Developmental Dysplasia of the hip (DDH)

What is Developmental hip dysplasia?

Developmental hip dysplasia or DDH is a term used to describe a spectrum of conditions where the hip joint fails to develop properly in childhood. In the past terms such as congenital hip dislocation or CDH were used, though the current preferred term is DDH. The term Hip dysplasia is also commonly used. All of the above terms refer to the same condition.

Before we can understand what DDH is, it is perhaps useful to know a little bit about the hip joint itself. The hip is the largest joint in the body and consists of a ball (femoral head) and a socket (acetabulum). The bones are held together by strong ligaments. Being a ball and socket joint, the hip is freely mobile in all directions. There are numerous muscle groups around the hip that provide stability and movement.

As mentioned above, DDH represents a spectrum. On the less severe end of the spectrum is a slightly shallow acetabulum (or socket) but with the femoral head (ball) still inside the socket. This is a dysplastic hip which typically goes unnoticed during childhood but sooner or later will cause arthritis in the hip because of the poor articulation between the ball and socket. Patients with mild dysplasia present for the first time as adults with end-stage hip arthritis and need a hip replacement. These cases are however rare (no more than 10% of cases).

The more common scenario is where the hip is shallow at birth and during the first few months to years of life the hip joint gradually dislocates out of place. In developed countries (UK, USA and Europe) where babies are screened by clinical examination or ultrasound scanning, DDH may be diagnosed at birth or in the first few weeks of life. Diagnosis at an early age makes treatment much easier and the use of strapping around the hip (called a Pavlik Harness) cures the problem in most babies.

In India, there is no uniform protocol amongst obstetricians or paediatricians to screen for hip dysplasia in the neonatal period (first 4 weeks of life). DDH therefore goes unnoticed and the child presents at a much older age when surgery is the only option to treat the problem.

On the most severe end of the spectrum are the so-called Teratologic hip dislocations. Such dislocations occur when the baby is still developing in the womb. They are usually associated with genetic conditions such as Arthrogryposis (multiple joint contractures). Teratologic hips are difficult to treat and typically need surgery even at an early age.

What causes DDH?

There is no specific cause for DDH that happens in every child with the condition. However, there are many known risk factors that increase the statistical probability of a baby having DDH. These include

• First born female child
• Twins
• Oligohydramnios (where the amount of fluid around the baby is less than normal)
• Family history of DDH in first degree relatives
• Breech presentation
• Postural foot deformities (such as metatarsus adductus and calcaneovalgus feet)
• “Moulded baby syndrome” refers to a combination of DDH, Torticollis (Wry neck), foot deformity and plagiocephaly (flattened appearance to the back of the head). This is thought to result from abnormal pressure on the baby (moulding) within the womb.

A child with DDH may not have any of the above risk factors and the first indication may be a limp that is noticed when the child starts to walk. In India, we routinely see children as old as 10 years with dislocated hips, largely due to a failure to diagnose the problem at an early stage.

A significant number of all babies have shallow hips at birth (probably the result of developing in a cramped space within the womb) but the hips spontaneously become normal within the first 6 weeks of life as the baby starts to move the legs freely. In a small proportion of children, this process fails to occur and these hips gradually dislocate over a period of time.

What are the symptoms of DDH?

There are a wide variety of symptoms that vary with age of the child at diagnosis.

0 – 1 year:

• No symptoms are apparent, though observant parents sometimes notice that the legs are different lengths.
• In severe dislocations, it may be difficult to open the legs (called hip abduction) to change nappies. At this age, DDH is diagnosed by doctors during examination or by ultrasound scanning.

Walking age (1 – 16 years):

• Limping is the commonest symptom. It is typically a painless limp and can be difficult to spot.
• Pain is a relatively late symptom and indicates the onset of damage to the hip (tear of a cartilage ring in the hip joint called the labrum) or early arthritis. The pain may be sharp and worse with certain hip movements or just a “dull ache” after activity. Clicking or “giving way” of the hip can also occur.

How is DDH diagnosed?

