Wednesday 26 February 2014

Most important success factor in fusion surgery - Spinal Fusion Surgery in India


Lumbar spinal fusion is a type of back surgery in which a bone graft is inserted in the spine so that the bones in a painful segment of the spine fuse together. The fusion aims to stop the motion at a vertebral segment, which should decrease the pain caused by the joint. After the surgery it will take several months (usually 3 to 6, but sometimes up to 18 months) before the fusion is set-up. This surgery has been improved over the last 10 to 15 years, allowing for better success rates, and shorter hospital stays and recovery time.

Indications and contraindications for spinal fusion
The vast majority of people with low back pain will not need fusion surgery and will be able to manage the pain primarily with physical therapy and conditioning. A fusion surgery may, however, be recommended for patients with:
  • Low back pain caused by degenerative disc disease that limits the patient's ability to function (after non-surgical treatments, such as physical therapy and medication, have failed)
  • Isthmic, degenerative or postlaminectomy spondylolisthesis
  • A weak or unstable spine (caused by infections or tumors), fractures, or deformity (such as scoliosis)

Before beginning the main part of a spinal fusion procedure, your surgeon will need to gather material for a bone graft, which is used later on to join the targeted spinal bones together. Depending on individual circumstances and your surgeon’s preferences, this graft material can come from bone harvested from one of your own hips or ribs, from bone harvested from a special donor cadaver, or from artificial materials such as plastics or ceramics.

Once the graft material is ready, your surgeon will make an incision and create an opening that exposes the site of the fusion. Potential locations of this incision include your abdomen, your back and the side of your neck or torso. After exposing the site of procedure and removing the spinal disc that sits between your spinal bones, your surgeon can place the bone graft in one of several ways. First, he can place the graft material directly into the empty space left by the removed spinal disc. Alternatively, he can place the graft material inside a device called a spacer or cage, then insert this device into the gap between your spinal bones. Your surgeon can also lay the graft material over the rear surfaces of the targeted spinal bones.
All of these techniques will lead to fusion of your bones and incorporation of the graft material by triggering your body’s natural healing process. Frequently, bone grafts are held in position by metal rods or plates and screws during this healing period.

Spinal Fusion Uses

Problems in your spinal column that can lead to a need for spinal fusion include a form of bone slippage called spondylolisthesis, debilitating forms of abnormal spinal curvature or deformity, and mechanical spinal instability caused by problems such as accidents or injuries. Surgeries that can produce enough spinal instability to require fusion as a follow-up procedure include complete or partial removal of a damaged spinal disc (discectomy); removal of all or part of the section of spinal bone that forms the back of the spinal canal (laminectomy); and widening of the gaps in your spinal column that allow nerves to pass through from your spinal cord (foraminotomy).

Spinal Fusion Benefits

The rigidity and stability provided by spinal fusion can prevent dangerous degrees of spinal motion, ease pain and other symptoms associated with unwanted or excessive spinal motion, and help prevent damage in the soft tissues situated near your spine. In the vast majority of cases, these benefits are either permanent or remain for extremely extended periods of time.


Fusion surgery success rates vary between 70% and 95%, and there are several factors that will impact the success rate of the surgery, including:
  • Spine fusion for conditions that arise from gross instability (e.g. isthmic or degenerative spondylolisthesis) tends to be more successful than surgery done for pain alone (e.g. degenerative disc disease).
  • Individuals with only one badly degenerated disc (especially L5-S1) but an otherwise a normal spine tend to fare better than those undergoing multilevel fusions. Fusion surgery is generally considered for one or possibly two levels, and multilevel fusions should be avoided except in cases of severe deformity.
  • Individuals who have significant disc degeneration usually find more pain relief from a fusion than those with only minor degeneration on the MRI scan (e.g. still have a tall disc).

The most important success factor in fusion surgery is confirming that a patient's back pain is truly caused by degenerative disc disease, rather than some other condition. This is done by a combination of a careful review of the patient's history, a physical exam, and diagnostic tests (such as x-ray and MRI), and/or possibly a discogram.

