Treatment of Spondylolisthesis Available in India

Spondylo means "vertebra" and listhesis means "to slip". Spondylolisthesis is when one vertebra slips forward over the vertebra below it. Most often, that happens in the low back (lumbar spine) because that part of your spine bears a lot of weight and absorbs a lot of directional pressures.

NON SURGICAL TREATMENT :

Initial treatment for spondylolysis is always nonsurgical. Non surgical treatment includes -
Anti-inflammatory medications : Such as ibuprofen, may help reduce back pain.
Back brace and Physical Therapy

Periodic X-rays will show whether the vertebra is changing position.

SURGICAL TREATMENT :

Surgery may be needed if slippage progressively worsens or if back pain does not respond to nonsurgical treatment and begins to interfere with activities of daily living. A spinal fusion is performed between the lumbar vertebra and the sacrum. Sometimes, an internal brace of screws and rods is used to hold together the vertebra as the fusion heals.

Nerve compression, Damage of Spinal Nerve roots, Chronic back pain these are some complications may causes in spondylothesis.

Conservative therapy for mild spondylolisthesis is successful in about 80% of cases. When necessary, surgery produces satisfactory results in 85 - 90% of people with severe, painful spondylolisthesis.

There are dedicated specialized Spinal ( JCI Accreditaed ) Hospitals in India, like Indraprastha Apollo Hospital - New Delhi, Apollo Hospitals - Chennai, Manipal Hospital, wockhardt Hospital - Mumbai, MOIT Hospital - Chennai etc.

The Hospitals is best in the world in terms of
o State of the art diagnostics.
o World class operating theaters & Intensive care unit.
o Highly Qualified & experience doctors & surgeons may be trained abroad.
o English speaking highly trained paramedical staff

How to Have a Safe Recovery From Spinal Fusion Surgery

Back pain might make someone extremely uncomfortable and it can cause intense pain at times. A doctor might have even added extra stress when they recommended the patient for spinal fusion surgery. Although the doctor may have chosen this procedure over other forms of treatments, the patient can feel like they should have tried more medication and physical treatment rather than impose spinal fusion surgery. However, if the operation is needed, it can provide a quicker fix than some other treatments. Once the surgery has taken place, there needs to be some things that are followed to ensure a safe and speedy recovery.

After the surgery, the patient is required to follow the doctor's advice to the utmost. This can be enhanced through acute listening to the doctor on pain management strategies. Though this seems an obvious tip, it is often forgotten. The doctor will clearly indicate the dos and don'ts after the operation together with a recommendation of a physiotherapy course. The major challenge is actually never on listening to the doctors but rather on following their instructions and guidelines. The advice is meant for the patient's health so it is necessary to follow it straight away and do as directed.

Keeping good communication with the doctor is also vital after the surgery. Spinal fusion surgery is actually associated with various complications hence the need to handle it with ultimate care and attention. In case of any problems, the patient should contact the doctor immediately to allow for diagnosis that will enable the problem to be fixed as soon as possible. In case there is no change in the continuing pain, the patient should discuss it with their doctor to try to come up with some new solutions.

Away from the doctor's requirements, there are many things that the patient can do personally to improve the healing process. All this starts with positive thinking. This, though sounding funny is actually crucial during the recovery. If someone is always thinking that they will never recover, then it is going to be true in real life. It is best for the individual to always come up with ways that they can use to mentally influence and aid their recovery.

Before the spinal fusion surgery, the patient needs to prepare them self for it. They need to bear in mind that the surgery will cause changes in many of their daily activities. The preparation entails having enough food in the freezer such that it may not strain the back while cooking worsening the condition. Properly arranging the house in a suitable manner will help the patient's entry and exit without any problem. It is important to make all the arrangements right before the spinal fusion surgery.

The patient should also exercise routinely as recommended by a qualified therapist. This will enable the individual to gain strength in their back while struggling with the physical limits. It's best to start the exercises as soon as possible. All these strategies should be completed by taking a good rest. This though does not mean staying in bed all day and night.

All in all, it is important for a patient to have a safe recovery from spinal fusion surgery to make sure that they can have a comfortable lifestyle afterwards. This means that the patient should follow their doctor's advice but they should also make a personal effort to carry out what is needed to make sure the recovery is successful.

