At some point in life most people experience acute pain in their lower back which is extremely painful. Pain in the spine causes a lot of discomfort and disruption in the life of an individual and hence, it is always better to get it checked on time. There are patients who even wonder when they should consult a neurosurgeon or a spine surgeon for their back pain. It is advisable that a physical examination is done by a primary care physician for low back pain before consulting a spine surgeon.

Why consult a Physical care Physician First?
The main reason to consult a primary care physician at first is that he would prescribe medications for severe lower back pain. The medications could include non-narcotic pain medications such as Ultram or non-steroidal anti-inflammatory drugs such as Motrin. The physician can even refer you to a chiropractor or for physical therapy to get relief from the back pain. Mechanical means are made use of by a chiropractor mainly to alleviate the back pain of the patient.

If the patient feels better with the physical therapy or the medications prescribed by the family doctor and is able to resume normal activities, then there is no need to see a spine surgeon. It is often recommended to take good care of the back and to exercise. A combination of ergonomics, regular stretching and improved everyday posture is beneficial as it reduces the chance of causing pain in the lower back. Exercise plays a very important role and it provides the possibility of reducing the pain.

Conservative Care for Treating Lower back Pain
It is best for patients to consult a conservative care specialist if after consulting a chiropractor they do not find any reduction in their pain and they do not want to undergo spine surgery. The conservative care specialists are well-trained in rehabilitation of musculoskeletal disorders and specialize in spine care. The role of the conservative care specialist is similar to a cardiologist who specializes in treating neurological disorders.

The specialist for spine care works along with the surgeon in a spine center to treat the lower back pain. The specialist is trained in diagnostic techniques and is capable of making use of a combination of diagnostic tests as well as injection techniques such as epidural steroid injections to diagnose the source of the lower back pain in a patient. They can even advise patients whether it is appropriate to consult a spine surgeon for surgery. Surgery is done to correct the anatomical conditions and it is performed only when non-surgical treatments are not successful in alleviating the pain of the patient.

When Is The Right Time To See A Spine Surgeon?

Carpal tunnel syndrome is a condition that causes numbness or tingling in the hands and arms besides other symptoms. Carpal tunnel is basically a narrow passage on the palm side of the wrist. This condition is caused when a nerve in the carpel tunnel is compressed. Since this median nerve runs up through the hands to the forearm, it affects the arms as well. Not only does it cause nerve pain, but also results in limited functionality of the thumb.

To prevent this syndrome, one needs to understand its causes. We have discussed some of the primary causes below:

Issues with the thyroid hormone: Hypothyroidism, an imbalance or lack of thyroid hormones in the body, can create problems that lead to issues with the overall musculoskeletal system. An over-active pituitary gland can also cause issues that affect mobility and motor skills. This can lead to or exacerbate the carpal tunnel syndrome.
Arthritis: Arthritis causes swelling and inflammation of joints and tendons, which tend to increase the symptoms of carpal tunnel. Eventually, arthritis can also lead to compression of the median nerve and other structures in the wrist, thereby leading to carpal tunnel syndrome.
Pregnancy or menopause: During pregnancy as well as menopause, women experience tingling or numbness in their hands, which is believed to be caused by carpal tunnel. Experts say that when a fluid called oedema builds up in the tissues around the wrists and other parts of the body, it puts a pressure on the median nerve, leading to pain.
Work pressure: Experts believe that behaviours can increase the risk of carpal tunnel. The other instances which cause this syndrome include physical labour, using mechanical tools and repeated stress to the wrist. However, various studies suggest that there isn t any direct association between using a computer and carpal tunnel syndrome. It may just cause different forms of hand pain.
Imbalance of body fluids: Fluid retention in the body increases the pressure within the carpal tunnel, which irritates the median nerve. This is common during pregnancy and menopause as discussed earlier.
Obesity: One of the significant risk factors for this syndrome is being obese. So be careful about gaining excess weight.
Other conditions: Certain conditions like hormonal imbalance, diabetes and kidney failure may increase the chances of carpal tunnel syndrome. It also occurs in people who usually have narrow carpel tunnels. In some cases, it is inherited and is passed from one generation to the next.
Inflammatory conditions: Illnesses that end up in inflammation, such as rheumatoid arthritis, can affect the lining around the tendons in the wrist and put pressure on the median nerve.
Fractures: A fracture in the wrist can cause narrowing of the carpal tunnel and irritate the nerve. 

