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?

With changing lifestyles, the small household chores have become the workouts for most of us. When not done properly, however, these cause more harm than good. The spine often bears the brunt of this damage. Read on to know if you are damaging your spine on a daily basis. If yes, time to change the way you do these activities.

Carrying shopping bags: While two bags might look more expensive, carrying one bag tilts the weight to one side and causes the spine to bend. Instead, opt for two small bags, and this weight distribution is friendly on the spine.
Cleaning the floor: Either sit down completely or stand and use a mop. Never bend down and try to clean the floor with a cloth. The spine posture created during this is very unhealthy and puts pressure on the spine.
Tying up shoe laces: While it is difficult to sit down and tie the shoe laces, it is definitely worth the effort. Bending down and tying is harmful to the spine posture, and when repeatedly done, can be damaging in the long run.
Washing vessels: Bending and washing vessels is a strict no-no. It puts too much pressure on the back and the disk wears out faster. Try standing and keep a stool at knee level, on which you can rest the knee. Take turns to do this on the right and left knee.
At the washbasin: Bending down to brush the teeth or wash face is bad on the spine. Over a long period, this can put lot of strain on the spine. Try to rest your hand on the wall or the sink and see the pressure on the spine reduce.
Office/school bags: It is very easy to sling a bag onto the shoulder and go on. The bag could contain books of a school kid or laptop of an office goer, whatever may be the situation, this puts uneven pressure on the back and can cause shoulder and spine issues. Always try to put the bag on both your shoulders. This distributes the weight and makes it easy on your shoulders and spine. Especially for people who are going to do some walking with the bag, it is definitely not advisable to carry it on one side.
Sitting: For those who end up sitting for long hours, there is too much stress on the back and so support is advisable. Take short breaks and avoid sitting for more than an hour at a stretch.
Bad mattress: While a soft mattress is very inviting, it does not support the spine and does not leave you fresh in the morning. Choose a mattress that supports the spine and see the difference.

Spine Health - 8 Everyday Activities That Are Actually Harming It!

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!

A broken bone or a crack in the commonly known as a fracture. Any bone in the arm can be broken, but common areas for fractures in the arm is wrist, specifically the distal radius, forearm bones (radius and ulna), elbow, humerus and shoulder. 

What causes fracture in bones?

Fall: Falling an outstretched hand or elbow is the most common cause of a broken arm.
Sports injuries: Direct blows and injuries on the field or court are a common cause of all types of arm fractures.
Significant trauma: Any of your arm bones can break during a car accident, bike accident or other direct trauma.
Abuse: In children, a broken arm may be the result of child abuse.
How to identify?

An audible snap or cracking sound may be your first indication you've broken an arm.

Signs and symptoms include:

Severe pain, which may increase with movement
Swelling
Bruising
Deformity, such as a bent arm or wrist
Inability to turn your arm from palm up to palm down or vice versa
When to see a doctor?

If you have enough pain in your arm that you can't use it normally, see a doctor right away and do the same for your child. Delay in diagnosis and treatment of a broken arm, especially for children who heal faster than adults do, can lead to poor healing and deformity.

Fracture In Upper Limb Bones - 4 Things That Can Cause It

Osteoporosis is a condition wherein the bones become brittle and weak; so much so that even mildly stressful activities such as coughing, bending over or even a slight fall (such as the one from a high rise chair) can result in fractures. Osteoporosis-related fractures commonly occur in the spine, hip or the wrist. The human body has a continuous mechanism of bone absorption and removal. In case of osteoporosis, the creation of new bones doesn t happen in accordance with the removal of old bones.

Spinal Fractures:

The bones of the spine get extremely vulnerable to breakage and even cracking open. The fractures in the spine, also known as vertebral compression fractures can cause a sharp stinging pain in the back that may make sitting, standing, or even walking a very tardy task.

Risk Factors:

Increasing age

Abnormally less or high body weight

Smoking

Menopause or low levels of sex hormones

Gender: This disorder is more likely to affect women as compared to men. Also women, who are above 50 are more likely to suffer from this debilitating disorder.

Race is a significant risk factor of osteoporosis. If you are of Asian descent, you are more likely to be affected by it.

Having a family history of osteoporosis will put you at a greater risk of this disorder.

Symptoms:

Fractured or collapsed vertebra causing back pain

A stooped posture

A shrunken appearance (as if one has had loss of height)

Very fragile bones, thus increasing risks of fractures

Severe and sudden pain in the back

Difficulty in twisting or bending the body

Lower spine fractures are way more troublesome as compared to fractures in the upper spine. Fracturing more than a bone in the spine also remains a huge possibility.