The investigation of choice depends on age of the child.

0 – 4 months of age: Ultrasound scanning of the hips using the Graf method. Alpha and Beta angles have to be calculated and these angles guide treatment. The Graf method is precise and has been standardised to a high degree. Specific training in ultrasound scanning for hip dysplasia is necessary in order to obtain good quality ultrasound scans.

Children older than 4 months: A good quality AP pelvis x-ray will clearly demonstrate the problem. Various lines are drawn on the x-ray by orthopaedic surgeons but these are probably of little interest to parents.

Arthrogram: This is a dye test which requires a general anaesthetic. In babies and young children up to the age of 18 months, a large part of the ball of the hip joint is made of cartilage not bone. The cartilage is not visible on x-rays and some contrast agent on the outside is required to outline the entire ball (cartilage + bone). An arthrogram also provides useful information to the surgeon about whether the hip can be put back in place without the need for open surgery.

CT Scans: are obtained post-operatively after a body cast (Hip spica) has been applied. X-rays performed through a spica are difficult to interpret. A CT scan clearly shows whether the operation to reduce the hip has been successful. Most good paediatric orthopaedic centres would insist on a CT scan prior to discharging the patient from hospital.

A CT scan is also sometimes obtained to visualise the hip in 3-D where the anatomy is abnormal or unusual. It is a good investigation in cases where previous surgery has been performed.

MR scans/ MR arthrograms: These tests are of use in teenagers or adults with symptoms suggestive of damage to acetabular labrum. Labral tears can be quite painful and restrict activities particularly sports.

In most cases, a simple x-ray of the hips is sufficient to confirm DDH.

What are the treatment options?

Treatment of DDH is entirely dependent on the age of the child. The younger the child at diagnosis, the less the intervention required. It is therefore important that the diagnosis is made soon after birth.

A proportion of babies have dislocated or dislocatable hips at birth. In most modern hospitals, paediatricians or obstetricians will examine babies for DDH. In certain developed countries, all babies have a hip ultrasound scan a few weeks after birth to rule out DDH. This system is obviously ideal in picking up all cases of DDH but it is expensive, difficult to implement and “over-treats” the problem. Remember that a proportion of babies with shallow hips get better by themselves. If the hip remains abnormally shallow at 3 months of age or if the hip is frankly dislocates, treatment is mandatory.

If your child has any of the risk factors mentioned previously, the safest course of action is to obtain an ultrasound scan of the both hips performed in accordance with the Graf method.

Pavlik Harness:

This is the least invasive method and therefore the most preferred by parents (and surgeons!). The harness can be used from birth to the age of approximately 4 months, though it can be difficult in children older than 3 months. It is a system of straps that is applied to both legs and keeps the legs opened (called hip abduction). The baby can kick both legs freely within the harness and it does not interfere with normal growth of the baby.

Once the baby has been placed in a harness, ultrasound scans must be repeated every week until the hip is anatomically located back in the hip joint. This may take 2 – 4 weeks. A further 6 weeks in the harness is necessary. If the baby grows out of the initial harness, it can be changed easily for a larger size. Average time in the harness is likely to be between 10 and 12 weeks.

In the vast majority of babies under 3 months (90% or more), treatment with the Pavlik harness is the only treatment that is necessary. There is good evidence to suggest that the hips become entirely normal when assessed at 5 years of age.

In summary, early diagnosis (soon after birth) and Pavlik harness treatment should be considered as the gold standard in managing hip dysplasia. Complications are minimal and it is effective.

Please click here for instructions on how to look after your baby in a Pavlik harness.

Closed Reduction and hip spica application:

If the child is older than 3 months at diagnosis, Pavlik harness is not appropriate. In this group (3 months to 12 months), an arthrogram will be necessary.  A short general anaesthetic is given. The hip is examined when the child is fully relaxed. A radio-opaque dye is also instilled into the hip joint to provide contrast. If the hip can be put back in place without undue force, a hip spica is applied. The term closed reduction refers to reducing a dislocated joint without the need for an incision. This is in contrast to an open reduction where an incision is necessary.

