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Dr. Sunil

Radiologist, ludhiyana

300 at clinic
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Dr. Sunil Radiologist, ludhiyana
300 at clinic
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My favorite part of being a doctor is the opportunity to directly improve the health and wellbeing of my patients and to develop professional and personal relationships with them....more
My favorite part of being a doctor is the opportunity to directly improve the health and wellbeing of my patients and to develop professional and personal relationships with them.
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I am 33 years old, I have backache from last 1 year, x ray indicate there is borderline slip disk, what kind of precaution can I take for future?

MBBS, MS - Orthopaedics
Orthopedist, Delhi
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.
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Ultrasound - How it is Beneficial over Other Imaging Techniques?

DNB (Radio Diagnosis), MBBS
Radiologist, Hyderabad
Ultrasound - How it is Beneficial over Other Imaging Techniques?

Ultra sound is commonly known as sonography. It is a process of reproducing ultrasound images of soft tissues of a particular body part and other organs on the computer screen with the help of the echoes of the sound waves produced by the transducer, a high-frequency generating instrument.
Ultra sound is commonly used during the different stages of pregnancy to denote the foetal health, date of delivery, birth defects etc. However, in recent times, the ultra sound has also been associated with the diagnosis of other body parts such as the eyes, heart, gall bladder, liver, ovary, uterus, kidney, uterus, testicles, and ovaries. Ultra sound has also been useful in conducting biopsies for suspecting cancer patients, although not all of the cancers are detected by this imaging process. 3D & 4D ultrasound imaging are useful for looking at a particular body portion with much more precision and in slow motion respectively.

The advantages of ultra sound are:
1. The process of ultrasound imaging is a painless and a fast one. It does not require any insertion of needles or similar objects to denote the problems of the concerned body part.
2. The process is more convenient as compared to other similar imaging processes like MRI, mammogram and x-rays as they can capture images of the soft tissues, blood flow & cysts more clearly than the other processes.
3. The process is free of any harmful effects as there are no chances of exposure to radiation as compared to similar processes such as CT scans or X-rays. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.

4891 people found this helpful

Hello Dr. Sir, I am Harvinder singh from yamunanagar, Haryana. I have lower back pain since last 2 years. Its slip disc and sciatica pain in left leg. I am very unhappy with this problem. Please advice me best of best treatment for the same and where I can get the same.

BAMS
Ayurveda,
Hello Dr. Sir, I am Harvinder singh from yamunanagar, Haryana. I have lower back pain since last 2 years. Its slip di...
You may use yogi joint pain churna for few days, if its helpful for you, then continue to get relief from sciatica.
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My age is 28 and I am suffering from back pain due to L3, L4, L5 Disc bulging. Kindly suggest me a solution to over come from back pain without surgery.

Diploma In Orthopaedics (D. Ortho)
Orthopedist, Amravati
My age is 28 and I am suffering from back pain due to L3, L4, L5 Disc bulging. Kindly suggest me a solution to over c...
Hello, Medication like methylcobalamine with muscle relaxant and analgesic will reduce pain; you can take them . I will advise to check your vit B12 and vit D3 level. Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.
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Uterine Fibroid - How Removing Them Will Help You?

MD - Obstetrtics & Gynaecology, MBBS, Diploma in Specialised Advanced Gynaecological Endoscopy
Gynaecologist, Delhi
Uterine Fibroid - How Removing Them Will Help You?

It is very common for women to have heavy and painful periods or have a feeling of fullness in the lower abdomen. Although, it may not sound very alarming these could be the symptoms of uterine fibroids. These are the most common types of benign tumours found in women. The fibroids are basically some tissues and muscle cells that grow within the uterus, outside the uterus, or along the wall of the uterus. The fibroids are usually benign and asymptomatic and do not require any treatment unless they cause problems. 

Know the causes 

Though the exact cause of fibroid formation is not known, it is believed that the female hormones estrogen and progesterone have a role to play in their formation. Fibroids are formed only when a woman is producing these hormones and they are not seen in women in non-reproductive age i.e. before starting of menses or after stoppage of menses (menopause). If fibroids are persisting even after menopause or especially if increasing in size then it is an alarming sign. Such a fibroid needs to be taken care of immediately. 

