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SPINE PAIN

Back pain comprises of neck pain or cervical pain, upper back and lower back pain. The incidence is increasing mainly because of the life style, long sitting hours and hardly any time for walk and exercises. Many causes of back pain and spine degeneration can be avoided by regular exercises and posture management. Now back pain is not considered as an old age related problem as significant number of younger population is suffering from chronic low back pain or chronic neck pain.
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Spine pain

Spine pain

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Shoulder Pain

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Spine Endoscopy: Endoscopic Discectomy for slipped disc and sciatica

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FAQS

Spinal Cord Stimulator for Chronic Pains

Starting from Conservative treatment in the form of physiotherapy under qualified doctor’s order, to surgical management, many solutions are available. But the most exciting are the minimally invasive spine interventions, which gives the best solution for back pain. More than 70% of spine surgeries can be avoided now with spine interventions.

If your doctor permits, the long term solution is to go for regular walks and exercises. Depending on the type of symptoms and whether nerve compression is involved, pain specialist will prescribe medications and may suggest for some minimally invasive spine Intervention, which usually gives long term relief.

Back pain may come from Disc, facet joints which are small joints in spine, muscles around spine, bones of spine and nerves coming from spine. You pain specialist after physical examination makes a provisional diagnosis and may order MRI/ CT Scan or X ray to confirm the diagnosis.

We cannot avoid working but we can modify our lifestyle to prevent and manage our back pain. More commonly seen with prolonged sittings. We just need to stretch and get out of our chair after every 30-40 min, just a min or two to avoid constant loading on spine. B. Workouts depends on the type of back disorder. Rest is not advisable for most of the back problems. Infact, in some cases, rest aggravates the spine problem specially lower back and neck pains. C. Rest is only indicated in severe conditions like sciatica, pinched nerves, severe disc bulge, spine fractures. D. Your spine doctor or spine specialist will advise you stretching or strengthening exercises depending on the type of spine pain.

Depends on the pathology. Many minimally invasive and target specific spine interventional techniques are now available and can prevent more than 70% of spine surgeries. Surgery at times is required to prevent a permanent damage to the nerves. Severity of pain is not directly related to severity of the problem. B. Biacuplasty or cooled Radiofrequency or Annuloplasty are the proven procedures for disc repair. Vertebroplasty for spine compression fractures and metastases of spine. Endoscopic discectomy for slipped disc or disc bulge which causes sciatica and radiating leg pain.

Medications are required in acute phase to prevent you from landing into chronic pain states. Prevention is always better than cure. But once back pain develops, follow the pain and spine specialist advise on medications. B. Medicines are not dangerous. Their misuse or overuse of drugs without doctors consultation may lead to side effects. Medicines are approved for clinical use only after their research on efficacy and safety profiles.

The cost of the procedure varies from Centre to centre. At specialized centre like IPSC India in New Delhi, it cost 1.5 Lac INR. Advantages are: By selectively removing that bulging part, we relieve the nerve off the pressure. Patients are awake throughout the procedure and this adds safety to the procedure as we can detect any touching to the nerve while removing the disc.

Vertebroplasty has several advantages: Do not require general anaesthesia. No need to open spine. No need to put rods and screws. No need of prolonged hospitalization. All these reduces the risk of complications.

Procedures

Ozone Discectomy

Success rate is about 88% which is comparable to surgical discectomy (50% to 90%) IPSC India has been pioneer in Ozone Discectomy or Ozonucleolysis for Slipped disc or Prolapsed Disc. We have treated thousands of Patients not only from across India but also International patients from USA, UK, Nigeria, Afghanistan, Iraq, Bangladesh, Nepal and Saudi Arabia. We have the Original , closed circuit-Self calibration Ozone Machine, imported from Italy. Ozone in PIVD/Slipped disc In case of prolapsed inter-vertebral disc (or, slipped disc) different other mechanism acts. Inter-vertebral disc is filled with nucleus pulposus which is a jelly like material which holds water (90% of disc material is water). When ozone is injected into the disc the proteo-glycan bridges in the jelly-like material are broken down and they no longer capable of holding water. As a result disc shrinks and mummified which is equivalent to surgical discectomy and so the procedure is called ozone discectomy or ozonucleolysis. It has been published in ANESTHESIA AND PAIN journals that up to 85% of disc operation can be avoided with these non-surgical interventions. Success rate is about 88% which is comparable to surgical discectomy (50% to 90%). Complications are remarkably low and much less than surgery. OZONE THERAPY 1. Most Of the Interventional Pain Procedures are done in Local Anaesthesia under Fluoroscopy Guidance in Procedure room as Day care (3 to 4 Hours stay). 2. Usually One to Two Procedures at an interval of 2-4 weeks are required but in Resistant cases additional procedure may be required. 3. Trial procedures are required in Advance Interventions before placing costly Implants
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Spine Endoscopy

