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!

An orthopaedic fracture is a serious issue that will require lots of care for the bones to heal and re-join. A broken bone is usually plastered so that the tissue may grow back together by fusing eventually, over a period of weeks. When these bones begin to rebuild in an effort to come together, the new bones are called soft callus. This will require lots of energy, which primarily comes from calories. This ensures that essential proteins like amino acids can be taken from the right type of food which would stimulate good blood flow. 

So, let us take a look at the best diet that one can follow in order to recover from a fracture.

Kale: Leafy green vegetables and herbs like kale can help in supplying good amount of protein and iron as well as calcium, which is highly important for good and strong bones. One can also find plenty of calcium in salmon and other kinds of sea food like sardines; consuming these can speed up the process. Sea vegetables like seaweed can also help in the process.
Yogurt: Calcium can be supplied by various other kinds of food including yogurt, which has two kinds of amino acids. These amino acids are lysine and glutamine, which can assist the bones in swift calcium absorption for better recovery of the broken bones.
Spinach: This is a very important ingredient in the bone healing process thanks to its dual elements of calcium and zinc, which come together to cause the appropriate chemical reaction for bone rebuilding. Other zinc heavy food items include pumpkin seeds and wheat germ as well as red meat.
Broccoli: Ingredients like broccoli are rich in Vitamin K1, which is known to very good for the bone recovery process. This vitamin helps in mineralisation of the bone so that they may fuse with each other and form a new mass. One can have up to one cup of this green vegetable per day for a quick and effective fracture recovery process. Other ingredients like cheese and raw dairy products are known to have plenty of this vitamin as well.
Green Bell Peppers: High on vitamin C which helps in producing the skin and tissue structuring element called collagen, green bell peppers are an excellent ingredient that can help you in your fracture healing process. Vitamin C can also be found in citrus fruits like oranges, strawberries as well as tomatoes.
Milk: While milk has plenty of calcium, it also has another important ingredient called vitamin D. When calcium and vitamin D come together, the bones tend to heal much faster as vitamin D helps the bones in absorbing the calcium at a much high rate.

Recovering from Fracture - 6 Foods You Must Consume

In today s stressful environment, more and more people are being diagnosed with psychological disorders such as insomnia and depression. Neither of the two are things which people feel lucky to possess. However, it is interesting to note that there is a link between the two conditions. Also, the problems are a lot more common than a person is likely to first think; 80% of depressed people suffer from chronic insomnia!

For a long time until recently, many people were of the opinion that most depressed people were insomniac. But that is not really correct. The two issues do overlap to a large extent, but they are different from each other. Again, that does not mean one cannot affect the other.

When a person has depression, one of the main things that he or she can experience is a lack of pleasure from the activities and happenings which occur in his or her daily life. Similarly, when a person does not get enough sleep or even just cannot sleep, he or she is quite likely to display a tendency to worry. Often, worrying sets the stage for depression to develop in the person. In fact, doctors have observed that people who do not sleep enough are more likely to undergo treatment for depression than the others.

Recent findings have concluded that when a person sleeps better, the case of depression also shows an uptick. In addition to this, the habit of sleeping well can also go quite a long way to make sure that a person does not relapse into depression. According to some sleep therapies, people who suffer from lack of sleep are advised to follow a systematic routine of getting to bed and getting out of bed. Activities including reading in bed or watching TV after going to bed must be avoided. While there are various means to help a person sleep better, the choice as to which one would suit a person in the best possible way is only best decided by the person s personal doctor. What is for sure is the fact that a person can effectively sleep to a better life!

So, it can be said that if a person wants to cure his/her depression and enjoy life being peppy, napping away is not such a bad idea after all. Having said that, everything is good only up to a certain limit!

Insomnia and Depression - Is There A Link Between Them?

When you run your hands over the soles of your feet, the surface should be smooth to touch. However, sometimes, the surface may not be so smooth. Piezogenic pedal papules are papules on the medial, posterior or lateral aspects of both heels and result from herniation of fat. These papules are usually asymptomatic and can range from a size of 2mm to 10mm. In some cases, they can be a little painful. This is seen commonly in large lesions. They become apparent when the patient stands with his full weight on his feet and disappear or shrink when the weight is removed. Piezogenic papules can also occur on the wrists. This is a fairly common condition that affects women more than men. Piezogenic pedal papules can occur at any age including infancy.

There is no known cause for the herniation of fat that causes this condition. However, there are a few factors that could increase your risk of suffering from this condition. These factors are:

Obesity
Orthopedic problems
Flat feet
Collagen disorders such as EDS
Jobs which entail standing for long hours
Excessive weight bearing
This condition can also affect newborn babies with no predisposition. The diagnosis of this condition is often confused with infantile pedal papules, xanthoma and tophi. Since they are prominently visible only when pressure is applied, it is essential for a doctor to physically examine the patient while he or she is standing. This condition does not affect the health of a person and is largely only a cosmetic issue. Thus treatment is not usually necessary but some of the things you could do to relieve the discomfort are:

In cases where Ehlers-Danlos syndrome triggers the condition, patients may be recommended betamethasone and bupivacaine injections. These injections need to be administered repeatedly for complete pain relief.
Orthotic soles or custom made inserts for shoes can help relieve the pain and distribute pressure equally.
Heel taping
Compression stockings
Avoid excessive or prolonged weight bearing
Avoid standing for extended periods and try not to run too much
Rest the feet and keep them elevated to help alleviate the symptoms
Lose weight if you are on the heavier side
Electro acupuncture
Piezogenic pedal papules are benign and are no reason to worry. If they begin to affect the quality of your life, you could consult a podiatrist. 

