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!

All healthy individuals will always have some amount of urea in the blood. Yet, when the urea level in the blood becomes too high, that means there is a malfunction in some part of the body due to which the body is not being able to remove this excess urea successfully. This urea can be formed in the liver when there is a process in terms of the protein metabolism's chemical balance. This urea is then transported to various parts of the body until the kidney cleans it out as urine. But when this urea does not get cleaned out properly, the urea gets concentrated in the blood and signifies a problem with the kidneys and other internal organs as well as the blood flow to the kidneys. 

The cause may include burns, heart failure, renal artery embolism, vomiting and loose motions as well as more serious ailments like diabetes. This can lead to long term kidney damage and symptoms like thirst, fluid retention, headaches, fatigue, dizzy spells, accelerated pulse, restlessness in limbs, pain in the abdomen and more. Here are the best ways to reduce the blood urea levels in a natural manner.

Herbal medicines:

Ayurveda is an ancient science that can be used for the benefit of many patients suffering from chronic and painful ailments like diabetes, kidney failure, cardiovascular ailments and more. One of the mainstays of ayurveda includes the use of herbs to create medicines and concoctions that will help in giving relief with their 100% natural elements. Medicines like mutrakrichantak churna, punarnava mandur, varunadi vati and many others can be used to avoid dialysis and bring down the urea levels in the blood by aiding better functioning of the kidneys.

Punarnava: the name of this herb has been derived from two words - puna and nava. While puna means again, nava means new and together they help in renewed functioning of the organ that they treat. This herb helps in flushing out the excess fluid in the kidneys by reducing the swelling without any side effects. This herb is basically a kind of hogweed.
Varun: this is the common caper which can be used to break down the stones present in the renal region and even as a cure for urinary tract infection. This herb helps in removing any element that may be obstructing the urinary tract and finally removes the excess fluid build up and inflammation.
Gokshur: this is a diuretic that can be used as a herbal tonic to give strength to the weak kidney cells for regeneration.
Other aspects of ayurvedic treatment for this condition include proper protein intake and better hydration along with massages and yogic postures.

How to Reduce Urea Levels in Blood Naturally

The treatment options for bone cancer depends on the type of cancer one is suffering from, the general health of the patient, the stage of cancer and the general preference of the patient. Different treatment options are designed for different types of cancer, based on the diagnosis. Each treatment responds in a different way. An oncologist decides the treatment options considering all the factors mentioned above. For instance, some cancer is best suited to surgery, while some cancer needs radiotherapy or chemotherapy to curb them. In many cases, all three modes of treatment might be required to tackle the growth of the cancer cells.

Surgery:
The goal of surgery is to eradicate the cancer cells in totality along with some surrounding healthy tissues. This involves special techniques to remove a tumor in one piece. Following are the types of surgeries that are available:

Removing the cancer cells sparing the limb: At the very first sight, the surgeon tries to understand whether it is possible to separate cancer cells from the tissues and the nerves. If the same is possible, the surgeon tries to save the limb while getting rid of the cancer cells. For the sake of safety and to ensure that the surgery is effective, the surgeon removes some of the healthy bone from the body and may replace the same with tissue from other parts of the body. To achieve this, a doctor might seek the help from of a bone bank or use a special metal prosthesis.
Surgery that does not involve the limbs: If the bone cancer does not involve the legs and the arm, surgeons can remove the affected bone along with some healthy bone from the surrounding areas. Cancer of the ribs and the spine are good examples of this type.
Surgery that affects the limb: Bone cancer that has spread to a significant extent and is strategically located in such areas that it is very difficult to remove, requires amputation. While this form of treatment is being increasingly discouraged by the wider medical community, it still does exist. In such cases, patients are fitted with artificial limbs and trained to do their job without the use of natural limbs.
Chemotherapy:
This is a form of drug treatment that uses powerful chemicals to kill cancer cells throughout the body. This medication is mostly given through an IV and the medication kills whatever cancer cells it comes across. 

Radiation therapy:
Radiation therapy involves the usage of special X-ray beams that have high power and can kill cancer cells. The patients are required to lie on a table, while a machine moves around the affected area and treats it with high energy X-rays, thereby killing the cancer cells. Radiation therapy is often used in conjunction with chemotherapy to reduce the size of a tumor before operating on it.


Bone Cancer - Know The Treatment Options!

Dilation and curettage procedure which is commonly referred to as D&C is a minor surgical procedure where the cervix is dilated while a special instrument is used for scraping out the lining of the uterus. It is important to know what you can expect before, after and during the process so that you can stay ahead of unnecessary worries and help the process to be smooth and fruitful.

When do doctors recommend dilation and curettage process?
You may be required to undergo the dilation and curettage procedure for one of many reasons. It can be used for removal of tissues in the uterus during or after an abortion or miscarriage or to remove little pieces of placenta after delivery. This process aids in preventing infection as well as heavy bleeding. On the other hand, it can help in diagnosing and treating abnormal uterine bleeding including polyps, fibroids, hormonal imbalances and even uterine cancer. A sample of the tissues in the uterus is tested under a microscope to check if there is any abnormal cell present.

What can you expect during the dilation and curettage process?
The D&C procedure is a minor one and takes about 15 minutes even though you will have to spend about 4 to 5 hours in the healthcare facility. Before the procedure, your doctor would check complete history, and at this point, you should tell your doctor if you suspect that you are pregnant, you are sensitive to latex or any medicines or if you have a history of bleeding disorders. You will then be given anesthesia so that you don t feel any pain or discomfort during the procedure. Before this procedure, you will have to empty your bladder.

