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!

Injuries are an inherent part of sports. All athletes have sustained some injury or another during the span of their careers. No matter which sport you play, be it football, hockey, tennis or cricket, whether you are representing your country or your college, you are likely to get hurt at some time. An injury has the potential to end careers and ruin dreams. That is because the injury takes a toll not just on the body but the mind as well. It instils confusion and hesitation and sometimes after an especially traumatic accident, athletes find it difficult to return to practice because they are crippled by a sense of fear.

That is why along with treatment or surgery, a sportsperson also needs to undergo rehabilitation therapy.

Why Psychological Rehabilitation is Important? 

After suffering a serious injury that almost jeopardized their career, athletes suffer a wide range of psychological and physical challenges, which makes them retreat from the outside world. These are problems they would not be able to cope with unless they opt for rehabilitation programmes.

  It helps them accept that getting back to the game will be a mammoth task 

  Inspires in them the confidence to keep trying 

  Deal with the pain 

  Go about their practice sessions with as little discomfort as possible 

  Overcome feelings of fear or despair 

  Cope with depression 

  Prevents the person from sinking into a state of self-pity which hinders recovery 

  Look at the injury not as something that might put an end to their career but as a mere impediment in the path to success 

Psychological rehabilitation adopts a wholesome and expansive approach to healing the athlete. It takes into account several factors in chalking out a course to recovery that is individualistic   

  The personality- the toughness, determination, will power of the athlete, ability to deal with anxiety

  Medical history- past injuries or illnesses 

  Resources of coping- the athletes  support system, a network of friends and family, management of stress, treatment and medicines etc 

Psychological rehabilitation also takes into account the individual s response to therapy to ensure that it is as effective as possible. These are   

  Cognitive appraisal - Monitors a person s growth or decline in self-esteem or worth as well as confidence. The aim of rehabilitation is to restore the person s faith in his/her capabilities 

  Behavioural response - This ensures that the individual s behaviour shows traces of denial or avoidance because negativity will only delay recovery 

  Emotional response - The profile of Mood States (POMS) is utilized to analyze or gauge the person s emotional reaction to therapy. It is supposed to uplift the athlete mood and deal alleviate feelings of despair or hopelessness. Medicines and physiotherapy become more successful in treating a sports injury when coupled with psychological rehabilitation. 

Athletic Injuries - How Effective Is Psychological Rehabilitation As A Line Of Treatment?

Spondylosis is a disease of the bone which involves wear and tear of the discs. The latter is the cushion between the joints of the neck and the neck bone. While it is mostly observed in aged people, it is not too uncommon among the youth as well. It can present with symptoms such as numbness, neck pain, headache, stiffness near the shoulder area etc. Ayurvedic treatment has been extremely promising in treating both cervical and lumbar spondylosis.

The food connection: Ayurveda states that there is a close connection between Spondylosis and food. In Ayurvedic terms, an increase of Vata Dosha can lead to the problem of Spondylosis. For instance, consumption of frozen or processed food, sodas, junk food, low consumption of water, excess consumption of curried food heighten the chances of Spondylosis.

Habits matter: As per the books of the Ayurveda, a reckless lifestyle increases the chances of Spondylosis. Habits such as day sleep, regular walking for a long distance, urging the suppression, rigorous exercise daily, work that involves bearing of weight on the neck, head and shoulder, night awakening etc. can wreak havoc and result in Spondylosis. On the other hand, healthy lifestyle changes can help a person refrain from this condition.

Psychological Factors: Ayurveda states that even psychological factors can go a long way in making a person suffer from Spondylosis. Certain factors such as excess stress, loss of interest in day to day work, fear of failure, feeling of frustration, too much anger, grief resulting from personal loss etc. play a major role in Spondylosis.

Visible Symptoms of Spondylosis:
Some medical symptoms that can be easily identified as the signs of Spondylosis include fatigue, pain in the arm, shoulder, and forearm, difficulty in functions pertaining to neck rotation, extension, joint stiffness, muscular spasm, headache, weakness in the arm, difficulty in movement, difficulty in muscle coordination etc.