Spine Endoscopy: Endoscopic Discectomy for slipped disc and sciatica Endoscopic Discectomy is a minimally invasive spine interventional technique that utilizes an endoscope to treat herniated disc, protruded disc or disc bulge, extruded, or degenerative discs that are a contributing factor to leg and back pain. Since we don’t have to cut the muscles and bones to open the entire spine, spine endoscopy has shown to be a boon for patients with spine problems. With the advancement in technology using 3 Chip camera and 4K monitors, now we can see each and every structure inside with more clarity and thus can avoid injury to important structures. At IPSC, we have best of the equipment’s for your safety and efficacy of the procedure.
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FAQS

Spinal Cord Stimulator for Chronic Pains

Endoscopic Discectomy is a minimally invasive spine surgery technique that utilizes an endoscope to treat herniated, protruded, extruded, or degenerative discs that are a contributing factor to leg and back pain. Spine endoscopy or Endoscopic discectomy is required for cases of slipped disc or disc bulge where your protruded disc is compressing the nerves.

Our lower back has multiple bones called vertebrae and in between two vertebrae, there is a cushion called intervertebral disc. Around the disc, there are nerves which start from the spinal cord and goes down to the legs. When the disc ruptures or bulges out, it compresses the nerve and your pain starts going down to your legs which is called radiculopathy or sciatica.

More than 70% of the patients usually don’t need any additional procedure. In some cases even after removing the disc, there may be some swelling on the nerves left which can be dealt with a minor procedure after 2 weeks. Although reherniation is rare, but it is possible if we don't take proper precautions after endoscopic discectomy. IPSC protocol usually advise 4 weeks of lumbar support belt after the procedure, along with some restriction of activities like prolonged sitting, forward bending, and weight lifting.

It takes 4-6 weeks for the disc to become normal. From the skin, you won’t feel anything but the inside tissue takes time to heal. Although, we encourage patients to start walking after 1-2 days of rest, but certain precautions like forward bending, lifting heavy weights, pushing heavy objects, sudden twisting movements, are must.

The purpose is to remove the pressure off the nerve which have compressed the nerves because of disc herniation and bulge. Prolonged compression of the nerve may lead to permanent loss of the functions of the nerve.

You may feel pain and paraesthesia, pins and needles. There may be loss of sensation in some part of the leg and at times, even weakness in the lower limbs.

We make a small hole on the skin under local anaesthesia and infiltrate the entire track up to the disc with local anaesthesia. Patients are awake throughout the procedure and this adds safety to the procedure as we can detect any touching to the nerve while removing the disc. Through this small hole we insert the spine endoscope which is fitted with camera. Through this camera we can see inside, on our screen. Once we reach the herniated material or the bulging part of the disc, we start removing it without disturbing the normal disc and other tissues.

Since we don’t cut the bones and other important tissues of the spine to reach the bulging part of the disc, no rods and screw and fixation is required after endoscopic discectomy.

No Interventional procedures are 100% safe. Though the chances of complications are rare but the chances of infection, bleeding and nerve trauma are there. All these complications can be managed, if they do happen. As compared to open surgery, endoscopic spine procedure is much safer for slipped disc and sciatica.

No! Spine endoscopy or Endoscopic discectomy is required for cases of slipped disc or disc bulge where your protruded disc is compressing the nerves. When the disc compresses the nerve, your pain will start going down to your legs which is called radiculopathy or sciatica.