What are the symptoms? 

Fibroids often remain quiet for long periods of time. They cause nonspecific symptoms in the pelvis and abdomen including: 

  1. Fullness in the abdomen 
  2. Low back pain 
  3. Irregular menstruation 
  4. Cramping with menstruation 
  5. Painful sex 
  6. Increased urgency to urinate 
  7. Anemia, leading to tiredness and weakness 
  8. Infertility Diagnosing the fibroids 

When these symptoms are recurrent, it is good to confirm the diagnosis. This can happen with a pelvic exam followed by ultrasound scanning to confirm the size and location of the fibroids. A blood test also may be done to confirm anemia, which is common due to heavy periods.

Treatment Options 

Management of fibroids can range from doing nothing to periodic monitoring to surgical removal. 

  1. If pain and heavy bleeding are the only symptoms, then pain killers like ibuprofen should suffice for symptomatic relief. Anemia, if severe, may require iron supplementation. 
  2. Embolization is an option which shrinks the fibroid, at the same time preserving the uterus. The blood flow to the fibroid is cut off, thereby preventing its further growth. It takes about 1 to 3 hours and requires some bed rest after the procedure. There could be some pelvic pain and vaginal bleeding, which will gradually subside. The fibroids may grow back, but the benefits of keeping the uterus are definitely there. This is suitable in case of single fibroid with specific blood supply. 
  3. The next surgical option is myomectomy, where the portion of the uterus which contains the fibroid alone is removed. This is done in women who still wish to get pregnant and in women who would like to retain the uterus. This can also be achieved laparoscopically( key hole surgery). In such cases, fibroids are cut into small pieces and then removed from the body. This procedure should be done by a doctor specialised in advanced gynecological endoscopy as all this cutting should be done in a bag to avoid any spillage of cells inside the abdominal cavity. This procedure is known as Laparoscopic Myomectomy with In-bag Moecellation. 
  4. In women who have crossed their pregnancy phase, hysterectomy or complete removal of the uterus is advised. In these women, the bleeding and pain may not have subsided even after years of treatment with hormones. The growing fibroids could be pressing on the adjacent organs, causing pressure. This is the only definitive treatment and should be done in women have completed their family and don’t desire to be pregnant. 
  5. Myomectomy and hysterectomy may be done laparoscopically or with an open method depending on the overall health, the size and location of the fibroids in the uterus.

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

3960 people found this helpful

I have had a limbo sacral spine MRI. Conclusion of result is "Mild annular disc bulge with superimposed broad based posterocentral disc protrusion and annular tear at L4-L5 level is causing indentation on thecal sac. No central canal or existing foramina stenosis or nerve root compression" can anybody tell is it worrisome.

MBBS
General Physician, Mumbai
The report is not very worrisome coz there is no nerve compression .But you should be careful ,follow your exercise routine and treatment properly. Do spine extension exercises. Do not lift weights. Take calcium supplements. Take anti-inflamatory medication when needed.
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5 Ways to Deal With Uterine Cysts

Diploma in Advance Endoscopy, Royal College of Obstetricians and Gynaecologists (MRCOG), MS, MBBS
Gynaecologist, Delhi
5 Ways to Deal With Uterine Cysts

A uterine cyst, also called as ovarian cyst, is the formation of a fluid-filled sac within the ovary of a woman. Uterine cysts may sometimes cause several physical symptoms. They can cause great pain and unpleasant sensations. Most cysts go away by themselves, but still sufficient measures should be taken to deal with the inconvenience caused by a uterine cyst. In severe cases, the cyst can damage the ovaries. Scar tissue is also likely to build up in such cysts to form an adhesion, which causes discomfort.

Uterine cysts can cause great damage to the sexual organs of a woman, and hence, it should never be ignored. Here are 5 ways to deal with uterine cysts:

  1. Using Birth Control Pills: In case of recurrent uterine cysts, you can take oral contraceptives with the prescription of a doctor. This will prohibit ovulation, and the development of new cysts will be prevented. The risk of ovarian cancer is also reduced.