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Tuesday 18 February 2014

Laminotomy surgery in india at Affordable Cost - Bone Spurs, Bulging Disc, Herniated Disc, Pinched Nerve, Spinal Stenosis

If spinal stenosis is the main cause of your neck pain, then the spinal canal must be made larger and any bone spurs pressing on the nerves must be removed. One way that this is done is with a complete laminectomy (lam-in-eck-toe-mee). Laminectomy means "remove the lamina". The lamina is the back side of the spinal canal and forms the roof over the spinal cord. Removing the lamina gives more room for the nerves and lets the surgeon remove any bone spurs from around the nerves. A laminectomy reduces the pressure on the spinal cord and relieves the irritation and inflammation of the spinal nerves.
In the cervical spine, removing the lamina completely may cause problems with the stability of the facet joints between each vertebra. If the joints are damaged during the laminectomy, the spine may begin to tilt forward, causing problems later. One way that spine surgeons try to prevent this problem is to not actually remove the lamina. Instead, they simply cut one side of the lamina and fold it back slightly. The other side of the lamina opens like a hinge. This makes the spinal canal larger giving the spinal cord more room. The cut area of the lamina eventually heals to keep the spine from tilting forward.

The traditional way of treating a herniated disc is to perform a laminotomy and discectomy. The term laminotomy means "make an opening in the lamina," and the term discectomy means "remove the disc."

This procedure is performed through an incision down the center of the back over the area of the herniated disc. The muscles are moved to the side so that the surgeon can see the back of the vertebrae. X-rays may be required during surgery to make sure the correct vertebra is located. The doctor cuts a small opening through the lamina bone on the back of the spinal column. This procedure, called "laminotomy," is used to give the doctor room to see and work inside the spinal canal. View animation of laminotomy.
The nerve roots are moved out of the way. Upon locating the problem disc, the surgeon removes it, easing pressure and irritation on the nerves of the spine. Small instruments that fit inside the disc are used to remove as much of the nucleus as possible. This prevents the remaining disc material from herniating in the future. View animation of discectomy. The muscles of the back are returned to their normal position around the spine. The skin incision is repaired with sutures or metal staples.

Microdiscectomy
Improvements have been made in the tools available to the spinal surgeon for performing a laminotomy and discectomy. Microdiscectomy is essentially the same as traditional discectomy, but this newer approach has several advantages. A much smaller incision is need when performing a microdiscectomy. There is less damage to nearby parts of the spine. Patients tend to recover faster.
A small incision is made in the back just above the area where the disc is herniated. Muscles are moved aside to see the vertebrae. The surgeon positions a microscope in the small incision. The remainder of the surgery is performed like the traditional method.

Endoscopic Discectomy
Many surgical procedures have been revolutionized by the use of special TV cameras. The procedure is still the same, but even smaller incisions (1/4 inch) are made to insert a special magnified TV camera into the spinal canal so that the surgeon can actually see the disc material. Through these tiny incisions, the camera and several other surgical instruments are inserted. Rather than looking through a microscope, the doctor watches the TV screen while working with specially designed instruments to remove the disc material.
Torn cartilages of the knee are now routinely removed with an arthroscope, and gallbladders are routinely removed with a laproscope. These small scopes give doctors a method of doing surgery with smaller incisions and with less risk to the nearby tissues. The same approach is evolving with spine surgery. Endoscopy of the spine is still in experimental stages and is not yet widely used. It might eventually give doctors a way to remove a disc with even less risk of injury than microdiscectomy.

A laminotomy of the spine is used to treat the following conditions:
This surgical procedure is carried out in two steps beginning with the laminotomy. Once this is accomplished, the second procedure, the micro discectomy, is performed. A high powered stereoscopic microscope is used to provide illumination and magnification to allow the nerve and surrounding structures to be visualized clearly through an incision less than one inch long. The nerve root is carefully protected with a specialized retractor, and protruding disc fragments, along with any remaining loose or degenerated disc material, are then removed with a small grasping device.


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MedWorld India offer free, no obligation assistance to international patients to find world class medical treatment in India. A large number of people from all over the world are now traveling to India for top class medical treatment like Heart Surgery, Cancer Care, Spinal fusion surgery in India, sleeve gastrectomy surgery in India, and other major surgeries. India offers an unmatched cost and quality advantages because it has world class hospitals and globally trained and experienced surgeons across every specialty. Whether you are considering cervical disk replacement surgery, brain tumor surgery in India, heart valve replacement surgery, or prostate cancer treatment in India, we offer support and services to facilitate the care you require. We can help you find the best heart hospital in India, IVF hospital in India, or best cancer hospital in India.

