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!

Osteoporosis is a medical condition marked by a decrease in bone density. It results in the brittleness of bones and their fracture. Osteoporosis does not display any signs or symptoms but manifests itself in advanced age.

Homeopathic remedies for Osteoporosis

Silica or Silicea-This remedy is for people who are often nervous, feel sweaty during the night, get easily tired and are a highly nervous lot. The injuries of such people take the time to heal/ are difficult to heal and their spine is weak. Generally, these patients have delicate or refined features.
Symphytum- Meant for those fractures that occur because of mild trauma, this remedy is useful in cases where pain persists in old but healed fractures and also when bones need to be strengthened.
Calcarea carbonica- This remedy is administered to people who are overwhelmed by a lot of work and stress, get tired easily after work and have a proclivity to stress a lot. Generally, these people are overweight and have a lot of body flab and easily get depressed by cold/chilly weather and dampness in the air. They have swollen joints, experience a recurring back pain and get a sweaty head in the night. An interesting characteristic of these people is also that they have a craving for eggs and sweet things.
Calcarea phosphorica- This remedy is meant for people who have a deep, uncontrollable and intense desire for travel. They want a change in their environment and have a general sense of dissatisfaction. People requiring this medication have pain in their neck, upper back and hips. Fractures, if any, are slow to heal and there maybe deposits of calcium in the bones. Post-exercise, these people feel greatly tired.
Phosphorus- Meant for people who experience a burning pain between their shoulder blades, phosphorus as an osteoporosis remedy is given to those people who have an intense desire for refreshing foods like ice cream, beverages, carbonated drinks etc. Such people are usually lanky and their faces often get flushed. They are sensitive, suggestible and susceptible to the imagination. They get easily tired after a round of exercise and work.
Homeopathy Dosage
Unless directed by a homeopathic physician, take doses of low potency like 6X, 6C, 12X, 12C, 30X or 30 C if you are going in for self-medication. Follow the instructions printed on the label.
If you are taking a single dose, ten wait for its response. If the medicine is working, then wait for its full effect to manifest. If there is little or no response, take another dose. If there is no response at all after taking the second dose then change the medicine.

Please note that dosage depends upon the individual and the intensity of his/her ailment,

Osteoporosis - How Homeopathic Remedies Can Help?

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

Bone cancer is a rare form of cancer in the cancer family. It affects one of the bones of your body and spreads to other bones. But, more often, it has the tendency to affect the long bone in the legs and the arms. There are many types of bone cancers. While some of them can affect children, the others typically affect the adults. This type of cancer is different than those cancers which get initiated from other parts of the body and spread to the bones.

What are the symptoms of bone cancer?
The typical signs and symptoms of bone cancer include acute pain in the bone, tenderness in the affected area, swelling of certain bones, a tendency of bone breakage, fatigue with little or no effort, unexplained weight loss, shortness of breath etc.

What are the causes of bone cancer?
There is no particular reason for bone cancer. Studies have shown that an error in the structure of the DNA leads to bone cancer. This error leads the bone to grow and divide in an uncontrolled manner leading to non-extinction of cells. These cells keep growing and form a mass invade to other parts of the body, leading to cancer.

What are the different types of bone cancer?
The type of the bone cancer can be distinguished from where cancer originates from. Some of the common bone cancer type includes the following:

Osteosarcoma: This is the form of cancer that originates from the bone cells and is often witnessed in young adults and children. They often attack the arm and the leg.
Chondrosarcoma: This form of cancer begins from the cartilage cells. The exact place of damage appearance includes legs, arm, and pelvis. This is typically observed in middle-aged persons in older adults.
Ewing's sarcoma: Though researchers are yet to find out the location this form of bone cancer originates from, it is mostly considered to affect the legs, arms, and legs of young children.
What are the risk factors?
While doctors are yet to researching for the exact reason of bone cancer, there are certain risk factors which have been associated with the bone cancers.

Inherited genetic syndromes: Certain genetic condition such as the hereditary retinoblastoma and Li-Fraumeni syndrome which are passed on from generations are a prime culprit of bone cancer.
Paget's disease: This is a bone-related disorder that affects the bone and increases the chance of bone cancer.
Radiation: Exposure to a huge amount of radiation increases the chances of bone cancer and other associated cancers.
How is bone cancer detected?
Imaging tests such as the bone scan, x-ray, MRI, PET scan and the CT scan can diagnose bone cancer. Apart from these, oncologists might order a biopsy that includes removing a part of the tissue and test the same in a laboratory can also help to detect bone cancer.