Symptoms of Lumbar Spinal Stenosis

Lumbar spinal stenosis describes the narrowing of the spinal canal in the lower back (or the lumbar segment of the vertebral column). Someone can develop lumbar spinal stenosis for a variety of reasons, the most common are a previous back injury or just a result from the natural process of aging.

Regardless of the reasons of why lumbar spinal stenosis develops, the symptoms are caused by an abnormal protrusion of muscle tissue or bone, which compress the nerve roots in the lower back. In more severe cases of lumbar spinal stenosis, the spinal cord itself is compressed causing extreme pain and possible paralysis.

There are many common symptoms of lumbar spinal canal stenosis. These symptoms include numbness, cramping, pain or weakness in one or both feet, the legs or the buttocks. Usually, these symptoms will become more pronounced with walking, standing straight or leaning backward. These symptoms will become less noticeable may become less noticeable when sitting down or leaning forward.

Stiffness or tightness in the muscles of the legs can be another symptom. Muscle stiffness is often present in lumbar spinal stenosis patients due to the constant irritation of the nerves that lead to the legs. This irritation causes the nerves to fire constantly, which can cause the leg muscles to spasm and stiffen.

The loss of bladder and bowel control and the incomplete emptying of the bladder is another set of symptoms due to the partial or near-total disruption of the nerves in and around the lower back that are responsible for the regulation of bladder and bowel function. In the most severe cases of lumbar spinal stenosis, nerve function can be lost to the extent that control of the bladder and rectal muscles may be completely compromised.

Obviously, lumbar spinal stenosis will result in back pain. However, the pain may range from almost unnoticeable to a constant, severe pain. When the pain is present, it will feel as if it is radiating from the patient's lower back into the hips and legs. The patient will usually be able to point to specific region on the lower back where their pain seems to be the most severe.

After considering the patient's medical history and the patient's description of symptoms, a spinal doctor will usually order diagnostic testing. Confirming that a patient is suffering from lumbar spinal stenosis usually will require imaging tests, such as Computed Tomography (CT) scans or x-rays of the lumbar region. MRI technologies have been invaluable in cases of spinal stenosis due to their high sensitivity in detecting small changes in the anatomy of the lower back.

Lumbar spinal canal stenosis often is the result of other injuries to the lower back as well as changes in anatomy and function of the spine taking place as part of the natural process of growing old. A complete and conclusive diagnosis should be entrusted to your doctor.

Back Surgery and Its Different Types

Are you suffering from severe back pain that hasn't relieved through non-surgical treatments such as physical therapy, medications and steroid injections? If other remedies have failed to provide relief from long-term chronic backache then surgery may be the only option for you.

However, the surgery cannot be considered as an initial treatment for back pain. In most cases, backache tends to be temporary and can be managed by using non-surgical approaches and self-care. Exercise, physical therapy, and acupuncture are usually successful in treating back and neck pain.

Unfortunately, there is no option left for chronic pain sufferers other than going under the knife.

Back surgery is usually recommended to only a small percentage of cases. In particular, surgical treatment for back may be recommended if a person has severe back pain caused by wear and tear; or pain that continues to worsen despite other treatments; has back instability from injury; has acute arm or leg pain caused by nerve compression in the spine; or has nerve problems.

Back Surgery Options

There are several different types of back surgery. The type you choose depends on your back condition.

Discectomy: Also called open discectomy it is the most common surgical treatment for a ruptured or herniated disc in the spinal canal causing the pressure on the nerve. In this type of procedure, a surgeon removes one or more of your affected discs through a small cut over the center of your back. This relieves the pressure on the nerves.

Spinal Disc Replacement: This procedure is relatively new and is still not widely used by the surgeons. Spinal disc replacement aims to restore disc height and relieve painful movement between two vertebrae. While performing a spine replacement, your surgeon will remove the degenerated or injured discs and replace them with artificial ones.

Laminectomy: This procedure involves the removal of parts of the bone, bone spurs, or ligaments overlying the spinal canal. In a laminectomy, a surgeon cut opens the back and removes or disrupts the lamina, a plate along the vertebra that covers the spinal canal, in order to enlarge the spinal canal to allow more space for the nerves to pass. This relieves nerve pressure caused by spinal stenosis.

