Causes of Pain in the Lumbar Spine (lower back problem) - Spine Best Hospital in India

Have you ever asked, "Why do so many people suffer from low back pain?" The answer involves a brief overview of the lumbar spine. Although the entire spine is involved in everyday activities of rest and movement, the low back can be vulnerable to many pain-provoking disorders. Simple sprains and strains from overexertion, a herniated disc from a slip and fall, degenerative disc disease or spinal stenosis from normal aging, and other disorders can cause low back pain.

To help you understand back pain, the following brief and illustrated anatomy lesson is provided. 

What Is the Lumbar Spine?

The lumbar spine (low back) is the third major region of the spine; it is below the cervical spine and thoracic spine. Most people have five bones (vertebrae) in the lumbar spine, although it is not unusual to have six. Each vertebra is stacked on top of the other and between each vertebra is a gel-like cushion called an intervertebral disc. The discs help to absorb pressure, distribute stress, and keep the vertebrae from grinding against each other.

Ligaments and Tendons: Connective Lumbar Spine Soft Tissues

The vertebrae and discs are held together by groups of ligaments . Ligaments connect bone to bone, whereas tendons connect muscle to bone. In the spine, tendons connect muscles to the vertebrae. The ligaments and tendons help to stabilize the spine and guard against excessive movement in any one direction.

Lumbar Spine Joints

The spine also has joints that are similar to knees, elbows, and other joints. The spinal joints are called facet joints 

The facet joints have been described as finger-like, and they link the vertebrae together. The facet joints are located at the posterior area of the spinal column (on the back side of the spinal column).

In addition, the facet joints help to make the spine flexible and enable you to bend forward, backward, and side to side.

The lumbar spine has several distinguishing characteristics:

·         The lower the vertebra is in the spinal column, the more weight it must bear. The five vertebrae of the lumbar spine (L1-L5) are the biggest unfused vertebrae in the spinal column, enabling them to support the weight of the entire torso.

·         The lumbar spine's lowest two spinal segments, L4-L5 and L5-S1, which include the vertebrae and discs, bear the most weight and are therefore the most prone to degradation and injury.

·         The lumbar spine meets the sacrum at the lumbosacral joint (L5-S1). This joint allows for considerable rotation, so that the pelvis and hips may swing when walking and running.

·         The spinal cord travels from the base of the skull through the spinal column and ends at about T12-L1 - where the thoracic spine meets the lumbar spine. At that point numerous nerve roots from the spinal cord continue down and branch out, forming the "cauda equina," named for its resemblance to a horse's tail. These nerves extend to the lower extremities (buttocks, legs and feet). Because the spinal cord does not run through the lumbar spine, it is quite rare that a lower back problem would result in spinal cord damage or paralysis.

Lumbar Intervertebral Segment

Physicians usually explain a patient's pathology by focusing on one intervertebral segment, or spinal segment. The lumbar spine has 5 intervertebral segments, termed lumbar segment 1 through 5 (e.g. L1, L2, L3, L4, and L5).

Each lumbar spine segment is comprised of:

·         Two vertebrae, such as L4-L5, stacked vertically with an intervertebral disc between them. A healthy disc is cushiony, with a lot of water, and has a sponge-like substance. It acts like a shock absorber in the spine, allowing flexibility and providing protection from jarring movements.

·         The two adjacent vertebrae are connected in the back of the spine by two small joints called facet joints. The facet joints of the lumbar spine allow movement to bend and twist the low back in all directions.

·         There are nerves that branch off from the spinal column at each level of the spine. They pass through small holes in the back of the lower spine. They then connect together to form the sciatic nerve, which travels into the legs down the back of each thigh and into the calves and feet.

Doctors usually talk about a patient's lumbar disc problem, or nerve or other lower back problem, as the level that includes two vertebrae and the disc between them, such as L3-L4 or L4-L5. If the disc at the very bottom of the spine is affected, that segment is called the lumbosacral joint L5-S1

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Treatment of Vertebral Compression Fractures in the Spine - Benefits of Kyphoplasty

What is Kyphoplasty

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.

To confirm the presence of a compression fracture following tests needs to be done after a physical examination:

• Blood tests,
• Spine x-rays
• Radioisotope bone scan or
• MRI

How is Kyphoplasty Performed ?

Kyphoplasty is performed under local or general anesthesia. Using image guidance x-rays, two small incisions are made and a probe is placed into the vertebral space where the fracture is located. The bone is drilled and a balloon, called a bone tamp, is inserted on each side. These balloons are then inflated with contrast medium until they expand to the desired height and removed. The balloon does not remain in the patient. It simply creates a cavity for the cement and also helps expand the compressed bone. 

