1. Dr. Kshitij Chaudhary discusses indications for spine surgery and how to select the right patients.
2. He outlines a fail-safe system involving 10 steps to determine if a patient's back pain is truly from the spine and if surgery is warranted, including determining the cause of pain, identifying red flags, assessing for mechanical pain syndromes, and evaluating for true physical disability.
3. Key factors include whether non-operative options were tried, the patient's functional limitations, expectations, and comorbidities which can impact surgical outcomes.
Nonoperative care versus surgery in lumbar disc herniation with radiculopathy...Kshitij Chaudhary
This is a brief review of the current state of evidence for nonoperative versus operative care for lumbar disc herniation with radiculopathy. The current NASS guidelines are summarized.
Leveraging technology for preoperative planning in orthopaedic and spine surgeryKshitij Chaudhary
This talk was presented by Dr. Kshitij Chaudhary at the APROC SICOT 2015 conference at Sir HN Reliance Foundation Hospital. This talk is about technology that can help with preoperative planning. It includes a brief mention of 3D printed, patient-pathology-specific models that are being used in orthopedic and spine surgery.
Critical Appraisal of an RCT using GATE - SPORT Trial Kshitij Chaudhary
This is a presentation given at the research methodology workshop at IOACON 2016, Kochi, India. Critical appraisal of the SPORT RCT study is presented using the GATE framework developed by Prof Rod Jackson. SPORT was a large multicenter trial conducted in the USA that compared surgery versus nonoperative treatment for lumbar disc herniation
Evidence based management of osteoarthritis in primary care - Dr Jonathan Quickepcsciences
Dr Jonathan Quicke is an NIHR Academic Clinical Lecturer in Physiotherapy (Keele University). Dr Quicke presented at the 2017 Musculoskeletal Education Day, where he discussed how we can ensure that best practice can be implemented within general practice for patients suffering with osteoarthritis
Nonoperative care versus surgery in lumbar disc herniation with radiculopathy...Kshitij Chaudhary
This is a brief review of the current state of evidence for nonoperative versus operative care for lumbar disc herniation with radiculopathy. The current NASS guidelines are summarized.
Leveraging technology for preoperative planning in orthopaedic and spine surgeryKshitij Chaudhary
This talk was presented by Dr. Kshitij Chaudhary at the APROC SICOT 2015 conference at Sir HN Reliance Foundation Hospital. This talk is about technology that can help with preoperative planning. It includes a brief mention of 3D printed, patient-pathology-specific models that are being used in orthopedic and spine surgery.
Critical Appraisal of an RCT using GATE - SPORT Trial Kshitij Chaudhary
This is a presentation given at the research methodology workshop at IOACON 2016, Kochi, India. Critical appraisal of the SPORT RCT study is presented using the GATE framework developed by Prof Rod Jackson. SPORT was a large multicenter trial conducted in the USA that compared surgery versus nonoperative treatment for lumbar disc herniation
Evidence based management of osteoarthritis in primary care - Dr Jonathan Quickepcsciences
Dr Jonathan Quicke is an NIHR Academic Clinical Lecturer in Physiotherapy (Keele University). Dr Quicke presented at the 2017 Musculoskeletal Education Day, where he discussed how we can ensure that best practice can be implemented within general practice for patients suffering with osteoarthritis
Crimson Publishers - Efficacy of Core Strengthening Exercise on a Geriatric S...CrimsonpublishersMedical
Efficacy of Core Strengthening Exercise on a Geriatric Subject with Lumbar Spine Degeneration-Evidence Based Study by Subramanian ss* in Research in Medical & Engineering Sciences
Early Outcome of Discectomy with Interspinous Process Distraction Device a Re...CrimsonPublishersOPROJ
Early Outcome of Discectomy with Interspinous Process Distraction Device a Retrospective Cross-Sectional Study by Gunaseelan Ponnusamy* in Crimson Publishers: Orthopedic Research and Reviews Journal
Abhijeet Danve, MD, FACP, FACR, prepared useful Practice Aids pertaining to axial spondyloarthritis for this CME activity titled “Overcoming Challenges in the Diagnosis and Management of Axial Spondyloarthritis: New Insights and Implications for Clinical Practice.” For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at https://bit.ly/2A6Xi8d. CME credit will be available until August 27, 2021.
The Battle Sport Traumatology 2023 Castrocaro Terme FC.pdfNicola Taddio
In this presentation the author analyzes the various problems relating to the functional and mechanical instability of the ankle which has suffered a lesion of the lateral ligaments, the complications, failures and short and long term outcomes in order to have a 360 degree vision of the problem , the possible solutions and the correct management to avoid them.
Crimson Publishers - Efficacy of Core Strengthening Exercise on a Geriatric S...CrimsonpublishersMedical
Efficacy of Core Strengthening Exercise on a Geriatric Subject with Lumbar Spine Degeneration-Evidence Based Study by Subramanian ss* in Research in Medical & Engineering Sciences
Early Outcome of Discectomy with Interspinous Process Distraction Device a Re...CrimsonPublishersOPROJ
Early Outcome of Discectomy with Interspinous Process Distraction Device a Retrospective Cross-Sectional Study by Gunaseelan Ponnusamy* in Crimson Publishers: Orthopedic Research and Reviews Journal
Abhijeet Danve, MD, FACP, FACR, prepared useful Practice Aids pertaining to axial spondyloarthritis for this CME activity titled “Overcoming Challenges in the Diagnosis and Management of Axial Spondyloarthritis: New Insights and Implications for Clinical Practice.” For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at https://bit.ly/2A6Xi8d. CME credit will be available until August 27, 2021.
