Tag Archives: Neurosurgery

Lumbar Spondylosis

 

Definition:
Lumbar Spondylosis is a condition associated with degenerative changes in the intervertebral discs and facet joints. Spondylosis, also known as spinal osteoarthritis, can affect the lumbar, thoracic, and/or the cervical regions of the spine. Although aging is the primary cause, the location and rate of degeneration is individual. As the lumbar discs and associated ligaments undergo aging, the disc spaces frequently narrow. Thickening of the ligaments that surround the disc and those that surround the facet joints develops. These ligamentous thickening may eventually become calcified. Compromise of the spinal canal or of the openings through which the spinal nerves leave the spinal canal can occur.

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Lumbar spondylosis encompasses lumbar disc bulges, herniations, facet joint degeneration, and vertebral bony overgrowths (osteophytes). Degenerative changes, including osteophyte formation, increase with age but are often asymptomatic. Disc herniation is symptomatic when it causes nerve root compression and spinal stenosis. Common symptoms include low back pain, sciatica, and restriction in back movement. Treatment is usually conservative, although surgery is indicated for spinal cord compression or intractable pain. Relapse is common, with patients experiencing episodic back pain.

Symptoms:
Symptoms of lumbar spondylosis follow those associated with each of the various aspects of the disorder: disc herniation, sciatica, spinal stenosis, degenerative spondylolisthesis, and degenerative scoliosis. Pain associated with disc degeneration may be felt locally in the back or at a distance away. This is called referred pain, as the pain is not felt at its site of origin. Lower back arthritis may be felt as pain in the buttock, hips, groin, and thighs. As with spinal stenosis or disc herniation in the lumbar region, it is important to be aware of any bowel or bladder incontinence, or numbness in the perianal area. These signs and symptoms could represent an important massive nerve compression needing surgical intervention (cauda equina syndrome).

Causes:
Spondylosis is mainly caused by ageing. As people age, certain biological and chemical changes cause tissues throughout the body to degenerate. In the spine, the vertebrae (spinal bones) and intervertebral discs degenerate with ageing. the intervertebral discs are cushion like structures that act as shock absorbers between the vertebral bones.

One of the structures that form the discs is known as the annulus fibrosus. The annulus fibrosus is made up of the 60 or more tough circular bands of collagen fiber (called lamellae). Collagen is a type of inelastic fiber. Collagen fibers, along with water and proteoglycans (types of large molecules made of a protein and at least one carbohydrate chain) help to form the soft, gel-like center part of each disk. This soft, center part is known as the nucleus pulposus and is surrounded by the annulus fibrosus.

The degenerative effects of ageing can cause the fibers of the discs to weaken, causing wear and tear. Constant wear and tear and injury to the joints of the vertebrae causes inflammation in the joints. Degeneration of the discs leads to the formation of mineral deposits within the discs. The water content of the center of the disc decreases with age and as a result the discs become hard, stiff, and decreased in size. This, in turn, results in strain on all the surrounding joints and tissues, causing the sensation of stiffness. With less water in the center of the discs, they have decreased shock absorbing qualities. An increased risk of disc herniation also results, which is when the disc abnormally protrudes from its normal position.

Each vertebral body contains four joints that act as hinges. These hinges are known as facet joints or zygapophyseal joints. The job of the facet joins is to allow the spinal column to flex, extend, and rotate. The bones of the facet joints are covered with cartilage (a type of flexible tissue) known as end plates. The job of the end plates is to attach the disks to the vertebrae and to supply nutrients to the disc. When the facet joints degenerate, the size of the end plates can decrease and stiffen. Movement can stimulate pain fibers in the facet joints and annulus fibrosus. Furthermore, the vertebral bone underneath the end plates can become thick and hard.

Degenerative disease can cause ligaments to lose their strength. A ligament is a tough band of tissue that attaches to joint bones. In the spine, ligaments connect spinal structures such as vertebrae and prevent them from moving too much. In degenerative spondylosis, one of the main ligaments (known as the ligamentum flavum) can thicken or buckle, making it weaken.

