The intervertebral discs are made-up of two concentric layers, the inner gel-like Nucleus Pulposus and the outer fibrous Annulus fibrosus. As a result of advancing age, the nucleus loses fluid, volume and resiliency and the entire disc structure becomes more susceptible to trauma and compression. This condition is called as degeneration of the disc. The disc then is highly vulnerable to tears and as these occur, the inner nucleus pulposus protrudes through the fibrous layer, producing a bulge in the intervertebral disc. This condition is named as herniated disc. This can then cause compression to the spinal cord or the emerging nerve roots and lead to associated problems of Sciatica radiating pain from back to legs in the distribution of the nerve. Other symptoms could be a weakness, tingling or numbness in the areas corresponding to the affected nerve. Sometimes bladder compromise is also present, which is made evident for urine retention and this need to be taken care as an emergency.
Excessive weight, bad postures, undue movements, improper weight lifting and other kinds of traumas may weaken the intervertebral discs. When this occurs the pulpous nucleus will bulge against the annulus, or even be squeezed through it (extruded disc).

The first steps to deal with a herniated or prolapsed lumbar disc are conservative. These include rest, analgesic and anti-inflammatory medication and in some cases physical therapy. At this point, it is convenient to have some plain X-rays done, in search of some indirect evidence of the disc problem, as well as of degenerative changes on the spine.

If in a few days these measures have failed, the diagnosis has to be confirmed by means of examinations that give better detail over the troubled area, as the MRI, CT which will show the disc, the space behind it and in the first case, the nerves. In some instances, the EMG (electromyography) is also of great value, as this will show the functionality of the nerves and muscles.

Once the diagnosis has been confirmed, one of the best alternatives existing today is the Ozone Discolysis as the results obtained are excellent and practically has no complications. This novel treatment avoids the use of surgery in 80% of those who needed it. In most patients left with painkillers as the only treatment, the symptoms eventually disappear, only that this could take weeks to months. Ozone speeds up these developments, see the same result in a few weeks. The problem has to be seen and approached integrally and frequently the combination of therapies has to be used, most frequently physiotherapy. Also, it has to be known that those who had a herniated disc have 10 times more chances of having another herniation than the rest of the population.

If despite the ozone therapy the symptoms persist, Drill Discectomy/ Laser Discectomy are good alternatives before open surgery (Discectomy) which has to be contemplated in those true emergencies, as mentioned above, this is possibly the first choice.

Once the conservative treatment fails:

Early aggressive treatment plan of pain has to be implemented to prevent peripherally induced CNS changes that may intensify or prolong pain making it a complex pain syndrome. Only 5% of total LBP patients would need surgery & 20% of discal rupture or herniation would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then.

Depending upon the diagnosis one can perform & combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon pt`s pathology & response to treatment.

Using precision diagnostic & therapeutic blocks in chronic LBP, isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of LBP after conservative treatment has failed.

LESI: Lumbar Epidural Steroid Injection

Indicated in   Acute radicular pain due to irritation or inflammation.

Symptomatic herniated disc with failed conservative therapy
Acute exacerbation of discogenic pain or pain of spinal stenosis
Neoplastic infiltration of roots
Epidural fibrosis
Chronic LBP with acute radicular symptoms
Epidural- lumbar injection
ESI Treatment Plan

Compared to interlaminar approach better results are found with a transforaminal approach where drugs (steroid+ LA/saline +/- hyalase) are injected into anterior epidural space & neural foramen area where herniated disc or offending nociceptors are located. Whereas in interlaminar approach most of drug is deposited in posterior epidural space.Drugs are injected total 6-10 ml at lumbar, 3-6 ml at cervical & 20+ ml, if caudal approach is selected. Lumbar ESI is performed close to the level of radiculopathy, often using paramedian approach to target the lateral aspect of the epidural space on involved side. Cervical epidural is performed at C7-T1 level.

SNRB- Selective Nerve Root Block 

Fluoroscopically performed it is a good diagnostic & therapeutic procedure for radiculopathy pain if

There is minimal or no radiological finding.
Multilevel imaging abnormalities
Equivocal neurological examination finding or discrepancy between clinical & radiological signs
Postop patient with unexplainable or recurrent pain
Combined canal & lateral recess stenosis.
To find out the pathological dermatome for more invasive procedures, if needed
Intradiscal Procedures 

Provocative Discography - Coupled with CT

A diagnostic procedure & prognostic indicator for surgical outcome is necessary for the evaluation of patients with suspected discogenic pain, its ability to reproduce pain(even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options & in assessing previously operated spines.

Percutaneous Disc Decompression (PDD)

After diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed

Ozone Discolysis: Ozone Discectomy a revolutionary least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a daycare setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. The total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no postoperative discomfort or morbidity and low cost.

Dekompressor: A mechanical percutaneous nucleosome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression.

Epidural Adhenolysis or Percutaneous Decompressive Neuroplasty for Epidural Fibrosis or Adhesions in Failed Back Surgery Syndrome (FBSS)

A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ L.A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with epiduroscope.

Procedures That Can Help Treat Slip Disc & Sciatica!

