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!

In Ayuveda, muscle cramp is known as  khalli vaata . Vyaana vaata it is a biological force that is responsible for regulating the functioning of your voluntary muscles. In case of a muscle cramp, the vyaana vaata gets impaired. Metabolic wastes are harmful toxins that tend to get accumulated in your system if not flushed out of your body and deposited between your muscle tissues and nerve-endings. This toxic waste is known as 'aama' in Ayurveda and it is known be a prominent cause of cramps. Besides aama, vata dosha is also responsible for muscles cramps.

Ayurveda provides a number of remedies to treat the problem of muscle cramps. The following are some of the most effective remedies to relief the discomfort of muscle cramps:
1. Drink warm milk to get instant relief from abdominal cramps. The alkaline properties of milk help to pacify the acidic condition in stomach that results in cramps. It is also a rich source of calcium which is known to aid in the relaxation of troubled muscles.
2. Physical activity including stretching exercise is effective in reducing the acute pain of leg cramps.
3. Garlic compound which is also called as 'Lagsunadivati' is helpful in relaxing muscles and it is also known to calm the  vata dosha  that aids in relieving muscle cramps.
4. Do warm up exercises and stretching exercises to lessen the risk of developing a muscle cramp during your workout session
5. Increase the intake of foods that are rich in minerals, calcium, potassium and magnesium as it is known to reduce the chances of muscle cramps.
6. Massage the painful region with 'prasarini taila' or 'mahanarayana taila' to relax the strained muscle.
7. Apply ice pack on the strained muscle to reduce the swelling and pain of the muscle.
8. Sinhanaada guggulu is well known to provide instant relief from muscle cramp. It has medicinal properties which have a mild laxative effect. It eases the problem of abdominal cramps and lessens the discomfort associated with it.
9. In case of extreme pain, 'Lakshmivilaas rasa',  Prataapa lankeswara rasa , are among the most effective Ayurvedic medications which are known to provide relief in case of chronic muscle cramps.

Muscle Cramps - How to Treat them Effectively through Ayurveda

An abnormal swelling in the neck can be symptom of various problems. While it can be something as non-threatening as a swollen gland due to a cold that can be cured with simple medication, a swollen neck can also turn out to be a cancerous lump in the neck. When faced with an irregular swelling in the neck, it is best to not panic or jump to conclusions until you consult with an Ear-Nose-Throat Specialist. The possible problems that a swelling in the neck can indicate are:

Swelling or enlargement of the salivary glands: The salivary glands may become enlarged due to an infection or due to foreign materials getting stuck in them. While foreign objects or formation of stones in the salivary glands might require surgical removal, they can often be dissolved with medication and other non-invasive treatments. And infection in the salivary glands is often treated with antibiotics or other medication. These treatments can be prescribed and administered by ENT Specialists.
Thyroid disease: The thyroid gland may swell up and cause a swelling of the neck. These are often called goiters in colloquial language and are a result of thyroid diseases such as hypothyroidism and hyperthyroidism. They usually require a series of medication and treatment and are not considered an ENT problem despite the swelling of the neck.
Benign cysts: Benign cysts can form in any part of the neck or in the glands, much like it can form in any part of the body. An ENT Specialist can prescribe a surgical removal of the cyst lest it turns cancerous later in life. It should also be removed in case it grows or relocates, going on to cause other problems.
Lumps in the muscles: Lumps in the neck muscles are formed by injury or torticollis. These usually aren t considered ENT problems and can be treated by general physicians and sometimes chiropractors.
Cancerous cysts or growths: One of the most daunting problems posed by a swelling of the neck is the possibility of cancer. While thyroid cancers as well as cancerous growths in the salivary glands are slow to develop, a swelling in the neck should immediately be investigated by an ENT Specialist in order to rule out all possibilities.

Neck Swelling - When It's An ENT Disease!!

Rotator cuff is the name given to four muscles and their tendons, which keep your arms in your shoulder sockets, allowing you to lift your arms and do day-to-day stuff like combing your hair, cutting vegetables etc.

The shoulder joint is a very important joint of the body and this is why any tear that happens in the rotator cuff can be devastating.

Causes

Tears can happen in rotator cuff due to a number of factors like injury and degeneration due to age. Tears that happen due to an injury to the shoulder are called acute. Degenerative tears are tears that happen due to degeneration of the tendon over time.

Common causes of degeneration are lack of proper blood circulation, which impedes the rotator cuff s ability to repair itself. Repetitive stress is another cause where we stress the tendon by repeating the same shoulder motions again and again while playing games like tennis, cricket etc. and doing jobs that require us to extend our arms upwards a lot. Lifting heavy objects can also lead to tears.

Symptoms

Chronic shoulder and arm pain are good reasons for you to see your doctor. If you suffer from pain in your shoulder at rest, while sleeping on the affected shoulder or pain while lifting and lowering your arm, then there is no time to wait.

The doctor will do a physical examination by moving your arm in different directions. He may follow it up with X-rays and MRI to check how big the tear is in your rotator cuff.

Treatment

Once confirmed that you indeed have a rotator cuff tear, your doctor will start the treatment. The goal of any treatment is to reduce pain and make your shoulder joint work properly again.

Nonsurgical Treatments: 

Nonsurgical treatments include rest, using of a sling to protect the shoulder and modifying your daily activities. This means you may not be able to do activities that cause shoulder pain. Your doctor can also prescribe pain and anti-inflammatory medicines. Strengthening and physical therapy bring up the rear of this type of treatment.

