The medical term  spina bifida  or spinal bifida refers to a congenital defect in the spine. In simpler terms, spina bifida is a defect in the neural tube. Based on the severity of this disease, spina bifida can be divided into three different types:

Myelomeningocele
Meningocele
Occulta
The symptoms of spina bifida vary depending on each of these three types. Let's take a closer look at its symptoms here:

Myelomeningocele

Myelomeningocele is the most severe form of spina bifida. In this type of neural defect, spinal canal of the baby remains open in the middle or lower back along a few vertebrae. Due to this opening, a sac is formed at the back of the baby at birth, which exposes the baby to several life-threatening infections.

Some of the common symptoms of this type of spina bifida are:

Seizures
Presence of uneven hips
Deformed feet
Curved spine or scoliosis
Bladder and bowel problems
Muscle weakness
Paralyzed leg muscles.
Physical deformities from moderate to severe levels are also very common in this type of spina bifida.

Meningocele

Meningocele is a ratherrare form of spinal bifida in which a sack of fluid stays in open at the back of the baby. Here the protective membranes that usually stay around the spinal cord push out through the vertebrae s opening. Though this sack contains no part of the spinal cord, it may cause minor disabilities.

Some common symptoms of this kind of spina bifida are:

Membranes forming a visible sack on the back at birth
Presence of a small opening in the baby's back
The good news is that this sack can be removed through surgery without hampering the normal development of the spinal cord.

Occulta
Spina bifida occulta is the mildest form of spina bifida, which, in majority of the cases, often stays hidden as its symptoms are rarely visible. As it doesn t even cause any form of disabilities, it generally goes unnoticed. It doesn t cause any damages to the nerves or the spinal cord.

Some common symptoms of occulta are:

Presence of a gap between the vertebrae
An area on the back formed with extra fat
Acluster or small group of hair on the back
A dimple or birthmark on the back.
In this kind of spina bifida, neither any sack of fluid is formed, nor are there any visible opening in the back. Sometimes, people who have spina bifida are not aware of it due to its minimal symptoms.
Spina bifida usually affects a child before birth, when the brain or the cord or the protective covering over them fails to develop completely. Knowing about the symptoms can be one of the best ways to identify and diagnose this disease and opt for proper treatment solutions. If you wish to discuss about any specific problem, you can consult a Neurosurgeon.

Spinal Bifida - Know The Signs That Indicate It!

Lower back pain is one of the most common ailments among adults all across the world. You may wake up in the morning with an energising drink before going out to work. After you arrive at work, you may have to sit there till lunch, which involves further sitting and you are required to sit for more hours for completing the remaining work. Then you come back home by sitting in the car and have the night s meal while again sitting. Did you know sitting through the day is the major culprit behind your back pain? Thankfully, yoga has effective ways of treating back pain to a considerable degree.

You can choose to do the following yoga poses for alleviating your back ache:

Supine hamstring stretch: You will have to lie back on your back and bend the right knee to the chest. Then you will have to place a rolled-up towel around the football and straighten the leg towards the ceiling and press both the heels. In case your lower back feels strained, you can bend your left knee and place the foot right on the ground. Hold the position for about 3 to 5 minutes and practice regularly for soothing back pain.
Two knee twist: You will have to bend your knees to the chest while lying on the back and try to bring out the arms forming a T-shape. Then try to exhale and lower down the knees on the ground towards your right side. Keep both the shoulders pressed down firmly and hold this position for about 2 minutes for best results.
Sphinx: You will have to prop yourself on the forearms while lying on the stomach. You will then have to align the elbows right under the shoulders and press through the tops and palms of the feet. You are likely to feel terrific sensations down your lower back, but it is advised to bear through it as it allows the flow of blood to that region which is required for healing. Practice the position regularly and hold it for at least one minute.
Thread the needle: This is quite an easier pose where you will have to lie flat on your back by bending both the knees with your feet flat on the ground. You will now have to bend the right knee by placing the outer left ankle through the right thigh. You will have to thread the right hand between the leg and interlace the hands behind the left thigh.
These positions would help in soothing your lower back pain, but it is recommended to consult a doctor if the pain still persists. Ayurvedic Tiktaksheer basti, massage therapy and certain oral medicines can help a lot in speedy recovery from spine/back related problems.

