Traditionally spine fractures are being fixed by open surgery which involves exposure of the spine bones via completely detaching the muscles from the bones. Thereafter pedicle screws are placed into bones and rods applied and muscles approximated with each other and skin closed. After this open surgery and dissection of the muscles they become dysfunctional permanently. This causes loss of natural muscle strength into the lower back resulting in chronic low back pain and failed back syndromes. In the modern era, we fix the spine fractures without any muscle dissection. We insert the pedicle screws percutaneously via small stab incisions via tubes through the muscles without damaging any of the muscle fibres. This causes lesser blood loss , lesser post operative surgical site pain, lesser hospital stay leading to better early and long term outcome in terms of preservation of natural muscle strength and full functional capabilities. Thus, after MIS fracture fixation patients can be made to sit, stand and walk on the same day and can be discharged on the next day. For more details you can watch our video on our YouTube channel "MIS spine clinic".

Kyphoplasty is a minimally invasive surgery for spinal vertebral fractures which should be performed ideally in the first three months of fracture. In this small key hole incision is made percutaneously into the skin. Through the incision a deflated balloon is entered into the fractures bone and inflated in place slowly so as to fill the cement with in collapsed segment in order to regain the normal shape and stability. What are Vertebral Compression Fractures? As age progresses our bones become weak and fragile thus leading to fractures even by minimal trauma like picking up a bucket or slipping in the room or diseases like cancer. One of the major causes of the vertebral fractures is Osteoporosis i.e. bone weakening due to decrease the calcium levels. It is more common in females above 40 years of age after menopause i.e. stop of normal menarche cycle as after which the calcium levels in body are significantly reduced. But balloon kyphoplasty cannot be used in every kind of vertebral fractures. It can only be helpful in vertebral compression fractures with an intact posterior wall of the vertebra. In case the posterior vertebral wall is fractured we cannot do kyphoplasty as the cement may leak out on the spinal cord which may lead to weakness in the leg or paralysis. In such cases we should go for fixation rather than kyphoplasty to stabilize the fracture. What are the causes of vertebral fractures? • Osteoporosis • Injury- fall/accident • Pathologicaldue to tumours

What is selective epidural injection/ block? There is an space in the spinal canal which is occupied by the spinal cord, remaining space surrounding the spinal cord or nerves is the epidural space. Therefore the medicine injected into this space spreads directly around the nerves and provide direct effect. In selective injection we directly put the medicine over the nerve which is compressed or inflammed(swollen). Therefore swelling in the nerve is subsided and patient gets direct relief in pain caused by this nerve. Compression over the nerve is not affected by this procedure and that remains as it is. When this block should be given? This procedure is not indicated in every patient of slip disc/ sciatica/ spinal stenosis. Usually this procedure is indicated in a patient who has small disc prolapse/ herniation/ slip disc and his pain is not controlled with atleast 6 weeks or lesser period of medicines. When it should not be given? 1.Cauda equina syndome( involvement of bowel and bladder) 2.In a large disc prolapse with a potential to cause cauda equina syndrome 3.Severe spinal stenosis. What are side effects of this procedure? Usually there are no side effects in trained hands. If the medicine goes into a blood vessel of the nerve it may cause weakness. If the injection has been given in a above-mentioned contraindicated patient it may cause cauda equina syndrome.

WHAT IS A SPINAL TUMOUR? A tumour is an abnormal growth of cells. Spinal tumours can be- Vertebral tumours –affecting the bones of spinal column Spinal cord tumours—affecting the nerves and cord. If cells in the spine grow and multiply abnormally to cause a tumour, this is called a primary tumour. If abnormal cells have spread to the spine from a tumour in another part of the body, this is called a secondary tumour or metastasis. WHAT ARE THE DIFFERENT TYPES OF SPINAL TUMOURS AND WHERE DO THEY OCCUR? NON-MALIGNANT SPINAL TUMOURS Low grade or slow growing spinal tumours can grow but they do not spread to other parts of the body. However, these tumours can grow to a considerable size, causing damage by putting pressure on the tissue around them in the spine. MALIGNANT SPINAL TUMOURS High grade or rapidly growing tumours are called malignant. They are cancerous. They do spread and destroy the tissue surrounding them. The most common spinal tumours are malignant metastases that have spread to the spine from malignant primary tumours in other parts of the body such as the prostate, breasts, lungs, kidneys and bowel. Procedures Done for them are- 1. Transpedicular Biopsy 2. Vertebroplasty 3. Decompressive laminectomy ± Tumor excision 4. Piecemeal or enbloc tumour excision and complex spinal reconstruction Dr. Pravin decides the line of treatment as per international guidelines after thorough clinical and imaging reports evaluation.

The spinal column is involved in less than 1% of all cases of tuberculosis (TB). Spinal TB is a very dangerous type of skeletal TB as it can be associated with neurologic deficit due to compression of adjacent neural structures and significant spinal deformity. Therefore, early diagnosis and management of spinal TB has special importance in preventing these serious complications.

Back pain is frequent complaint. It is the commonest cause of work-related absence in the world. Although back pain may be painful and uncomfortable, it is not usually serious. Even though back pain can affect people of any age, it is significantly more common among adults aged between 25 and 55 years. Pain in the lower back may be linked to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, lower back muscles. Pain in the upper back may be due to disorders of the aorta, tumors in the chest, and spine inflammation. The risk factors for back pain? • A mentally stressful job • A sedentary lifestyle • Age – older adults are more susceptible than young adults or children • Gender – back pain is more common among females than males • Obesity • Smoking • Strenuous physical exercise • Strenuous physical work What are the symptoms of back pain? The main symptom of back pain is, as the name suggests, an ache or pain anywhere on the back, and sometimes all the way down to the buttocks and legs. If any of the following symptoms accompanies a back pain your should see your doctor: • Weight loss • Elevated body temperature (fever) • Swelling on the back • Persistent back pain – lying down or resting does not help • Pain down the legs • Pain reaches below the knees • Arecent injury, blow or trauma to your back • Difficulty urinating – passing urine is hard • Loss of bowel control • Numbness around the buttocks

INJECTIONS FOR YOUR BACK & NECK CERVICAL EPIDURAL CERVICALFACET BLOCKS LUMBAR EPIDURAL FACET BLOCKS ROOT BLOCKS A lumbar caudal epidural steroid injection is an outpatient procedure for treating low back and leg pain. Facet & root blocks are injection into a specific joints of spine and along the nerve roots as required. Introduction In a lumbar epidural injection, an anti-inflammatory medicine is injected into the epidural space to reduce inflammation. A local anesthetic (numbing medicine) may also be injected. When the injection is done through the bony opening in your tailbone then this is called a caudal epidural injection. An injection in a joint of the back is called a facet joint injection. An injection along the nerve root sleeve is called a root block. Getting Ready for Treatment : • Provide a list of all medicines you take, including aspirin and anti-inflammatory drugs. • Don’t eat 6 hours before the injection but you can have a light drink 4 hours before injection. • Arrange for a responsible adult to drive you home after the procedure. • Bring all X-ray & MRI images on the day of the procedure • You need to stop blood thinning drugs like asprin, clopidogriel etc. 5 – 7 days before the injection. But consult your cardiologist before hand. During the Procedure: The injection takes just a few minutes. But extra time is needed to get ready. Alocal anesthetic will be used to numb your skin. The doctor will then insert a thin needle directly into the epidural space. A type of X-ray or C-arm may be used to ensure the safe and proper position of the needle. Contrast “dye” may be injected into your back, this helps get a better image. Once the doctor is sure the needle is correctly placed the medicine will be injected.