What are Piezogenic Pedal Papules?

Pneumonia is a serious ailment in the lungs which can affect people of all ages even though kids are most vulnerable to this. According to the estimates of the World Health Organization, over 160 million children across the globe get affected by pneumonia every year out of whom 20 million have to be hospitalized, and 2 million die.

Who is most susceptible to pneumonia?
Children who are exposed to the smoke of tobacco or have poor nutrition, asthma, high blood sugar, cold, flu, poor shelter, HIV infection and lack of proper breastfeeding are at risk. Also, if children don t get an adequate amount of zinc in the diet, then they can get affected by pneumonia.

As the germs reach the lungs, this organ becomes infected and inflamed with a buildup of fluid. It can lead to breathing problems which can make inhibit the entrance of oxygen in the bloodstream. This prevents the cells in the body in performing their normal functions and infections cannot be flushed out of the body.

What are the common signs and symptoms of pneumonia?
The common symptoms of pneumonia include vomiting, chills, chest pain, rapid breathing and shortness of breath, chest retractions during respiration, fatigue, high temperature, nausea, muscle weakness, wheezing and coughing of green and slightly bloody mucus. It may also include unconsciousness, lethargy, convulsions and also feeding problems in infants. There is a type of pneumonia that does not show any major sign but which may interfere with daily functions is referred to as walking pneumonia.

How can pneumonia in children be prevented?
Having healthy habits and practising good hygiene is the best way to avoid pneumonia. Children must be encouraged to clean the hands frequently, coughing or sneezing into the elbow or sleeves instead of palms and to avoid interaction with people who are affected by any infection and flu. As a parent, you should provide proper nutrition to help your child have strong immunity and make sure that they get sufficient rest to ward off infection. You should not smoke in front of your kids as passive smoking is dangerous and help them stay away from pollutants.

You should ensure that your child is immunized as per prescribed schedule. Also, you should know about the warning signs of pneumonia and other ailments of the lungs which include fast breathing, frequent coughing, and difficulty in breathing to detect pneumonia in its early stages. And take them to visit the doctor as soon as you observe the signs. When it comes to an infant, you should breastfeed him/her as mother s milk contains all the vital nutrients, hormones, antioxidants and antibodies that your child requires to ward off infections including pneumonia.

Thus, being aware you can protect your child from contracting the disease.

In case you have a concern or query you can always consult an expert & get answers to your questions!

How To Protect Your Child From Pneumonia?

Getting a good night s sleep is essential for mental and physical wellbeing. Ideally, one should get at least 8 hours of continuous sleep every night. However, some people find this hard to achieve. They may have trouble going to sleep, wake up frequently or have a very poor quality sleep. 

Here are a few tips to help you improve your sleep: 

Set a sleep schedule: Like children, adults also need to go to sleep and wake up at the same time every day. This should be followed for at least 6 days a week. Having a sleep in the day may seem like a good idea but this can affect your ability to go to sleep in time at night and make you wake up the next morning feeling tired. Hence, train your body to sleep and wake up at the same time every day.
Avoid stimulants after sunset: Nicotine and caffeine can be very detrimental to your sleep cycle. The effects of these substances can often last for hours. Caffeine not only makes it difficult to fall asleep but can also make a person wake up frequently at night. Alcohol can make a person seem sleepy initially but can make him or her wake up earlier than usual and hence, disrupt the sleep schedule. So, avoid these substances for at least a few hours before going to bed. Instead, you could drink a cup of calming chamomile tea to soothe the nerves and help you sleep well.
Create the right sleep atmosphere: Ban the television, tablet and other mobile screens from your bedroom. The light from these devices makes it difficult to fall asleep and the material being seen can play on your mind for hours and make you toss and turn. Make your room as dark as possible to make it easier to fall asleep. Using blackout curtains can be a good idea. Also, make sure the noise and temperature levels are conducive to sleep.
Exercise: Exercise has many benefits. This includes better sleep quality. A workout tires the body and reduces the chances of waking up in the middle of the night. However, timing your exercise routine is very important. The ideal time for a workout is in the early morning or early evening. Do not work out just before going to bed as this can have a stimulating effect on the mind.
Limit naps: Avoid napping through the day. While this may seem like a good way to catch up on sleep, it can have a detrimental effect on the quality of your night sleep. If you must nap in the afternoon, keep it short. Training your body to associate sleep with darkness can make it easier for you to fall asleep at night.
Hence, if you are also having any sort of troubles with your sleep, immediately apply the above discussed tips in your daily life and you will see the results within a few days.

Suffering From Sleep Problems - 5 Tips To Help You Get Over Them!

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