Ayurved has a very unique way of drug administration called Basti in which various medicines are given through the anus ( Rectal route)...For Lumbosacral / spine disorders a very specialised form of enema Tiktaksheer Basti (Medicated Bitter Milk enema) is given which shows amazing results. Kindly consult a specialized Ayurvedic practitioner for additional details.

Kati Basti (Vasti) is a traditional Ayurvedic treatment used for lower backache and disorders of lumbosacral region, including slip disc, lumbar spondylosis, sciatica, spinal problems etc. Kati Vasti is a part of external oleation (Snehana) therapy in Ayurveda. It is very safe, non-invasive and green category procedure.

In this procedure, you will get instant relief from backache. After completing a course of 7 to 21 days, you may not need any kind of oral medicines. It is a complete therapy for back pain and lumbosacral disorders.

However, the results vary person to person, but in most of cases, people get quick relief after the procedure.

Lower Back Pain - 4 Yoga Asanas For Treating it

Radiology is a special branch of medical science that uses various techniques of imaging for the diagnosis and the treatment of several types of diseases in the body. The different types of imaging techniques used in radiology are X-rays, Computerised Tomographic scan (CT Scan), ultrasound, Magnetic Resonance Imaging (MRI) and nuclear medicine which includes Positron Emission Tomography(PET).

Role played in evaluating hip replacement
Hip replacement surgeries have become extremely common in the recent times, and radiological evaluation remains the mainstay of the overall hip replacement procedure. Thus, the role played by radiology is quite significant in such situations. All the specific anatomical landmarks and the measurements are used to make sure the placement is perfect during the hip replacement surgery. Radiological imaging helps in the assessment of the following conditions that are as discussed below.

The length of leg
The inequality in the length of the two legs is prevalent after a hip replacement surgery which can create a great deal of discomfort and inconvenience to the patients. A greater difference in the length of the two legs increases the chances of dislocation, and this is a situation where radiological evaluation plays a crucial role. With the help of radiological imaging, the length of the legs can be made almost equal.

The horizontal center of rotation
In this case, horizontal center of rotation helps in the assessment of the acetabular component of the prosthesis. This is calculated by the measurement of the distance between the center of the head of the femur and the acetabular teardrop. This distance should be bilaterally equal, and it is just not possible without the help of the imaging techniques of radiology.

Acetabular inclination
The acetabular inclination is the angle formed between the face of the cup and the transverse axis. If the angle is less, then it results in a stable hip, but the abduction is limited. On the other hand, if the angle increases then there are high chances of dislocation of the hip. Thus, with the help of radiological evaluation, proper and effective angular inclination is given which is optimum for the patient.

The stem positioning of the femur
The main aim of the stem positioning of the femur in a hip replacement surgery is placing the stem in a position which is neutral within the shaft. To get a proper idea of the positioning, the imaging techniques are of utmost importance which cannot be achieved perfectly without the imaging.

Thus, the crucial role the different techniques of radiological imaging plays during the overall procedure of a hip replacement surgery can be perceived. With the use of the different imaging techniques, the results obtained are closer to perfection.

How Radiological Evaluation Can Help In Case Of Hip Replacement?

Joint Replacement Surgery is a procedure where the damaged surface of the advanced arthritic joints are removed and replaced with artificial joints, such as metallic, plastic and ceramic joints.
These surfaces closely replicate the original anatomy.

When do you need a knee replacement?
When you suffer from severe pain or deformity in the joint (knee in this case), the pain or stiffness and deformity makes it difficult to perform simple tasks. Severe grade IV osteoarthritic knees of  people over 50 years when have pain, swelling and deformity fail to respond to medicines, physiotherapy, injections and rest.

