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Spine Disease: Current Trends in Management

#Yearly 266 million cases of lumbar disc disease occur worldwide<br>#Highest incidence of this disease in India<br>#Estimated that 30% (70 Million) will need surgical intervention<br>#Who estimates 11% (7.7 million) become permanently disabled<br>#This incidence higher in India due to poor facilities and lack of awareness.<br>#Likely yearly disability in India=14 lakh people<br>

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Spine Disease: Current Trends in Management

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  1. Dr(Lt Col retd) Shishir KumarSenior Consultant Orthopedics,Spine and Joint Replacement MS (Gen Surg), Dip Ortho, M.Ch. (Ortho), PDf (Trauma Surgery)

  2. Spine Disease:Current Trends in Management Dr. Shishir Kumar

  3. Prof AB GoregaonkarHOD OrthopedicsSion Hospital Mumbai Initial Training Instrumental in generating interest in Spine Surgery

  4. Military Hospital Kirkee -Pune -Spinal Cord Injury Centre -85 bedded -Largest in Asia -Paraplegic Home -For those who can’t go home -Queen Mary Technical Institute -Reskilling of injured patients

  5. Multiple Fellowships

  6. Why are we talking about Spine?

  7. Burden of disease-Low back pain • Single leading cause of disability worldwide • Most common reasons for missed work.  • The second most common reason for visits to the doctor • 80% people will experience back pain in their lifetime • Most are mechanical or non-organic • $50 billion each year on back pain--USA

  8. What is the disability due to spinal disease • Yearly 266 million cases of lumbar disc disease occur worldwide • Highest incidence of this disease in India • Estimated that 30% (70 Million) will need surgical intervention • Who estimates 11% (7.7 million) become permanently disabled • This incidence higher in India due to poor facilities and lack of awareness. • Likely yearly disability in India=14 lakh people

  9. Why does it occur in Humans?Back-Ache: A price for evolution

  10. Why Humans?

  11. Why Humans?

  12. Prevention • Jogging • Cycling • Sports • Yoga

  13. Prevention Ergonomics

  14. Age of Disease

  15. Effect of aging

  16. Young Mechanical back pain Postural Heavy work Prolapsed disc causing sciatica Injuries Developmental defects

  17. Mechanical Back pain

  18. Prolapsed disc (Slip Disc) Bulge Prolapse Extruded

  19. Slip Disc (Prolapsed Disc)

  20. Conservative Management • Rest • Analgesics • Muscle Relaxants

  21. Physiotherapy • Spinal flexion exercises/Extension Exercises • Lumbar support ???? • IFT/TENS—good in elderly • Local heat—SWD,

  22. Which patient needs advice of a ‘Spine Surgeon’? • Sudden onset radicular pain (Sciatica) • Long standing radicular pain (Sciatica) ---no response to treatment • Radicular pain (Sciatica) with weakness of any limb • Any bowel bladder involvement • Neurogenic claudications- Bursting pain in legs on walking • Backache with deformity

  23. Is Going to Hospital Covid safe? • Segregation in OPD • Social distancing • Valveless masks • Pre- operative segregation in ward • Status negative- shifted to Covid negative ward • Health staff - PPE • Negative air flow OT • Patient mask • If Covid positive, surgery postponed as mortality high

  24. Are all patients who fail conservative treatment need surgery?

  25. Office Procedure-Epidural steroids • Severe leg pain due to degenerative disc disease, spinal stenosis, and post-laminectomy syndrome • 70% of patients may get relief

  26. Office Procedure-Selective nerve root block • More effective for disc herniations. • Can identify the cause of root pain • Inject steroids or hyaluronidase—chemical neurolysis

  27. Facet Joint Injections

  28. If all fails-Surgery.Which Surgery-Large Scar?

  29. Gold StandardMicro-discectomy

  30. Day care same day walking

  31. Is Spine surgery safe?

  32. Safety Features • Imaging • Anesthesia • Instruments • Neural monitoring • Skilling

  33. Keyhole and daycare surgery

  34. cost

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