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!

Breast cancer, is a type of cancer, which is common to women, where cancer cells grow on the breasts or the female mammary gland. It starts out with the formation of a small lump in your breast and can spread out to your other organs very rapidly. It generally affects women above forty years of age. Breast cancer can be classified into two types. They can either start forming on the inner linings of your milk ducts ( known as Ductal carcinoma) or in the lobules which supply milk (known as Lobular carcinoma).

There are many causes responsible for breast cancer they are mentioned below: 

Obesity or post-menopausal obesity (Learn more about Heart Diseases Post Menopause)
Exposure to frequent radiation (X-ray)
Consumption of alcohol
Being taller than average
Start of periods at an early age
Late menopause
Hormone replacement therapy
Consumption of birth control pills
The most common symptoms of breast cancer are as follows: 

Formation of a lump in your breast
Swelling or shrinking of your breast
Change of size, shape and color of your nipple
Blood or milk discharge from the nipple
Breast pain
Itching sensation
Appearance of rashes (Learn more about to maintain the skin health)
Breast cancer if not diagnosed and treated at an early stage may turn out to be fatal. Ayurveda offers promising cures for breast cancer.

A few of the Ayurvedic remedies are mentioned below: 

Include foods, which are well supplied with vitamin D in your diet. Researches show that women with less amount of vitamin D in their bodies are more likely to develop breast cancer. Consider including foods like eggs, orange juice, dairy products and fish like salmon in your diet.
Drink more of green tea as it has anti cancer properties.
Exercises like walking, yoga, meditation and certain breast exercises can help you to relax the pain sensation, reduce stress and also get cured.
Incorporate bitter gourd in your diet. Researches show that bitter gourd can kill those cancer cells, which cause breast cancer.
Ayurvedic herbs like Ashwagandha, tulsi, curcumin have certain properties that can destroy cancer cells.
Since, breast cancer has less survival rates, it is absolutely essential for you to visit an Ayurvedic practitioner if you wish to get cured through Ayurvedic treatment.

Treating Breast Cancer With Ayurveda

The liver is a critical organ as it plays a vital role in body metabolism and digestion. Liver diseases are a challenge for medical professionals, as often, these symptoms are not obvious until the disease has progressed to quite an advanced stage. In most cases, diagnosis in the early stage is very difficult, which can help in early intervention and disease arrest. It is not just the disease, but the causes and treatment of liver cancer are also surrounded by myths. 

Read on to know some of the myths and facts about liver cancer.

Liver cancer is caused by alcohol: This is one of the most common myth, which is not true. While alcohol definitely has a role to play in liver cancer, not all victims are alcoholics. Non-alcoholic fatty liver disease (NAFLD) which puts a person at risk for liver cancer is not related to alcohol and is seen in people who are obese, diabetic, high cholesterol and have no connection with alcohol. There is also no correlation between the amount of alcohol and the severity of liver damage. However, stopping alcohol consumption altogether definitely helps in improving liver condition.
Liver cancer can be detected on routine tests: While abnormal protein levels on routine blood tests indicate abnormal liver, it is most often ignored and does not get diagnosed further. However, this should be taken up in detail and should be diagnosed. Early diagnosis greatly improves prognosis and can reduce treatment costs significantly. The chances of liver regeneration also would be greatly improved.
Routine medications can lead to liver cancer: Liver plays a very important role in metabolism, and most drugs are liver-toxic. Taken over a period of time, they can cause incremental damage and lead to liver cancer. Some are more toxic than others, so asking for the effect of liver is always a good question.
Cirrhosis is a precursor to liver cancer: This is definitely true, as left untreated, liver cirrhosis can lead to cancer. The added danger is that cirrhosis also is a silent disease, with often no symptoms and gets detected quite late. Periodic tests for cirrhosis in a patient who has a family history and alcohol consumption is a must.
Lifestyle has no connection to liver cancer: Absolutely wrong. A good healthy lifestyle including healthy weight, good portions of fresh fruits and vegetables, proper exercise, minimal alcohol use, and no smoking helps not just the liver but overall health. These play a cumulative effect on liver health, and having a good lifestyle, can help in delaying onset even in a person who is predisposed to cirrhosis and/or liver cancer through family history.
Liver cancer is definitely a silent killer, but keeping eyes open definitely, helps.