Aim of the surgery

    Correct the deformity: Relieve the pain and give near full movements almost immediately after the procedure. Details including techniques and safety, it is a safe, rewarding surgery with a success rate of as high as 99.5% when done by an able and experienced professional.
    Anaesthesia: Usually it is the spinal cord epidural where one is rendered numb for 3 to 4 hours waist down. Sometimes a general anaesthesia is given. A 4 to 5 inches cut is made in front of the knee and all the damaged cartilages, bones, loose bodies are removed from the lower end of the thigh, upper end of the tibia (usually of few millimetres) and the surface re-crafted to match the size and shape of the artificial joint (it is usually imported). They are fixed with bone cement. The ligaments and muscles are reattached and the parts closed.
    Recovery: Stand up and walk a few steps with a walker the day after the procedure i.e. in 24 hours. Physiotherapy in hospital for 5 to 7 days and/or walking, progressively longer walks and exercises over the following 15 days. Stitches are removed in 15 days. The patient can return back to normal activity in 4 to 8 weeks the surgery.
    Activities: Normal walks of 3 to 5 km per day Climbing stairs, cycling, swimming, and driving can be performed with the new implant(s) now.
    Avoid: Squatting/kneeling Prohibited: contact sports like football, cricket, tennis; jumping; adventure sports Longevity of joints: 15-35 years depending on the materials used.

Joint Replacement Surgery - When Should You Go for  it

The intervertebral discs are made-up of two concentric layers, the inner gel-like Nucleus Pulposus and the outer fibrous Annulus fibrosus. As a result of advancing age, the nucleus loses fluid, volume and resiliency and the entire disc structure becomes more susceptible to trauma and compression. This condition is called as degeneration of the disc. The disc then is highly vulnerable to tears and as these occur, the inner nucleus pulposus protrudes through the fibrous layer, producing a bulge in the intervertebral disc. This condition is named as herniated disc. This can then cause compression to the spinal cord or the emerging nerve roots and lead to associated problems of Sciatica radiating pain from back to legs in the distribution of the nerve. Other symptoms could be a weakness, tingling or numbness in the areas corresponding to the affected nerve. Sometimes bladder compromise is also present, which is made evident for urine retention and this need to be taken care as an emergency.
Excessive weight, bad postures, undue movements, improper weight lifting and other kinds of traumas may weaken the intervertebral discs. When this occurs the pulpous nucleus will bulge against the annulus, or even be squeezed through it (extruded disc).

The first steps to deal with a herniated or prolapsed lumbar disc are conservative. These include rest, analgesic and anti-inflammatory medication and in some cases physical therapy. At this point, it is convenient to have some plain X-rays done, in search of some indirect evidence of the disc problem, as well as of degenerative changes on the spine.

If in a few days these measures have failed, the diagnosis has to be confirmed by means of examinations that give better detail over the troubled area, as the MRI, CT which will show the disc, the space behind it and in the first case, the nerves. In some instances, the EMG (electromyography) is also of great value, as this will show the functionality of the nerves and muscles.

Once the diagnosis has been confirmed, one of the best alternatives existing today is the Ozone Discolysis as the results obtained are excellent and practically has no complications. This novel treatment avoids the use of surgery in 80% of those who needed it. In most patients left with painkillers as the only treatment, the symptoms eventually disappear, only that this could take weeks to months. Ozone speeds up these developments, see the same result in a few weeks. The problem has to be seen and approached integrally and frequently the combination of therapies has to be used, most frequently physiotherapy. Also, it has to be known that those who had a herniated disc have 10 times more chances of having another herniation than the rest of the population.

If despite the ozone therapy the symptoms persist, Drill Discectomy/ Laser Discectomy are good alternatives before open surgery (Discectomy) which has to be contemplated in those true emergencies, as mentioned above, this is possibly the first choice.

Once the conservative treatment fails:

Early aggressive treatment plan of pain has to be implemented to prevent peripherally induced CNS changes that may intensify or prolong pain making it a complex pain syndrome. Only 5% of total LBP patients would need surgery & 20% of discal rupture or herniation would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then.

Depending upon the diagnosis one can perform & combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon pt`s pathology & response to treatment.

Using precision diagnostic & therapeutic blocks in chronic LBP, isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of LBP after conservative treatment has failed.

LESI: Lumbar Epidural Steroid Injection

Indicated in   Acute radicular pain due to irritation or inflammation.