Foraminotomy: While performing this operation, your surgeon will carry out a keyhole procedure to widen your foramina- the bony holes through which nerve roots exit the spine. This expanded space reduces pressure on your spinal nerves caused by the inter-vertebral foramen, thereby relieving pain.

Vertebroplasty: During this procedure, your surgeon will first make a small cut on your back. Then, using X-rays as guidance, he/she will slowly inject cement-like mixture into your compressed vertebrae to stabilize the spine and relieve pain.

In a similar surgical procedure, called kyphoplasty, a balloon-like device is inserted in an attempt to widen the compressed vertebrae before injecting the bone cement.

Spinal Fusion: Also known as spondylodesis, spinal fusion is the most common surgery for chronic back pain. This operation is aimed at treating broken spinal bones (vertebrae) and increasing the strength of the spine by fusing two or more vertebrae together.

In a spinal fusion, a surgeon joins two or more spinal bones together using metal hardware, including a bone graft, and special metal scaffolding made of rods, screws or plates.

A spinal fusion is typically done to treat spondylolisthesis (unstable spine), or spinal weakness or instability.

The Lumbar Multifidus Muscle & Chronic Low Back Pain

It is well known that within the general population, 60-80% of individuals will experience an episode of low back pain (LBP) during their lifetime, with many experiencing more than one episode.

Spinal stabilization therapy has become very popular for treating LBP, and appears to be more effective over time than minimal intervention and exercise therapy alone. It has also been observed to reduce pain and disability associated with low back pain, as well as medication use and recurrence rates. Increasing our understanding of the mechanics of the low back - specifically with respect to the ability to stabilize the spinal "Neutral Zone" - was critical to the development of this exercise approach. From a rehabilitation and exercise perspective, our focus has shifted to strengthening and reactivating the stabilizing muscles of the spine, while encouraging proper motor control and "grooving" proper movement patterns. The lumbar mutifidus muscle(s) play a key role in stabilizing the spine. Therefore, neuromuscular training directed at 'neutral zone' stabilization is thought to impact these muscles and the outcome of LBP, disability, recurrence and prevention.

To quickly review, the "Neutral Zone", originally proposed by Panjabi, is defined as the part of the range of intervertebral motion, measured from the neutral position, in which spinal motion can occur with minimal non-muscular, passive resistance from spinal structures.

Lumbar multifidus muscles (LMM) are important stabilizers of this neutral zone, and dysfunction in these muscles is consistently associated with low back pain in existing studies. This dysfunction may be the result of reflexive inhibition from the spine leading to atrophic changes in the LMM musculature and fatty replacement that can be visualized on MRI.

This article discusses the role of LMM in recurrent (chronic) low back pain and reviews several literature-based approaches pertaining to the assessment and treatment of LMM dysfunction. The "Additional References" section below can serve as a resource for those interested in more information on this topic.

Multifidus Function:

• Multifidus are important stabilizers of the lumbar region, and account for more than two-thirds of the stiffness in the spine when it is in the neutral position.

• LMM is divided into deep in superficial fibers: the deep fibers span 2 segments and are tonically innervated; while superficial fibers span 3-5 levels and function physically. This anatomical architecture makes it suitable mechanically as well as anatomically for optimal stabilization.

Multifidus Atrophy and Low Back Pain:

• The pathological process that involves the LMM and can accompany LBP closely includes LMM atrophy and replacement of this muscle with fat (this can also occur after low back surgery). This is typically classified as: none, slight and severe in imaging studies. Such changes have been demonstrated in adults with LBP, and do not appear to be correlated with Body Mass Index.

• "Dorsal ramus syndrome" (low back pain with referred leg pain) produced by the irritation of structures supplied by the dorsal ramus (i.e. facet joints and LMM) might very well explain atrophic changes observed in the LMM after injury. In turn, abnormalities of the LMM might explain referred leg pain in the absence of other MRI abnormalities such as obvious disc or neural compromise.

