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Dr. Rajni Juneja

Radiologist, Delhi

600 at clinic
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Dr. Rajni Juneja Radiologist, Delhi
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I pride myself in attending local and statewide seminars to stay current with the latest techniques, and treatment planning....more
I pride myself in attending local and statewide seminars to stay current with the latest techniques, and treatment planning.
More about Dr. Rajni Juneja
Dr. Rajni Juneja is a trusted Radiologist in Model Town, Delhi. She is currently associated with Gayatri Nursing Home in Model Town, Delhi. Save your time and book an appointment online with Dr. Rajni Juneja on Lybrate.com.

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Gayatri Nursing Home

Shop No. A2/6A, Part 1, Model Town. Landmark:-Near Model Town Metro Station, DelhiDelhi Get Directions
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Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

MBBS, MD, FIMSA, FIPP
Pain Management Specialist, Delhi
Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

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 

  1. PVP is generally safe with low risk.
  2. Ectopic cement leak is frequent but generally inconsequential.

Outcome 

  1. PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
  2. 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.
  3. PVP does augment height of VB but ideal would be kyphoplasty.
  4. Patient is either off medicine or on reduced doses.
  5. Patient feels so well that he almost forgets if he had VB

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

4342 people found this helpful

I have problem of sleep disc, and sometimes its agony what are the exercise for this?

M.D. (Ayurveda )
Ayurveda, Patiala
I have problem of sleep disc, and sometimes its agony what are the exercise for this?
Slip disc is a serious problem and can become debilitating too. Ayurveda has panchakarma to maintain such serious conditions. It can reduce the pain as well as its recurrence. Kindly consult some panchakarma consultant for best treatment. And consult yoga expert for exercises. Good luck.
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6 Symptoms of Uterine Prolapse

MBBS, M.S( Gynaecology)
Gynaecologist, Surat
6 Symptoms of Uterine Prolapse

The uterus is a muscular structure held in place inside your pelvis with the help of muscles, ligaments, and tissues. These muscles weaken in women due to pregnancy, childbirth or delivery complications and can lead to severe complications. One such complication is a uterine prolapse. Uterine prolapse occurs when the uterus sags or slips from its normal position into the vaginal canal.

The causes of uterine prolapse are varied and include:

- Delivering a large baby
- Pregnancy
- Difficulty in labor and delivery
- Reduction in estrogen levels post menopause
- Traumatic childbirth
- Loss or weakening of the pelvic muscle
- Conditions which lead to increased pressure in the abdominal area such as a chronic cough, straining, pelvic tumors or accumulation of fluid in the abdomen
- Loss of external support due to major surgery in pelvic area

Uterine prolapse can be complete or incomplete depending on how far the uterus sags into the vagina. Women who have minor uterine prolapse may not have any visible symptoms. However, if the condition worsens, it manifests itself in visible signs.

Symptoms of moderate or severe prolapse are:

1. A feeling of fullness or pressure in your pelvis when you sit
2. Seeing the uterus or cervix coming out of the vagina
3. Vaginal bleeding or increased discharge
4. Painful sexual intercourse
5. Recurrent bladder infections
6. Continuing back pain with difficulty in walking, urinating and moving your bowels

Without proper attention, the condition can cause impairments in the bowel, and can also affect bladder and sexual function. If you wish to discuss about any specific problem, you can consult a Gynaecologist.

2752 people found this helpful

Herniated Disc - What are the Risks Involved in it?

MCh - Neurosurgery, MBBS
Neurosurgeon, Chennai
Herniated Disc - What are the Risks Involved in it?

The symptoms caused due to herniated disc can be very severe and can also cause a bit of disability. The disc of the spine is like a cushion and separates the set of bones on the backside. The discs are shock absorbers of the spine and are mainly composed of 2 parts, a soft jelly centre called the nucleus and a tough outer covering called the annulus.

Effects of Herniated Disk
A herniated or cracked disc is a severe condition and it seems to happen most commonly in the lower back.  It happens when a fraction of the soft centre gets pushed through the destabilized area due to degeneration, trauma or by putting pressure on the spinal cord. 

Nerves are located precisely at the back of every disc and are responsible for controlling everything in our body. While a disc gets herniated, the external covering of the disc tears and creates a bulge. The soft jelly gets shifted from the centre of the disk to the region where the damage has occurred on the disc. Most commonly, the bulge occurs in areas where the nerve is located and it causes strain on the affected nerve. It has been observed that individuals do not feel any painful sensations even if their disc gets damaged.

