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Dr. Rajesh Gandhi

Orthopedist, Mumbai

0 - 1200 at clinic
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Dr. Rajesh Gandhi Orthopedist, Mumbai
0 - 1200 at clinic
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Personal Statement

I believe in health care that is based on a personal commitment to meet patient needs with compassion and care....more
I believe in health care that is based on a personal commitment to meet patient needs with compassion and care.
More about Dr. Rajesh Gandhi
Dr. Rajesh Gandhi is a renowned Orthopedist in Andheri West, Mumbai. He is currently associated with Gandhi Nursing Home in Andheri West, Mumbai. Book an appointment online with Dr. Rajesh Gandhi on Lybrate.com.

Lybrate.com has an excellent community of Orthopedists in India. You will find Orthopedists with more than 25 years of experience on Lybrate.com. You can find Orthopedists online in Mumbai and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.

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Gandhi Nursing Home

106, Garden View Bldg, Shastri Nagar, Andheri West, Landmark: O Kalkata Restuarent, MumbaiMumbai Get Directions
1200 at clinic
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Gandhi Nursing Home

106, Garden View Bldg, Shastri Nagar, Andheri West, Landmark: O Kalkata Restuarent, MumbaiMumbai Get Directions
0 at clinic
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Belle Vue Multispeciality Hospital

The Link, 1st floor, Link Road Extension, Andheri West. Landmark: Next to Audi Showroom.Mumbai Get Directions
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I am 25 year old male and have backache for last 2 months. I have used pain relief ointment cream for couple of days but haven’t got any relief. What should I do now?

FRHS, Ph.D Neuro , MPT - Neurology Physiotherapy, D.Sp.Med, DPHM (Health Management ), BPTh/BPT
Physiotherapist, Chennai
I am 25 year old male and have backache for last 2 months. I have used pain relief ointment cream for couple of days ...
Do take ift and laser therapy for pain relief 10 days followed by strengthening exercise from neuro physiotherapist avoid bending forward do core muscle strengthening exercise do use firm hard and even mattress for sleep best wishes.
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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

Sir good evening .sir mere kamar me 3 sal se rah rah kar dard hota rahta hai .Mujhe mere kamar me chot lagi hai maine bahoot dawa kiya fir bhi nahi sahi huaa.

DHMS (Hons.)
Homeopath, Patna
Sir good evening .sir mere kamar me 3 sal se rah rah kar dard hota rahta hai .Mujhe mere kamar me chot lagi hai maine...
Hi, physiotheraphy ki, help lijiye. Bhari weight uthaney ke liye jhukna mana hain. Kamar ko right, left ghumayen. Homoe medicines, leyen. @ rhus tox 200-6 pills, thrice a day. @ macrotnin200-6 pills, thrice. Thandi vastu, thnda vatavaran, she bachana chahiye. Mast, raheyen.
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Dear Madam, I am 32 years old man I am suffering from left leg and left hand pain in regular for past 2 months I consulted some Doctor And take some medicine with exercise but no any relieve please advice and help.

BPT, MPT - Orthopedic Physiotherapy
Physiotherapist, Sangrur
Dear Madam, I am 32 years old man I am suffering from left leg and left hand pain in regular for past 2 months I cons...
Hello lybrate user take physiotherapy regular treatment. After treatment start daily exercises of leg and hand. Exercises must be prescribed by qualified physiotherapist only. Because may be your exercise duration time or repetitions are less, not in proper way, correct position of joint, etc. Regular three months exercise will give you beneficial results.
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Suddenly 1 month I saw that my right heel so pain in early morning. I visiting my nearest general physician doctor, he asked me calcaneal spur is present my heel. Pls give me some medicine name & I try to cure my heel problem.

D.A.M.S( A. M.), D.AC/B.E.M.S
Acupressurist, Mumbai
Suddenly 1 month I saw that my right heel so pain in early morning. I visiting my nearest general physician doctor, h...
You should take acupressure therapy and take biochemic calc flour 200x + calc phos 200x 4 tab each thrice a day with warm water and take it 5 days
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I have a back pain from one month and it painful very much I couldn't get relief please suggest me some exercise or any medicine.

BPTh/BPT
Physiotherapist, Kota
I have a back pain from one month and it painful very much I couldn't get relief please suggest me some exercise or a...
Dear, low back pain are often referred for physical therapy for four weeks as an initial conservative (nonsurgical) treatment option before considering other more aggressive treatments, including back surgery. The goals of physical therapy are to decrease back pain, increase function, and teach the patient a maintenance program to prevent future back problems. Common forms of physical therapy include: 1.Passive physical therapy (modalities), which includes things done to the patient, such as heat application, ice packs and electrical stimulation. For example, a heating pad may be applied to warm up the muscles prior to doing exercising and stretching, and an ice pack may be used afterward to sooth the muscles and soft tissues. OSee Physical Therapy: Passive PT (Modalities) for Back Pain 2.Active physical therapy, which focuses on specific exercises and stretching. For most low back pain treatments, active exercise is the focus of the physical therapy program. This article focuses on active physical therapy and exercise as a means to help recover from back problems and prevent or minimize future flare-ups of low back pain Low back pain has lasted between two and six weeks, or if there are frequent recurrences of low back pain, physical therapy is often recommended. Some spine specialists consider physical therapy sooner, particularly if the pain is severe. •Read more: Exercise and Back Pain In general, the goals of physical therapy are to decrease pain, increase function, and provide education on a maintenance program to prevent further recurrences. A physical therapy program for back pain usually has two components: 1.Passive physical therapy to help reduce the patient's pain to a more manageable level 2.Active exercises Passive Physical Therapy - Modalities Acutely, the physical therapist may focus on decreasing pain with passive physical therapy (modalities). These therapies are considered passive because they are done to the patient. Examples of modalities include: •Heat/ice packs •TENS units •Iontophoresis •Ultrasound.
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I have a back pain from 15days using pain relief sprays but not working I want something to get relif of thst so please just csn give the answer M.

BHMS
Homeopath, Delhi
I have a back pain from 15days using pain relief sprays but not working I want something to get relif of thst so plea...
Hello, you can take homoeopathic medicine rhus tox 30 (4 drops in little water) thrice a day for a week and update.
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Doctor I am 19 year old and I have knock knees what should I do. I want to become and navy officer. Please help me?

MBBS
General Physician, Mumbai
Doctor I am 19 year old and I have knock knees what should I do. I want to become and navy officer. Please help me?
It’s difficult for you to be selected for navy officer and we can treat your knock knee problems after clinical examination
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I am 34 yrs male, have lower back ache, did my x ray shows mild reduction at l5 s1, what should I do. Will swimming improve it or worsen it.

BPTh/BPT
Physiotherapist, Mumbai
I am 34 yrs male, have lower back ache, did my x ray shows mild reduction at l5 s1, what should I do. Will swimming i...
Hi consult physiotherapist and before starting swimming do strengthening exercise of back and core muscles. Do check your calcium and vitamin d levels. Best wishes.
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