder may also lead to various complications such as compartment syndrome, which leads to compression of blood vessels resulting in pain. 

Treatment
The basic treatment for this condition is the rice protocol which is rest, ice, compression and elevation. You should rest the muscle, then apply ice to the affected area to reduce the pain. You can also take nsaids (non steroidal anti-inflammatory drugs) to reduce the pain. In severe cases, the doctor may drain the lump surgically.


It is advisable to not return to your normal sports routine in order to allow the muscle to recover. If you carry on with your regular routine, it may result in further complications like the formation of scar tissue. You may undergo various stretching exercises to relieve the pain and make a gradual return to your normal sporting activities.


Causes and Symptoms of Muscle Contusion

Osteoarthritis (oa) is a degenerative disease that affects the various bone joints, leading to painful movement and thereby limiting the patient's mobility. Knees, hips, joints of hands and legs are affected.

Symptoms of oa

The symptoms revolve around the bones and joints including:

 Pain and stiffness of the joints
 Swelling of the joints
 Inability to form a clench
 Difficulty holding things 
 Stooped posture 
 Weakness of legs and hands
 Reduced height over time

Treatment options in allopathy are limited to nonsteroidal analgesics to control pain and in severe cases, surgical correction, in case of oa. However, homeopathy takes into account the triggering symptoms, the associated symptoms, and the status of the immune system before deciding on a treatment regimen.

With this holistic approach, homeopathy achieve the following:

 Reduce the pain, swelling and stiffness
 Slows the pace of further degeneration
 Improves mobility of the affected joint (s)
 Improves the body's overall immune system, thereby allow the body to promote healing on its own
 Homeopathic intervention in the early phases is particularly helpful, as it will arrest disease progression
 It also enable better absorption of minerals and nutrients essential for bone health. This allows healing of existing bone fractures and avoids further bone damage by strengthening the bones
 Homeopathic treatment also enables the body's chemical state to withstand stress and illnesses better
 It vitalizes the body's natural healing and ability to repair itself, to create a better state of health and well-being

Some of the popular homeopathic medications based on areas and associated symptoms are listed below:

Knee joints:

 Bryonia alba: pain worsened with movement, relieved with rest; associated with swelling and stiffness of the joints; difficulty in climbing stairs.
 Calcarea carbonica: swelling and pain that is worsened when getting up from a seated position. The joints feel cold and painful.
 Sulphur: worse with climbing stairs, prolonged standing, feeling of warmth in the knees. 

Hip joints:

 Colcynthis: cramping pain improved by pressure.
 Rhus toxicodendron: pain when getting up from a seated position.
 Pulsatilla nigricans: associated with muscle stiffness and cramping.

Finger joints:

 Antimonium crudum: the pain pain gets worse in cold weather, improved by applying something warm) 
 Benzoic acid: there is an associated crackling sound when the fingers are moved or if there are nodes in the area of joints. The urine is highly offensive in these people. 
 Calcara fluorica: there are stony hard nodes formed in the joint area, greatly reducing the mobility.

These medications are safe, completely natural, do not induce habit formation, and are approved by fda. They don't just treat the symptoms but help manage the patient as a whole. This justifies why homeopathy is definitely a good option in treating osteoarthritis.

Homeopathy for Osteoarthritis: Why is it a Good Option?

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!

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