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!

Infection caused in the kidneys, bladder, urethra or the ureters is known as urinary tract infection. According to doctors, women are generally more at risk of suffering from this condition than men. Some of the causes which contribute to the development of this infection are:

1. Invasion of bacteria: like any other infection, one of the causes of urinary tract infection is the invasion of the bacteria escherichia coli in the bladder. This type of bacteria is most commonly found in the gastrointestinal tract and is most often held responsible for urinary tract infection.

2. Spreading of the bacteria from anus to urethra: the spread of the gastrointestinal bacteria from the anus to the urethra leads to the infection of the urethra thereby causing urinary tract infection. 

Some of the symptoms of urinary tract infection are

1. A nagging urge to urinate: one of the most predominant symptoms of urinary tract infection is a persistent, nagging urge to urinate. You would know your urinary tract is infected when you feel the urgency to urinate extremely frequently.

2. There is a burning sensation when you urinate: the symptoms of urinary infection are extremely visible and are felt intensely by the one suffering from it. If you feel a burning sensation while urinating, chances are extremely high that you are suffering from urinary tract infection.

3. Red colored urine: sometimes your urine may contain perceptible amount of blood in them. In most cases, presence of blood in urine is a definite sign of urinary tract infection.

4. Foul smelled urine: an internal infection in the urinary tract manifests itself in different ways. One of the chief symptoms of this infection is discharging foul smelling urine.

5. Pain in the pelvic area: women who suffer from urinary tract infection experience excruciating pain near the pelvic area, sometimes extending to the pubic bone.

Causes and Symptoms of Urinary Tract Infection

Carotid artery disease occurs when an oily, waxy substance called plaque builds up inside the carotid arteries. These are arteries that supply oxygenated blood to your brain, face, scalp, and neck.
Carotid artery disease is very serious as it can cause a brain stroke. It, in fact, starts with damage to the inner layer of the carotid artery. To stem this damage your body starts a healing process and this leads to a build up of plaque at the point where the artery is damaged.

When this plaque ruptures, platelets are rushed in and these create an obstruction to the flow of blood to the brain. When the blood supply to the brain is cut off, which happens in carotid disease, the brain cells begin to die causing a stroke. This neural death impairs the parts of the body that these brain cells control. So, you can get paralyzed, become speech or vision impaired, have long  term effects like paralysis or even die due to a stroke.

Causes of carotid disease

Smoking
High cholesterol levels
High blood pressure
High levels of sugar in the blood due to diabetes
What s even more worrisome is that carotid artery disease may not cause any signs or symptoms until the carotid arteries are severely narrowed or blocked. And what usually happens is that a stroke becomes the first sign of the disease.

How scary is that?
So, the next question that comes to the mind is - Can this condition be cured? Let s learn more about management and prevention of the same-

Prevention
Lifestyle changes are key. Since hypertension, uncontrolled diabetes, sedentary lifestyles and imbibing too much fat are all risk factors, taking care of them minimizes the risk of carotid disease and strokes. Heart healthy lifestyle changes that include moderate exercise are a great way to prevent carotid disease.

Treatments
Treatments for carotid artery disease include:

Medicines: Sometimes lifestyle changes do not stem the rot. You need medicinal help. Doctors usually prescribe statin medications to control your cholesterol levels. These lower the bad cholesterol that can narrow your carotid arteries and cause brain strokes and damage. Statins are usually prescribed for people who have:

Heart disease
Those who ve had a stroke
Diabetes
High LDL or bad cholesterol levels
Medicines like Aspirin and Clopidogrel to prevent blood clots are the mainstay treatment if you suffer from carotid disease. They prevent platelets from clumping together inside your carotid arteries and forming blood clots. Apart from these, your doctor may also medicate you for conditions that can damage your carotid arteries and cause strokes. These medicines are for lowering your BP, blood sugar levels, preventing the formation of blood clots anywhere in your body including inside your heart, and preventing and reducing inflammation.

Medical Procedures
These are used to open narrowed or blocked carotid arteries.
The two common procedures are:
Carotid endarterectomy: It s mainly for people whose carotid arteries are blocked 50 percent or more. In this, the inner lining of the carotid artery that is blocking blood flow is removed.
Carotid artery angioplasty and stenting: Here, doctors use a procedure called angioplasty to widen the blocked carotid arteries and restore blood flow to the brain. A stent is inserted into your carotid artery to broaden the lumen. 

