There are various forms of Paralysis. Paralysis of the lower limbs is one of the most severe forms of Paralysis. It is also known as Paraplegia. People suffering from such Paralysis lose all sense below the waist. They cannot move their legs or hips, cannot void without help, and cannot have intercourse. They barely feel anything below their waist. However, the degree of inability may vary from one person to another.

In people suffering from such Paralysis, there is usually substantial impairment in movement. Though such inability is not necessarily permanent, rarely do people recover from such inability. Lower Limb Paralysis may put people at risk of deep Vein Thrombosis.

Causes of Lower Limbs Paralysis:

Paralysis of the lower limbs usually results from injury to the spinal cord or the brain. However, spinal cord injury is the most common cause of such Paralysis. Such injuries inhibit the ability of the brain to receive and send signals from lower limbs. Causes of such inability may include:

Infections in the spinal cord

Lesions of the spinal cord

Tumors in the brain

Infections in the brain  

Nerve damage at the hip or waist.

Oxygen deprivation in the brain or spinal cord due to choking, violence, or surgical accidents.

Stroke

Congenital spinal cord deformities such as Spina Bifida etc.

However, the most common cause of Lower Limb Paralysis is congenital spinal deformity, such as Spina Bifida. The degree of Paralysis depends on the location of the spinal lesion and the extent of spinal cord or nerve damage. Some people with spinal lesions may even walk independently if the lesion is lower down the spine. However, people with upper spinal lesions are usually not able to do that. They may require ortho shoes as well as walking aids in order to ambulate. If these don t work, they may need wheelchairs for mobility. Usually these people learn to ambulate with the aid of ankle foot orthoses.

Treatment of Lower Limbs Paralysis:

There is no treatment for Paralysis. However, in some cases, people suffering from Lower Limb Paralysis are able to regain some of their ability with the help of physical therapy. What physiotherapy does is that it retains the spinal cord and the brain to strengthen nerve connections and muscles so that patients can work around their limitations. If paralysis is due to some underlying cause, removal of the cause can treat the patient.

If an infant is found to be suffering from Spina Bifida, doctors can operate on his spinal cord and bring down the severity of the problem. Such children are less likely than others to use walking devices.

Bowel and Bladder Management:

This is a serious aspect of Lower Limb Paralysis. Patients need to undergo routine bladder and bowel evaluation and device management plans to reduce the risk of organ damage.

Conclusion:

There is hardly any treatment for Lower Limb Paralysis. However, physical therapy may solve some of the problems. If it does not, management of bowel and bladder and watching out for deep Vein Thrombosis should be done on a regular basis.

One can also use alternative methods like Acupuncture, Chiropractic, Massage, and other holistic treatments. However, it is always recommended to consult an orthopedic doctor before opting for any methods.

Paralysis Of Lower Limbs!

What is spinal stenosis: The narrowing of the gaps in the spine or the backbone is called as spinal stenosis. This leads to pressure on the nerves and the spinal cord. 5% of cases of spinal stenosis are seen in the low back of the lumbar spine. In some cases the narrowing of the spine leads to the compressing of the nerve root, which leads to pain in the leg.

Causes of spinal stenosis: It can be caused by aging, arthritis, trauma to the spine, spondylolisthesis and tumor of the spine

Symptoms of spinal stenosis: There is constant pain in the back and legs as stenosis pinches the nerve responsible for sensation and muscle power. Other symptoms are numbness and tingling in the legs, frequent falling and pain while walking.

Treatment of spinal stenosis:
-  A routine program with exercises and physical therapy are the best treatment for spinal stenosis. The exercises are not a complete cure but they are beneficial in keeping the patient active. A physical therapy can be supervised and once the period of the same is over people easily transition to the exercise program. The key for exercise is starting slowly in order to build strength.

-  Generally, the patients are counseled not to perform strenuous activities as that might worsen the symptoms of spinal stenosis. In case of lumbar stenosis, patients find it comfortable when they are flexed forward. The doctor might recommend walking while being bent over and leaning when using a walker if not walking upright; sitting in recliners is also recommended instead of straight back chairs.

-  Injections of cortisone are usually given in the epidural space. This is believed to relieve the symptoms of spinal stenosis temporarily. Though there have been studies which question the use of these injections as they lead to the risk of osteoporosis related fractures. This is still being pondered over by the doctors as a suitable treatment option as it has its own benefits and risks.

-  Medications such as the anti inflammatory medicines like ibuprofen or aspirin are helpful in controlling the symptoms of spinal stenosis. Narcotic drugs might also prove to be helpful if used with care and for a short while. This is helpful for severe pain related to the nerves. Muscle relaxants like gabapentins might also be recommended. In some case antidepressants might also be given to provide relief from pain. 
Though side effects are a concern when using these medications and the patient should let the doctor knows about their allergies.

Treatment For Spinal Stenosis - 4 Things That Are Part Of It!

Does you back hurt only when you wake up in the morning or is it a chronic problem? If yes, then you need to take immediate steps to treat it. Back pain, being the common physical anomaly for people primarily in the age range of 35-50, is one of the top causes for office absenteeism and mid-life lethargy and fatigue. Usually back pain indicates an underlying problem that involves the nerves, bones and muscles.