What you must remember is that nonsurgical treatment relieves pain and improves function in the shoulder, but does not improve shoulder strength. The size of your tear may also increase over time.

Surgery: 

Surgery, which attaches the rotator cuff to your bone, is done if you suffer from continuous pain and symptoms over a year or so. If you have a large tear, conservative treatments will not work and surgery will have to be resorted to. 

If you have been suffering from chronic shoulder or arm pain, waiting and watching is definitely not an option. You must visit an orthopedic surgeon at the earliest. Remember, if treatment is not started soon enough, your rotator cuff tear will get larger and will require only surgery.

Rotator Cuff Tears: What Are My Options?

If you are suffering from gout, you should try undergoing a homeopathic treatment. Gout is a type of arthritis and is considered to be the most painful type. It is featured by the inflammation of joints accompanied by great pain. The pain and inflammation occur because of the deposition of urate crystals in a joint. The accumulation occurs when there is excessive uric acid present in the blood.

Here are some effective homeopathic remedies for the treatment of gout:

Colchicum: This medicine is the primary homeopathic medicine for treating gout because of its effectiveness. It is mostly used in chronic cases of gout. Usually, a patient experiences extreme pain in the big toe, which is too intense to be touched. The toe and other parts which get affected become swollen, red and hot. The pain worsens in the evening and at night. Patients who require this medicine should keep away from warm weather conditions. This medicine is also used in case of increased weakness and internal cold.
Ledum Pal: This effective medicine is used in cases where the pain travels in an upwards direction from below. The pain is likely to start at the feet and gradually move upwards, affecting the knees and legs. The pain also shoots through limbs. Small joints are commonly affected. There is a sensation of decreased warmth in the joints and in the body. The patient will find it difficult to tolerate any kind of external warmth. The pain improves by cold applications. The ankle balls or big toe may be swollen.
Benzoic acid: This homeopathic medicine is used for treating gout where offensive urine is experienced. The urine becomes very offensive with a very strong odor, which can be detected from a distance. The odor is usually repulsive and the color of the urine is brown. Extreme pain is experienced in the big toe and the knees are swollen.
Antim Crudum: This is an efficient homeopathic medicine used for treating gout. It is used when a patient experiences gastric symptoms along with joint pain and inflammation. The patient may develop an increased craving for food and hence, several problems occur due to over eating. Pain is experienced in the heels and fingers.
Sabina: This homeopathic medicine is important for treating gout in women, when the patient already suffers from another female disorder. Uterine symptoms are experienced along with the basic symptoms of gout. Shooting pain is experienced in the toes and heels. The joints get swollen and look red and shiny.
Homeopathy offers a completely natural treatment for different types of gout and goes beyond just curing the symptoms. You need to consult your doctor before starting a homeopathic treatment for gout.

5 Homeopathic Remedies for Treating Gout Pain

Injuries are very common, especially head injuries are one of the leading causes of death and disability in adults. As per surveys conducted, 1.7 million people suffer from head injuries every year and this estimation is increasing day by day.

There are several types of head injuries from mild as a cut, bruise, bump, contusion to severe ones caused due to a concussion, fractured skull bone, deep cut, internal bleeding, brain damage, etc.

A head injury is a comprehensive term which consists of an array of injuries that damage the skull, scalp, brain, and blood vessels and tissues in the head. It is generally referred to as a traumatic brain injury (TBI) and brain injury, depending upon the type and extent of trauma.

Causes of Head Injury-

A head injury can occur due to many reasons. Some common causes of these head injuries are:

Vehicle accidents

Domestic violence

Street fights

Fall from height

Child abuse

Subdural hematomas

Brain hemorrhages

Symptoms of Head Injury-

A head injury is followed by various symptoms depending upon the intensity of the injury. Here is a list of all the possible symptoms of brain injuries:

Nausea and vomiting.

Fatigue or sleepiness.

Extreme headache.

Confusion.

Loss of muscle control or paralysis in the part of the body controlled by the part of the brain that is affected.

Coma.

Dilation of the pupils and related visual problems; Blurred vision, photosensitivity, blindness, loss of muscle control in the eyes.

Cerebrospinal fluids might come out of the ears and nose, sometimes accompanied by blood.

Problem breathing.

Low pulse rate.

Increase in blood pressure.

Difficulty in swallowing.

Loss of hearing.

Problems in cognitive functions.

Numbness or tingling in the limbs.

Loss of bladder and bowel control due to loss of control over muscle functions.

Loss of consciousness.

Treatment of Head Injury-

Diagnosis of a brain injury has to be detailed and very quick at the same time. It always comes under emergency cases. Some of the steps involved are:

Cardiac and pulmonary function test.

Glasgow Coma Scale test.

Pupil dilation and corneal function test.

Brain stem reflex tests.

The most common way of diagnosis is the use of CT scans and MRI scans.

A severe head injury often needs surgery to reverse symptoms like chronic fatigue, bleeding, or loss of bodily function. Diagnosis involves finding out the type and severity of the injury and treatment involves removing the problem surgically.

Take Away-

Head injuries take time to heal, but medical treatment along with neurosurgery can aid the process of recovery and also help a person to lead a healthy life in the future. Most young patients recover fully, while some older patients or patients with preexisting neurological conditions live with a degree of disability.

All You Must Know About Head Injury & Its Treatment!

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