Diagnosis and Treatment:

Firstly, an X-ray or a computerized tomography (CT scan) will be done to have a closer look at the bones. A bone density test is another commonly used method of diagnosing osteoporosis. 

Steroids and medications: Some medications may be used to prevent or combat osteoporosis. These include alendronate, ibandronate, risedronate and zoledronic acid.

Physical therapy: Just like muscles, bones get stronger too when you exercise. Weight-bearing and muscle- strengthening exercises are the most helpful in this regard and are considered best for the treatment of osteoporosis. Cardiovascular exercises such as walking, jogging or even swimming can prove to be immensely beneficial.

Diet: Make a diet chart that includes high-calcium food items, dairy products such as yogurt, cheese, and low-fat milk, tofu, green vegetables such as collard greens and broccoli, sea fish such as salmon and sardines.

Salt: Limit salt intake

Therapy: Hormone replacement therapy (treatment method consisting of estrogens to alleviate and treat symptoms of osteoporosis) is another method of treatment that can be recommended by the doctor.

Osteoporosis Spine Fractures: Risks, Symptoms and Treatments

Spinal fractures are extremely painful and usually happen when an external force applied to the spine exceeds the vertebral column s ability to bear the load. Many times, the bone fragments pinch and damage the spinal cord, which leads to an injury or dislocation of the bony vertebra. Although spinal fractures can develop anywhere along the spine, the most common site is the lower back.

What causes spinal fractures?

Spinal fractures can occur due to both minor trauma/falls and major accidents. The following are the probable causes of such fractures-

  Injuries sustained while playing a sport
  A traumatic injury
  Spinal instability
  Injuries sustained after falling from a height
  A whiplash
  Injuries sustained in an accident
  An underlying condition such as Osteoporosis, which causes the spinal bones to weaken

Symptoms observed:

Spinal fractures are characterized by the following symptoms-

  Muscle spasm and swelling
  Numbness
  Acute pain that worsens when you walk or stand for a long time
  A tingling sensation
  Restricted mobility of the spinal column
  Spinal deformity/disability
  Sudden onset of pain in the lower back region

What are the various types of spinal fractures?

Spinal fractures primarily fall into four categories, namely the following-

  Compression - Compression fractures are quite common in people with osteoporosis or bone cancer. The bones become fragile and brittle. If sudden force is applied with extreme pressure, the vertebra may not be able to support the load and that may result in a fracture.

  Burst - Severe trauma, such as a car accident can cause burst fractures. The external pressure is so much that the vertebra gets crushed. As a result, the bony fragments spread out and cause spinal cord injury. Unlike a compression fracture, where only a part of the vertebra is damaged, a burst fracture leads to multiple fractures in the vertebra.

  Flexion-distraction - This type of fracture is likely to happen if you are involved in a car accident. Normally, the spine is made to flex forward. However, a sudden jerk that pushes your body forward can put a lot of pressure on the spine and cause the vertebrae to break.

  Fracture-dislocation - This debilitating condition results from a torn ligament and broken bone.

What is the treatment for spinal fractures?

Treatment options for spinal fractures include both non-surgical and surgical methods.

  Non-surgical treatment - Most cases of spinal fractures can be treated with immobilization in a corset or brace for up to 10-12 weeks. Bracing will help prevent deformity and reduce pain.

  Surgical treatment - The doctor may recommend surgery in severe cases. The two standard surgical procedures are-

Vertebroplasty - The surgeon will insert a tube, known as a catheter, into the compressed vertebra. Through the catheter, he/she will inject bone cement into the fracture site. This will harden and stabilize the vertebral column. Vertebroplasty has proved to be an effective procedure to reduce pain. The surgery restores mobility and prevents loss of bone due to bed rest.

Kyphoplasty - During this procedure, the surgeon inserts a catheter into the spinal column under the guidance of an X-ray. Next, he/she makes small incisions along the back and inserts an inflatable bone stamp. The tamp, once inflated, bring back the vertebral body to its original height. It also creates a cavity to be filled with bone cement, which seals the cracks. The bone cement stops the vertebra from collapsing again. After the whole procedure, the surgeon will remove the catheter and stitch the incisions.

Following surgery, you will need to wear a brace for about 6-12 weeks. Physical therapy is strongly recommended initially to help you get back to your daily activities in a week or two.

Spinal Fractures - All You Should Know!

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