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Spinal Surgery Disorders
Treatment of Neurological Problems
Treatment of Knee replacement
Treatment of Nerve And Muscle Disorders
Treatment of Hip Disorders
Neuro Physiotherapy Treatment
Treatment of Knee Injury
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Treatment of Sports Injuries
Treatment of Splinting
Treatment of Spondylosis
Arthritis And Pain Management Treatment
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Orthopedic Physical Therapy
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The intervertebral discs are made-up of two concentric layers, the inner gel-like Nucleus Pulposus and the outer fibrous Annulus fibrosus. As a result of advancing age, the nucleus loses fluid, volume and resiliency and the entire disc structure becomes more susceptible to trauma and compression. This condition is called as degeneration of the disc. The disc then is highly vulnerable to tears and as these occur, the inner nucleus pulposus protrudes through the fibrous layer, producing a bulge in the intervertebral disc. This condition is named as herniated disc. This can then cause compression to the spinal cord or the emerging nerve roots and lead to associated problems of Sciatica radiating pain from back to legs in the distribution of the nerve. Other symptoms could be a weakness, tingling or numbness in the areas corresponding to the affected nerve. Sometimes bladder compromise is also present, which is made evident for urine retention and this need to be taken care as an emergency.
Excessive weight, bad postures, undue movements, improper weight lifting and other kinds of traumas may weaken the intervertebral discs. When this occurs the pulpous nucleus will bulge against the annulus, or even be squeezed through it (extruded disc).
The first steps to deal with a herniated or prolapsed lumbar disc are conservative. These include rest, analgesic and anti-inflammatory medication and in some cases physical therapy. At this point, it is convenient to have some plain X-rays done, in search of some indirect evidence of the disc problem, as well as of degenerative changes on the spine.
If in a few days these measures have failed, the diagnosis has to be confirmed by means of examinations that give better detail over the troubled area, as the MRI, CT which will show the disc, the space behind it and in the first case, the nerves. In some instances, the EMG (electromyography) is also of great value, as this will show the functionality of the nerves and muscles.
Once the diagnosis has been confirmed, one of the best alternatives existing today is the Ozone Discolysis as the results obtained are excellent and practically has no complications. This novel treatment avoids the use of surgery in 80% of those who needed it. In most patients left with painkillers as the only treatment, the symptoms eventually disappear, only that this could take weeks to months. Ozone speeds up these developments, see the same result in a few weeks. The problem has to be seen and approached integrally and frequently the combination of therapies has to be used, most frequently physiotherapy. Also, it has to be known that those who had a herniated disc have 10 times more chances of having another herniation than the rest of the population.
If despite the ozone therapy the symptoms persist, Drill Discectomy/ Laser Discectomy are good alternatives before open surgery (Discectomy) which has to be contemplated in those true emergencies, as mentioned above, this is possibly the first choice.
Once the conservative treatment fails:
Early aggressive treatment plan of pain has to be implemented to prevent peripherally induced CNS changes that may intensify or prolong pain making it a complex pain syndrome. Only 5% of total LBP patients would need surgery & 20% of discal rupture or herniation would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then.
Depending upon the diagnosis one can perform & combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon pt`s pathology & response to treatment.
Using precision diagnostic & therapeutic blocks in chronic LBP, isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of LBP after conservative treatment has failed.
LESI: Lumbar Epidural Steroid Injection
Indicated in – Acute radicular pain due to irritation or inflammation.
- Symptomatic herniated disc with failed conservative therapy
- Acute exacerbation of discogenic pain or pain of spinal stenosis
- Neoplastic infiltration of roots
- Epidural fibrosis
- Chronic LBP with acute radicular symptoms
- Epidural- lumbar injection
ESI Treatment Plan
Compared to interlaminar approach better results are found with a transforaminal approach where drugs (steroid+ LA/saline +/- hyalase) are injected into anterior epidural space & neural foramen area where herniated disc or offending nociceptors are located. Whereas in interlaminar approach most of drug is deposited in posterior epidural space.Drugs are injected total 6-10 ml at lumbar, 3-6 ml at cervical & 20+ ml, if caudal approach is selected. Lumbar ESI is performed close to the level of radiculopathy, often using paramedian approach to target the lateral aspect of the epidural space on involved side. Cervical epidural is performed at C7-T1 level.
SNRB- Selective Nerve Root Block
Fluoroscopically performed it is a good diagnostic & therapeutic procedure for radiculopathy pain if
- There is minimal or no radiological finding.
- Multilevel imaging abnormalities
- Equivocal neurological examination finding or discrepancy between clinical & radiological signs
- Postop patient with unexplainable or recurrent pain
- Combined canal & lateral recess stenosis.
- To find out the pathological dermatome for more invasive procedures, if needed
Provocative Discography - Coupled with CT
A diagnostic procedure & prognostic indicator for surgical outcome is necessary for the evaluation of patients with suspected discogenic pain, its ability to reproduce pain(even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options & in assessing previously operated spines.