A post-operative CT scan is necessary to confirm that the hip is concentrically reduced, meaning that the ball is sitting in the centre of the socket. Sometimes the ball can appear on x-rays to be sitting well but the CT scan shows otherwise. Some centres use an ultrasound scan rather than a CT.

The hip spica is changed at 3 months under general anaesthesia. The total period in the spica is 6 months. This may seem a long time to some parents but children have not started walking at this age and there are no long-term adverse effects that result from hip spica treatment.

When the ball of the hip joint is dislocated, the socket also becomes quite shallow. Keeping the hip joint well reduced in a spica promotes development of the socket (remodelling) and improves stability of the hip. Children less than 1 year of age possess considerable remodelling capacity and it is important to harness this potential.

Medial open reduction:

This is a minimally invasive procedure undertaken in children under 18 months of age. There are numerous advantages with this procedure compared to a traditional “anterior open reduction”. The operation is performed through a small incision in the groin and therefore not visible to the outside. There is minimal blood loss and less postop pain.

The medial open reduction is also referred to as “assisted closed reduction” or “relaxed closed reduction”. This term is used because a forcible closed reduction causes damage to the blood supply of the femoral head and poor long-term results.

Medial open reduction is followed by immobilisation in a hip spica cast for 4 – 6 months. This will depend on a number of factors including ease of reduction, age of the child and progress of hip development within the spica.

Long-term results of medial open reduction have proven that this is a minimally invasive procedure that is safe and effective.

Anterior Open Reduction with femoral and pelvic osteotomy:

This procedure is typically used in children older than 18 months who have been walking for a period of time on the dislocated hip. A thick membrane called the capsule surrounds all joints of the body. When a child walks on a dislocated hip, the capsule enlarges and becomes quite lax. This enlarged capsule needs to be tightened up in order to prevent the hip from re-dislocating after surgery. The anterior open reduction procedure is designed to address this particular problem of a capacious and redundant capsule.

The anterior open reduction is performed through a “Bikini” incision. There are several tight structures (muscles, tendons and ligaments) that are divided or lengthened. The hip joint is relocated and the capsule repaired to keep the joint in place. Typically, the shallow socket (acetabulum) is also corrected by means of a pelvic osteotomy wherein the socket is divided and reset in the correct alignment. In addition to the pelvic osteotomy, the thigh bone may also need to be divided and reset, called a femoral osteotomy. Pelvic osteotomies sometimes need to be stabilised with a pin. Femoral osteotomies require plate and screws to maintain the bone in place during the healing process.

The child is placed in a hip spica for a period of 10 weeks after surgery. During this time, the hip joint stabilises and the osteotomies heal. On removal of the spica in the out-patients, the child is referred for a course of physiotherapy to improve hip movements and to encourage progressive weight-bearing. It may be up to 3 months from surgery before the child is able to walk normally.

If pins or metal plates have been used to secure an osteotomy, these require removal approximately 6 – 12 months later.

Who is at risk of DDH? How can DDH be prevented?

There is no way to prevent DDH from occurring but if your child has any of the risk factors mentioned above, obtaining an ultrasound scan of the hips by a trained sonologist and consulting a paediatric orthopaedic surgeon as soon as possible after birth will facilitate early treatment of the condition, typically without the need for any surgery.

 

What is a Spinal Fracture?

The spine is composed of blocks of bone called vertebrae stacked one above the other with an intervening soft shock-absorber like tissue called a disc lying between each pair of vertebrae.

What causes it?

Normal vertebrae can fracture due to falls from a height, road traffic accidents and other high velocity accidents. Vertebrae can lose their strength due to osteoporosis and these osteoporotic vertebrae are susceptible to fractures from low velocity injuries. Massive injuries to the spine can result in a loss of the normal alignment of the spine – dislocations. Depending on the extent of the initial damage to the spinal cord, some spinal cord injuries are permanent whereas others recover over time.

What are the symptoms/effects?