High Cholesterol Level - Can It Cause Carotid Disease?

Reducing, limiting or stopping the intake of alcohol can be a bumpy road. Impossible as it may seem, it is possible to recover from alcoholism with proper care and support. Recovery being a gradual process, denial often plays a spoilsport. The first step is to accept that alcohol abuse is occurring and take the necessary steps to remedy it. 

Here is a list of a few steps that psychologists suggest can get rid of alcoholism:

Doing a cost-benefit analysis: The first thing a psychologist suggest is to do a cost-benefit analysis. For instance, the benefits of drinking could be having fun, a possible way to relax, forgetting about the problem at hand etc. On the other hand, the benefits of not drinking could be a better state of physical and mental well-being, improving relationships, having more time and energy to lead a healthy life etc. Similarly, the cost of drinking could be problems in relationships, depression, anxiousness, poor performance at work etc. The cost of not drinking, on the other hand, could be finding other solutions to deal with problems, losing drinking buddies, taking up more responsibilities etc.
Setting goals: The next step is to set goals pertaining to giving up alcohol for good. It is important to be realistic while doing this. The goal should be specific and precise in nature. For instance, the goal could be writing the date of quitting alcohol in a personal diary or something such as drinking a certain amount of alcohol during weekdays and weekends etc. It is important to announce or share the goal with dear ones. It helps to reduce temptations and avoid bad influences.
Cutting back drinking or quitting at one go: The next step is to work towards the goal. Once the goal is set, it must be adhered to. Keeping a personal diary to measure everyday drinking goes a long way in quantifying and ultimately limiting it. Instead of going out and drinking with buddies, drinking at home could help curb alcohol intake. Drinking slowly is also helpful when trying to quit alcohol.
Get sober safely: While some people can give up drinking over-night, some need medical and psychological assistance to quit. Either way, it makes sense to seek expert advice while quitting alcohol. Suddenly quitting alcohol can result in withdrawal symptoms. Nausea, headache, anxiety, sweating, shaking, elevated heartbeat etc. are some of the withdrawal symptoms. It is possible to counter these symptoms medically.
Change in lifestyle: While the body gets used to an absence of alcohol, it is necessary that certain lifestyle changes are made. For instance, daily exercise, building a good support network, developing a new interest, eating healthy food, meditation etc. helps a person to quickly get used to life without alcohol.

De- Addiction - 5 Things Your Psychiatrist Will Suggest!

One of the most common health problems people have is indigestion. As per ayurveda, the accumulation of Ama or toxins leads to an imbalance in the way the small and large intestines functions along with various other participating organs like the liver and more. And this is the rootcause for indigestion.

The digestive tract or system is one of the most important organs of the body. Ayurveda relies on the rhythms and functions of the body to find the rootcause of ailments. Indigestion usually occurs because of bad daily habits & less physical activity.

There are many ways to treat to indigestion in an ayurvedic way. Let us look at the top tips for the same:

Timely intake of meals: For better digestion, one must take meals at the same time everyday. Also, do not sit down for the next meal before the previous meal has been digested properly.
Sleep: Sleep is a major factor that cure stress and creates a balance of sorts in one's routine, thus aiding proper digestion.
Exercise: Some form of movement and exercise is imperative to keep the digestive system in prime working condition. Walk and yoga especially are ideal to boost one's digestive health.
Aloe vera: An ounce of aloe vera a day will keep indigestion away. Break off, a leaf and scoop some gel into a smoothie for smooth digestion.
Turmeric: Haldi or turmeric helps in reducing bloating and is one of the most commonly used spices found in ayurveda. This spice is a staple in indian cooking as well, where pretty much all dishes are seasoned with cooked turmeric.
Meditation: This is one of the best ways to give digestion a positive push with a good dose of mindfulness and awareness for better balance in the body.
Avoiding unhealthy food: One must avoid unhealthy food that are excessively fried, fatty, sweet or cold so as to aid the digestive fires in doing their job effectively.
Triphala: This combination of three fruits ensures that your digestive system remains in good working condition.

Digestion Problem? Know The Simple Ayurvedic Remedies to Cure It!!  

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!

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