The First step is to email your Medical Reports to us for an opinion from leading doctors in India. We will send you an expert medical opinion and estimate for the cost of your treatment from at least three leading hospitals in India. Once you decide, we help you schedule appointments, apply for a medical Visa and make the arrangements for your stay.

MedWorld India has a team of dedicated doctors who personally attend to all your queries. We are the only facilitators that appoint a personal doctor to the patient from the time of enquiry till the time the patient fully recovers. Your personal doctor will stay in constant contact with you, your local doctor and your medical team in India throughout your stay, and will relay information back to your loved ones. From initial registration of interest, to returning the patient back to his or her home country after the procedure and recuperation, MedWorld India will ensure the whole process is as smooth and stress-free as possible for its patients. We believe that timely, affordable and quality medical treatment is every human beings right. We are dedicated to this cause and strive to deliver the benefit and pleasure of medical care to people across the globe.

Our mission at MedWorld India is simple. We want to help you to safely and successfully receive your medical procedure(s) at a world-class healthcare facility for a fraction of the cost elsewhere.


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Friday 14 February 2014

Kyphoplasty at Best Spine Surgery Hospitals in India

If you have been diagnosed with a spinal fracture caused by osteoporosis, cancer or benign tumors, balloon kyphoplasty is a treatment option you may want to consider. Balloon kyphoplasty is a minimally invasive procedure that can significantly reduce back pain and repair the broken bone of a spinal fracture. The procedure is called balloon kyphoplasty because orthopaedic balloons are used to lift the fractured bone and return it to the correct position. 

Before the procedure, you will have a medical exam and undergo diagnostic studies such as X-rays, to determine the precise location of the fracture. Balloon kyphoplasty can be done under local or general anesthesia—your physician will decide which option is appropriate for you. Balloon kyphoplasty takes about one hour per fracture treated. It can be done on an inpatient or outpatient basis, depending on medical necessity. After the procedure, you will likely be transferred to the Recovery Room for about an hour for observation. The aim of Kyphoplasty is to reduce the pain of fractured vertebra, to reinforce the weakened bone and to restore normal vertebral height.

When is Kyphoplasty recommended ?

Kyphoplasty is done on patients who experience painful symptoms or spinal deformities due to vertebral compression fractures resulting from osteoporosis. Kyphoplasty is also performed on patients who:
  • Are aged or are in poor health to tolerate open spinal surgery.
  • Have too frail bones for surgical spinal repair
  • Have a vertebral damage due to a cancerous tumor
  • Are younger and have osteoporosis caused by a long-term steroid management or a metabolic disorder

Limitations in the traditional treatments of vertebral compression fractures have led to the refinement of such procedures as kyphoplasty. This procedure provide new options for compression fractures and are designed to relieve pain, reduce and stabilize fractures, reduce spinal deformity, and stop the "downward spiral" of untreated osteoporosis.

Additional benefits of kyphoplasty include  :
  • Short surgical time
  • Only general or local anesthesia required
  • Average hospital stay is one day (or less)
  • Patients can quickly return to the normal activities of daily living
  • No bracing required
Kyphoplasty utilize a cement-like material that is injected directly into the fractured bone. This stabilizes the fracture and provides immediate pain relief, in many cases. Kyphoplasty has the additional advantage of being able to restore height to the spine, thus reducing deformity. After either procedure, most patients quickly return to their normal daily activities.

  • Dedicated team of International trained and vastly experienced Spine Surgeons, Rheumatologists, Neurologist, Physicians and Physiotherapist.
  • Latest Generation Diagnostic and Imaging facilities including dynamic digital X rays, Spiral CT scanning , MRI and Electrophysiology unit all under one roof.
  • Use of most advanced Surgical techniques for treatment of spinal ailments with focus on Minimal Access Micro Endoscopic spine surgeries, Functional spine preservation techniques and Spinal Arthroplasty for all( disc diseases) as well as instrumentation. Minimally Invasive Surgery ensures quicker recovery and return to active life.
  • Physiotherapy and Rehabilitation by experts after the surgery help you regain functional abilities quickly helping in vastly improved overall results.