Percutaneous Disc Decompression (PDD)
After diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed
Ozone Discolysis: Ozone Discectomy a revolutionary least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a daycare setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. The total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no postoperative discomfort or morbidity and low cost.
Dekompressor: A mechanical percutaneous nucleosome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression.
Epidural Adhenolysis or Percutaneous Decompressive Neuroplasty for Epidural Fibrosis or Adhesions in Failed Back Surgery Syndrome (FBSS)
A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ L.A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with epiduroscope.
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I am a girl of 23 years old. I'm good at lying and backache. Kale I am taking the drug, but it does no good. Now what do I do?
Hello I'm 28 years old from delhi. From last 1 year I'm having upper back right sided mid right side pain and discomfort. Pain feels like pressure a high pressure and weakness there all the time. When I'm sitting in a chair or lying in bed pain speed in whole upper back and feels weakness in right hand like hand raise or holding right hand into chair. this weakness only in right side upper back and mid back. Its feel like coming from deep inside not from bone and not from muscle. My vit d low near 18. Currently taking calcium tab 1200 mg per day and taking my hormone medicine aldactone 50 and cetapin xr 500 mg. Can it's something as or simply a upper back pain? My max hospital saying it's cms? Bt only 1 part of body cms nt appears. Anything can help stress in mind always taking nerve relaxant also in night any treatment can help me or not?
Hi I have an query that my mother has been suffering from leg pains for 6 years, we have tried so many treatments but her legs are so weak that she can't walk properly, pls guide me what can we do. Is there any way to get rid of this disorder as we are so depressed. We have tried with many medicines and physiotherapy also but all is in vain. Please suggest doctor, what more we can do. Thank you.
Sir,I have been suffering from lambar spine problem for the past 6 years.I am 38.When ever I sit for more than 15 min or ride bike ,I get severe pain and radiation on buttocks and both sides of back.I tried allopathy for 3 years under the treatment of good neurologists and homeopathy for 3 years .They all consider it a minor problem.Only a little bit of relief. I am doing physiotherapist suggested exercises. But no improvement. I am seeing hell of a pain and radiation. Is there any permanent cure to this painful disease? Pls suggest me a way out.
Lower back pain is one of the most common ailments among adults all across the world. You may wake up in the morning with an energising drink before going out to work. After you arrive at work, you may have to sit there till lunch, which involves further sitting and you are required to sit for more hours for completing the remaining work. Then you come back home by sitting in the car and have the night’s meal while again sitting. Did you know sitting through the day is the major culprit behind your back pain? Thankfully, yoga has effective ways of treating back pain to a considerable degree.
You can choose to do the following yoga poses for alleviating your back ache:
- Supine hamstring stretch: You will have to lie back on your back and bend the right knee to the chest. Then you will have to place a rolled-up towel around the football and straighten the leg towards the ceiling and press both the heels. In case your lower back feels strained, you can bend your left knee and place the foot right on the ground. Hold the position for about 3 to 5 minutes and practice regularly for soothing back pain.
- Two knee twist: You will have to bend your knees to the chest while lying on the back and try to bring out the arms forming a T-shape. Then try to exhale and lower down the knees on the ground towards your right side. Keep both the shoulders pressed down firmly and hold this position for about 2 minutes for best results.
- Sphinx: You will have to prop yourself on the forearms while lying on the stomach. You will then have to align the elbows right under the shoulders and press through the tops and palms of the feet. You are likely to feel terrific sensations down your lower back, but it is advised to bear through it as it allows the flow of blood to that region which is required for healing. Practice the position regularly and hold it for at least one minute.
- Thread the needle: This is quite an easier pose where you will have to lie flat on your back by bending both the knees with your feet flat on the ground. You will now have to bend the right knee by placing the outer left ankle through the right thigh. You will have to thread the right hand between the leg and interlace the hands behind the left thigh.
These positions would help in soothing your lower back pain, but it is recommended to consult a doctor if the pain still persists. Ayurvedic Tiktaksheer basti, massage therapy and certain oral medicines can help a lot in speedy recovery from spine/back related problems.
Ayurved has a very unique way of drug administration called Basti in which various medicines are given through the anus ( Rectal route)...For Lumbosacral / spine disorders a very specialised form of enema Tiktaksheer Basti (Medicated Bitter Milk enema) is given which shows amazing results. Kindly consult a specialized Ayurvedic practitioner for additional details.
Kati Basti (Vasti) is a traditional Ayurvedic treatment used for lower backache and disorders of lumbosacral region, including slip disc, lumbar spondylosis, sciatica, spinal problems etc. Kati Vasti is a part of external oleation (Snehana) therapy in Ayurveda. It is very safe, non-invasive and green category procedure.
In this procedure, you will get instant relief from backache. After completing a course of 7 to 21 days, you may not need any kind of oral medicines. It is a complete therapy for back pain and lumbosacral disorders.
However, the results vary person to person, but in most of cases, people get quick relief after the procedure.