The spaces created by the balloons are then filled with PMMA, the same orthopaedic cement used in vertebroplasty, binding the fracture. The cement hardens quickly, providing strength and stability to the vertebra, restoring height, and relieving pain.

Recovery from kyphoplasty

Pain relief will be immediate for some patients. In others, elimination or reduction of pain is reported within two days. At home, patients can return to their normal daily activities, although strenuous exertion, such as heavy lifting, should be avoided for at least six weeks. 

Patients should see their physician to begin or review their treatment plan for osteoporosis, including medications to prevent further bone loss. 

Candidates for kyphoplasty

Kyphoplasty cannot correct an established deformity of the spine, and certain patients with osteoporosis are not candidates for this treatment. Patients experiencing painful symptoms or spinal deformities from recent osteoporotic compression fractures are likely candidates for kyphoplasty. The procedure should be completed within 8 weeks of when the fracture occurs for the highest probability of restoring height.

Benefits of Kyphoplasty

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

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Who may require Lumbar Disc Replacement Surgery ?

Whomay require Lumbar Disc Replacement Surgery 

All those individual suffering from discogenic back pain as diagnosed by a combination of clinical symptoms of back pain, and radiating leg pain and diagnostic tests supported by radiological evidence of degenerative disc disease are ideally suited for this procedure. These patients must also have undertaken conservative treatment (bed rest, traction, physical therapy, medication) for a considerable period of time with no satisfactory results. 

Details of the Surgery

Disc replacement surgery is done to stop the symptoms of degenerative disc disease. Discs wear out or degenerate as a natural part of aging and from stress and strain on the spine. Eventually, the problem disc collapses, which causes the vertebra above to sink toward the one below. This loss of disc height affects nearby structures - especially the facet joints.

When the disc collapses it no longer supports its share of the load in the spine. The facet joints of the spine begin to support more of the force that is transmitted between each vertebra. This increases the wear and tear on the articular cartilage that covers the surface of the joints. The articular cartilage is the smooth, slippery surface that covers the surface of the bone in any joint in the body. Articular cartilage is tough, but it does not tolerate abnormal pressure well for long. When damaged, articular cartilage does not have the ability to heal. This wear and tear is what is commonly referred to as arthritis.

Shrinking disc height also reduces the size of the neural foramina, the openings between each vertebral pair where the nerve roots leave the spinal column. The arthritis also results in the development of bone spurs that may protrude into these openings further narrowing the space that the nerves have to exit the spinal canal. The nerve roots can end up getting squeezed where they pass through the neural foramina.

Replacing the damaged disc with an artificial disc, or implant, called a prosthesis can restore the normal distance between the two vertebrae. The artificial disc sits between the two vertebrae and distracts or jacks up the upper vertebra. Enlarging the disc space relieves pressure on the facet joints. It also opens up the space around the spinal nerve roots where they pass through the neural foramina.

Another benefit of the artificial disc replacement is that it mimics a healthy disc. Natural motion is preserved in the spine where the new disc is implanted. And it helps maintain stability in the spinal joints above and below it.  

 

Who can benefit from this procedure?

For many years, the standard of care for chronic pain from a degenerated disc has been spinal fusion surgery. Bone graft donated by a bone bank or taken from your pelvic bone is used to fuse two or more vertebral bones together. The spine is stabilized but you will lose motion at that level. The increased stress on the next lumbar vertebra can cause problems later. 

The artificial disc replacement is used to reduce or eliminate the pain while still allowing motion. One advantage of the artificial disc is that it may also prevent premature breakdown of adjacent levels of the lumbar spine. 

You may be a good candidate for a lumbar artificial disc replacement if you have chronic pain and disability from lumbar disc degeneration despite nonoperative treatment for at least six months. The artificial disc replacement provides an alternative to spinal fusion. The device helps restore the normal space between two vertebrae. You will still have movement at the level where the ADR is implanted. 

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Most Advanced Technology for Spinal Tumor at World Best Hospitals in India

Spinal Tumor RemovalSurgery

Advanced medical technology has enabled surgeons to remove spinal tumors that were previously inaccessible due to potential damage and death caused by spinal surgery. Today, neurosurgeons are able to use laser-assisted and high-powered microscopes in a field called microsurgery. 

Using such technology, doctors are now able to distinguish between healthy and unhealthy tissue as well as to view microscopic blood vessels and nerves within the operating field. Throughout the spinal surgery procedure, doctors can test the function of nerves using electrodes that helps to prevent nerve damage. Advancements in spinal surgery technologies also employ the use of sound waves that effectively disintegrate tumors. Special suctioning tools remove the fragments.

