Spine surgery is conventionally performed as  open surgery , which means the region being worked on is opened with a long entry point to permit the surgeon to view and access the area. Technical and scientific advances have permitted more back and neck conditions to be treated with a less obtrusive surgical technique. The minimal invasive spine surgery (MISS) does not include a long cut, and it prevents causing damage to the muscles around the spine. As a rule, this causes less pain after the surgery and a speedier and healthy recovery.

Spine surgery is normally suggested when non-surgical treatments like medicinal or exercise based methods have not helped in lessening the excruciating symptoms of your back problem. Moreover, surgery is just considered if your doctor can pinpoint the correct reason of your pain, for example, a herniated circle or spinal stenosis. 

MISS is also called less obtrusive spine surgery. In these procedures, surgeons utilise particular instruments to get to the spine through little cuts. The surgery process is as follows:

During the surgery, a little entry point is made and the tubular retractor is embedded through the skin.
It is also inserted into the delicate tissues down to the spinal cord.
This makes a passage to the little range where the problem exists in the spine.
The tubular retractor holds the muscles open and is set up all through the surgery.
The surgeon gets to the spine utilising the little instruments that fit through the focal point of the tubular retractor.
Any bone or disk material that is expelled goes out from the retractor.
Any gadgets needed for the fusion process, for example, screws or rods, are embedded through the retractor.
A few surgeries require more than one retractor.
Keeping in mind the end goal to see where to put the entry point and embed the retractor, the surgeon is guided by fluoroscopy.
This strategy shows ongoing X-ray pictures of the patient's spine on a screen throughout the surgery.
The surgeon additionally utilises a microscope to enlarge the view through the retractor.
Towards the end of the procedure, the tubular retractor is expelled and the muscles come back to their original position.
This restrains the muscle damage that is more ordinarily found in open surgeries.
It is very important to talk about these risks with your doctor before your surgery or procedure.

Infection: Antibiotics are consistently given to the patient some time before, during, and regularly after the surgery to reduce the danger of infections.
Bleeding: A specific measure of bleeding is normal; however, this is not commonly dangerous.
Pain in the grafted area: Some patients will encounter surgical pain at the bone joint site.
Recurring symptoms: A few patients may encounter a repeat of their side effects.
Pseudarthrosis: Patients who tend to smoke are more prone to pseudarthrosis. This is a condition wherein there is insufficient bone formation. In case that this happens, a minor surgery may be required.
Nerve damage: It is possible that the nerves or veins might be harmed during these operations. These complications are extremely uncommon.
Blood clots: Another complication is blood clots in the legs. This poses a threat because these clots can break off and settle in the lungs.

Minimally Invasive Spine Surgery - A Guide On What To Expect?

Migraine headache is characterized by a severe headache usually affecting one side of the head. There are other symptoms along with headache like nausea/vomiting, sensitivity to light and sound. Some patients experience neurological phenomena like changes in vision, temporary loss of sensation and altered sensation, a phenomenon known as an aura (flashes of light, zigzag patterns, bright spots, tingling in the arms and the legs). Migraine headache can last for 2 to 3 days. 

Symptoms: The symptoms depend on the stage of a migraine attack. The stages of a migraine attack can be: 

Prodrome, Aura, Headache or attack, and Postdrome. 
Prodorme: One to two days prior to the migraine attack, patient may experience; 
Mood swings. 
Cravings for food. 
Increased yawning. 
Stiff neck. 
Constipation and frequent thirst and urination. 
In case of an aura (during or before a migraine), there may be visual, motor, speech, and sensory illusions and disturbances such as, 

Loss of vision. 
A strange sensation of needles pricking an arm or a leg. 
One side of the body becomes weak and numb. 
There are visual illusions such as the appearance of flashes of light, zigzag patterns, bright spots. 
There is a problem in hearing and speaking. 
In some cases, there may be a hemiplegic migraine (the limb becomes weak). 
During a Migraine Attack (lasts for 4 to 72 hours), there may be 

A throbbing pain on either one or both sides of the head 
Blurred vision, light-headedness. 
Nausea and vomiting 
Sensitivity to light and sound 
Sensitivity to touch and smell (though rare) 
In Postdrome (after a migraine), there can be 

Mood swings. 
A person may be sensitive to light and sound. 
Dizziness and weakness 
Confusion 
Extreme fatigue 
An amalgamation of environmental and genetic factors may be responsible for a migraine. Trigger varies for each patient: 

Stress and extreme physical exertion 
Obesity 
Alcohol and caffeinated drinks and beverages 
Salty and processed foods 
Altered sleeping habits 
Hormonal alterations in women (Constant fluctuation in the level of oestrogen) 
Oral contraceptives and certain vasodilators (nitroglycerin) 
Preservatives like MSG (monosodium glutamate) and Aspartame (sweetener) 
Sunshine, certain odours, travel, etc can trigger migraine. 
Treatment and Prevention: 

Medicines under supervision to abort an attack of migraine and special drugs to stop attacks. 
Lifestyle changes are helpful to decrease attacks: 
Avoid your trigger for migraine. 
Follow regular sleep -wake cycle. 
Regular exercise, meditation. 
Avoidance of alcohol, caffeine containing beverages. 
Other treatment options that can be availed from pain specialist: 
Transcutaneous supraorbital nerve stimulation 
Intramuscular stimulation. 
Botulinum toxin injection. 
Occipital nerve block.

Migraine Pain - Facts About It!

What are the Different Kinds of Arthritis and How to Treat Them?

Arthritis is a very common medical condition that affects a lot of adults as they age. It occurs due to inflammation of the joints, which can be caused by a number of factors such as aging, injury or infection.