Fractures and dislocations of the spine can lead to spinal cord and nerve root injury causing varying degrees of muscle paralysis, sensory alterations and loss of bladder and bowel control.

How are they diagnosed?

Fractures and dislocations are diagnosed by a thorough clinical examination, followed by x-rays, CT scans and MRI scans. The CT scan reveals the extent of the bony injury whereas the MRI scan provides information regarding spinal cord compression and ligamentous injury.

What are the treatment options?

There are two issues here – a) bone and ligamentous injury and b) neural injury. Many spinal fractures can be managed without surgery as bony injuries heal over time. However, in the presence of a massive ligamentous injury (e.g. fracture dislocations) operative stabilisation is advisable.

Complete damage to the spinal cord results in permanent paralysis and surgery does not alter the neurological outcome. However, surgical stabilisation in this instance may permit early institution of rehabilitation. Incomplete injuries may recover over time and there is a role for surgical decompression and stabilisation in this instance.

Who is at risk?/How can I prevent it?

Adhering to occupational health and safety rules and regulations, following traffic laws and avoiding excessive speed while travelling on the road will reduce the incidence of spinal cord injuries.

Following a Myocardial infraction or heart attack, the area of infraction often leaves behind by a nonfunctional scar. This can leads to a dilatation of the heart over a period of time and change its shape from a normal elliptical one to a globular one resulting in reduction of heart function and can lead to heart failure. By an operation called Linear Endoventricular Patch Plasty or commonly called Modified Dor’s Procedure, the elliptical shape of heart is restored, thus restoring its normal pump function. The procedure is done in isolation or along with the routine CABG.

Capsule Endoscopy: – Evaluates small intestine which cannot be assessed by Gastoscope and Colonoscope.

Man has been fascinated since long to view the milieu interior of gastrointestinal tract. We have advanced video endoscopes, which can permit viewing of esophagus, stomach, and duodenum with a traditional gastroscope. Likewise the entire large intestine and part of terminal ileum can be scanned to a great detail by using colonoscope. Detection and treatment of various upper GI and lower GI lesions including tumors, ulcers and bleeding lesions has been simplified with endoscopic methods.

However, the small intestine is difficult to study by endoscopic methods due to the enormous length (14 feet) and anatomic feature (loosely supported and looped structure on the mesentery). Push enteroscopy can examine part of jejunum and a double balloon technique can examine almost the entire small bowel. However endoscopic examination with these techniques is very cumbersome (can take up to 4 hrs), with inadequate information and is not patient friendly. These difficulties with traditional flexible instruments propelled the development of a technological marvel; an endoscope that could make its way through the 14 feet of small bowel. A pill sized camera with sufficient battery life to image the entire small intestine- Capsule endoscopy.

This unique video capsule is 11×26 mm n size and weighs less than 4 grams. The device captures two images per second and has a battery half-life of 8 hours.

After a overnight fasting, patient swallows the capsule which travels through the GI trace by means of peristalsis. Images are transmitted by digital radio frequency communication channel to an external data recorder unit. The data recorder is tied around patient like a Holter monitor. Patient can continue normal activities during the entire procedure, which can be done as a ambulatory procedure. The data recorder is then connected to a dedicated computer for analysis. The non-invasive nature of capsule endoscopy makes it an attractive option over traditional endoscopy, as it requires little preparation, with no need for sedation. The procedure does not cause any discomfort to the patient and provides a more physiologic view of small intestine
Capsule endoscopy has been found to be superior to CT scan or MRI, for detection of small bowel lesions like tumors, ulcerations secondary to NSAIDs, vascular malformations, diverticulae etc. In patients with bleeding from small intestine, capsule endoscopy has been shown to be as accurate as intraoperative enteroscopy and superior to angiogram and tagged RBC nuclear scan. Capsule endoscopy has been shown to change patient management in up to 75% of cases with GI hemorrhage from small bowel. Now the last frontier in luminal endoscopy (visualization of small bowel) has also been conquered with this mega invention.