Usually we advise conservative treatment in the form of medications, physiotherapy in selected cases and some exercises after examining the patient. If the condition is not urgent, we usually wait for 2-4 weeks. But, in cases where the disc herniation is large and compressing the nerves, it is advised to get it removed as soon as possible. Compression of the nerves for longer duration, may lead to irreversible damage to the nerve. In these cases, patient may develop foot drop or muscle weakness or some neurological deficit.

If there is a major loss of function like loss of bladder and bowel control, loss of limb movements, sense less leg, in such cases we do open surgical discectomy. In patients with some numbness or tingling, we can safely go for endoscopic discectomy.

No. We only remove the protruded part of the disc. By selectively removing that bulging part, we relieve the nerve off the pressure.

Although rare, but it is possible if we don't take proper precautions after endoscopic discectomy. We usually advise 4 weeks of lumbar support belt after the procedure, along with some restriction of activities like prolonged sitting, forward bending, and weight lifting.

No. That is not required in the endoscopic procedure. In fact, we preserve even the normal disc which is close to protruded disc. This prevents the collapse of the disc in future.

Yes. We make a small hole on the skin under local anaesthesia and infiltrate the entire track up to the disc with local anaesthesia. Patients are awake throughout the procedure and this adds safety to the procedure as we can detect any touching to the nerve while removing the disc.

Complications are possible but rare with this technique as compared to open surgery. The possibility of nerve injury, bleeding, and infection at the site are there and in most cases are manageable.

Yes, it is covered but one day admission is required for insurance purpose. At IPSC, for non-insurance patients we do this procedure as a day care and we discharge them after 4-6 hours of observation.

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Epidural Procedures

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Shoulder Pain

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Epidural Procedures

Injection procedures are injections administered to relieve pain in the neck, shoulders and arms caused by a pinched nerve or inflamed nerve(s) in the cervical spine. A cervical epidural is an injection of anti-inflammatory pain medications like cortison into the cervical region of the spine. This injection is not given in bone or spinal cord. A patient may need an epidural for one of many reasons. The procedure can be performed as a diagnostic tool in uncovering the exact site and nature of neck pain, or it can be used to treat chronic pain, inflammation, and stiffness in the neck and shoulders. Cervical epidural is typically reserved for cases where significant nerve damage around the spine is responsible for pain. Before the procedure, a patient is given a shot of local anesthetic to numb the area. Procedure is done under fluoroscopic(Special X-Ray) guidance and local Anesthesia. After confirmation of nerve roots involved, by injecting contrast as seen in this video, solution is injected. Procedure is done in OT and takes 25-30 minutes. After procedure patient is shifted to recover room for observation. Patients are usually discharged after 2 hours.
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Vertebroplasty

Vertebroplasty and Kyphoplasty for Osteoporotic spine fracture and spine metastasis Advanced age, asthma, diabetes, emphysema, menopause, chronic steroid use and rheumatoid arthritis are all risk factors for osteoporosis. The resultant weakening of bones can lead to compression fractures of the spine causing severe pain, deformity, loss of height, immobilization, and in some cases, failure to thrive. Historically, vertebral compression fractures have been treated either with conservative methods of cast or brace immobilization with long term bed resting or with major surgery. This surgery requires a long incision, screws and rods for fixation and is done under general Anaesthesia. These treatments are limited by long recovery times and disruption of daily life. Now, these painful spine fractures can be treated with a Minimally Invasive, Non Surgical procedure known as VERTEBROPLASTY, an innovative alternative to traditional treatments which stabilizes fractures of the spine safely and effectively, often providing immediate pain relief.
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Vertebroplasty

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Multiple level Spine fracture managed with vertebroplasty at IPSC India

Vertebroplasty and Kyphoplasty for Osteoporotic spine Fractures

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FAQS

Spinal Cord Stimulator for Chronic Pains

Vertebroplasty or targeted cementoplasty is one of the most advanced procedure for immediate and significant pain relief in patients with spine fracture or compression fracture due to osteoporosis. Osteoporosis is a condition where the bones becomes porous and fragile and leads to fracture with even minor trauma or jerk.

