Back pain


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This brief information booklet is for public awareness about the spine and backache. Although very few percent of patient require spine surgery but all patients of backache must consult the specialist, as soon as possible to avoid serious complications like Paralysis and loss of control over urine and stool. If required Minimally Invasive Spine Surgery should be undertaken. For which you may contact : 9810091720

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Back pain

  1. 1. BACKACHE<br />Why does it happen and how to get rid of it ?<br />91440017780<br />DR. MANOJ SHARMA<br />M.B.B.S., MS (ORTH.), DNB (ORTH.), SPINE FELLOWSHIP (GERMANY),<br />MISS FELLLOWSHIP(SEOUL, KOREA), MIITS USA, AO SPINE FELLOWSHIP (HOLLAND)<br />CHAIRMAN, DEPTT. OF ORTHOPAEDICS <br />JAIPUR GOLDEN HOSPITAL DELHI<br /><br />Email:<br />The primary roles of our spine is maintaining stability, protecting the nerves and allowing range of motion. The vertebral column consists of 33 vertebrae. Each vertebra consist of anterior body and a posterior bony arch, through this runs the spinal cord (main nerve from the brain), at each level 2 small nerves come out, to go to hands and legs. Two vertebra are connected to each other by a disc in front and facet joints behind. This constitutes a motion segment<br />Backache pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Backache is the most common cause of disability worldwide; it ranks only behind respiratory infection as most common cause of work absence. 80% of population will experience backache at least once in there lifetime. 14% of new patient coming to a doctor, are of backache and it is the most common cause of disability in person less than 45 years of age. It is third most common reason for surgical procedure in USA with economic effect of about $85 billion annually. Most common cause of backache is mechanical, from fatigue and strain, like from unnatural posture while sitting, standing and walking, sudden twist and turn, carrying weight on one side such as postman, children with school bags. Poor muscle balance and obesity. Fatigue results from occupation with forward bending or lifting weights like computer workers, teachers, bankers, sedentary life style with sporadic burst of overexertion, driving bikes. High heels put stress on back muscles and ligaments. Smoking, alcohol intake, inadequate diet low in calcium and diseases like diabetes, kidney, predisposes backache. Slip disc causes backache in about 3% of patients.80% of the patients of backache, improve with the non-surgical treatment. We should immediately consult a specialist if the patient is more than 50 yrs of age, suffering from cancer, fever chills and unexpected weight loss, significant injury to the back, numbness around buttocks or difficulty in passing urine, weakness of legs, patients on steroids. <br />.<br />DISC is a padding between two vertebrae. It is tough fibrous shock-absorber. Each disc contains a tyre-like outer band (called the annulus fibrosus) that encases a gel-like substance (called the nucleus pulposus). Nerve roots exit the spinal canal through small passageways between the vertebrae and discs. Pain and other symptoms can develop when the damaged disc squeezes into the spinal canal or nerve roots. <br />114300069850240030069850-11430069850<br />A common cause of low back and leg pain is HERNIATED (SLIP) DISC. Symptoms may include dull or sharp pain, muscle spasm or cramping, sciatica, and leg weakness or loss of leg function. Sneezing, coughing, or bending usually intensifies the pain. Rarely bowel or bladder control is lost, and if this occurs, seek medical attention immediately. Slip disc occurs generally in cervical (neck) or lumbar region (lower back). The pain and numbness (tingling, heaviness or weakness), travels into the hand or the legs.Sciatica is a symptom frequently associated with a lumbar herniated disc. Pressure on one or several nerves that contribute to the sciatic nerve can cause pain, burning, tingling, and numbness that extends from the buttock into the leg and sometimes into the foot. Usually one side (left or right) is affected. <br />Initial treatment of slip disc patient is medicines, including pain killers, bed rest for 3-4 days, heat application, lumbar belt or cervical collar and physiotherapy in form of diathermy, interferential therapy, tens, pelvic traction and spinal exercises (some times manipulation), under expert guidance.