 

 

The spine also called the back bone is designed to give us stability, smooth movement as well as providing a corridor of protection for the delicate spinal cord. It is made up of bony segments called vertebra and fibrous tissue called inter vertebral discs. The vertebra and discs form a column from your head to the pelvis giving symmetry and support to the body. The spine can be divided into 4 parts. The uppermost is the cervical region, consisting of 7 small vertebrae that form the neck. As we move down the body, the next 12 vertebra make up the thoracic region or mid back from which the ribs are hinged. The 5 lumbar vertebrae are the largest of the mobile vertebra and supports 2/3 of the body’s weight. The lowest region of the spine is the sacrum and coccyx. The sacrum is a triangular plate made up of five fused vertebral segments while the four coccyxes terminate the bony spine.

Treatments and procedures:

1.Deformity Correction:
Scoliosis and Kyphosis surgery to straighten a bent spine
2.Minimally Invasive Spine Surgery:
Pain Relief in case of slip disc, through Key Hole Surgery
3.Spinal Reconstruction:
Restoring Normalcy to spine with artificial materialincase of spinal tumours, spinal fractures and spinal
infections
4.Movement Preserving Spine Surgery:
Artificial Disc Replacement and Preserving Spine Flexibility in case of degenerative spinal disorders
5.Spinal Tumor Surgery:
Removal of Tumor and Prevention of Paralysis
6. Spinal Fracture:
Early surgery to prevent Spinal Cord Damage
7. Revision Spine Surgery:
Complex Spine Surgeries on patients with failed previous spine surgery
8. Geriatric Spine Surgery:
Ensuring better quality of life through spine surgery using minimally invasive spine surgery techniques

Services & Facilities:

.Intra-Operative SSEP and MEP Neuro Monitoring
.Advanced Spine Instrumentation for Minimally Invasive Spine Surgery
.Physiotherapy with Rehabilitation following spine surgery
.CathLab facility for Interventional Neuro-Spinal Radiological Procedures

What is Hepatitis?

Many people mistakenly think that Hepatitis means Viral Hepatitis, and that all forms of hepatitis are contagious. Actually, the word Hepatitis is a catch-all term that refers to any inflammation of the liver — the irritation or swelling of liver cells from any cause.

What are its symptoms?
Hepatitis may occur with limited or no symptoms, but often leads to yellow discoloration of the skin, mucus membranes, and conjunctivae, poor appetite and malaise. Hepatitis is acute when it lasts less than six months and chronic when it persists longer. The condition can be self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis.

Types and causes of Hepatitis?
Several viruses are known to cause Hepatitis. Common forms of Viral Hepatitis include Hepatitis A, B, and C:

Hepatitis A: Hepatitis A is a virus that causes liver disease. It is most commonly found in contaminated food or water. Hepatitis A is the least dangerous form of Hepatitis because individual affected by them almost always recuperate naturally. Also, it does not lead to chronic inflammation of the liver. But about 15% of people with Hepatitis A become so ill that they need hospitalization; that is why anyone at risk of infection, as well as all people with any form of chronic liver disease, should get the Hepatitis A vaccine.

Hepatitis B: This form of Hepatitis causes liver damage. Most people recover from the virus within six months, but sometimes the virus will cause a lifelong chronic infection, possibly resulting in serious liver damage.
It can spread through sex (100 times more efficient than the HIV virus), blood transfusions (mostly before 1975), and needle sharing by intravenous drug addicts. The virus can pass from mother to child at birth or soon afterward; the virus can also pass between adults and children to infect whole families.

Hepatitis C: Hepatitis C is the No. 1 reason for liver transplant. At least 80% of patients with Hepatitis C develop a chronic liver infection. It often does not show any symptoms. No vaccine is yet available to prevent Hepatitis C.
It is usually spread through contact with blood or contaminated needles, including tattoo needles. The disease can be passed on through blood transfusions. As opposed to Hepatitis B, Hepatitis C is only infrequently spread through sex.

Prevention/Treatment:

Hepatitis A:
Immunization of children (1-18 years of age) consists of two or three doses of the vaccine. Adults need a booster dose six to twelve months following the initial dose of vaccine. In order for the vaccine to be effective the individual has to be 15–20 years or more.