Bone Cancer - Risk Factors Associated With It!

Yoga is recommended for people with joint inflammation or arthritis. In the case of certain individuals with different sorts of arthritis, studies have shown that consistent yoga practice can lessen joint pain, improve flexibility of the joint and release the stress and strain to provide better rest. Yoga comes with a wide range of practices; however, for the most part, it includes adopting specific bodily postures. It also includes breathing and meditation exercises. 

Some of the yoga postures to cure arthritis are as follows:

Sun salutations: They are the perfect way to begin a day. They can be reflective and calming as you develop the strength to breathe fresh air. Stand with both feet touching, and afterwards, join your hands, palm-to-palm, and place them on your chest. Breathe out and raise your arms upward. Gradually twist backwards and extend your arms over the head. Unwind your neck and breathe in. You must keep in mind that it is one breath for every movement.
Kid's pose and child's pose plus: This is a truly gentle and simple approach to stretch the lower back. Get into the stance by dropping down onto your knees, spread your knees wide and join your toes. Place your hips back onto your feet or heels and stretch your arms forward onto the ground.
Bovine pose (cow pose): Get on all fours with your hands; keep your wrists directly under the shoulders, and spread your fingers wide. Your knees need to be at the hips' width and directly under your hips. Point your abdomen upwards, as your shoulder bones push down towards your abdomen, and tilt your pelvis up and back so that you are sitting.
Furious cat: Turn around the cow pose to do the furious cat pose. From all fours, pull your belliy in and your back arches into a back bend. Point your hips back toward your lower legs to build the space between every vertebra.
Prostrate twisting: Bending should be very useful, but if the bending or twisting brings on any pain, leave it quickly. Lie on your back, draw your knees toward your abdomen, and wrap your arms around your legs, giving yourself a little hug. Shake yourself from side-to-side or forward and backward.
Bridge pose: Lie in a straight position on the floor, twist your knees, and set your feet on the floor. Breathe out and press the inner parts of your feet and your arms into the floor. Push your tailbone up, tighten your hips, and lift them off the floor until your thighs are parallel to the floor. Keep your knees right above your heels and lift the upper part of your hips toward your stomach.

Arthritis - 6 Yoga Positions That Are Beneficial for You

Arthritis is a common musculoskeletal condition that affects elderly men and women. Joint pain, stiffness and inflammation are the most common symptoms of this condition. This pain can get so bad as to affect your movement and leave you unable to do simple things like walking up stairs or even simply turning a doorknob. 

Arthritis cannot be reversed but with medication and a few lifestyle changes, your quality of life can be improved.

Exercise and weight loss: Though it is difficult to do, losing weight can help relieve the pain of arthritis. This takes the pressure off your joints and increases the range of possible motions. Though exercising may be the last thing you want to do, it can help increase your flexibility and help strengthen your muscles. Aerobics, stretching and strength training are ideal for arthritic patients.
Assistive devices: Arthritis can make a person knock kneed or bow legged. Wearing unloading braces, shoe inserts or walking with a cane or shoe inserts can help redistribute your weight and take the pressure of your joints. It can also help relieve pain and prevent arthritis from worsening.
Eating right: Some types of food can worsen arthritic symptoms. This includes processed foods like white flour and sugar, yeast, chemical additives, gluten, hydrogenated and trans fats, milk products, caffeine, alcohol and tobacco. Hence, avoid consuming these foods and instead have a diet rich in fruits, vegetables, nuts and whole grain. You could also try alkaline foods like green leafy vegetables, wheatgrass and aloe vera.
Massage therapy: A massage not only de-stresses the body, but can also relieve muscle and joint pain by improving blood circulation. Massages also help break up muscular waste deposits and increase the amount of oxygen circulated in the body. This helps transport nutrients to tissues and carries toxins away. Ideally, an arthritic patient should have a massage 2-3 times a week in the beginning and at least twice a month once the condition has stabilised.
Supplements: Along with eating healthy, including a few supplements in your daily diet can also help alleviate arthritic symptoms. When it comes to rheumatic arthritis; the anti-inflammatory properties of vitamin C help fight arthritis by promoting bone and cartilage growth and reducing infection. Fish oil is rich in Omega-3 fatty acids that help reduce inflammation, Vitamin D is another supplement that helps relieve arthritic pain by helping the bones absorb calcium faster and preventing further loss of cartilage.

Arthritis - 5 Easy Ways You Can Ease Your Suffering

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