  2. Laparoscopy: In case the cyst is small, a laparoscopy surgery can be conducted by a doctor. This will enable the surgical removal of the cyst. The process of laparoscopy involves making of a small incision around the navel region. A small instrument or device is inserted into the abdomen, which removes the cyst.

  3. Laparotomy: Laparotomy is a surgical procedure of removing a large uterine cyst. This procedure is applied when a cyst becomes too large to be removed using laparoscopy. The procedure involves the removal of the cyst via an incision made in the abdomen. An immediate biopsy is conducted and in case the cyst is found out to be cancerous, a hysterectomy surgery is conducted, which removes the ovaries and uterus completely.

  4. Herbal Tea: Moving from medical procedures to natural ways for dealing with uterine cysts, herbal tea is believed to be one of the best natural treatments for uterine cysts. Herbal tea helps in the breakdown of large cysts and the side effects of the cysts such as discomfort or pain are eased. Have a cup of herbal tea every day to get rid of uterine cysts.

  5. Diet: Uterine cysts may develop due to an unhealthy diet. Modern food items contain synthetic and natural estrogens, which cause disruption in ovarian health. Consuming adulterated meat, where the animals are given hormones, and antibiotics may result in uterine cysts. Soy contains a great amount of estrogen, which leads to uterine cysts. All the food items which may lead to ovarian cysts should be avoided.

Uterine cysts are common in women and are caused due to several complications. You should not let uterine cysts develop as development increases severity.

2464 people found this helpful

Health Benefits Of Barley

Diploma in Diet n Nutrition, BHMS
Homeopath,
Health Benefits Of Barley

Did you know barley water is good for kidney stones?
Barley (jau), a member of grass family, is a cereal that has been cultivated for over 13, 000 years. Packed with carbohydrates (78%), fat (1%), protein (10%) and water (10%), barley is a rich source of essential nutrients, dietary fiber, vitamins such as niacin, manganese, phosphorus and vitamin B6.

With several health benefits to its name, barley water is termed as the elixir to good health. It has been found to be beneficial in reducing chances of heart disease, soothing bowels, reducing blood cholesterol levels, improving blood sugar regulation in the body and acts as nutritive broth for fever, cold and cough. Additionally, studies support that barley water has also been found to play an integral role in maintaining renal health.

What is a renal stone?
A renal stone is a solid stony piece consisting of crystal forming substances in the urinary tract. They are usually formed when the urine is abundant in substances such as calcium, oxalate and uric acid and lack substances that inhibit their accumulation. While small kidney stones can pass through the urinary system without any symptoms, a stone larger than 5 mm can result in blockages in the urinary tract causing severe pain in the back and lower abdomen.

What causes renal stones?
- A family history for stones, lack of adequate water in the body, high BMI, excessive intake of diets rich in protein, sodium and sugar have been found to be some of the common causes for stone formation.

Try protein foods & supplements
- Medical conditions such as hyperthyroidism, inflammatory bowel syndrome and renal tubular acidosis have also been found to alter the digestion of calcium.

How does barley water aid the dissolution of renal stones?
Studies show that regular use of barley water can dissolve and eliminate existing kidney stones and prevent the occurrence of stones and other kidney problems. Use of diuretics either natural or synthetic can help speed up the expulsion of the stone.

Diuretic in nature, barley water helps to flush toxins from the kidneys by creating bladder pressure and increasing the frequency of urination.

- It helps maintain the PH levels in the body, making it alkaline, preventing various urinary tract issues, including kidney stones.

- The vitamin B6 and magnesium in barley helps break down the masses of toxic calcium oxalate (primary cause for stones) in the kidney.

Dietary fiber in barley reduces the amount of calcium that is excreted by the body through urine, restoring renal health and cleansing the kidneys.