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Wednesday 12 February 2014

Computer Guided Techniques in Spine Surgery - Cervical Disc Replacement Surgery in India

Cervical discectomy is surgery to remove one or more discs from the neck. The disc is the pad that separates the neck vertebrae; ectomy means to take out. Usually a discectomy is combined with a fusion of the two vertebrae that are separated by the disc. In some cases, this procedure is done without a fusion. A cervical discectomy without a fusion may be suggested for younger patients between 20 and 45 years old who have symptoms due to a herniated disc.




  • Anterior Approach: The patient is made to lie down on his back under general anesthesia. A horizontal incision is made just 2 inches above the clavicle on either left or right side. The thin muscle layer is cut and the trachea and esophagus are shifted to one side along with the nerves and vessels. 
    The surgeon has a clear view of the cervical vertebrae. An X-ray is done to confirm the involved disc. An operating microscope can also be used to get a better picture of the operating field. The anterior longitudinal ligament is gently removed to reach the osteophytes and the disc fragments. The osteophytes are scraped off and the intervertebral disc is dissected.Once the disc is removed the vertebral bodies are gently distracted to their original distance to fill the space with bone graft. This helps to relieve the compression from the nerves as the diameter of the intervertebral foramen is enlarged. Sometimes cervical discectomy is followed by spinal stabilization using screws and plates

  • Posterior Approach: The patient is sedated under general anaesthesia and made to lie on his abdomen. The neck is slightly bent and head is supported on the head rest. An incision is made on the back of the neck in the midline. The skin, fascia and muscles are retraced to reach the vertebrae. An X-ray is done to confirm the level of affected disc.

    Edges of the lamina are shaved off to give a clearer vision. Incase of central herniation, both lamina may have to be removed in order to get full view of the fragmented disc. The posterior longitudinal ligament is incised and a small hole is made in the ligamentum flavum. The surgeon now uses a surgical microscope to magnify the operating area and the disc fragments and bony spurs are carefully removed. The muscles fascia and skin are stitched
Minimally invasive cervical disc replacement surgery entails inserting an artificial cervical disc between two cervical vertebrae after the inter- vertebral disc has been surgically removed in the process of decompressing the spinal cord or a nerve root. The intent of the device is to preserve motion at the disc space. It is an alternative to the use of bone grafts, plates and screws in pursuit of a fusion following procedures such a disc removal, which necessarily eliminates motion at the operated disc space in the neck.

Cervical disc replacement surgery is most typically done for patients with cervical disc herniations that have not responded to non-surgical treatment options and are significantly affecting the individuals' quality of life and ability to function.

The advantages of Minimally invasive cervical disc replacement surgery :
  • Maintaining normal neck motion
  • Reducing degeneration of adjacent segments of the cervical spine
  • Eliminating the need for a bone graft
  • Early postoperative neck motion
  • Faster return to normal activity
  • Postoperative neck braces are not required for disc replacement operations.
Our network hospitals have the most advanced spine surgery facilities. The spine surgeons here use minimally invasive and computer guided techniques in spine surgery. In a Minimally Invasive spine surgery the surgeon makes a few small incisions unlike the open surgery where a single large incision is made. Minimally Invasive spine surgery has several important benefits for the patients. If you have been advised spine surgery your first choice should be the latest minimally invasive technique developed by our world best hospitals in India. Most advanced Technology like Intra Operative MRI, Brain Suite and Computer Assisted Navigation System are deployed by highly trained surgeons for accurate and safe Spine Surgeries through a small incision.

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Saturday 8 February 2014

Spinal Fusion Surgery in India at World Best Hospitals

Hospitals in India have established an international reputation for spinal fusion surgery. The hospital provides the very highest standards of clinical skills and nursing care in a comfortable relaxing setting. India has developed as a medical hub for the patients coming from other countries like the U S, Europe, the Middle East and more. India is one of the best destinations for medical treatment because of its world-class standards of medical care, highly trained surgeons and undeniably diverse tourist attractions. Health access international offers a premium service for patients wishing to benefit from the high quality of Indian medical services. Patients gain access to Indian medical expertise, superior healthcare, and the latest medical technology.

What is spinal fusion surgery?