The Battle Sport Traumatology 2023 Castrocaro Terme FC.pdfNicola Taddio
In this presentation the author analyzes the various problems relating to the functional and mechanical instability of the ankle which has suffered a lesion of the lateral ligaments, the complications, failures and short and long term outcomes in order to have a 360 degree vision of the problem , the possible solutions and the correct management to avoid them.
Here is my talk from Therapyexpo. if you are wondering what the Egyptian theme is all about slide two outlines the first known clinical test for the lumbar spine from a text written ~3000 years ago
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Indications for Surgery in Adult Spondylolisthesis
1. Dr. Kshitij Chaudhary, MS, DNB
Consultant Spine Surgeon
Sir HN Reliance Foundation Hospital
Mumbai
@kcspine
I N D I C A T I O N S F O R S U R G E R Y
H O W T O C H O O S E T H E R I G H T P A T I E N T ?
2. A N O N .
"If operating on the wrong leg is a medical error,
what do we call operating on a someone who doesn't
need it.”
10. Fail-safe system
1. Is pain a diagnostic trap? Non-spondylogenic ?
2. If spondylogenic - Any red flags?
3. Is pain mechanical? If so, which syndrome?
4. Is pain a true physical disability? Yellow Flags?
5. After history, PE, imaging and tests – what is structural
lesion?
6. Does clinical picture fit with structural lesion?
20. Back pain or leg pain predominant ?
D., Frymoyer, J. F., & Weinstein, J. (2011). Predominant Leg Pain Is Associated With Better Surgical Outcomes in Degenerative Spondyl
90%
10%
50%
50% 90%
10%
27. Is there a nonoperative option?7
Paracetamol / NSIADS
Pregabalin
Physical therapy
Manipulation
TENS
Brace
Traction
No studies: Workgroup Consensus Statement - NASS
28. Is there a nonoperative option?7
Epidural steroid injections
Small or no benefit
Chou R et al. Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis: A Systematic Review and Meta-analysis. Ann Intern Med 2015.
Friedly JL, et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med 2014;371:11-21.
Controversial
@kcspine
33. What is the functional limitation?
Dissatisfied with their symptoms
t.al. (2013). Who Should Undergo Surgery for Degenerative Spondylolisthesis? Treatment Effect Predictors in SPORT. Spine, 38(21), 17
9
34. Oswestry Disability Index
• 0 to 20: Minimal disability
• 21-40: Moderate Disability
• 41-60: Severe Disability
• 61-80: Crippling disability
• 81-100: Bed-bound or exaggeration
Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine 2000 Nov 15;25(22):2940-52
35. Patient expectations
“Patient expectation can be a self fulfilling prophecy”
n et.al. (2013). Who Should Undergo Surgery for Degenerative Spondylolisthesis? Treatment Effect Predictors in SPORT. Spine, 38(21)
10
Most important presentation, not because I am giving it.
Because I believe choosing the right patient for surgery is more important that surgery itself and the outcome of the surgery is heavily dependent on this decision.
But the wisdom to choose the right patient is important.
Decision is more important than the incision.
61y woman with L4-5 spondylolisthesis. How will you evaluate?
Before starting out you have to know two facts about degenerative lumbar spine problems
First:
One famous study (Boden). Took normal people with healthy backs and did their MRI. Found that 2/3 of patients had degenerated discs.
An algorithm is defined by Webster as an “organized method for solving a problem in a finite number of steps”.
Have to go sequentially. Do not try to answer question 6 before answering questions 1,2 and 3
Big mistake
Spondylogenic - origin from the spinal column and associated structures. Aggravated by activities and relieved or reduced by rest
Neurogenic - tension, irritation, compression of lumbar nerve roots (usually cause referral of pain to legs)
Viscerogenic pain - Kidneys, retroperitoneal organs, pelvic viscera. Back pain alone is rarely the sole symptom. Usually other associated symptoms. Not related to activity.
Vascular pain - AAA - deep boring back pain unrelated to activity. PVD, Varicose veins - Vascular claudication mimic pain produced by root irritation. We will discuss this more in detail later.
Psychogenic pain - Rare, Never forget that emotional illness does not protect patient against organic disease. Investigate thoroughly and don’t be lazy and say that it is all in the patient’s mind.
Beware!
indicate psychological barriers to recovery
If you are a music lover who like Indian classical music you will instantly recognize rag bharavi.
On history, Now I can recognize the pain pattern
PE, I will verify the suspicion and the anatomic level of involvement
Also I know everything there is to know about other systems, such as vascular system, viscera, other joints such as hips, SI joints which can mimic spondylogenic back pain.
After all this I am now ready to review the images. If there is perfect marriage between what I see on the images and the presentation of the patient then I have a diagnosis. If not then, maybe I have made a mistake or missed something and should return to the patient and start over.
The problem is that degenerative changes in the spine are so ubiquitous, that frequently non spondylogenic back pain gets blamed on the disc degeneration. So one has to be very careful.
Better outcomes in patients who are optimistic about surgery.