Ways to prepare barley water:
- Boil 1 litre of water with a tablespoon of barley pearls and boil on a low flame for about 30 minutes or until the water has reduced to half.
- Strain and cool this mix and drink it through the day.
- Add lemon juice or honey to make the mix tasty

Regular use of barley water ensures that the renal system is hydrated, healthy and free of depositions such as renal stones. So, go ahead and add this elixir to your diet to ensure a healthy renal system and a healthier you. Eat healthy, stay healthy!

5 people found this helpful

I am 54 year old male having MRI [LS-SPINE]. Finding Reveal Annular Tear, circumferential Disc Bulge With Small Posterocentral Protrusion at L4-L5 level, Causing No Significant Neural Compression Or Canal Stenosis" I have no pain anywhere since 5 months only difficulty in standing or on walking without pain. Become tired for few seconds, then start again walking. Ortho. Says no need to worry it will heal naturally. Spine Surgeon says need of "DISC FIX" treatment required. Getting confuse. WHAT TO DO.'

MBBS
General Physician,
Hi, Thanks for your question. I do understand your pain and discomfort. As per your history is concerned please follow: 1)If there is no neuro deficit then no need of surgical treatment so wait for that time to come during this time do physiotherapy and steroid treatment . I hope I was able to address your query. If you have any further questions, please do not hesitate to write to me. Wishing you all the best. Thanks
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Hello doctor plzz say me is surgery essential for Diffuse annular disc bulge seen at l4 and l5 level causing indentation over thecal sac with bilateral recess narrowing and significant nerve decompression.

MS - Orthopaedics, MBBS
Orthopedist, Hyderabad
Pivd l4-l5 initially can be treated with rest, physical therapy, medication, epidural steroid injection. If the problem is severe n you are having numbness n weakness in the feet n radiculopathy then you will meed surgery.
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Back bone slip disk, sitika. I ask in Hindi rid ki haddi ke manke sarke hue hai. Unka koi ilaj hai kya. Koi bhi ilaj jese aurved ya koi or ilaaj hai to please batana. Unko bahut pain hota hai. Or koi kam bhi nahi kar sakte hai. Pura bed rest hai.

BPTh/BPT, MPTh/MPT
Physiotherapist, Noida
Back bone slip disk, sitika. I ask in Hindi rid ki haddi ke manke sarke hue hai. Unka koi ilaj hai kya. Koi bhi ilaj ...
Apply hot fomentation twice daily. Avoid bending in front. Postural correction- sit tall, walk tall. Extension exercises x 15 times x twice daily. Bhujang asana. Core strengthening exercises. Back stretching. Do the cat/cow stretch.
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Natural Ways to Treat Swollen Legs, Ankles and Feet

MBBS, MS - Orthopaedics
Orthopedist, Delhi
Natural Ways to Treat Swollen Legs, Ankles and Feet

You know that feeling after a long day when your feet are so sore or swollen that you can’t bear the thought of standing on them for any longer? once you take off your shoes and sit down, or even soak them in a warm bath, it’s still an unpleasant experience. Luckily, I’ve collected 10 natural remedies for such an occasion and I want to share them with you.
 
Important: regular swelling vs potential health risks
When experiencing swelling in the feet and legs, apply pressure to the area with a finger. If the dimple created by the finger remains for more than a couple of seconds, it may indicate oedema, which can be the result of heart, liver, or kidney problems. When this occurs, see a doctor at the first possible opportunity.
If you experience swelling in one leg but not the other, you should also see a doctor as this may be an indication of deep venous thrombosis (a blood clot blocking the blood vessels).
If the swelling is accompanied by shortness of breath, fever, bluish skin, and chest pains, get immediate medical attention.
 