The D&C procedure comprises two main steps, dilation, and curettage.
Dilation involves opening of the lower part of the uterus or the cervix for allowing insertion of a slender rod. This is done to soften the cervix so that it opens and allows curettage to be performed. Curettage involves scraping of the lining and removal of the uterine contents with the help of a spoon-like instrument known as a curette. This may cause some amount of cramping, and a tissue sample would be taken out for examination in the laboratory.

After the completion of the procedure, you may experience slight bleeding and cramping. In some rare cases, adhesions or scar tissues may start forming inside the uterus, and this condition is termed as Asherman s syndrome which can cause changes in the menstrual cycle along with infertility. This problem, if arises, can be solved with the help of surgery and therefore, you should report any abnormality in your menstrual cycle to your doctor.

Dilation & Curettage Process - What To Expect From It?

Rubbery cushions (discs) between the bones (vertebrae) stack up to form the spine. When a nerve between the disc and vertebrae is pressed and inflamed, that condition is called herniated disc. The herniated disc is also referred to as the ruptured disc or the slipped disc. This is caused when the soft jelly is pushed out due to a tear in the exterior. Herniated discs can lead to an irritation of the nerves and result in tremendous pain. It may also cause the arms and legs to become numb and weak. However, some people suffering from this condition may not display any symptoms at all.

Herniated disc generally occur in the lower part of the vertebral column. The herniated disc may also be seen in the thoracic spine or cervical spine. The symptoms of a herniated disc include pain in the legs, feet, or the buttocks, pain in the shoulder blade, tingling of the feet, numbness of the feet and hands, muscle weakness, neck pain or muscle spasm in the neck. Most common causes of herniated discs are aging, excessive weight or lifting of heavy weight.

Prevention of herniated disc

Herniated discs are very commonly found in people who are aged between 35 or 55 years. They are seen more commonly in the men in comparison to the women.
A herniated disc cannot be prevented easily, but there certain things that you can do to reduce the risks. Maintaining the proper techniques of lifting is important. You should not be bending at your waist. You should always bend the knees and keep the back straight. This helps you to use your leg muscles which are very strong to support the weight.
As the saying goes, precaution is better than cure, so here are few precautions that can be taken to avoid herniated discs. Practicing a proper posture can help in reducing the risk of a herniated disc. It is extremely important for an individual to maintain a healthy posture while standing, sitting, walking, and even sleeping. It is imperative that you stretch your muscles when you are sitting in one position for a long time.
Another important thing to avoid is high-heeled shoes, as they are few of the most common causes of a herniated disc. It would be a good idea to go for flat and well cushioned comfortable footwear as they can go a long way in reducing the risk of the herniated disc.
Exercising regularly can go a long way in keeping the muscles of the legs, stomach, and back very strong. You should try to balance your flexibility and strength by exercising regularly. The best form of exercise to avoid herniated disc or ruptured disc is aerobic exercise.
It is true that as you start to age, the chances of getting a herniated disc increase significantly. However, if proper precautions are taken, the stress put on the spine can be effectively reduced, thereby eliminating the risk of a herniated disc. 

Herniated Disc - Is There A Way It Can Be Prevented?

Uterine cancer of cancer of the uterus is a fairly common type of cancer. In fact, this is the fourth most common type of cancer to affect women. This type of cancer is usually diagnosed in its early stages and hence can be easily treated. However, did you know that this type of cancer can be prevented? This is primarily because most cases of uterine cancer are caused by an increased amount of estrogen as compared to progestin. Here are a few tips to keep in mind.

Birth control pills: The regular use of birth control pills for at least a year is believed to reduce the risk of uterine cancer by at least 50%. The longer these contraceptives are used for, the more effective they are. The protection provided by them lasts for 15 years after their use has been discontinued.
Reduce weight: Being overweight not only increases the risk of lifestyle diseases such as diabetes and high blood pressure but can also increase a woman s risk of suffering from uterine cancer. This is because fat cells produce estrogen that further dis-balances the estrogen to progestin ratio. Reducing weight can thus help lower the estrogen levels in the body and prevent cancer. To lose weight, one must keep a strict control over portion sizes, eat nutritious food and exercise regularly.
Use an IUD: Some methods of contraception not only prevent unwanted pregnancy but also reduce the risk of uterine cancer. Many IUDs or Intrauterine Devices contain progestin. This helps balance the estrogen and progestin levels in the body. Additionally, it also reduces the risk of hyperplasia. This is a condition marked by the abnormal thickening of the lining of the uterus. In many cases, this condition is a precursor to uterine cancer.
Question Your Family: Genetics can also influence the risk of developing uterine cancer. For example, people carrying the gene responsible for Lynch Syndrome or hereditary nonpolyposis colorectal cancer have a much higher risk of uterine cancer as compared to others. Thus, if you know of family members who have suffered or are suffering from uterine or colon cancer, it is a good idea to undergo genetic testing.
Broccoli - A super food: Some foods can also help strengthen the immune system and reduce the risk of uterine cancer. Broccoli is one such vegetable. This is known as a super food that can prevent cancer. The best way to eat broccoli is by steaming it. This has the higher amounts of glucosinolate as compared to fried or boiled broccoli.

Uterine Cancer - 5 Tips To Help You Keep It At Bay!

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