Symptomatic herniated disc with failed conservative therapy
Acute exacerbation of discogenic pain or pain of spinal stenosis
Neoplastic infiltration of roots
Epidural fibrosis
Chronic LBP with acute radicular symptoms
Epidural- lumbar injection
ESI Treatment Plan

Compared to interlaminar approach better results are found with a transforaminal approach where drugs (steroid+ LA/saline +/- hyalase) are injected into anterior epidural space & neural foramen area where herniated disc or offending nociceptors are located. Whereas in interlaminar approach most of drug is deposited in posterior epidural space.Drugs are injected total 6-10 ml at lumbar, 3-6 ml at cervical & 20+ ml, if caudal approach is selected. Lumbar ESI is performed close to the level of radiculopathy, often using paramedian approach to target the lateral aspect of the epidural space on involved side. Cervical epidural is performed at C7-T1 level.

SNRB- Selective Nerve Root Block 

Fluoroscopically performed it is a good diagnostic & therapeutic procedure for radiculopathy pain if

There is minimal or no radiological finding.
Multilevel imaging abnormalities
Equivocal neurological examination finding or discrepancy between clinical & radiological signs
Postop patient with unexplainable or recurrent pain
Combined canal & lateral recess stenosis.
To find out the pathological dermatome for more invasive procedures, if needed
Intradiscal Procedures 

Provocative Discography - Coupled with CT

A diagnostic procedure & prognostic indicator for surgical outcome is necessary for the evaluation of patients with suspected discogenic pain, its ability to reproduce pain(even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options & in assessing previously operated spines.

Percutaneous Disc Decompression (PDD)

After diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed

Ozone Discolysis: Ozone Discectomy a revolutionary least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a daycare setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. The total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no postoperative discomfort or morbidity and low cost.

Dekompressor: A mechanical percutaneous nucleosome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression.

Epidural Adhenolysis or Percutaneous Decompressive Neuroplasty for Epidural Fibrosis or Adhesions in Failed Back Surgery Syndrome (FBSS)

A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ L.A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with epiduroscope.

Procedures That Can Help Treat Slip Disc & Sciatica!

Carpal tunnel syndrome is a condition that causes numbness or tingling in the hands and arms besides other symptoms. Carpal tunnel is basically a narrow passage on the palm side of the wrist. This condition is caused when a nerve in the carpel tunnel is compressed. Since this median nerve runs up through the hands to the forearm, it affects the arms as well. Not only does it cause nerve pain, but also results in limited functionality of the thumb.

To prevent this syndrome, one needs to understand its causes. We have discussed some of the primary causes below:

Issues with the thyroid hormone: Hypothyroidism, an imbalance or lack of thyroid hormones in the body, can create problems that lead to issues with the overall musculoskeletal system. An over-active pituitary gland can also cause issues that affect mobility and motor skills. This can lead to or exacerbate the carpal tunnel syndrome.
Arthritis: Arthritis causes swelling and inflammation of joints and tendons, which tend to increase the symptoms of carpal tunnel. Eventually, arthritis can also lead to compression of the median nerve and other structures in the wrist, thereby leading to carpal tunnel syndrome.
Pregnancy or menopause: During pregnancy as well as menopause, women experience tingling or numbness in their hands, which is believed to be caused by carpal tunnel. Experts say that when a fluid called oedema builds up in the tissues around the wrists and other parts of the body, it puts a pressure on the median nerve, leading to pain.
Work pressure: Experts believe that behaviours can increase the risk of carpal tunnel. The other instances which cause this syndrome include physical labour, using mechanical tools and repeated stress to the wrist. However, various studies suggest that there isn t any direct association between using a computer and carpal tunnel syndrome. It may just cause different forms of hand pain.
Imbalance of body fluids: Fluid retention in the body increases the pressure within the carpal tunnel, which irritates the median nerve. This is common during pregnancy and menopause as discussed earlier.
Obesity: One of the significant risk factors for this syndrome is being obese. So be careful about gaining excess weight.
Other conditions: Certain conditions like hormonal imbalance, diabetes and kidney failure may increase the chances of carpal tunnel syndrome. It also occurs in people who usually have narrow carpel tunnels. In some cases, it is inherited and is passed from one generation to the next.
Inflammatory conditions: Illnesses that end up in inflammation, such as rheumatoid arthritis, can affect the lining around the tendons in the wrist and put pressure on the median nerve.
Fractures: A fracture in the wrist can cause narrowing of the carpal tunnel and irritate the nerve. 

Carpal Tunnel Syndrome - Most Common Causes

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