When is Surgery Recommended for Herniated Disc?
Surgery for herniated disc is recommended only after options like steroid injections, pain relievers, exercise and non-steroid anti-inflammatory drugs do not work. If the pain persists even after these options, then it becomes important to go for surgery. There are certain risks involved in this surgery like infection, bleeding or nerve damage. 

There are chances that the disc may get ruptured again if it is not removed. If you are a patient suffering from degenerative disc disease, then there are chances that problem occurs in other discs. It is very important that a patient maintains healthy weight to prevent any further complications.

The main factor that increases the risk of herniated disc is excess body weight, which causes a lot of stress on the lower back. A few people become heir to a tendency of developing this condition. Even individuals with physically demanding jobs are prone to this condition. 

Activities like bending sideways, pushing, twisting, repetitive lifting can increase the risk of a herniated disk. At times, emergency surgery is also required to avoid paralysis in a patient. If you wish to discuss about any specific problem, you can consult an orthopedist.

3511 people found this helpful

MPT
Physiotherapist, Mumbai
Herniated disks or bone spurts in the vertebrae of the neck might take too much space and compress the nerves branching out from the spinal cord which may cause severe back pain.

My husband is diabetic & his height is 5ft n 11 inch & weight 94 kg. From two months he is having edema in both foot. His blood reports of kidney I s. Cretenine 1.09. He is suffering from disc slip problem also so cant walk. I am worried about foot edema.

MBBS, MS - Orthopaedics
Orthopedist, Delhi
My husband is diabetic & his height is 5ft n 11 inch & weight 94 kg. From two months he is having edema in both foot....
Sleep on a hard bed with soft bedding on it. SPRING BEDS, FOLDING BEDS OR THICK MATRESS ARE HARMFUL Use no pillow under the head. DO HOT FOMANTATION. Paracetamol 250mg OD & SOS x 5days. Caldikind plus 1tab OD x10. Do neck, back & general exercises. It may have to be further investigated. You will need other supportive medicines also. Make sure you are not allergic to any of the medicines you are going to take. If it does not give relief in 4-5days, contact me again.. Do not ignore .It could be beginning of a serious problem. KINDLY CONSULT A PHYSICIAN FOR OEDEMA & RELTED PROBLEMS.
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I am male 39 I have a problem of obesity combined with disk problem. If to reduce tummy I go for walk the backache develops. If I take rest for improving disk problem then tummy gets large. Suggest solution.

Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurveda, Faridabad
I am male 39 I have a problem of obesity combined with disk problem. If to reduce tummy I go for walk the backache de...
1. Mix three teaspoons of lemon juice, one teaspoon of honey, and one-half teaspoon of black pepper powder in one glass of water. 2. Drink it in the morning on an empty stomach. 3. Do this daily for at least three months. 4. Drink mint tea or make a paste of green mint with some simple spices and eat during meals. 5. Eat vegetables such as bitter gourd and drumsticks to control obesity. Warm mustard oil or sesame oil (1 teaspoon) with 3-4 cloves of crushed garlic and 1 tsp of ajwain (carom) seeds until it roasts to a reddish brown colour. Ensure that it does not get burned. Massage gently this oil on your affected areas. After that do hot fomentation with salt potli (bag). take 1 tsf triphala churna daily....n practice yoga daily twice..
3 people found this helpful
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Know More About Uterine Fibroids

MBBS, DGO
Gynaecologist, Delhi
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Symptoms and treatment of Uterine Fibroids

3387 people found this helpful

Hello doctor. I am I 32 years female and I have slip disc problem from last two years .I have 2 years baby vd normal delivery. I am not able to sleep properly because when I sleep suddenly I awake 2-3 times at night nd I try to sleep again but I sleep after 30 to 40 min. Now I am gaining fat and weight also. I take proper meal and I don't take more junk food also. Please tell me what to do? My all checkup report are normal & thyroid also.

BAMS, MD (Panchkarma)
Ayurveda, Mumbai
Hello doctor. I am I 32 years female and I have slip disc problem from last two years .I have 2 years baby vd normal ...
Hello lybrate user, thanks for writing. If you want fast, permanent weight loss, you can try our research oriented holistic medicines for assures results. You can lose up to 10 kg weight per month, without crush dieting, with out side effect, without gym, without surgery. Tips for you: 1. Eat plenty vegetable and fruits. 2. Drink 9 glass of water per day. 3. Avoid dieting for weight loss. 4. Avoid oily thing. 5. Have 5to 6 servings of food per day. If you have any questions you can contact us by lybrate.
6 people found this helpful
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