5 Ways to Stop Muscle Cramps

Muscle cramps are feared and loathed by all of us alike – they hurt, they slow us down and they just give us a helpless feeling! The most common cause of these cramps is premature fatigue which affects the reflex control of muscles. Here are 5 ways guaranteed to beat these troublesome muscle cramps:

1. Take rest
The most easy and sure-shot way to kill a muscle cramp is to take rest. Just rest your body, be at one place and the cramp will not last more than 3-4 minutes. Moving around will only cause the pain to be aggravated and eventually affect other areas as well.

2. Consume solutions rich in salt
Whenever you encounter a troublesome cramp, the first instinct is to reach for water. However, studies have shown that salt solutions are far more effective in countering cramps as compared to plain water. You can have pickle juice and similar drinks which have a high salt concentration.

3. Be physically active
The most common reason for muscle cramps is over-straining of the body. If you are planning to indulge in an extremely intensive physical activity, make sure to train well in advance. Also, keep the duration and intensity of the training at a similar level to that of the actual activity.

4. Keep your body hydrated
Dehydration is the root of a number of troublesome conditions, muscle cramps being one of them. Make sure to always carry a water bottle with you and drink a minimum of 7-8 glasses of water on a daily basis.

5. Indulge in light passive muscle stretching
When faced with a muscle cramp, in addition to resting, try and gently stretch the affected muscle. This continuous and light passive stretching lets the brain know that it can relax the muscle and help it return to normal.




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5 Winning Ways to Stop those Nasty Muscle Cramps

Are you suffering from rheumatoid arthritis and looking for an effective treatment? You can choose homeopathic treatment as it is natural and is free from any side effect. Rheumatoid arthritis is a form of autoimmune disease, which causes inflammation of the joints. The inflammation can be chronic and does not subside on its own. It leads to destruction of your joint tissues. Here are some top homeopathic medicines, which are used for treating rheumatoid arthritis:

Causticum: This is one of the primary homeopathic medicines used to treat rheumatoid arthritis when there are joint deformities. The patient weakens over time and the muscles lose strength eventually. The patient feels extremely restless during the night and the restlessness is associated mostly with the legs. Contractions in the tendons likely result in deformities and intense pain. The pain is tearing in nature. Due to weakness of the forearm muscles, the patient may not have a firm grip on anything. The pain usually improves by keeping the affected the area warm.
Caulophyllum: This is an effective medicine for rheumatoid arthritis and is commonly used for women. It is used when small joints are affected more, compared to the larger joints in the limbs. This medicine is mostly used to treat arthritis of fingers of your hands and feet. The pain keeps on changing positions all the time within a small span of time. At one moment, you may feel it on your right hand, and soon after it may affect your left hand. Gradually, it shifts towards the feet as well.
Colchicum: This homeopathic medicine is usually required during chronic stages of rheumatoid arthritis. It affects several tissues such as periosteum, synovial membranes and other muscle tissues. The inflamed parts turn red, become hot and swollen. The pain is expected to worsen during the evening and night. The fingertips may feel numb and you may feel some joint stiffness as well. A feverish feeling is also likely.
Ledum Pal: This medicine is used in the cases of rheumatoid arthritis where the rheumatoid starts in the feet and travels upwards spreading to the upper joints of the body. The patient feels cold, but still cannot bear any amount of warmth. The small joints present in the feet are commonly affected. Swelling in the toes and ankles is a common symptom.
Bryonia: This is an excellent homeopathic medicine for rheumatoid arthritis. It is used when all the joints and joint membranes are swollen and affected. The pain experienced is unbearable and increases with motion. The inflamed joints become red and swollen.
To know the best homeopathic remedy which is ideal for treating your rheumatoid arthritis, you should visit a homeopathic doctor.

Rheumatoid Arthritis - 5 Homeopathic Remedies For It!

As you age, many parts of the body start to wear down. Your spine is no different in this regard. When age affects the condition of the cervical section of the spine, it is known as cervical spondylosis. Other names for the disorder are neck arthritis or cervical osteoarthritis.

Even though age causes most cervical spondylosis, other factors may also be responsible for the onset of the disorder. Here is a look at some common causes for the same.

Causes for cervical spondylosis:

  Bone spurs - Your body may try to strengthen the joints by growing additional bone tissues. These are known as bone spurs. These spurs can pinch down on the nerves and the spinal cord, leading to pain and other symptoms.

  Dehydrated discs - The spine houses shock-absorbing pad-like structures between the vertebrae, called discs. These discs contain a gel-like substance that gives them its unique shock absorbing properties. Over time, the gel dries out, causing greater friction between bones during movement.

  Injury - A neck injury can lead to cervical spondylosis. The disorder may not appear as soon as you suffer from the injury but may take years to develop.

  Excessive physical strain - Some profession may require people to lift heavy weights or overexert themselves physically. These people may develop cervical spondylosis later on because of this work.

Symptoms of cervical spondylosis:

Here are some symptoms that are commonly associated with cervical spondylosis.