Hepatitis B:
Safe and effective vaccines provide protection against Hepatitis B for 15 years and possibly much longer. Currently, the Centre for Disease Control and Prevention recommends that all new-borns and individuals up to 18 years of age, and adults at risk of infection be vaccinated. Three injections over a six to twelve month period are required to provide full protection.

Hepatitis C:
No vaccine is yet available to prevent hepatitis C.

These measures would indeed be helpful when countering the disease. Further, it is always good to avoid any situation that would lead to Hepatitis.

The back bears a heavy load; it supports the weight of the body, sustains the weight of objects that are lifted or carried, and absorbs the stresses that result when parts of the body move. The back is a complex combination of muscles, ligaments, tendons, and bones-all attached to the backbone. The backbone is a series of interconnected blocks of bone called vertebrae. They form a tube-like “vertebral canal” that contains and protects the spinal cord and its bundles of nerves.

Causes of Low-Back Pain:

Low-back pain may be caused by abnormal development of the backbone, excessive stress on the back, injury, or any one of a number of physical disorders that affect the bones or the discs in the spine. The following are among the most common:

1. Ruptured or Herniated Disc. This is a frequent cause of low-back pain, and is sometimes called a “slipped” disc. Actually, an intervertebral disc cannot “slip” out of position. It can rupture, however, and when it does, some of the disc’s fragments push backward (prolapse posteriorly) into the spinal canal and press on nearby nerves, causing pain, numbness, tingling, and sometimes weakness in the leg or foot. A disc may rupture after a relatively minor stress, such as bending over to pick up an object. Pain may occur immediately after the rupture occurs, or it may grow steadily worse over the next few minutes or hours. Pain from a ruptured disc may involve the center or one side of the back, and it spreads gradually to the leg. This leg pain, which may be accompanied by numbing or tingling sensations, may affect the thigh, the back or outside of the calf, or the edge or top of the foot. Called Sciatica, leg pain or numbness is caused by the pressure that the ruptured disc’s fragments exert on the components of the sciatic nerve, which runs from the spinal cord down the thigh to the calf and foot. Each vertebra has a cylinder-shaped body, a vertebral arch, and several bony protuberances. The body of the vertebra rests on a cushion of tissue, known as an intervertebral disc that can act as a shock absorber. The vertebral arch extends from the body of the vertebra up and over the spinal cord to safeguard the spinal nerves. The bony protuberances are the places at which muscles, ligaments, tendons, and other bones join the backbone; they allow for normal flexibility of spinal movements.

2. Degeneration of the Vertebrae or Discs. Low-back pain occurs when parts of the vertebrae or the intervertebral disc deteriorate. When vertebral joints begin to wear down, the condition is called osteoarthritis. When the intervertebral discs start to degenerate, the spinal canal may become narrow and bone spurs can develop, a condition known as Spondylosis. Osteoarthritis and spondylosis produce intermittent aching or stiffness in the low back. Such low-back pain may spread into the buttocks and the thighs and may be aggravated by exercise or poor posture. People with osteoarthritis or spondylosis often feel stiff when they try to bend forward or stretch backward, because with these diseases, the backbone loses its mobility.

3. Spinal Stenosis. Narrowing of the vertebral canal is known as spinal stenosis. It may be due to overgrowth of vertebral joints associated with backward bulging of the discs or to degenerative diseases such as osteoarthritis or spondylosis (accompanied by thickening of the normal spinal ligaments). Pain from spinal stenosis, which typically occurs during walking or other exercise, develops after a few minutes of activity, accompanied by numbness, tingling, or cramps in the legs, and eases after a few minutes of rest

4. Sprains. Just as a sudden twist of the foot can cause a sprained ankle, an abrupt movement of the spine can sprain the muscles and ligaments of the back. A sprain is a partial tear of a ligament that has been overstretched. The pain from a sprain is located over the damaged ligament.