10 natural remedies:

1. Soak your feet in epsom salts
Pour 250g of epsom salt into a hot bath, and take a nice long soak. You can also add essential oils to the mix for enhanced relaxation. Your feet will thank you, your body will thank you, and you’ll emerge from that bath a happier person.
2. Massage the area
Massaging the painful area increases blood flow and moves the fluids that accumulate and cause the swelling. If you want to indulge, get someone to massage your feet for you, preferably with hot essential oils.
3. Stop smoking
If you smoke tobacco (cigarettes, cigars, etc.), you should know that one of the many negative effects of nicotine is constriction of blood vessels, which can lead to sore feet.
4. Stay hydrated
When the caffeine and sodium we consume accumulate in the body, they can cause swelling and pain in the limbs. The best way to dilute them and flush them out is by drinking water. If you want to maximize the efficiency of hydration, squeeze a lemon or lime into the glass of water for a boost of vitamins and antioxidants.
5. Eat healthy, avoid excess salt
While we need salt for our body to function well, when we overdo it, it can have adverse effects. Reduce the amount of salt you consume every day, and consider cutting down on caffeine as well.
6. Elevate the legs
If you’re suffering from chronically sore legs/feet, try keep your legs elevated for 30 minutes, three times a day. You will notice a difference within a couple of days. Also, when you’re in bed, use a couple of pillows to prop up your feet. Elevating the legs helps to drain the excess fluids that causes the swelling and pain.
7. Avoid sitting for prolonged periods
Whether you’re flying, taking the bus, or just sitting in an office all day, keeping your legs stationary can lead to pain and swelling. If you know you’re going to sit for a long period of time, make sure to stand up, stretch, and walk around every 20 minutes or so.
8. Use compression socks when traveling
If you’re going to fly overseas, another excellent solution is to use compression socks. These socks apply pressure to your feet, preventing fluid from building up – the main cause of swelling and pain in the feet.
 9. Exercise
Exercise will help boost your cardiovascular system, which in turn will reduce the possibility of swelling in the limbs. Exercise increases blood-flow in the body and reduces weight. 
10. Take magnesium supplements
Magnesium is essential for our body’s function. That said, many people suffer from a magnesium deficiency. By adding magnesium to your system, you will improve your overall health, reduce hangover symptoms and suffer less pain in your extremities

3 people found this helpful

5 Ways to Train Your Brain to Learn Faster and Remember More

MCh Neurosurgery, MS - General Surgery, MBBS
Neurosurgeon, Guwahati
5 Ways to Train Your Brain to Learn Faster and Remember More

The brain is not a stagnant realm fed with a granted quota of intelligence and memory at birth. It is always in a state of flux. Exercising your brain in various ways accelerates its ability to perform better. It is in your hands to have a sharper take on situations and occurrences. Playing games that require brainstorming, solving quizzes, crosswords or playing chess makes you feel rejuvenated and tired at the same time; the reason being activated brain cells. A healthy brain will affect your life decisions positively and you probably will think rightly before you leap.

Tips to exercise those brain cells:

  1. Meditate and calm your mind: Ten minutes of meditation each day can help you get over anxiety. When your mind is at peace you think out pros and cons with enhanced insight. This composure reflects in each of your actions. Meditation demands your brain to be quiet when it is accustomed to work; you therefore have greater control over it.
  2. Music can improve your brain abilities: Music is the best antidote for a sloppy brain. Music excites the neurons healing a bruised memory. It gifts you with clarity of thought. Apart from listening to music one must try to play a musical instrument. Teaching yourself things puts your mind through a strict regimen of constructive activities.
  3. Take out time to learn a new language: We are paralyzed the minute our brain gives up. Due to several external and internal reasons each one of us is likely to suffer from cognitive disorders on being subjected to extreme pressure or shock. Trying to learn a new language motivate your brain cells to have a wider vocabulary, which further restricts your chances of brain damage.   
  4. Mental mathematics could better your intelligence: Calculators, computers and phones are ridding us of our ability to compute individual data. Computation and consolidation of data helps your mind to work faster with precision. So, you now know those lessons on mental mathematics in childhood were actually the key to a well rounded brain. 
  5. Think of something novel: The more the number of neurons the merrier is your brain. Take pains to direct your mind on a novel track. Thinking beyond what is given and expected helps your brain grow new neurons. It builds up your creativity letting you discover more of your capabilities. Consult an expert & get answers to your questions!
3685 people found this helpful

I am suffering from sciatica for the last 6 months. Tried back exercises and muscle relaxants. The condition is due to L4/L5 disc herniation. Kindly advice.