• Advanced imaging (MRI) of the lumbar multifidus can measure atrophy and fatty replacement with good inter-observer reliability.

Multifidus Atrophy and Reflexive Inhibition:

• LMM is divided into five distinct myotomes, each innervated by a single spinal segment - medial branch of the dorsal ramus - which also innervates the zygapophyseal joints. The shared innervation suggests that nociceptive input from the facet joints could result in reflexive inhibition and subsequent atrophy of the LMM at the same level.

• LMM atrophy seen in the human spine as a result of reflexive inhibition is caused by afferent feedback from the zygapophyseal joint. This in turn impedes the voluntary activation of the LMM. The inhibitory response might explain (at least in part) the efficacy of manual approaches such as manipulation and mobilization directed at the facet joints.

• In animal models, rapid onset of LMM atrophy can occur within as little as three days after experimentally induced nerve root injury.

• LMM atrophy tends to be local in studies comparing multifidus size and symmetry between chronic low back patients and healthy asymptomatic subjects.

• LMM atrophy is typically associated with reduction in the ability to voluntary contract the muscles.

• There is also evidence to suggest that those with LBP and LMM atrophy demonstrate a significantly decreased ability to perform isometric contractions of the multifidus muscle.

Clinical Application & Conclusions: Multifidus Atrophy - Treatment:

• In one study a randomized group of patients were allocated into three programs: i) stabilization training, ii) stabilization training combined with dynamic resistance, and iii) stabilization training with dynamic-static resistance. CT scan was used to monitor LMM development over 10 weeks of training. Conclusions indicated that concentric and eccentric contraction phases were critical to induce LMM re-growth.

• Exercise specifically designed to increase the ability to contract LMM improves functions and reduces LBP disability.

In general, the research supports the concept that the LMM are critical stabilizers for the lumbar spine neutral zone, and that atrophy in these muscles is strongly correlated with low back pain & dysfunction. It has been suggested that the atrophy perpetuates an inhibitory feedback loop that begins with pain in the spine and can be associated with additional areas sharing the same segmental innervations (i.e. from the dorsal rami of the spinal nerve), which would include the intervertebral disc and facet joints. The sequela to this is mostly likely reflexive inhibition of the multifidus and fatty replacement of that musculature, subsequent weakening of the area, and insidious dysfunction and pain.

It was noted that LMM atrophy can exist in the general population, including highly active and elite athletes. This may be one reason for the high recurrence of low back pain - particularly after traumatic episodes where LMM atrophic changes occur. This would further suggest that conditioning of the LMM is an integral part of low back function - not only from a rehabilitation perspective but also as a prophylactic or preventive measure for promoting general back health...as always, GET YOUR PATIENTS EXERCISING!

Foot Drop

Foot drop is a colloquial term for a particular symptom often associated with sciatica. The condition is described as the inability to elevate the front of the foot due to actual or perceived muscular weakness, also known as a dorsiflexion deficit. In the vast majority of cases, a structural issue is blamed for the pain and often operated upon using the latest spinal surgery techniques. Unfortunately, many patients do not find relief from their sciatica and associated lower body issues due to poor treatment results, or far more commonly, misdiagnosis of the root cause of the symptoms.

Foot drop is not difficult to diagnose, since most patients will notice it for themselves. It is common for affected sufferers to have difficulty walking normally, since the front of the foot will not operate in a manner consistent with a normal gait. Patients usually shuffle along with the foot pointed straight out, or even down, and typically have difficulty in climbing stairs or moving quickly without hitting their toes. Some patients have variable degrees of a dropped foot, with the symptoms coming and going to one extent or another, predictably or unpredictably. Many other patients have total objective loss of functionality, also known as complete foot drop. These patients can not elevate the frontal foot at all, despite their best efforts.

The most common reason for foot drop to occur is a problem with the L5 spinal nerve root. This structure is located in the lower lumbar spine, right above the lumbosacral juncture. The L5 vertebral level is one of the most common locations in the spine to suffer a variety of degenerative conditions, including the universality of disc desiccation, the common incidence of herniations and the normalcy of spinal osteoarthritic change. Other less common conditions also affect this level more than other spinal areas, including spondylolisthesis, lumbar scoliosis and various degrees of hypolordosis and hyperlordosis.