Liver Cancer - Common Myths & Facts About It!

The uterus is set up inside the pelvis with different muscles, tissue, and tendons. Due to pregnancy, labour or complicated delivery, in a few ladies, these muscles tend to weaken. Additionally, as a woman ages and with a loss of the hormone oestrogen, her uterus can drop into the vaginal canal, bringing about the condition known as a uterine prolapse.

The following conditions can bring about a prolapsed uterus:

Pregnancy with complicated or even ordinary delivery through the vagina.
Weakness in the pelvic muscles with the increase in age.
Weakening and loss of tissue after menopause and loss of normal oestrogen.
Conditions leading to increased weight in the abdomen, for example, constant coughing (with bronchitis and asthma), straining along with constipation, pelvic tumours (uncommon), or clogging of liquid in the abdomen.
Being overweight puts extra strain on pelvic muscles.
Previous surgery in the pelvic region leading to loss of outer support
Smoking
However, this condition can be treated effectively:

Self care at Home: You can strengthen your pelvic muscles by performing Kegel workouts. You do these by contracting your pelvic muscles, as though attempting to stop the stream of urine. This exercise makes the pelvic muscle strong and gives some support. Have your specialist train you on the best possible approaches to exercise your muscles.
Medications: Oestrogen (a hormone) cream or suppository ovules or rings embedded into the vagina help in strength and endurance building of the tissues in the vagina. However, oestrogen is just for use in some of the postmenopausal ladies.
Surgery: Based on your age and whether you wish to conceive a child naturally, surgery can repair the uterus or remove it. The uterus as in many cases can be expelled with a hysterectomy. During the surgery, the specialist can repair the hanging or saggy vaginal dividers, urethra, bladder, or rectum. The surgery might be performed by an open abdomen procedure, through the vagina, or through little cuts in the abdomen or vagina with particular instruments.
Other Therapy: In case that you do not need surgery or have a poor possibility for surgery, you may choose to wear a steady gadget, called a pessary. It is worn in the vaginal tract to strengthen the falling uterus. It can be utilised briefly or can be long-lasting. They come in different shapes and sizes and should be fitted according to the person. In case that the prolapse is extreme, a pessary may not work. Prolapse surgery is always preferred by vaginal route. Likewise, pessaries can disturb the insides of the vagina and may bring about a noxious release.
It can be prevented in the following manner:

Decrease your weight.
Try to avoid constipation by consuming a high-fiber diet.
Do Kegel exercises to strengthen the pelvic muscles.
Stay away from heavy lifting or straining.

Prolapsed Uterus -  7 Conditions That Can Cause It!

If you are concerned about breast cancer, you should know about the steps you can take to prevent the condition. Breast cancer is a type of cancer developing from the breast tissue. Symptoms such as a lump in the breast, fluid flowing from the nipple, changes in the shape of the breast and occurrence of red scaly patches on the breast denote breast cancer.

You need to make certain lifestyle changes in order to prevent breast cancer. The ways you should adopt include the following:

Limit your alcohol intake: The more you consume alcohol, the more you put yourself at the risk of getting breast cancer. It is recommended for you not to drink more than one drink per day. Small amounts of alcohol increase the risk of breast cancer as well.

Abstain from smoking: There is a direct link between tobacco smoking and breast cancer, and the risk is even more in premenopausal women. You should quit smoking to reduce the risk of breast cancer along with many other conditions, which can develop because of the ill-effects of smoking.

Control your weight: Obese women are more prone to breast cancer when compared with women with a healthy weight. This is especially true when obesity occurs at a later stage in life, after menopause.

