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!

The various angles and contours of our body define us and our personality to a great extent. There are many instances where women, in particular, may feel that they can do with a little more shape in areas like their breasts and buttocks. For this, there are various toning exercises and diet plans that may help over a long duration of time. But for those who would like a more wholesome appearance in less time, there is always the option of getting implants. Much like breast implants, one can also avail the option of getting butt implants that can add some curves to that region of the body. Let us find out all there is to know about this kind of surgical and cosmetology procedure.

Butt augmentation or butt implants are usually done with the help of gluteal implants that can be injected into the muscles of that region of the body. These can greatly enhance the shape of the butt.

Butt implant, basically a body contouring procedure, can be done with liposculpture, which seeks to remove the excess fat from the area as well. However, this can increase the time taken to complete the surgery.

The augmented rear will have a rather firm, but natural feel after the surgery is completed. It will have the taut feeling that a person gets to enjoy when he or she indulges in heavy workouts that involve lifting weights and plunges.

There are many shape options that will be given to the patients who are about to go through this procedure. The shapes will include oval or round, depending on the overall figure and built of the patient.

There are other options in this regard too. One can go in for cohesive silicone or solid silicone for the filling, which will form the implants and give shape to the butt region. Also, one can choose from a variety of surfaces that can go from smooth to textured. One can also choose gel options for the buttocks so that it suits the body type and kind of shape that the patient wants.

The location of the implants is another very important factor that one needs to consider in such cases. There are three locations that one can choose from. The patient can choose the top portion that lies towards the upper sides of the buttocks, or the crease where both the cheeks meet. The third location is towards the lower part of the buttocks.

The other things to consider are the shape and skin quality before the procedure. One will also have to evaluate the upper lower and mid buttock area so as to ascertain the best area when it comes to implants.

Top Things To Know About Butt Implants

Most of the arthritic conditions don t have any cures. Ankylosing Spondylitis is also a type of arthritis that does not have a cure. It is a kind of arthritis of the spine; it affects the vertebrae. It primarily affects the spine, but it may also affect other areas such as shoulders, hills, hips, ribs, small joints of the feet and hands etc. In very advanced stages, it may also affect eyes, lungs and heart. 

However, what really makes it scary is Ankylosis. When Ankylosis takes place, there is formation of new bony structures in the spine. These structures cause some sections of the spine to fuse and make the spine immobile. 

Symptoms of Ankylosing Spondylitis 

  Pain and Stiffness 

One may feel a constant pain coupled with stiffness in areas like buttocks, lower back, hips etc. These symptoms may go on for months. It often starts at the sacroiliac joint. 

  Bony Fusion 

The formation of bony structures in the spine in advanced stages may affect movement of the back, neck, hips etc., and may also impair the ability to perform daily activities. The formation of bony structures may go to the extent of fusing the ribs in the rib cage to the breastbone or spine. This may limit the ability to expand the chest while taking deep breaths. 

  Pain in Ligaments and Tendons 

Ankylosing Spondylitis may also affect the tendons and ligaments that attach the muscles to the bones. This may precipitate pain and stiffness beneath or behind the heels. 

Cause of Ankylosing Spondylitis 

The cause of this disorder is not yet known, yet a genetic link cannot be ruled out. It has been observed that most of the people affected with Ankylosing Spondylitis carry a specific gene in them. People carrying this gene are susceptible to spondylitis. However, there are about 10% people who carry this gene, but don t have any sign of Ankylosing Spondylitis. So, a sure determinant of cause of this disease is not completely known. 

Diagnosis of Ankylosing Spondylitis 

To diagnosis Ankylosing Spondylitis, the physician has to look at several factors. 

These include: 

  Symptoms exhibited by the patient 

  Physical Findings 

  X-Rays of pelvis and back regions 

  Taking chest measurements while taking deep breaths 

  Laboratory tests Based upon the complete diagnosis, physician can positively determine if the condition is indeed Ankylosing Spondylitis. 

Treatment 

While a cure for Ankylosing Spondylitis is still not on the horizon, there are some treatments which can reduce pain and discomfort and thereby improve daily activities. Goals of treatment Since the disease can t be cured, the goal is to reduce pain and stiffness, prevent deformity, maintain a good posture, and help perform daily activities. In fact, if treatment is proper, the patient may lead to a semblance of a normal life. However, it calls for a team approach. The team must include a physical therapist and an occupational therapist, apart from a rheumatologist. If the patient is suffering from bony growth, the doctor may go for an osteotomy.