Knobby, abnormal bone growths (known as bone spurs or osteophytes) can form in the vertebrae. These changes can also cause osteoarthritis. Osteoarthritis is a disease of the joints that is made worse by stress. In more severe cases, these bones spurs can compress nerves coming out of the spinal cord and/or decreased blood supply to the vertebrae. Areas of the body supplied by these nerves may become painful or develop loss of sensation and function.

Carrying around excessive weight can cause lumbar spondylosis. Spending much of the day seated can also be a contributing factor. An injury or trauma to the back can also contribute, as can genetic factors.

The main Risk Factors:
• Age: As a person ages the healing ability of the body decreases and developing arthritis at that time can make the disease progress much faster. Persons over 40 years of age are more prone to developing lumbar spondylosis.

• Obesity: Overweight puts excess load on the joints as the lumbar region carries most of the body’s weight, making a person prone to lumbar spondylosis.

• Sitting for prolonged periods: Sitting in one position for prolonged time which puts pressure on the lumbar vertebrae.

• Prior injury: Trauma makes a person more susceptible to developing lumbar spondylosis.

• Heredity or Family history
Diagnosis:
Physical Examination:
A thorough physical examination reveals much about the patient’s health and general fitness. The physical part of the exam includes a review of the patient’s medical and family history. Often laboratory tests such as complete blood count and urinalysis are ordered. The physical exam may include:

*Palpation (exam by touch) determines spinal abnormalities, areas of tenderness, and muscle spasm.

*Range of Motion measures the degree to which a patient can perform movement of flexion, extension, lateral bending, and spinal rotation.

*A neurologic evaluation assesses the patient’s symptoms including pain, numbness, paresthesias (e.g. tingling), extremity sensation and motor function, muscle spasm, weakness, and bowel/bladder changes. Particular attention may be given to the extremities. Either a CT Scan or MRI study may be required if there is evidence of neurologic dysfunction.

X-rays and Other Tests:
Radiographs (X-rays) may indicate loss of vertebral disc height and the presence of osteophytes, but is not as useful as a CT Scan or MRI. A CT Scan may help reveal bony changes sometimes associated with spondylosis. An MRI is a sensitive imaging tool capable of revealing disc, ligament, and nerve abnormalities. Discography seeks to reproduce the patient’s symptoms to identify the anatomical source of pain. Facet blocks work in a similar manner. Both are considered controversial.

The physician compares the patient’s symptoms to the findings to formulate a diagnosis and treatment plan. The results from the examination provide a baseline from which the physician can monitor and measure the patient’s progress.

Treatment:
Each patient is treated differently for arthritis depending on their individual condition. In the early stages lifestyle modifications or medicines are used for treatment and surgery is needed only if these measures are ineffective.

Yoga:
A few yoga poses and sequences can help lumbar spondylosis. Sun salutations, also known as Surya Namaskar A and B, are good for back strengthening and flexibility. The cobra pose, or Bhjangasana, stretches the lower back. The locust pose, or Shalabhasana, strengthens the lower back because it requires lifting one’s upper and lower body off the ground from a prone position on the floor. Meditation & pranayam 

Exercises:
Physical therapy is often prescribed to relieve problems caused by lumbar spondylosis. Back extensions are used on patients who can tolerate them. The patient lies face down on her stomach and then slowly lifts only her upper body off the floor. The arms may be placed palms down under her chest to take some strain off the back muscles. If lying down is too painful, this exercise can also be done against a wall. The patient puts her hands against a wall, standing about a foot away, and bends back, using a combination of lower back muscles and arms.

Stretches to Avoid:
Lying on the back and bringing the knees into the chest is an example of a common lower back stretch that flexes the spine. This is not recommended for people with lumbar spondylosis. Bending down to touch one’s toes from a standing position is also not recommended. Reaching for the toes while sitting can be problematic, too.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.ehow.com/about_5039006_lumbar-spondylosis-exercises.html
http://www.physiotherapy-treatment.com/lumbar-spondylosis.html

 

Magnetic Resonance Imaging (MRI)

fMRI - Functional magnetic resonance imaging s...