<br />80-85% of patients improve by non-surgical treatment but the rest may require surgery, in form of discectomy (removal of herniated disc), to relief pressure on nerve root. Gone are the days when this surgery was major with serious complications. Now this surgery is possible by the Minimally Invasive techniques, where recovery is very fast and patient can resume his day to day activities from next day, whereas patient takes months to recover after conventional surgery. Percutaneous Endoscopic Disc Surgery is one such procedure performed by us in Jaipur Golden Hospital, New Delhi, under local anesthesia. This is latest treatment for slip disc patient all over the world. No anesthesia is required, we keep talking to the patient during surgery and patient experiences relief of pain right on operation table. This surgery is accomplished by 6 mm spine endoscope (YESS, R Wolf, Karlstorz, Germany). We have specialized centre to perform this surgery, since 2002, to provide excellent results to our patients. We organized an international conference on this technique in New Delhi (Endospine 2007), attended by spine surgeons from Korea, Germany and USA.<br />251460040005040005<br /> <br />DISC DEGENERATES with age, like graying of hairs and becomes less flexible and dehydrated and can produce neck or back pain increases with sitting, bending forward, coughing and sneezing. In first stage disc tears or cracks and a chemical leaks out, from nucleus to the nerves, irritating them and causing back and leg pain. Diagnosis is confirmed by MRI and discography (a contrast dye is injected into the disc, which stretches the disc and produces the disc pain). Discogenic pain is cured by artificial disc replacement (Arthroplasty). The model consists of two metal metallic plates that have teeth to anchor the implant between the bones or vertebral bodies. Between the two plates is a plastic core made up of polyethylene that allows for motion. Hence the artificial disc preserves the motion and maintains the disc height which was not possible with conventional surgery (spinal fusion). <br />DR. MANOJ SHARMAMS (ORTH.), DNB (ORTH.), SPINE FELLOWSHIP (GERMANY), MISS FELLLOWSHIP(SEOUL, KOREA)CHAIRMAN, DEPTT. OF ORTHOPAEDICS JAIPUR GOLDEN HOSPITAL DELHI<br />SPINAL CANAL STENOSIS is another common cause of backache. Symptoms are back pain going into the legs along with numbness, which increases with standing and walking. This leg pain and numbness (or tingling) becomes relieved on sitting or lying down. Symptoms are due to compression of spinal nerves by enlarged bones or ligaments or disc. If this happens in cervical (neck) reason, it is called CERVICAL MYLOPATHY, which is very incapacitating. Patient finds difficulty in walking due to weakness and lack of coordination in legs and numbness in hands. Common causes are advancing age (disc degeneration) can be treated initially by physiotherapy but mostly require surgery in form of Laminotomy and instrumented spinal fusion. Recently dynamic soft stabilization is possible like dynesys, diam, which preserves movement yet controls backache.<br />285750011557022860001155701485900115570 <br />Cervical and Lumbar Spondylosis Intervertebral disc serves as a shock absorver, load distributor and spacer. As we age the disc looses its water content and these functions. Disc space becomes narrow, which pinches the nerves. There is stress on the facet joints behind. Spine becomes painful with radiating pain into the hands or legs. Such wear and tear in our spine causes cervical spondylosis in the neck. Its main symptoms are neck pain, pain radiating to arms, chest, upper back and head. It may be associated with numbness/tingling/weakness and giddiness. Lumbar spondylosis causes back pain, which is more in the morning or after change of posture. It increases with exertion and may radiate to the hips and thy. It may cause severe nerve compression, which may require surgery, like spinal fusion. This surgery is also required for other spine diseases which weakens the spine and produce backache like TB, Tumors, Spondylolisthesis, Deformities and Fractures. Spinal fusion is performed to fuse two vertebrae together permanently. Screws, rods and cages alongwith bone graft and now BMP, are used to ensure excellent results. <br />254698547625 <br />Non-Operative Treatment of Backache 85% of patients improve by conservative means like Anti-Inflammatory Medicines (Movon-P (Activa Ipca), Dynapar, Ace Proxyvon), Muscle Relaxant (Skelact), Opioids (Tolydol), Anti-depressant (Tryptomer), Neuropathic Pain Modulators (Lyrica (Pfizer)). Physiotherapy passive therapies like ultrasound, TENS, IFT and massage relieves inflammation and muscle spasm. Lumbar and cervical traction helps in relieving the nerve pressure and muscle spasm, aligns the spine and relieves pain. Stretching and strengthening exercises for neck, abdomen and back helps in relieving pain, improve our posture and shields the disc from loads and injuries. Spinal injections of local anesthetic combined with steroids, into the facet joints, trigger points, around the nerves and in epidural space (spine), reduce back pain and radicular leg pain. Bracing (belts/collar) helps in supporting neck or back in severe backache. Long term use is harmful, as it weakens the muscles. Life Style Modification is very helpful like stop smoking, reduce alcohol intake, nutritious diet with calcium like milk and milk products, reduce weight by avoiding sweet and fatty diet, regular exercise, avoid sudden jerks and forward bending for long hours, adopt right posture like sitting erect, lift weight by bending the knee and hip, not the spine.