Some ayurvedic treatments to deal with Spondylosis

Treatment: 

Home Remedies For Cervical Spondylosis:

Use Cow's ghee in your food. It is a best natural "Vata" reliever and gives nourishment to the nerves and other body parts.

1 tablespoonful of Turmeric should be consumed once every day, after boiling it in milk for half an hour. It is a very useful herbal treatment for cervical Spondylosis.

Constipation must be avoided at all costs. Constipation may increase pain in Cervical Spondylosis.

Herbs have divine healing powers and they have the ability to cure any type of disease from the root. They were gifted to us by God when he created life. So believe in God if you want to get rid of your problems!

Ayurvedic herbs are unique natural remedies for Cervical Spondylosis. Ayurvedic principles are different in many ways from modern medicine for example - Drinking water from a copper pan after keeping it overnight is also very useful in Rheumatoid arthritis and Cervical Spondylosis.

Consuming castor oil at night with milk or alone is a very useful herbal remedy for arthritis, especially rheumatoid arthritis and Cervical Spondylosis.

Improve your nutrition as the first step.It plays an important role to fight diseases. When nothing works, nutrition does!

Use herbal juices like Aloe vera juice (Kumari Saar) and Amla Juice (Amla Saar) in routine. Amla is the richest source of natural Vitamin C. Vitamin C improves the natural immunity of the body. 100 gm of Amla juice contains 30 times more vitamin C than 100 gm of oranges.

Greeva Basti- A compound created with Bala Ashwagandhadi oil, Medicated oil and black gram paste is applied on the affected area. Regular application of this can regenerate the muscle bone and reverse Spondylosis to a considerable extent.

Ayurvedic Herbs For Spondylosis
Some ayurvedic herbs are known to be extremely beneficial for treating Spondylosis. When these are consumed or applied on the affected area, they can fetch surprising result for a Spondylosis patient. Some of these herbs include Prishniparni (Uraria picta), Ashwagandha (Withania somnifera), Guggulu (Commiphora mukul), Shunthi (Ginger), Bala (Sida cardifolia), Amalaki (Emblica officinalis), Gambhari (Gmelina arborea), Shallaki (Boswelia serrata), Rasna (Pluchea lanceolata), Castor root (Ricinus communis) etc.

Spondylosis - Is Ayurveda The Best Form Of Treatment?

Mobility for a person is very important, and when you look through, the hip is a very important component to this. It connects the upper and lower parts of the body and helps in movement. It is a ball and socket joint, where the hip bone provides a socket, into which the upper part of the thighbone (femur) sits into, allowing for free movement.

Like any other human organ, the hip also is prone to damage. Be it natural ageing, infection, injury, or diseases, hip movement can be affected, leading to limited movement and increased pain and stiffness. For these people, being able to get back a hip which will allow them to be back on their feet is a boon for sure. It helps in relieving pain and improving mobility, almost giving people a second lease of life.

Reasons for hip replacement:

With natural ageing, the hip joint can lose its ability to move, due to normal wear and tear of the hip and thigh bones
Diseases of the hips (infectious or autoimmune) can also lead to hip replacement
Injury or trauma is another major cause that requires hip replacement
Joint problems, leading to repeated dislocations
Tumours of the relevant bones
Understanding the procedure in detail

The affected bones (whether diseases or worn out) are replaced with a prosthesis which is compatible with the normal body tissue.
While some materials fuse to the natural bone, others do not and are simply placed as a separate unit
This is a surgery which requires hospitalisation and stays for up to 5 days depending on patient s overall health condition
The entire procedure may take a couple of hours and is usually done under general anaesthesia
An incision is made through the side of the hip
Both the hip and the thigh joints are prepared, diseased tissue removed, re-shaped, etc. to make way for the prosthesis
The prosthesis is introduced through the same incision and positioned into place
As noted earlier, there are two types. The ones which fuse to the bone have pores in them into which normal bone eventually grows.
The other variety is the cemented version, and a glue is used to keep it in place
Most doctors now use a combination, that is cement a porous prosthesis, into which bone will grow, and the incisions are closed
The patient stays in the hospital for 1 to 4 days depending on overall health
Once discharged, infection and pain control are continued
Exercise and physiotherapy play a major role in restoring normal function
Weight management is also very important

Hip Replacement - Understanding The Procedure In Detail!