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Definition:
MRI is a noninvasive technique for visualizing many different body tissues. Unlike x-rays, MRI does not use any radiation. Instead, it uses radio waves, a large magnet, and a computer to create images.As with a CT scan, which does use x-rays, each MRI picture shows a different “slice,” or cross-section, of the area being viewed. Because these slices usually are spaced about a quarter-inch apart, your doctor can get a detailed representation of a particular area.

Most MRI machines are large, tube-shaped magnets. When you lie inside an MRI machine, the magnetic field temporarily aligns all the water molecules in your body. Radio waves cause these aligned particles to produce very faint signals, which are used to create cross-sectional MRI images — like slices in a loaf of bread.

The MRI machine can combine these slices to produce 3-D images that may be viewed from many different angles.

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You may click to see more MRI pictures

MRI of the brain and spinal cord:
MRI is the most sensitive imaging test of the brain and spinal cord. It’s often performed to help diagnose:

*Tumors
*Developmental abnormalities
*Aneurysms
*Stroke
*Pituitary gland diseases
*Multiple sclerosis
*Dementia progression
*Spinal cord injuries

Functional MRI of the brain (fMRI) can be used to identify important language and movement control areas in the brain in people who are being considered for brain surgery.

MRI of the heart and blood vessels:
An MRI that focuses on the heart or blood vessels can assess:

*The size and thickness of walls in the heart’s chambers
*The extent of damage caused by heart attack or heart disease
*The buildup of plaques and blockages in the blood vessels
*Structural problems in the aorta, such as aneurysms or dissections
*MRI of other internal organs

An MRI may be used to check for tumors or other abnormalities of the:

*Lungs
*Liver
*Kidneys
*Spleen
*Pancreas
*Uterus
*Ovaries
*Prostate
*Testicles

MRI of bones and joints
MRI may be used to help evaluate:

*Joint disorders, such as arthritis
*Joint abnormalities caused by traumatic or repetitive injuries
*Disk abnormalities in the spine
*Bone infections

MRI of the breasts
MRI may be used in addition to mammography to detect breast cancer, particularly in women who have dense breast tissue or who may be at high risk of the disease.


Risks Factors
:
For most individuals, there are no known harmful effects from exposure to the magnetic field or radio waves used in making MRI images. Allergic reactions to the dye are very rare.

Preparation for the test:-
Before an MRI exam, eat normally and continue to take your usual medications, unless otherwise instructed. You will be asked to change into a gown and to remove:

*Jewelry
*Hairpins
*Eyeglasses
*Watches
*Wigs
*Dentures
*Hearing aids
*Underwire bras

The presence of metal in your body may be a safety hazard or affect a portion of the MRI image. Tell the technologist if you have any metal or electronic devices in your body, such as:

*Metallic joint prostheses
*Artificial heart valves
*An implantable heart defibrillator
*A pacemaker
*Metal clips to prevent aneurysms from leaking
*Cochlear implants
*A bullet, shrapnel or any other type of metal fragment

Also tell the technologist if you think you’re pregnant, because the effects of magnetic fields on fetuses aren’t well understood. Your doctor may recommend choosing an alternative exam or postponing the MRI.

It’s also important to discuss any kidney or liver problems with your physician and the technologist, because problems with these organs may impose limitations on the use of injected contrast agents during your scan

If you know you have an implant, or are concerned, discuss the issue with your doctor, as other options may exist. (Some pacemakers, for example, can be reprogrammed prior to an MRI so that they are not disrupted.)

An IV is inserted into a vein if the particular scan you’re having requires a dye to make areas of inflammation or abnormality easier to detect. This dye is called gadolinium, and is different from the contrast dye used for x-rays or CT scans. Before undergoing the scan, remove metal objects such as belt buckles or watches, which could dislodge in the presence of the magnet and hurt you.

What happens when the test is performed?

