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!

You might be surprised to know that unknowingly you are consuming poisons in your daily meal. Forget getting nutrients from these items, you end up troubling your health by consuming these food items. White rice, pasteurized cow milk, refined salt and refined sugar are the 4 white poisons, which are not good for your health. As they don t have the right amount of protein, vitamins or minerals to keep your body healthy. Moreover, they increase the risk of developing other diseases like hypertension and diabetes. It has also been found via research that eating white rice increases the risk of diabetes by 17 percent.

Here is why you should stop eating these poisons:

    Pasteurized Cow Milk: The only good thing about this milk is that it has a longer life. The process of pasteurization keeps the milk good for a longer period, but harms its nutritive value. It removes enzymes, vitamin A, B 12 and C from the milk. The process also transfers hormones and antibiotics into the milk. Researchers have found that the process also destroys essential and good bacteria like lactobacillus acidophilus. Moreover, about 20% of iodine gets removed from the milk and thus after consuming it, you are more likely to develop constipation.
    White or Refined Rice: The process of refining rice leads to the removal of the outer layer and germ from it. The rice is left with endosperm, only. This layer contains starch in a huge quantity which can increase your blood sugar or glucose levels to a great extent.
    Refined Sugar: White sugar or refined one is full of chemicals. It has no nutritional value. The chemical is derived from sugar cane or beet. Then, the juice of this substance is extracted to get fibre free sugar. The juice is mixed with lime during the refining process. This kills all vitamins present in the juice. Calcium sulphate and sulphuric acid are also used for bleaching of the sugar. This is done to make the sugar look more white than natural.
    Refined Salt: Normal table salt contains iodine. This is needed for a healthy body. But refining of salt removes iodine from the salt. Fluorides are added during the process of refining. The fluorides are bad when consumed in excess. Consumption of refined salt also increases blood pressure.

4 White Poisons that We Eat Unknowingly

While the very mention of the word  Farting  makes some of you cringe and cover your nose, you can t ignore the sheer obviousness of the whole process. It is as natural as eating, drinking, sleeping & other daily habits you associate yourself with. Farting occurs mainly when the air is trapped within your body. Air might be swallowed during eating or from intestinal gas and chemical reactions in the stomach. In hindsight, farting can be a good thing. Don t think so?

Here are 6 reasons for you to believe that farting is actually wonderful and not as gross as you think it might be:

The hydrogen sulphide present in the fart is poisonous and smelly, but if used in small amount, is known to be beneficial in the prevention of heart disorders and strokes.
The smelling farts containing hydrogen sulphide, which is known to be useful for slowing down the ageing process
Farting, openly and without inhibition, while being in a relationship can actually be considered as taking a step forward in terms of honesty and comfort in the relationship. If you can share the process with your other half without hesitation and can accept the pungency that comes with it, then the relationship is definitely working well.
Farting can work as a self-defensive mechanism, as proved by recent researchers.
Holding your fart for a long time might cause uncomfortable conditions, such as bloated bowel movements and haemorrhoids. No matter how much you hold them, the farts will release themselves once you re relaxed, especially when you re sleeping.
Bottom-line: Just let it go. If you wish to discuss any specific problem, you can consult a doctor.

5 Reasons Why Farting is a Wonderful Thing

Pcos or polycystic ovary syndrome is an endocrine disorder in women, in which the female hormones, progesterone and estrogen, are imbalanced. This imbalance leads to the formation of cysts (benign masses) in the ovaries. Pcos tends to affect your heart functions, fertility, menstrual cycle and appearance.

There are certain symptoms, which can be indicative of pcos; these symptoms tend to begin as a woman's menstrual cycle starts. In certain cases, however, pcos may also affect a woman in her mid age. Pcos can also cause excessive hair growth in unwanted places like above the upper lip, chin, arms and chest like a male.
The symptoms are:

Increase in the production of male hormone, leads to development of male characteristics
The size of the breasts may reduce
The tone and the texture of the voice may change and become similar to a man's voice
Hair may start to fall
You may suffer from acne and pimple breakouts on your face
It can lead to sudden weight gain
It may affect a woman's fertility
It may lead to pain in the pelvis
Other symptoms: apart from these symptoms, a woman may also experience other health complications such as high levels of bad cholesterol, high blood pressure and diabetes.

Causes: the causes of pcos are not well known, however, the likely causes are genetics and hormonal complications. If someone in the family has pcos, then the risk of being affected by pcos rises significantly. The other likely cause is the overproduction of the male hormone androgen in the female body. Although androgen is a male hormone, the female body also produces it in trace amounts. However, in some cases, when it is overproduced, it might impair the ovulation process.

Diagnosis and treatment: once the condition is diagnosed, there are certain treatments, which are recommended for the patient. The condition in itself does not have a cure, but the symptoms can only be controlled. Medications to control the androgen levels in the female body may be administered if you have androgen hormone complication. A balanced diet and an exercise regimen can be chalked out to control body weight and regulate blood sugar levels. If pcos leads to ovulation problems, then medications to facilitate ovulation may be advised.

PCOS: What You Need to Know About It

Be it burgers, bagels, muffins, sandwiches or simple toasts, bread has made headway into the diets of a huge portion of the populace. Although a staple diet for many since time immemorial, the consumption of bread has increased extensively in the recent past. But, which type of bread should we intake to incur the best health impacts is a question that bothers many. The general assumption is that the wholegrain variety is the best alternative. However, the barrage of marketing tactics makes it impossible to distinguish the best variety from the others. 

There are a whole lot of myths surrounding the best variety of bread and you must choose wisely before settling for one particular type. It is expedient to look beyond the overt appearance or the name of the bread, one needs to be wary of the ingredient before taking a call.

Mostly, white bread is made out of refined flour which is often striped off essential nutrients and fibers. To worsen the situation, white bread is often bleached with certain chemicals to enhance its appearance.
Certain assumptions deem brown bread as the healthier option. Unfortunately, it isn't true always. More often than not, brown bread is simply white bread with artificial coloring added to it or is caramelized. They essentially add no surplus nutritional value.

Similarly, multigrain bread can often mislead the consumers about its health impacts. Unlike whole wheat bread, multigrain breads are usually chemically treated with softened grains. This does not effectively recover the lost nutrients of the bread.

Whole wheat bread has more pronounced health benefits. It contains more wheat germ and fibers in comparison to the more processed varieties of bread. Having evaded the toxic additives, it has relatively healthier effects on our blood sugar levels.

As you realize that the bread that you eat does not necessarily affect your health favorably, wisdom lies in seeking out the least harmful variety. In that context, rye bread or spelt bread contains greater amount of minerals. Besides, bread made from barley, oats and millets have greater mineral content than the commercially hybridized varieties and promote better health.

Brown Bread Vs White Bread Vs Whole Grain?

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!

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