  Shoulder pain - Patients suffering from cervical spondylosis often complain about pain in the shoulder blade. This pain increases while the person is standing, sitting, coughing, sneezing and tilting their head backwards.

  Weakness - People with cervical spondylosis also suffer from muscle weakness. For instance, you may not be able to grab things tightly in your hands, if you suffer from the spinal disorder. Furthermore, lifting the arms may be difficult.

Other minor symptoms of cervical spondylosis include stiffness in the neck that grows worse with time and headache that affects the back part of the head.

Treatment for cervical spondylosis:

Treatment is not necessary in many cases due to the absence of any distinguishing symptoms. However, if the spondylosis interferes with normal life, medical intervention is required. Treatment for the disease includes-

  Physical therapy - Physical therapy sessions often help deal with the pain and stiffness resulting from the cervical spondylosis. Your doctor will prescribe weekly sessions, which will aid to reduce the symptoms of the condition after some time.

  Medications - Pain medications help manage the discomfort related to the condition. However, these drugs do not have any long-term effect on the body. They only provide temporary relief from the pain.

  Surgery - Surgery for cervical spondylosis is uncommon. However, if the condition does not respond to other forms of treatment, the operation may be required to remove bone spurs, herniated discs and rectify parts of the spinal column.

You can also ask your doctor about home remedies to follow to manage the symptoms of the disease.

Cervical Spondylosis - How Can It Be Treated?

Osteoporosis is a Latin word for  porous bones . A healthy bone holds tiny spaces within it resembling a honey comb. Osteoporosis causes an expansion in the dimension of these spaces so much so that the bone loses out on its density and strength, at the same time turning brittle and thin on the outer part. People afflicted with osteoporosis are prone to experiencing fractures at the slightest stimulation while engaging in daily chores. It usually affects one s wrists, hip and the spine, thus rendering a stooped posture, loss in height and back pain as a result of a collapsed vertebra. Factors such as lowered estrogen count in women and testosterone in men, long term use of certain medications, certain medical conditions such as damage to the liver or the kidneys and a sedentary lifestyle along with excessive tobacco and alcohol consumption make one vulnerable to osteoporosis.

Tips To Help you manage and prevent it-

Medications: Zoledronic acid, Ibandronate, Risedronate and Alendronate are some of the widely used medicines to combat the risks of fracture. However, these medicines carry considerable side-effects, for instance adnominal pain, nausea or a heart-burn like sensation. Ipriflavone, a laboratory manufactured product, in combination with calcium can be used as an alternative medicine to inhibit bone loss and alleviate pain.

Quit smoking: Smoking escalates the rate of bone loss and the chances of sustaining another fracture.

Refrain from excessive alcohol intake: Alcohol meddles with one s bone formation. Also, excessive alcohol intake might cause one to feel tipsy and thus fall down, aggravating risks of injuries and fractures even more.

Be careful while walking: Choose low or flat heeled footwear with soles that do not slip. Watch your step. Be careful with rugs, slippery surfaces, electrical cords or other scattered substances which might make you trip over and fall. Install  grab bars  in your house so that you can hold on to them if you suddenly feel unsteady on the feet.

How Can You Deal With Osteoporosis?

The difficulties associated with cervical spondylosis go far beyond spelling it correctly! The problem of cervical spondylosis can be extremely painful making it difficult to sit or walk. As if cervical spondylosis alone was not enough to put up with, it can often be accompanied by severe headaches. Bone spurs can be said to be a rather unusual phenomena but they can be one of the causes of cervical spondylosis is quite a few cases. This occurs when an extra bone grows to make the body stronger.

What causes cervical spondylosis?
While the causes of cervical spondylosis may vary, few causes are just as direct as injury is. A fall, or an accident can hasten the process of ageing and bring on cervical spondylosis sooner than what would have been usual. Sometimes, the nature of work can also lead to cervical spondylosis, as is the case with a lot of construction workers who suffer from it. Generally, as a person gets older, he or she can expect to suffer from cervical spondylosis. As a matter of fact, it affects about eighty five per cent of people over the age of sixty! One good thing though, is the fact that only in certain, chronic cases is the condition life altering, as most people are able to get on with their normal lives after taking some measures.

 How to treat it?
In order to ease the pain, it is a good option to make use of some muscle relaxants, which can go a long way. Also, in case the pain is really bad, there are steroid injections which are available which reduce the tissue inflammation. For this same purpose, a person suffering can also make use of a narcotic such as hydrocodone. One solution which usually is not required in the case of cervical spondylosis is surgery. The surgeries for the issue are usually to correct the form of the bone structure, basically to remove spurs and create more room. However, doctors usually recommend this sort of solution when the pain is excruciating and persistent in nature.

Usually, muscles of those who suffer due to cervical spondylosis can get very sore. A simple but also a surprisingly effective remedy for this is to use a heating pack or a cold gel pack on one s neck. Shot in the arm solution and a neck brace can an effective temporary solution. However, wearing a neck brace for too long can lead to weaker muscles, which will worsen the problem.

Cervical spondylosis is essentially a pain in the neck, but it is a manageable one!

Cervical Spondylosis - Causes + Treatment

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