Here are some risk factors for back pain:

Pregnancy
Stress related to work
Leading a sedentary lifestyle
Anxiety and depression
Being overweight
Over exercising
Strenuous physical work outs
Smoking
There are varied reasons as to why back pain may occur. Discussing the causes of back pain is beyond the purview of this article; the focus is now going to be on some of the stretches one can practice to get relief from back pain: 

Downward dog: A classic yoga pose, the downward dog stretches the entire back, hamstrings and the whole of the leg. Begin the process in a classic push up pose with the palms and toes on the floor. Keeping your back straight, lift your tailbone up and straighten your legs. Push the heels to the floor and breathe to get the most out of this stretch.
Child s pose: A simple stretch, it begins with you sitting back on your buttocks and then stretching the arms in front of you. Keep your forehead on the floor and breathe slowly.
Cat cow pose: If your common complaint is that of a sore and painful back, then this is one of the best stretches for you. A very simple pose, you begin by sitting on all fours, then transitioning into the cat pose by pushing your spine upwards. Hold the pose for one breath and then go to the cow pose wherein you lift your buttocks and the head while scooping your spine.

Back Pain - 3 Stretch Exercises You Must Follow!

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!

Concentrated pain in the neck can be especially tormenting. Before you look for a cure for this pain and start treating it, it is important that you try and find out the underlying cause behind it as well. Contacting a physiotherapist in time will allow you not only to avoid any and every side effect posed by neck pain, but also assist you to get good riddance from it.

Causes of Neck Pain:
There can be multiple causes of neck pain. The treatment of the same depends wholly on the factor that is causing the pain. Some of these causes of neck pain include

Misaligned hips,
Misaligned Spine,
Misaligned shoulders,
A constantly forward-tilted head,
Lack of movement of the head from one specific position,
Tensing up of the muscles in the upper back,
Tensing up of the muscles in the neck region, etc.
It is all these factors and a few more that end up resulting in stiffening of muscles in and around the neck and causing you intermediate to unbearable pain.
Side effects of neck pain:
Neck pain also has some side effects, which includes temporary loss of consciousness, nausea, vomiting, blackouts, temporarily blurred vision, headache, spondylitis, etc.

Exercises for neck pain:
Neck exercises are a predominant part of the treatment extended by every physiotherapist, to cure neck pain. Some of the most vital and effective exercises for neck pain are listed below.

Frog: Funny as it way sounds, the frog is one of the best exercises when it comes to treating neck pain. All you have to do is lie down on the floor with your knees apart, your feet joined, your hands laid upward on the floor at a 45-degree angle to your body and just stay there in that position for two minutes. This will force your back to arch naturally, slowly giving some relief to your neck.
Sitting floor: Try sitting floor for neck pain. All you have to do is sit straight with your back rested on a wall, with your legs laid straight forward. Bring together your shoulder blades and bend to help them meet your knees while curling the toes outward to optimal. Stay in this position for a good 3 minutes, without bending the legs.
Static wall: Lie down on the floor with your bottom against a wall and your legs up it. You can always scoot back a bit if there is the slightest of discomfort. The aim here is to help the tail bone lie comfortably on the floor. Tighten your thigh muscles but curling your toes outward and pointing your feet straight out from its previous position. Maintain this position for 3 minutes for maximum effect.
Static back: The static back is the most common and most helpful exercise for neck pain. All you got to do is lie down on the floor, while placing your legs on an elevated surface, such as an ottoman or a chair at a 45-degree angle to your body. Now put your arms at an angle of 45 degrees to your body as well, only sideways on your shoulder. Follow this position by lifting your palms and staying in that position for five to ten minutes.
All these exercises are aimed to positively influence one muscle or the other in and around the neck region and to help you get rid of that pain. Consult a physiotherapist first, and he/she will advise you on the best neck pain exercises.

Neck Pain - 4 Exercises to Control Pain

Pain causes a lot of discomfort in the body no matter whether the pain is in the back, legs or in the head. Almost all people experience lower-back pain at some point in their lives, which can be extremely painful and can cause considerable annoyance. The first medical specialty that comes to mind for relief of lower-back pain is Orthopedics. The other two specialists that play a vital role in treating lower-back pain are the neurosurgeons and the physiatrists.

Pain in the Back
It is very difficult for the body to source the pain when it is deep and this pain could be due to infection, disease or injuries in the back, stomach and heart. It is even possible that the pain radiates to different places in the body. Often back pain is accompanied by body changes like redness, fever, neurological problems, heat, and changes in body functions and for that diagnosis of the back pain may be very severe. Patients suffering from lower-back pain and with symptoms that comprise of weakness in the foot or other symptoms of a neurologic insufficiency must definitely see a neurosurgeon.

Back pain that occurs due to reversible problems is known to vanish in a few hours or in a day. However, if it continues longer and is accompanied by body changes, then there are chances that the condition can become worse. Visiting a doctor becomes a must for back pain if any of such characteristics are witnessed. It is always better to get evaluated by a physician.

When to Consult a Doctor Immediately

    Back pain that is followed by a shock like a car accident.
    The pain in the back worsens and is constant
    Back pain continues for more than 4-6 weeks
    The pain does not improve even after taking typical remedies such as taking pain relievers or after resting.
    Severe pain in the back in the night and that is alleviated by rest
    The back pain is accompanied by abdominal pain
    Numbness in the upper thighs, buttocks, groin or in the genital area
    Weakness or tingling sensation in the arm or legs

Role of a Neurosurgeon
The neurosurgeon provides non-surgical as well surgical care depending upon the nature of the illness or the injury, and he does not just operate. The neurosurgeons are experts and offer treatment to patients suffering from any injury or disease in the spine, brain or peripheral nerves that deal with arms, hands, feet and legs. But there are many other neurosurgeons that confine their practice to treating back pain.

Lower Back Pain - 8 Signs When You Must Visit Your Doctor

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