Ankylosing Spondylitis - How To Handle It?

Not all people who suffer from Tennis Elbow have swung their racquets, and those who have never been affected by the problem will not be able to understand how severe the pain and discomfort can be. It is a debilitating condition that affects one s normal lifestyle in both minor and major ways.

Platelet-rich plasma therapy is nowadays considered a promising treatment for consistent and chronic tendon problems including Tennis Elbow and Golfer s Elbow. It is often conjugated with autologous blood injection which is a quick and minimally invasive process using the cells of the patients without any use of any drugs.

What is Tennis Elbow?
The human elbow is a joint comprising of three bones: humerus in the upper arm, ulna, and radius in the lower arm. Each part of the bone is covered with cartilage that facilitates free movements of the bones. Tennis elbow occurs at times when the epicondyle layer on the elbow joint become inflamed or torn.

Understanding platelet-rich plasma therapy
PRP is a non-surgical, in-office treatment which starts withdrawing a little amount of blood. The blood is then spun in a centrifuge for concentrating the platelets in the place. This process also segregates the red and white blood cells. Then the platelets together with some amount of plasma are injected into the body in the affected region which has some injury and is not able to heal properly.

When a person is affected with Tennis Elbow, the platelet-rich plasma is injected into the Flexor Origin present on the medial side of the wrist extensor tendon origin at the lateral epicondyle. The doctor may need to jab the needle in different places.

Why is PRP suitable for Tennis Elbow?
The primary objective of using platelet-rich plasma therapy is utilizing the cells and protein of the body along with specific healing factors that can stimulate and jumpstart the process of healing in the tendons. To begin the healing process that has either stalled or could not be completed or has never started, the PRP is the best means. The first step of beginning the healing process is dealing with the inflammation. Experts are fascinated at the way in which the platelet rich plasma can replace the conventional anti-inflammatory medical treatments of Tennis Elbow.

The arrival of platelet-rich plasma has caused the corticosteroid shots to lose their popularity. Because, though they can relieve acute pain for a short span of time, they do not promote healing and may also cause further breakdown of the affected area.

PRP therapy is known for improving the natural healing process of the body. It has ignorable side effects, and the best part is that it is minimally invasive. Since Tennis Elbow is becoming more common these days, it needs to be treated in ways that would be able to complement one's situation and restore normal functionality. 

Consider Platelet- Rich Plasma Treatment For Effective Treatment Of Tennis Elbow

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!

Several spine-related problems like cervical spondylysis, lumbar spondylysis, prolapse of intervertebral disc, spinal stenosis, sciatica are most common among the people aging from 30 to 65+. They are very common among women also, especially after menopause.

Nowadays, these spine problems are very common because of our unhealthy lifestyle. Now in this modern era, our life has become very unhealthy. It's very sedentary. We don t walk, we sit in one place and one position for long hours. There is no laborious activity to our body.  We travel a lot on moped, bikes and cars. Our nutritious value of food has gone down.

Traditional medicines deal with the above discussed problems initially with painkillers, multivitamins and combinations of minerals. If there is no improvement traction, cervical belt or lumbar belt is suggested. Still if there is no improvement, the patient is asked to go for surgery. 

These problems cannot be solved only with yoga, or any kind of exercises or acupuncture, etc. They require very definite approach of treatment. 

Homoeopathy has very definite approach to a spine problem. In homoeopathy, the patient is first given a consultation in which he is asked only 5 questions which are enough to understand the symptoms related to the spine problem and symptoms related to the patients personality.

When this is done, the derived information is matched with the hundreds of homoeopathic medicines and the exactly indicated medicine is prescribed after determining the needs of the patient. Usually, the patient gets about 40 per cent relief in the first month and 40 per cent more in the next month. It is worth mentioning that any spine related problem is fully curable in about 5-6 months of homeopathic treatment.

Four effective exercise are recommended.

Here are some remedies that are also suggested to heal spinal issues:

One fist of coriander
5 leaves of kaddi patta with both the meals
Recipes prepared from sesame
Patients, who can have non-veg, can have soup prepared of goat's leg atleast twice a week
In the above way, patients can get rid of all painkillers and dangerous surgeries and can get cured to enjoy there life peacefully.

Spine Problems & Homeopathy!

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