DNB (Orthopaedics), Diploma In Orthopaedics (D. Ortho), MBBS
Orthopedist, Gurgaon
Herniated disc is likely to have a course with repetitive episodes of back and leg pain. It is important to avoid postures that may complicate the situation. Surgery is usually recommended, if there is any evidence of neurologic deficit, such as weakness of toes, persistent numbness or bladder/ bowel dysfunction. Most such cases can be managed conservatively with a combination of medication and physio.
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My MRI report of LS Spine is as: Diffuse Disc bulge at L3 /L4 indenting the thecal sac Partial desiccation of L4 / L5 with diffuse posterior disc bulge Indenting the thecal sac encroaching bilateral neural foramina (left>right) Partial desiccation of L5 / S1 Please tell. Me the seriousness of the problem with precautions Is this normal.

MBBS
General Physician, Bangalore
My MRI report of LS Spine is as:
Diffuse Disc bulge at L3 /L4 indenting the thecal sac
Partial desiccation of L4 / L5...
hello, this means a part of your spine is bulging out and in later cases it may compress your nerve roots and may cause pain of your lower back and your one or both of your lower limbs causing sciatica. but then, there are two things one is simple bulging of the disc and another is herniation of the disc where there is a tear in the cartilage, the later condition more often causes pain. bulging usually causes no pain. i would like to advice you to have a good posture, sit straight. prefer chairs without cushion. your mattress should not be too soft. sleep on a regular less bulky mattress where you can keep your spine straight. while trying to get up from a lying down position do it from one side. never try to sit up straight from the lying down position. change your position to left or right lateral then take support with your hands and get up. do a set of spinal exercises at least 20 minutes a day. you can do twice a day of 10 minutes duration too. you can consult me for the types and instructions of the exercises. if you have not get pain yet, consider yourself fortunate and start making these lifestyle changes.the pain you get in sciatica is ugly. prevention is better than cure. wish you a very good health.
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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!

1 person found this helpful

Pap Smear - All You Need To Know About It

DNB (Obstetrics and Gynecology), MD - Obstetrtics & Gynaecology, MBBS
Gynaecologist, Delhi
Pap Smear - All You Need To Know About It

A Pap Smear is a screening test done to to test for occurrence of uterine cancer. Carried out in a quick and simple way to extract a sample, the sample is collected from the cervix area of a woman during a pelvic exam. The examination of the sample takes place under a microscope thereafter to find abnormalities that can point towards cancer and pre cancer changes.

There are many reasons why women should get a pap smear screening done:

1. Women who are HIV positive should get this test done regularly so as to detect any anomalies in the cervix. This condition usually comes with higher risk of infections and cancer, which is why regular screening is required.

2. Age is also another factor and women over the age of 30 should go through an annual screening on a compulsory basis. This is also true for women who have been through pregnancy and child birth.

Preparing for a Pap Smear: To prepare for a pap smear test, you need to ensure that you are not menstruating at the time. Also, you may want to avoid sexual activity just before the test so as to get the most accurate readings. During the process, remember to stay calm and relax your body physically.

Procedure: The pap smear procedure is a quick one that might be only slightly uncomfortable. This test is usually carried out on the examination table at the gynecologist's clinic. The legs will need to be spread and placed in stirrups. The doctor will insert a speculum to hold open the vaginal opening so that the spatula can be inserted easily to take a sample from the area. This sample of the cells will be tested in a lab after due preservation.

Test Results: The test results can either be normal or abnormal. An abnormal result does not point at the presence of cancer. Rather it can simply mean that abnormal cells exist in the cervix. The doctor may ask you to go through these tests and screening more frequently so as to study the anomalies in a more detailed manner.

1 person found this helpful

My dad has a disc problem and in morning time he suffers from stiffness in lower back area. What should he do?

MS - Orthopaedics
Orthopedist, Chennai
My dad has a disc problem and in morning time he suffers from stiffness in lower back area. What should he do?
He should not bend down, avoiding bike riding and sitting for long time and lifting heavy weights. He should gentle back toning exercises. If not alright he might need surgery.
3 people found this helpful
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