5. Infection. An infection in one part of the body, such as tuberculosis, can spread to the backbone and produce an inflammation of the bone or, occasionally, an abscess. Back pain from an infection develops slowly and eventually becomes severe. In addition to the back pain, a spinal infection raises the patient’s temperature and brings on an overall feeling of weakness and bouts of chills. The pain is often associated with severe spasms and stiffness of the back.

6. Tumors. Spinal tumors are uncommon. They may arise in the vertebral column or within the spinal cord or nerve roots, or they may spread to the spine from cancer elsewhere in the body. Spinal tumors cause pain in the back and may produce weakness or numbness

7. Ankylosing Spondylitis. Ankylosing Spondylitis is an inflammation of the backbone that causes stiffness. It occurs mainly in men between the ages of 15 and 25. In the most severe form of the disease, the backbone becomes completely rigid. Initially, the low back is stiff and painful, and the pain is aggravated by rest. A person with Ankylosing Spondylitis will often awake with an aching and stiff back and will gain relief only by exercising.

Before an Operation is considered:

Many of the conditions that bring about low-back pain (ankylosing spondylitis, sprains, osteoarthritis, and even a prolapsed disc) can be treated through rest, appropriate medication, and mild exercise. An operation is not considered, in fact, until these and sometimes other conservative measures have proved unsuccessful. If a trial period of conservative therapy produces unsatisfactory results and low-back pain continues to interfere with a person’s day-to-day activities, an operation may be considered.

Even when an operation becomes a possibility, it will not be attempted until the spine has been carefully assessed. Before performing a surgical procedure, the surgeon must know the exact nature of the problem in the back. Consequently, he or she will study the back by means of X-rays or other tests, such as myelography, computerized axial tomography (CT), or magnetic resonance imaging (MRI).

In myelography, a radiopaque material is injected into the vertebral canal to outline any disorders that may be found in the vertebrae or discs. Usually, the patient is placed on a special table that makes it possible to change his or her position, thereby distributing the injected material up and down the vertebral canal. Because myelography may cause headaches, which can be aggravated by sitting up or standing, patients may be asked to remain in bed for a day after the test.

During CT, a patient is placed in a large, circular device that projects X rays through a cross-section of the body. The X-rays outline the densities of various tissues, and by analyzing these densities, a physician can detect abnormalities.

Magnetic resonance imaging (MRI) is a relatively new technique for showing the bones and other tissues of the body. MRI scans do not involve the use of X-rays, and they may or may not include the injection of a contrast agent in the vertebral canal to enhance the images seen by the physician. An advantage of this method is that soft tissues (such as ruptured discs) show up much better on an MRI scan than they do on an X-ray or a CT scan. The test takes a longer time to perform than an X-ray or CT, and the patient must lie quietly in a large magnetic tube for the time of the examination. However, this type of examination is proving to be a safe and highly effective way to diagnose spinal disorders.

In addition, electrical studies of the muscles and nerves may be useful in diagnosing and managing spinal disorders.

About Operations on the Back:

The type of operation a surgeon performs depends on the nature of a patient’s back problem. However, most procedures involve a Fenestration, which may require the partial removal of the vertebral arch to gain access to the cause of the patient’s low-back pain. If a disc has ruptured, a surgeon will perform a Microdiscectomy to investigate the vertebral canal, identify the ruptured disc, and remove a good portion of the degenerated disc material, especially those fragments that press on the nerve roots.

The surgeon may consider a second procedure-Spinal Fusion-if he or she feels that stabilization of the spine is necessary. A spinal fusion is performed by fusing the vertebrae together with bone grafts; sometimes, the grafts are combined with metal plates or other types of instruments.

Some types of herniated discs are suitable for treatment by microsurgery or by a technique known as percutaneous discectomy, in which the disc is repaired through the skin without making a surgical incision. For this technique, the surgeon uses an X ray as a guide for inserting a large bore needle into the center of the disc; the central portion of the disc is then removed by using fine instruments that are placed through the needle. You should discuss with your surgeon the various treatment options to determine which is the most appropriate for your specific problems.