If the cause of your back pain seems to be motion between segments of your vertebrae, spinal fusion may be a way to prevent motion and stop the pain. Spinal fusion surgery, also known as spondylodesis or spondylosyndesis, is a surgical technique used to combine two or more vertebrae. Spinal fusion is surgery to fuse spine bones (vertebrae) that cause you to have back problems. Fusing means two bones are permanently placed together so there is no longer movement between them.  Supplementary bone tissue either autograft or allograft is used in conjunction with the body's natural osteoblastic processes. This procedure is used primarily to eliminate the pain caused by abnormal motion of the vertebrae by immobilizing the vertebrae themselves.

Conditions where spinal fusion surgery is used:

Spinal fusion is done most commonly in the lumbar region of the spine, but it is also used to treat cervical and thoracic problems.
Conditions for which spinal fusion is most commonly done:
  • degenerative disc disease
  • discogenic pain
  • spinal tumor
  • vertebral fracture
  • scoliosis
  • spondylolisthesis
  • spondylosis
  • other degenerative spinal conditions
  • any condition that causes instability of the spine

 

Types of spinal fusion:

There are two main types of spinal fusion, which may be used in conjunction with each other:

Posterolateral fusion places the bone graft between the transverse processes in the back of the spine. These vertebrae are then fixed in place with screws and/or wire through the pedicles of each vertebrae attaching to a metal rod on each side of the vertebrae.
Interbody fusion places the bone graft between the vertebrae in the area usually occupied by the intervertebral disc. In preparation for the spinal fusion, the disc is removed entirely. The fusion then occurs between the endplates of the vertebrae. This procedure may be done through the abdomen (Anterior Lumbar Interbody Fusion or ALIF) or through the back (Posterior Lumbar Interbody Fusion or PLIF).
Using both types of fusion in conjunction yields the highest chances of successful fusion. This is known as 360-degree fusion.

Spinal fusion Surgery procedure:
Spinal fusion surgery requires general anesthesia. The procedure may take from two to 12 hours, depending on how extensive the surgery is and the technique your surgeon uses. Surgery may involve a large incision, or may be done using newer techniques with smaller incisions. To fuse the spine doctor needs small pieces of extra bone to fill the space between two vertebrae. This bone may come from your own body (autogenous bone), usually from a pelvic bone. Or, it may come from another person (allograft bone) by way of a bone bank. If the front of spine is fused, the disk is removed first. Bone graft substitutes, such as genetically engineered proteins, are being developed as alternatives to using bones from body or a bone bank. Sometimes, doctors also use wires, rods, screws, metal cages or plates.
Benefits of Spinal Fusion Surgery:
Any procedures done to reduce pain and improve mobility in patients are a benefit. Undergoing a spinal fusion might decrease pain in the back and legs, as well as reduce spine curvatures like scoliosis. Spinal fusion procedures are often recommended to those who suffer from severe back pain due to slippage of bones, causing misalignment. Other ailments a spine fusion might help improve are recurrent disc herniation, traumatic injury to the spine and fractures.
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Friday 7 February 2014

Questions and Answers about Scoliosis in Children - Treatment Options for Scoliosis

Scoliosis is a condition in which the spine—in addition to the normal front to back curvature—has an abnormal side-to-side “S-” or “C”-shaped curvature. The spine is also rotated or twisted, pulling the ribs along with it to form a multidimensional curve.

Three to five children out of every 1,000 develop spinal curves that are considered large enough to require treatment. Idiopathic scoliosis does tend to run in families, although no one genetic link has been confirmed.



Scoliosis occurs, and is treated, as three main types:
  • idiopathic scoliosis: the most common form, with no definite cause, mainly affecting adolescent girls, but existing in three age groups:
    • adolescent idiopathic scoliosis
    • juvenile idiopathic scoliosis
    • infantile (early-onset) idiopathic scoliosis
       
  • neuromuscular scoliosis: associated with a neuromuscular condition such as cerebral palsy, myopathy or spina bifida
     
  • congenital scoliosis: present at birth, caused by a failure of the vertebrae to form normally—the least common form
In general, curves measuring 25 to 50 degrees are considered large enough to require treatment. Curves greater than 50 degrees will likely need surgery to restore normal posture.

What will make the spine go back to being straight again?