<br />Osteoporosis is one of the common cause of backache specially in old age females. Osteoporosis is a condition characterized by the loss of normal density of bone, resulting in fragile bone. Bone becomes porous and weak with increase risk of fractures. Fractures can occur with minor injuries specially of spine, hip and wrist. Osteoporosis may be without symptom for decades unless the bone fractures. Fracture of spine causes severe “band-like” pain that radiates around from the back to the side of the body. Such multiple fractures can cause forward curving of the spine as well as loss of height, as many old females have. After the age of 35 both man and woman loose their bone density per year as a part of aging process. In females it is lost more, after menopause due to lack of estrogen hormone.<br />Risk factor for developing osteoporosis are female gender, Asians, thin built, family history, cigarette smoking, excessive alcohol, lack of exercise, low calcium intake/nutrition, malabsorption, low estrogen level, chemotherapy, disease like arthritis, lever disease, brain stroke, <br />hypothyroidism, hyperparathyrodism, patients on steroids, anti epileptics, blood thinners etc.<br />Traditionally, medical treatment of painful osteoporotic compression fractures consists of bedrest, narcotic medications and bracing. More recently, drugs such as Miacalcin have been used with some success to treat the acute pain associated with these fractures. These medical treatments are not without problems. While some patients improve with simple measures and time, many others do not. Pain may result in the need for chronic narcotics. Back braces are uncomfortable. Prolonged bedrest is poorly tolerated in the elderly due to medical problems such as blood clots, pneumonia and skin ulcers. Standard open surgery is not recommended due to poor outcomes.<br />Kyphoplasty is a new treatment option for patients with painful osteoporotic compression fractures. The kyphoplasty procedure is performed by inserting a balloon into the fractured vertebra through a thick needle in the back. The balloon is inflated to restore the normal height of the vertebral body. Cement is then injected in the vertebra to stabilize the fracture as depicted below.<br />The kyphoplasty procedure is minimally invasive and performed with limited surgery time. Only one day of hospitalization is required. Recovery is short and patients immediately return to their usual activities of daily living. Results of Kyphoplasty are over 90% good to excellent. Results are best for acute fractures less than 3 months old, but even patients with chronic or old fractures can benefit from the procedure.<br />91440027305-1143005080<br /> <br />LUMBAR EPIDURAL INJECTION<br />Epidural space is around the spinal cord and nerve roots. Injection given in this space can relieve backache by removing swelling of the nerves. It may provide permanent relieve in some patients. Injection is given under aseptic condition and flouroscopic control, in lumbar spine, by special epidural needle. Injection consists of anesthetic agent and steroid. Generally 3 injections are required. <br />LUMBAGO is popularly known as “Chuk”. It is a sudden severe pain in the back, generally after bending forward or lifting some weight. All movements of spine cause pain. It is mostly due to annular rupture (first stage of slip disc). But it is possible with other pre-existing <br />disease of spine like Spondylosis, infection etc. Generally patient improves within 2 or 3 days by rest, medicines, heat application etc. <br />2217420-127045720-1270960120-1270<br />This brief information booklet is for public awareness about the spine and backache. Although very few percent of patient require spine surgery but all patients of backache must consult the specialist, as soon as possible to avoid serious complications like Paralysis and loss of control over urine and stool. If required Minimally Invasive Spine Surgery should be undertaken. For which you may contact ….…... Dr. Manoj Sharma is a renowned Spine Surgeon of the country. He pioneered laser and Minimally Invasive Endoscopic Spine Surgery in India. He received his training in Spine Surgery from Germany, Korea, Holland and USA. He is active member of many national and international spine societies. DR. MANOJ SHARMAM.B.B.S., MS (ORTH.), DNB (ORTH.), SPINE FELLOWSHIP (GERMANY),MISS FELLLOWSHIP(SEOUL, KOREA), MIITS USA, AO SPINE FELLOWSHIP (HOLLAND)CHAIRMAN, DEPTT. OF ORTHOPAEDICS JAIPUR GOLDEN HOSPITAL, ROHINI, NEW DELHI Ph: 27525984-90, Ext.-244/159 Time: 11.30 a.m. to 1.30 p.m. Daily (Except Sunday)Clinic: 61 & 65, PKT D-10, Sector – 7, Rohini, Delhi- 85. Ph: 27042444, 27042666 Time: 6.00 P.M. to 9.00 P.M. Daily Clinic: 24/153, Shakti Nagar, Delhi (Shakti Nagar Crossing, Opp. Petrol Pump) Ph: 23849192, Mobile: 9810091720 Time: 2.30 to 4.30 Daily<br />