Carpal Tunnel Syndrome - Most Common Causes

Endoscopy refers to inserting microscopic cameras into the body through tiny incisions which throw up pictures of the inside of the body onto a screen. Endoscopy has been used for diagnostic purposes since the 1970s. Endoscopy for surgery has become popular from the 1990s.

Endoscopic spine surgery is a state-of-the-art surgery technique which involves micro incisions and minute tubes that cause almost no damage to surrounding tissues and muscles. It is a minimally invasive surgery and it is also called a pinhole surgery.

What are the advantages of endoscopic pinhole spine surgery?

There are a lot of reasons why doctors opt for an endoscopic surgery-

  It is also called Minimally Invasive Spine Surgery (MISS) because it causes little blood loss
  Recovery is almost immediate. A person can resume everyday activities within a week
  Very little pain around the surgery region so minimum pain medication is needed.
  No muscle or bone is removed.
  Since screws and rods are not used, full mobility of the spine can be restored
  The wounds are minute and do not usually require stitches and thus no ugly scars are left after the wounds heal.

What are the characteristics of an endoscopic spine surgery?

  The surgery is performed under local anaesthesia
  The person is discharged within 24 hours of the surgery
  The incisions that are made are microscopic

What are the different types of endoscopic surgery?

Endoscopic discectomy:
It is the least invasive of all spinal surgeries. It is used for treating herniated discs. Endoscopy reveals images of the spine. Through the same tunnel, surgery tools are inserted and the bulging or herniated disc is pulled out with a grasper. The wound does not always require stitches to close it.

Endoscopic Laminotomy:
This a substitute for open laminotomy. The camera helps locate exactly where the target area is. Then an incision is made below and above the lamina to relieve the pressure compressing the nerve.

Endoscopic facet rhizotomy:
With microscopic cameras, the nerves causing pain are identified and then the laser is used to numb these nerves which relieve pain. This type of surgery can also remedy a previously botched spinal surgery, facet joint arthritis or facet joint pain

Endoscopic foraminotomy:
This type of surgery again uses microscopic surgical tools guided by a tiny camera to enlarge a narrowed neuro of spinal nerve root canal to give it more room to move about without being compressed.

Endoscopic Spine Surgery & Pinhole Technique!

A small piece of bone is known as a fragment and it is very common that an avulsion fracture also tends to damage the protrusions of bone to which the tendons attach. This basically means that the tendon or ligament will come away from the bone and it will take a small piece of bone with it. It is sometimes very hard to find out what type of injury you have and this is why knowing the causes and symptoms of an avulsion fracture are very helpful in determining exactly how severe the injury is. 
Here are the causes of an avulsion fracture.
Causes:
Explosive Landing: Athletes who tend to jump or land with great impact tend to get these most commonly. Therefore, it is crucial for your health that if you participate in such sports, you do follow the correct method of jumping.
Explosive Extension: Similar to how an athlete landing ferociously can get an avulsion fracture, someone who is extending the legs very violently and explosively during an exercise can also get an avulsion fracture. This is because the bone getting extended could very well damage the protrusions to which the tendons are attached. 
Symptoms:
These are the two main causes of an avulsion fracture. There are not many symptoms of an avulsion fracture. This is because an avulsion fracture can only be determined by an MRI or by an X-ray scan. Therefore it is nearly impossible to diagnose that you have an avulsion fracture without looking at the results of the tests performed on the part of your body. However, the way you got the fracture and especially the details of it are very good indications of whether you have an avulsion fracture or not.