Surgery : - This is often the first step in treating tumors that can be removed with an acceptable risk of nerve damage. 

Newer techniques and instruments allow neurosurgeons to reach tumors that were once inaccessible. The high-powered microscopes used in microsurgery make it easier to distinguish tumors from healthy tissue. Doctors also can test different nerves during surgery with electrodes, thus minimizing nerve damage. In some instances, they may use sound waves to break up tumors and remove the remaining fragments. 

Even with advances in treatment, not all tumors can be removed completely. Surgical removal is the best option for many intramedullary and intradural-extramedullary tumors, yet large ependymomas at the end of the spine may be impossible to extricate from the many nerves in this area. Although noncancerous tumors in the vertebrae can usually be completely removed, metastatic tumors are less likely to be operable. When a tumor has spread to the spine, radiation alone is usually the treatment of choice. 

However, research has found that surgery combined with radiation may be more effective at preventing loss of nerve function in people who are healthy enough to tolerate an operation and who have tumors that have spread from an unknown location, have some evidence of nerve injury, have tumors resistant to radiation or have recurrent tumors that were previously irradiated. 

Recovery from spinal surgery may take weeks or months, depending on the procedure, and you may experience a temporary loss of sensation or other complications, including bleeding and damage to nerve tissue.

Recovery post SpinalTumor Surgery

Recovery post Spinal Tumor surgery depends on patient’s health before surgery. The patient’s care is monitored by periodical office visits and re-evaluation by the treating physician. This is important because some tumors, benign or malignant, may reoccur. Usually when the treatment period has ended, the symptoms clear up. Analgesics are given to control post-operative pain and cancer pain. Cancer pain may be difficult to control (e.g. ‘break through pain’). A pain management specialist may provide assistance if conventional drugs (e.g. pill, skin patch) do not provide relief. 

Any surgery, radiation treatment or chemotherapy can drain the patient nutritionally. Therefore, a proper diet is important to regain strength, lost weight, and a measure of health. A professional nutritionist can provide guidance. Depending on the extent of the surgery and the patient’s medical status, a course of physical therapy may be prescribed. Through exercise and modalities the patient can build strength, endurance and flexibility.

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.

Why should you choose to get Indian hospitals offer the best spinal surgery treatment in India at affordable prices. MedWorld india associated best spine surgery hospitals in India have the latest technology and infrastructure to offer the most advanced spine surgery at low cost.

Salient features of these Hospitals are:

• Comprehensive management of spine disorder from birth defects to degeneration of tumor and trauma.
• Dedicated team of International trained and vastly experienced Spine Surgeons, Rheumatologists, Neurologist, Physicians and Physiotherapist.
• Expert evaluation of spinal problems by dedicated team of 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.
• Physiotherapy and Rehabilitation by experts after the surgery help you regain functional abilities quickly helping in vastly improved overall results.

Advanced Minimally Invasive Treatment at World Class Hospital in India - Spinal Fusion Surgery in India

Medical professionals in India have recently given a new hope of life to all those patients suffering from chronic lower back pain  and who have not responded to physical therapy or  medical intervention. Most low back pain can be effectively managed with a variety of helpful interventions. Like Physical therapy, weight loss, smoking cessation and  medication  injections.

In case the above treatments do not work, the  best long-term outcome could be achieved with a Lumbar Fusion.

Doctors at MedWorld India affiliated Hospitals in India have expertise and vast experience in performing  Spinal Fusion - an Advanced minimally invasive surgery  is designed to stop the motion at a painful vertebral segment, which in turn should decrease pain generated from the joint. A severely degenerated disc between two vertebral bones or to a "slippage" of the spine bones (which is referred to as "spondylolisthesis"). Slippage of the bones results in misalignment of the spine and possible entrapment of the spinal nerves.

There are many approaches to lumbar spinal fusion surgery, and all involve adding bone graft to an area of the spine to set up a biological response that causes the bone graft to grow between the two vertebral elements and create a fusion, thereby stopping the motion at that segment. Other circumstances exist in which a fusion may best treat the source of back and leg pain. A lumbar fusion may be recommended for diagnoses such as a recurrent disc herniation, scoliosis or curvature of the spine, or for a traumatic injury of the spine such as a fracture. All of these different conditions can cause back and leg pain.

The procedure is performed in an advanced surgical center with Intra-operative MRI  guidance. The patient is monitored with an electrocardiogram, blood pressure cuff and blood oxygen-monitoring device.

Medical evaluation includes a physical exam. Diagnostic tests such as MRI (magnetic resonance imaging), steroid injection or discography may be conducted to diagnose and locate the symptomatic disc herniation and determine if the procedure is appropriate.

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