To treat spinal stenosis, the surgeon makes an incision that is long enough to allow inspection of all of the vertebrae that have contributed to narrowing of the vertebral canal. After performing a limited laminectomy, the surgeon performs a decompression operation by entering the vertebral canal and removing the material that is pressing on the spinal nerve roots. Occasionally, some form of spinal fusion or other type of stabilization may be indicated.

When a patient has a spinal tumor, the physician may opt to treat the patient with radiation or chemotherapy rather than a surgical operation. If an operation is needed, the surgeon performs a laminectomy, locates the tumor, and removes it from the spine, the spinal cord, and the nerve roots. Some tumors require that the operation be approached from the front of the spine, followed by spinal stabilization. Following the removal of a spinal tumor, the surgeon decides if further radiation therapy and/or chemotherapy should be given.

When a patient has a spinal infection with an abscess in the back part of the spinal canal, the surgeon removes the vertebral arch, locates the abscess, and drains away the pus. If the abscess is toward the front (anterior) in the disc space, the surgeon may make an anterior approach to the vertebral bodies. Appropriate antibiotics will be given to cure the infection.

Recovering from the Operation:

Recovering after back surgery varies with the type of operation that was performed. Following ordinary disc removal, most patients are able to get out of bed and move about on the same day after surgery and get discharged on the very next day. Patients who have undergone a spinal fusion or an operation for stenosis take longer to become mobile (upto 12-24 hours), and these patients may remain in the hospital for longer periods of time (48-72 hours) after the operation. In addition, they may be required to wear a brace or cast for a few weeks to months after surgery.

The length of stay for patients with spinal tumors depends on the type of tumor. Patients who have had an operation to drain an abscess of the spine stay in the hospital until the infection has been controlled.

A common problem after major back surgery is difficulty with urination. This problem usually subsides in three to four days. The insertion of a tube (catheter) into the bladder that will drain the urine may be necessary until the patient is able to void normally. After discharge from the hospital, most back surgery patients will need some time to recuperate before returning to their usual activities. The types of activities the patient can safely resume should be outlined by the operating surgeon and should be followed carefully by the patient. The period of recuperation varies, but it may range from weeks to months, and a back brace or physical therapy program may be recommended

Lifestyle Package for Women

According to studies, an unhealthy lifestyle can age a woman’s skin by more than 10 years and deteriorate the health faster than compared to men due to the weak physical specification. A lifestyle health checkup not only can help detect the risk factors but also improve a healthy lifestyle in order to live longer.

Benefits of the Package:

• Checkups especially designed to detect major health issues such as liver function test, cardiac risk evaluation and mammogram

• Use of latest technology for perfect assessment of the health

• Consultations with our medical experts

INVESTIGATIONS

• CBC

• ESR

• Blood grouping & RH typing

• Urine routine & microscopy

• Stool routine

• Peripheral Smear

• Audiometry

• PSA(Prostate Specific Antigen)

• Chest X ray

• Ultrasound abdomen & pelvis

• Sonomammogram(Less than 40 yrs)/Mammogram (Above 40yrs)

DIABETES EVALUATION

• Fasting Blood Sugar

• Post Prandial Blood Sugar

• HbA1C (Glycalated Haemoglobin)

Lipid Profile

• Total Cholesterol

• HDL

• LDL

• VLDL

• Triglycerides

Liver Function Test

• Alkaline Phosphatase

• SGOT

• SGPT

• GGPT

• Albumin

• Globulin

• Total Protein

• Total & Direct Bilirubin

KIDNEY PROFILE

• SR CREATININE

• SR Uric Acid

• Calcium

• Phosphorus

• BUN

Thyroid Profile

• T3

• T4

• TSH

CARDIAC RISK EVALUATION

• ECG

• ECHO Screening/Tread Mill Test

Other Investigations

• Vitamin B12

• Vitamin D

• Iron with TIBC

• Ferritin

CONSULTATIONS

• Physical examination

• Opthalmology Consultation

• Dental

• Diet Consultation

• Physician Consultation

• Gynecology Consultation