There are over a hundred different kinds of arthritis that cause various sorts of problems to those affected. However this condition can be broadly classified into two major types, which include the following:

1.Osteoarthritis

Also known as degenerative joint disease, osteoarthritis is the most common kind of chronic condition to affect the joints. This occurs when the cartilage that surrounds the joint wears away and allows the ends of bones to rub against each other causing immense pain and is often accompanied by inflammation and swelling. The primary cause of osteoarthritis is aging and occurs mainly due to pressure on the joints from lifting heavy weights.

2.Rheumatoid Arthritis

This is the most common type of arthritis that occurs due to joint inflammation. It is an autoimmune condition, which means that it is caused by a dysfunction of the immune system that leads to inflammation of the joints. Chronic inflammation causes joint deformities and even the development of rheumatoid nodules on the skin around the joint. Two-thirds of patients affected by rheumatoid arthritis are women.

Depending on the nature of the condition and the age and medical history of the patient, diagnosis, and treatment of arthritis varies. Although there is no permanent cure for arthritis, especially the type caused by aging, a number of remedies exist that provide relief from pain.

Some of the common methods of treatment for arthritis are:

Medication

Some medicines provide relief from the pain of arthritis if it is not too severe. These include painkillers, anti-inflammatory pills, sprays, and ointments, etc. In case of high-intensity pain, codeine is often prescribed.

Stem Cell Therapy

This method involves drawing platelets from the patient's own blood and injecting it into the inflamed parts of the joint in order to repair damaged muscles and alleviate pain.

Injections

A number of anti-inflammatory substances and lubricants can be injected into the affected joints to decrease pain. Ozone gas injections are an example of this.

Surgery

In extreme cases, surgical procedures are resorted to for treating arthritis. However, successful surgery cannot always be guaranteed and it comes with its own set of risks.



All You Need to Know about Arthritis - Types and Treatment

Atopic Dermatitis is a specific type of eczema which occurs when the epidermal layer of the skin is affected by eczema causing bacteria and other microorganisms. These eczemas are treatable and homeopathy finds a simple and natural solution to this disease. It not only helps to contain the disease from spreading it to other parts of the body but also helps in curing it of the root itself. There are some quick and effective remedies towards atopic dermatitis through homeopathy. Some of these are explained below.

Antimonium Crudum: People who have eczema which manifests as thick and hard boils are often given this medicine. In fact, it is administered both to children and the elder people. It has been seen that those who show symptoms of irritability in their behavior, get angry very soon and are most likely to be left alone, are the ones who are given this treatment to cure their eczema.
Arsenicum: Sometimes eczema is formed where boils turn thick and hard and have pus oozing out of it. For such skin infections, Arsenicum is the most widely used medicine that the homeopathic practitioners rely on. People who face such kinds of skin diseases are often seen to be depressed or melancholic in their lives. Thus, their mental feelings are often manifested in the form of eczema on their body.
Calcarea Carb: Eczema not only occurs on the body but also on the scalp. There are a few kinds of infections which have their roots on the scalp and then it starts spreading all over the face. For such kinds of infection, Calcarea Carb is the best form of homeopathic medicine which can be administered. In fact, patients with this problem are mostly children.
Graphites: Seems to be a very powerful and effective medicine against eczema which resembles ars. It is given to those patients whose skin becomes very hard and rough and there seems to be pus formation within the infection. Eruptions may be occurring in the eyes, behind the ears, and on the cheeks. Such infections are treatable with graphites.
Thus, if you are showing signs and symptoms of atopic dermatitis, then you should immediately consult your nearest homeopathic practitioner and get the proper medicine prescribed for yourself. Eczema would only spread and cause irritation in the skin if not timely treated and homeopathy offers one of the best types of treatments for this purpose.

Homeopathic Treatment For Atopic Dermatitis!

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!

Water effectively constitutes 70-75% of human bodies and keeps us protected from many harmful things. But many people have a frequent question: is it alright to drink water before you brush your teeth? Will it harm your body? Let us discuss the same in this article.

Many people believe that they should not drink water before brushing their teeth because of the bacterias present in saliva after you wake up. But this is a myth and it does not have any scientific logic. When you drink water after waking up before brushing, your saliva goes with the water down into the stomach which results in the killing of the bacteria due to the high acid content inside it. Therefore there is absolutely no harm if you drink water before brushing teeth.

If you are familiar with Japanese culture then you must know that the Japanese drink two glasses of water every morning immediately after they wake up. Drinking water immediately after you wake up without brushing your teeth does not harm you in any way. Doctors always recommend drinking two full glass or at least one, on an empty stomach. There are several benefits your body receives when you consume water every morning after you wake up.

Drinking water every morning has its own long list of benefits. Let us have a look at them-

Boosts your immunity- Drinking water every morning strengthens your immunity system. Helps you to fight diseases and germs much better.
Clears the bowels- After your drink water in the morning, you will get an urge of flushing out your bowels. This way the bowels remain clear and you do not face any constipation issues.
Speeds up metabolism- Your metabolism gets boosted when you drink water resulting in faster digestion and metabolic rate. It also keeps you hydrated through the day.
Prevents headaches and migraines effectively and it also helps in preventing colon infection because your bowels get cleared easily.
Helps in weight loss- Drinking water every morning helps you to lose weight by a significant margin due to the fact it occupies the stomach killing the desire to eat much in the morning.
Beneficial for skin- Increase in the freshness of your skin complexion which water delivers if you drink it every day in the morning. It flushes out the toxins and dead cells which helps in increase of new and fresh body cells.
Thus as you can see the long list of benefits you will receive if you drink water every day after you wake up.

Is It Alright To Drink Water Without Brushing Your Teeth?

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