Pain in the joint is an eventuality that only few can escape. It is an ailment that comes with age and promises to stay despite continued attempts at eradicating it. Being a problem that many are battling, it has provoked attempts at treating it. Various disciplines of medicines have tried in their own ways in dealing with this problem, but ayurveda with its strict reliance on natural products and aversion to chemicals has been most preferred. The various ways by which ayurveda treats joint pains are:
1. Massage: ayurveda focuses on massages as a remedial measure. Using few herbal oils and using them to massage regularly on the affected joints has been an accepted remedy for joint pains. A massage promotes blood circulation and creates a calming effect.

2. Hot and cold compresses: the effectiveness of this form of treatment has remained prevalent through generations. Extremely convenient and easy to use, you can use hot and cold compresses alternatively to ease the pain.

3. Fenugreek: fenugreek seeds have a long standing reputation of relieving you of pain. Boasting of antioxidant properties and the ability to reduce swelling, they must be finely grounded and swallowed with lukewarm water to enjoy best results.

4. Turmeric: in the hierarchy of ayurvedic medications, turmeric probably ranks the highest. It is packed with multiple benefits. Not only does it take care of the skin, it also helps in reducing joint pains. The most common way of having it is by mixing turmeric in a glass of warm milk and honey.

5. Apple cider vinegar: apple cider vinegar reduces joint pains by effectively eliminating the accumulated toxins. It is rich in magnesium and phosphorus and owing to its alkalizing effect, it has the ability to cure rheumatism.

Ayurveda and Joint Pain Remedies

Paralysis can be concluded as the state when the muscles lose functioning in any part of the body. Any kind of disruption in our nerve system can be responsible enough to cause paralysis. Our central nervous system and peripheral nervous system communicate and control our senses of movement. But interruption in nerve impulses can cause weakness in muscles which leads to muscle paralysis.

Symptoms
A paralysed patient will encounter symptoms like:

Decreasing the motor power
Decreasing vasomotor control
Loss of sensation
Decreasing bowel and bladder control
When it comes to treating a paralysis patient, physiotherapy is proven to be the best remedy. Physiotherapy has thoroughly helped patients with paralysis in getting to feel confident and independent. Physiotherapy includes various exercises and techniques which are developed with time in order to provide a complete rehabilitation to the patients.

Types of paralysis:
There are mainly four types of paralysis

Monoplegia: when one limb gets paralysed
Hemiplegia: when arm and leg of a single side get paralysed
Paraplegia: when legs get paralysed
Quadriplegia: when both sides get paralysed
Treating paralysis with physiotherapy

Physiotherapy is advised to patients with any type of paralysis. It should be started soon in order to improve blood circulation in the muscles. It also helps in relaxing the stiff muscles. This treatment improves the overall health condition of the patient.
Physiotherapy is also responsible for reducing any kind of swelling which takes place due to external brain injury.
Physiotherapy is helpful in making the patient stable and independent.
It also helps in maintaining the blood pressure.
It helps to improve the respiratory system.
Physiotherapy maintains the affected muscles and nerves. It provides strength to the affected muscles and works to prevent the limbs from getting deformed.
One major symptom of paralysis is a loss of bladder and bowel function. Physiotherapy helps in managing the paralysed bowel and bladder.
Physiotherapy involves different techniques which can be learnt from a physiotherapist in order to transfer a paralysed patient.
Othorsis, canes, braces, splints are the equipment that is advised to the patient by a professional physiotherapist.
Physiotherapy helps in resolving problems such as anxiety, anger, depression, a denial which takes place after post-paralysis mental trauma.
A physiotherapist provides safeguarding tips to the patient and his or her family in order to avoid accidents.
Physiotherapy has a big role in creating motivation in the patient's mind.
These are the benefits of physiotherapy which help the paralyzed limbs getting stronger and better. But it is always advised to be done under a professional physiotherapist.
 In case you have a concern or query you can always consult a specialist & get answers to your questions!

Paralysis - Can Physiotherapy Help You?

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