The overwhelming majority of affected patients will receive diagnostic imaging of the lumbar spine, usually in the form of CT scan, or better yet, magnetic resonance imaging. The findings will almost surely show one or more of these structural degenerative conditions, since these exist in virtually the entire adult population. Regardless of the structural problem located, there is almost a 100% chance that it will be blamed for sourcing the foot drop, without any additional thought. Patients with access to truly quality care will enjoy the benefit of neurological symptom correlation, which is one of the better ways of avoiding misdiagnosis. The rest are simply often scheduled for surgery or long term conservative care with no follow up testing at all...

Foot drop can surely occur due to herniated discs and other structural concerns, such as the incidence of osteophyte growth in the lower lumbar vertebrae. However, in many cases, non-structural processes are at work which cause the drop foot to exist and the structural findings, if any, may be only contributory or even coincidental to the symptomatic expression. I see this often in patients who still have dorsiflexion deficit, despite active and sometimes surgical treatment.

A great many patients have disc or vertebral issues at L5, since these are almost a given in the human spine. However, when symptomatic correlation is performed correctly, the actual expression will usually be far too diverse and widespread to possibly be explained from single L5 nerve compression. Regardless, surgery is often performed and results are, as expected, abysmal. Objective neurological correlation would save these patients from a world of anatomical injury and pain as they waste time, money and hope pursuing treatment which is not appropriate or indicated... Similarly, simply learning more about a diagnosed condition will help a patient see the holes in the working diagnostic theory. It is for this reason that I strongly urge all patients with foot drop, sciatica or general back pain to take active roles in their own care and thoroughly research their diagnoses, treatment options and prognoses, before agreeing to any ongoing or invasive therapy plan.

Manage Scoliosis Pain Using Stretching Exercises For Your Back

One potentially painful malady known as scoliosis is where a person's spine has an unnatural curvature that often leads to soreness and additional health problems. There are many scoliosis stretching workout routines regarding the upper body that will aid to prevent any type of curvature of the back from deteriorating, remove the curvature, build up physical posture, and likewise lessen the pain. Following is are a few stretching physical activities which have long been worthwhile for people with scoliosis.

1. Shoulders Stretching - Standing up with your shoulder-width apart from each other and additionally the knees bent slightly, move just one arm over your chest on a level plane with the floor, and utilize the alternative arm to grab the area around the bicep and bring the arm closer to your chest area. Proceed to stretch out the arm to the extent that you don't feel any pain. Then change to the other side and perform the same thing on the remaining arm.

2. Chest Stretching Routine - Chest stretching exercises are carried out while you are standing with your toes approximately shoulder-width from each other and with your arms thrust out to the side parallel to the ground surface. Drag arms in a backward direction and just push shoulder blades as close together as feels good.

Bicep stretching routines actually are very similar to this, only you will need to moderately contract your knees and also as your arms will be along the side of your body, move palms in a backward direction, after which pull arms back. You will not only actually feel this particular stretching exercise within your chest but inside of the biceps area, too.

3. Shoulder and also Triceps Stretching Workout - Stand in the same position as you practiced in the shoulder stretching routine. Elevate each of your arms above your skull, and next lower each of the arms at the same moment in time down the middle of your spinal column as far down you are able to effectively go.

4. Upper Back Stretching Workout - Using this type of stretching exercise, make sure that body posture is just as upright as is possible. Interweave your fingers together and then you can push arms forward just as far away from the chest as you may reach. You will definitely feel that stretching routine in your top back, especially between your shoulder blades.

It's vital to remember these particular stretching workouts might not be advantageous in all scoliosis patients. It is essential to go to a medical professional or a physical therapist prior to attempting this type of stretching routine. It is best that you only stretch out as much as you find comfortable for you personally. A certain amount of slight discomfort is regular, though nearly anything past that may actually do you harm.

To people with scoliosis, yoga may well be an enormously rewarding routine of exercises that is made of many of these upper-body stretching workouts in addition to breathing styles that could relax muscle tissue rigidity and build up physical posture. All of these scoliosis stretching routines may be completed nearly every day and can have tremendous positive effects for a lot of individuals.