The procedure is very safe in experienced hands. There are costly options available but they have not proved to be more safer than vertebroplasty. This procedure is done in Local anaesthesia, so we can even avoid the effects of general anaesthesia and patient can be discharged same day. IPSC India is pioneer in performing this procedure.

The goal of a vertebroplasty procedure is to stabilize the vertebral compression fracture to stop its painful movements. Vertebroplasty is considered a minimally invasive surgery because it is done through a small puncture in the skin instead of an open incision.

Vertebroplasty and Kyphoplasty, both the procedures are done to fix the compression fracture of spine vertebrae. In Kyphoplasty, we use balloon to create some space inside the vertebrae and then fill that space with cement. But this makes kyphoplasty a difficult procedure as compared to Vertebroplasty and requires general anesthesia. Most of the recent studies have shown that there is no difference in outcome between the two procedures. Cost of the procedure is also less as compared to Kyphoplasty which is done under general anesthesia and may require hospital admission.

Most people are able to walk after the procedure, but you may need to restrict yourself to home for 24 hours afterward to rest. Then you can slowly resume normal activity. Some patients, but not all, feel pain relief soon after vertebroplasty. These patients report that their pain is gone or is much better within 48 hours. At times, due to involvement of other nearby structures, pain relief is not complete after the procedures. In such cases, your pain specialist may advise another procedure like facet joint block or facet denervation, or myofascial trigger point injection.

Yes! percutaneous vertebroplasty can be performed in spinal vertebrae that are not suitable for surgical fixation, for instance because of osteoporosis or because general anaesthesia may not be advised in patients who are very sick. This procedure can also be performed in spine fractures due to spinal metastasis. Some cancers at some stages of cancer, spread to other areas like spine. These spinal pathologies are very painful and at times lead to fracture of spine.

The beauty of this procedure is its simplicity. “A small needle is advanced into the fracture using only local anaesthetic followed by the placement of bone cement into the fractured area. The cement hardens in about 10-15 minutes and remarkably the pain is gone.” “After performing good number of vertebroplasties, I can confirm that this is one of the most significant procedures for the treatment for vertebral compression fractures,”

The calcium phosphate cement flows into the spongy inside portion of the bone, filling in microfractures and other damaged areas, and it hardens in about 10 minutes' time.

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spinal cord stimulator

SPINAL CORD STIMULATOR

Spinal cord stimulation is used most often after nonsurgical pain treatment options have failed to provide sufficient relief.

Spinal cord stimulation therapy masks pain signals before they reach the brain. A small device, similar to a pacemaker, delivers electrical pulses to the spinal cord. It helps people better manage their chronic pain and reduce their use of opioid medications. It may be an option if you suffer chronic back, leg or arm pain and have not found relief with other therapies.
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SPINE SURGERY

At IPSC India, we believe in managing our chronic spinal pain patients with minimally invasive technique. But, there are conditions where we prefer to go for open spinal surgical procedures over less invasive techniques. At times, we do have patients who need urgent surgeries to prevent them from going into permanent damage. There are multiple myths about spine surgeries and decision to have spinal surgery can be difficult specially when we have multiple “free of cost advises” flouting around us.
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Spine Surgery

FAQS

Spinal Cord Stimulator for Chronic Pains

Fact: At IPSC India, we advise open surgical procedures only in selected cases where it is required. After discussing other options with patients, we advise surgery where surgery has a definite advantage over other treatment options.

Fact: Most of the spine surgeries are successful but at times some patients develop secondary problems which are not directly related to surgery. Infact, the medical authorities have withdrawn this terminology.

Fact: Some surgeries where we have to put implants to fix the spine, do take long time to recovery as bones need some time to fix the implant. Restriction in some activities are required after spine fixation surgery but usually patients are able to perform routine activities within weeks’ time.

Fact: Repeat surgery is extremely rare now with advancement of other techniques. Some secondary sources of pain after spine surgery can be managed effectively with minimally invasive techniques.