A scoliosis curve will not get straight on its own. Bracing will help it from getting worse. Surgery — a spinal fusion — is the only thing that will straighten out the spine, but it will not make it completely straight.

What happens if my child has just a slight curve?

Children who have mild curves (less than 20 degrees) or who are already full grown, will be monitored to make sure the curve is not getting worse. Your doctor will check your child's spine every 6 months and schedule follow-up x-rays about once a year.

Will having so many x-rays cause future health problems?

X-rays are necessary to follow the progression of the curve. There can be small negative effects with frequent x-rays, but these effects are minimized by using protective shields over certain body parts to protect the child from unnecessary exposure.

What happens if no treatment is done? Will the curve get worse?

Two factors can strongly predict whether a scoliosis curve will get worse: young age and a larger curve at the time of diagnosis. Children younger than 10 years with curves greater than about 35 degrees tend to get worse without treatment.
Once someone is done growing, it is very rare for a curve to progress rapidly. We know from studies that once someone is fully grown, scoliosis less than 30 degrees tends not to get worse, while those curves greater than 50 degrees can get worse over time, by about 1 to 1 1/2 degrees per year.


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Spinal Anatomy for Low Back pain and Neck Pain- Spine Treatment in India

The spinalcolumn is one of the most vital parts of the human body, supporting our trunks and making all of our movements possible. When the spine is injured and its function is impaired the consequences can be painful and even disabling.

The spine has three major components:
• The spinal column (i.e., bones and discs)
• Neural elements (i.e., the spinal cord and nerve roots)
• Supporting structures (e.g., muscles and ligaments)

 The spinal column consists of:
• Seven cervical vertebrae (C1–C7) i.e. neck
• Twelve thoracic vertebrae (T1–T12) i.e. upper back
• Five lumbar vertebrae (L1–L5) i.e. lower back
• Five bones (that are joined or "fused," together in adults) to form the bony sacrum

Spinal anatomy is a remarkably intricate structure of strong bones, flexible ligaments and tendons, extensive muscles and highly sensitive nerves and nerve roots. Without question, the composition and function of the spine is a marvel of nature, providing us with a unique combination of:
  • Structure to allow us to stand upright and move with precision
  • Protection for the spinal cord and nerve roots to safely relay messages to and from the brain and the rest of the body
  • Shock absorption accepts jolts and stress as we move about
  • Flexibility, especially in the lower and upper spine, allowing us to bend and twist in a full variety of movements
  • Strength provided by the bones, discs, joints and supportive muscles and connective tissue
Once back pain starts, however, the many benefits of this intricate anatomical construct can quickly be lost. Here are the basics of anatomical causes of spine pain:

Neck pain

The cervical spine (neck) supports the weight of your head and protects the nerves that come from your brain to the rest of the body. This section of the spine has seven vertebral bodies (bones) that get smaller – and provide more rotation - as they get closer to the base of the skull.
Most episodes of acute neck pain are due to a muscle, ligament or tendon strain, which is usually caused by a sudden force (e.g. whiplash) or from straining the neck (e.g. sleeping in the wrong position).

Upper backpain

The 12 vertebral bodies in the upper back that are attached to the rib cage make up the thoracic spine (middle or upper back) are firmly attached to the rib cage at each level, providing a great deal of stability and structural support, protecting the heart, lungs and other important organs within the chest.
Because there is little motion in the upper spine, it is rare to have pain caused by a herniated or degenerated thoracic disc. More common causes of upper back pain include irritation of the large back muscles and shoulder or joint dysfunction.

Lower back pain

Because the lower back carries the most load with the least structural support, it is the most likely to wear down or suffer injury.
Most episodes of lower back pain are caused by muscle strain. Even though this doesn't sound like a serious injury, the pain can be severe. Strong abdominal muscles and back muscles are important to provide support for this area of the spine and avoid injury.

Pain at the bottom of the spine

The iliac bones are part of the pelvis, and the sacrum is connected to this part of the pelvis by the sacroiliac joints. Pain can occur in the sacroiliac joints (where the sacrum connects to the pelvis), called sacroiliac joint dysfunction, and in the coccyx (tailbone), called coccydynia. Both of these conditions are more common in women than men.
The spine is an anatomically complicated structure. Knowing the basics can help you have a more meaningful discussion with your spine care provider.


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