Causes and Symptoms of Avulsion Fracture

A fall or an injury is among the most common causes of a fracture. For a fracture to heal; the bones must be set in the correct position and a cast may need to be worn so as to hold them in place. This allows the bones to grow new tissue and bridge the break. The food you eat can help you speed up this process. Some of the best foods to build strong bones and help a fracture heal are:

Milk: Milk is one of the richest sources of calcium and vitamin D. It is also rich in proteins. These three elements are crucial to building strong bones. Proteins help the body release amino acids which in turn come together and create new tissue for the bones. Calcium is, of course, the building block of our bones. However, it is vitamin D that enables the body to absorb this calcium and utilize it. If you do not like the taste of milk, you could substitute it with yogurt. This dairy product is considered equally rich in proteins, calcium and vitamin D. In addition, it also contains amino acids such as glutamine and lysine that helps the bones absorb calcium.
Kale: Kale is known as a superfood. One of the reasons for this is the amount of calcium it contains. Kale is one of the few vegetables that are rich in this mineral. Thus, lactose intolerant people can get their required calcium from this vegetable. Kale can be eaten raw or cooked. Kale can also be juiced. However, to benefit fully from the vitamins and minerals in this vegetable, it is best to eat it raw.
Spinach: Spinach is another green leafy vegetable that is rich in calcium. It also contains zinc. Zinc helps stimulate the chemical reactions needed to bind calcium and other minerals together to create new bones. In addition, spinach is also a rich source of vitamin K. While this vitamin does not play a direct role in healing bones, it helps speed up the healing process.
Broccoli: Broccoli is a cruciferous vegetable that is rich in vitamin K1. This is very beneficial to your overall health and bone health. Vitamin K1 aids in the mineralization process of fusing broken bones together and building new bone tissue. Thus, it helps the bones set correctly.
Citrus Fruits: Fruits such as oranges are chock-full of vitamin C. This nutrient helps build a strong immune system and aids in the fracture healing process. Vitamin C also helps the body create collagen that surrounds the broken bones and allows it to heal faster.

Food Items That Help You Recover From Fractures!

Knee replacement can be extremely painful. Previously, opioids or narcotics were administered for pain relief. But excessive addition of opioids is not exactly effective for controlling pain. 

Multimodal pain management has become an important part of the perioperative care of patients undergoing total joint replacement. The principle of multimodal therapy is to use interventions that target several different steps of the pain pathway, allowing more effective pain control with fewer side effects. Many different protocols have shown clinical benefit. The goal of this review is to provide a concise overview of the principles and results of multimodal pain management regimens as a practical guide for the management of joint arthroplasty patients.

Multimodal denotes administering two or more than two types of medications that work with different mechanisms. The following are the techniques used:

Pre-operative Femoral Nerve Block: Prior to the surgery, a catheter is placed beside the femoral nerve for blocking it. This nerve is located in the upper thigh. Medication is delivered through the catheter for the nerve to be numbed for 24 hours. Thus, pain signals to the brain are blocked. This method reduces the use of narcotics and the consequent side effects.

Patient Controlled Analgesia (PCA): This method is also known as  Pain Pump . An intravenous pump is used to administer pain relief medications, such as oxymorphone or morphine, after the surgery. The control button of the machine could be pressed, by the patient for 6 to 10 times per hour. The machine is used for two post-operative days.

Oral Medications: The oral medications include Non-Steroidal Anti-Inflammatory drugs or NSAID; such as Celebrex which is similar to aspirin, structurally. Alternatively, acetaminophen, such as Tylenol or its equivalent composition, can also be used.

Acetaminophen: It acts on the Central Prostaglandin Synthesis and relieves the patient of pain through multiple mechanisms.

Epidural Analgesia: It produces lower pain scores and involves less time for achieving physical therapy goals. However, this is subject to side effects such as dizziness, urinary retention and itchiness.

Gabapentinoids: These medications include membrane stabilizers such as Gabapentin and Pregabalin.

The objective of multimodal treatments is to provide quick relief to the patient and immediately so. Earlier the rehabilitation, more successful will be the knee replacement surgery.

Multimodal Pain Relief After Total Knee Replacement

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