Keep physically active: Regular physical activity is essential for you to maintain a healthy weight, which is important for preventing breast cancer. 150 minutes of moderate aerobic exercises or 75 minutes of vigorous exercises are recommended along with strength training.

Breastfeed: Breastfeeding plays an important role in preventing breast cancer. The more you breastfeed your baby, the more protected you are from breast cancer.

Limit the dosage and duration of hormone therapy: If you undertake combination hormone therapy for more than three to five years, you are at a higher risk of developing breast cancer. In case you are taking hormone therapy for menopausal symptoms, you should talk to your doctor about alternative options such as non-hormonal therapy and medications. If you still require hormonal therapy, you must use the lowest dose that will be effective.

Avoid exposure to radiation and pollution: Certain medical imaging procedures like computerized tomography involves radiation of high doses. There is a link between breast cancer and radiation exposure. Thus, you should abstain from getting exposed to radiation and avoid taking such tests if it is not very urgent.

Maintaining a healthy diet also helps in reducing your risk of developing breast cancer. You should include food items which are plant based in your regular diet, such as fruits, vegetables, nuts, whole grains and legumes. Also, consume healthy fats such as olive oil instead of red meat and butter.

How Can You Prevent Breast Cancer?

Kidney Cancer, more commonly known as renal cancer, first presents itself in the lining of the kidney. It then grows malignant and forms a tumor. The good news is that renal cancer rarely spreads to other organs. The bad news is that the tumors grow quite large before they can be detected.

Causes-
Kidney cancer has been found to occur most often in people who are older than 40 years of age. Though the cause of the cancer is not definitively known, there are a few factors that might increase the risk of developing kidney cancer. These include-

1. Obesity- Obesity can cause hormonal changes which in turn can increase the risk of cancer.

2. Smoking- As with any other kind of cancer, nicotine consumption, in the form of smoking cigarettes, increases the risk of developing the disease. In the case of renal cancer, it can, in fact, double the chances.

3. Pain Medications- A prolonged use of pain relievers over a period of time can increase the risk of renal cancer. Certain components of the medication can lead to kidney damage.

4. Genetic history- A medical history of family members, especially siblings, with the disease can significantly increase the risk of kidney cancer.



Symptoms-
In its early stages, kidney cancer remains asymptomatic, but as the tumor grow in size, symptoms begin to present themselves. These symptoms might include the following-

1. Blood in the urine.

2. A gradual loss of appetite leading to weight loss.

3. A persistent pain in your abdomen in conjunction with a lump.

4. A fever that is neither a result of an infection nor a cold, and one that lasts for weeks.

5. Swelling of the legs and ankles.

Treatment
Treatment for kidney cancer will depend on the size and location of the tumour and whether it has spread to other organs or parts of the body. Therefore, to determine the stage of cancer, diagnostic tests such as biopsy, are performed along with urine and blood tests. After determination of your cancer stage, the doctor will perform either a radical or a partial nephrectomy, where the cancerous tumor is removed along with additional tissues. Often, kidney surgery is followed by kidney transplant if both the kidneys need to be removed in nephrectomy. However, if nephrectomy does not cure your kidney cancer, then your oncologist may recommend cryotherapy, radiofrequency ablation or arterial embolization.

Kidney cancer in its advanced stage is often treated with either biological therapy where your body s immune system is utilized to fight cancer cells or targeted therapy where drugs are used stop the multiplication of cancer cells by blocking their signals. Due to such advancement in cancer treatment, the rate of success has gone up in recent years but you also need to follow a healthy lifestyle to make sure that the treatment can bring out the desired positive outcomes.

Kidney Cancer - What Causes It?

Don't wait any longer, manage your Radiologist online with a Lybrate doctor today

Consult for Radiologist - Online and Easy!

FilterClear All

COMMON SPECIALITIES

COMMON ISSUES