During the test:
The MRI machine looks like a tunnel that has both ends open. You lie down on a movable table that slides into the opening of the tunnel. A technologist monitors you from another room. You can talk with him or her by microphone.

The MRI machine creates a strong magnetic field around you, and radio waves are directed at your body. The procedure is painless. You don’t feel the magnetic field or radio waves, and there are no moving parts around you.

During the MRI scan, the internal part of the magnet produces repetitive tapping, thumping sounds and other noises. Earplugs or music may be provided to help block the noise. If you are worried about feeling claustrophobic inside the MRI machine, talk to your doctor beforehand. He or she may make arrangements for you to receive a sedative before the scan.

An MRI typically lasts about an hour. You must hold very still because movement can blur the resulting images. In some cases, contrast agents are injected into your veins to enhance the appearance of certain tissues or blood vessels in the images.

During a functional MRI, you may be asked to perform a number of small tasks — such as tapping your thumb against your fingers, rubbing a block of sandpaper or answering simple questions. This helps pinpoint the portions of your brain that control these actions.

After the test:
If you haven’t been sedated, you may resume your usual activities immediately after the scan. Nursing mothers shouldn’t breast-feed for 36 to 48 hours after an MRI if a contrast material was used. Very rarely, the contrast material can cause hives and itching.

A radiologist — a doctor specially trained to interpret MRIs — will analyze the images from your scan and report the findings to your doctor. Your doctor will then discuss any important findings and next steps with you.

It can be difficult if you are uneasy in tight spaces or have trouble lying flat for that amount of time. If you think you might have trouble getting through the procedure, talk to your doctor beforehand and discuss whether an anti-anxiety medicine might help. After the test is done, you can go about your normal activities.

How long is it before the result of the test is known?
MRI images are often recorded on film; if so, it will take at least an hour for the MRI department to develop the images and additional time for a doctor to examine and interpret them. If the images are stored in and displayed by a computer, there is no time required to develop the images, although the doctor’s interpretation still takes time. You can probably get preliminary results within a day or two, but the complete results might take four to seven days.

Resources:
http://www.mayoclinic.com/health/mri/MY00227
https://www.health.harvard.edu/diagnostic-tests/magnetic-resonance-imaging-of-the-brain.htm
http://www.draimaging.com/mri.htm

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Vakrasana-1 (Yoga Exercise)

 

This is the advanced stage of Vakrasana-1. Here the spine is twisted with the support of the knee alongwith the shoulder, and hence it involves more strain.
Pre position Sitting Position.

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How to practice the Asana(Exercise)
1. Bend the left leg in the knee and place it near the thigh of left leg.
2. Place the right hand beyond the folded knee of the left leg and in front of the left hand. Keep the palms of both the hands in opposite direction. There should be a distance of one foot between the two hands.
3. Press the standing left knee with the right hand and shoulders, and twist the neck to the left. Turn the sight also in the same direction and continue normal breathing.

Position:
1. In this Asana (Exercise)the spine is to be kept straight.
2. The lower end of the spine and both the hips be placed well on the floor and stabilize them.
3. Then with the support of the neck and shoulders twist the upper vertebrae to the left. Alongwith the neck, the sight should also be turned to the left side and stabilize it in that direction.
4. In Vakrasana (Type 1) the spine is twisted only with the help of the shoulders. Here the shoulders, the knee and the hand are placed in such a way that there is more pressure on the spine.

Releasing :
1. Turn the neck and the sight to the front.
2. Restore the right hand to its place and set right the palm of the left hand.
3. Straighten the left leg and take the sitting position.

Note: Perform this Asana by taking up the right leg making relevant changes.
Duration It should be maintained for two minutes on each side to have the expected benefits. With practice, it can be maintained up to six minutes.

Benefits: The elasticity of the spine increases as it gets twisted in its erect position. Alongwith the spine the belly and other internal organs also get twisted and receive the desired strain. It also has very good effect on the spinal cord and its functioning is improved.
Precaution : One should avoid the temptation of attaining the ideal position if strain is unbearable.

Reference Book:– Yoga Pravesh