How to Cure Cervical Spondylosis Permanently

By Dr.Ravindra Patil

What is Cervical Spondylosis

Cervical spondylosis is a common, age-related disorder of the cervical spine that is located in the neck region. This condition is also known as neck arthritis or cervical osteoarthritis. With age, the cervical discs gradually face wear and tear resulting in the breakdown of the structure. The fluid present between the cervical discs is lost which makes the spine stiffer, leading to cervical pain. This results in changes in the bones, discs, and joints at the spine of the neck.

As a result of the fluid dehydration and degeneration of the discs and cartilage in the surrounding area, abnormal growth or spurs of bones called osteophytes can occur leading to the narrowing of the passage from where spinal nerves exit, causing a related condition called cervical spinal stenosis.

Table of Contents

What is Spondylosis?

Spondylosis is an umbrella term that is used to describe any degeneration of the spinal cord. Spondylosis symptoms involve acute pain in the neck and back in old-age. Cervical spondylosis is prevalent among middle-aged and elderly people.

Spondylitis vs Spondylosis

Spondylitis and spondylosis both affect the spinal cord but there is a basic difference between the two. The meaning of spondylitis is that it is the inflammation of one or more typical cervical vertebrae leading to pain in the spine. Cervical spondylosis mostly refers to any kind of degeneration of the spine. So, even though the effects of both the diseases might be similar, their origin and cause are completely different.

Symptoms of Cervical Spondylosis: What is the difference?

Cervical spondylosis symptoms can vary from person to person and the extent of cervical spine pain depends on the age of the affected person. Some of the common spondylosis symptoms are:

• Excessive stiffness at the neck leads to pain in neck
• Cervical spondylosis headache that may originate at the main cervical spondylosis pain areas
• Pain in the shoulder and arms
• Failure to properly turn the head around
• Grinding noise or sensation when trying to turn the neck
• Cervical pain is severe in the morning and at night before bedtime
• If cervical spondylosis leads to spondylotic myelopathy, the following symptoms may occur:
  • Abnormal tingling, numbness, and weakness in the arms, hands, feet, and legs
  • Lack of balance and coordination
  • Abnormal reflexes, random muscle spasms
  • Loss of control over urinary bladder and bowels

Causes of Cervical Spondylosis

Wear and tear of the vertebrae in the spinal cord causes degenerative spondylosis. Other causes are:

• Bone spurs or abnormal outgrowths of bones called osteophytes
• Dehydrated Spinal Discs
• Herniated Discs:
• Injury of the neck
• Stiffness of the Ligament
• Excessive Stress and Overuse

Risk Factors of Cervical Spondylosis

The greatest risk factor of cervical spondylosis is aging. Other risk factors are:

• Heavy physical actions like heavy lifting
• Poor posture in people who work at desk jobs
• Genetic factors and family history
• Smoking
• Being overweight and inactive

How to prevent cervical spondylosis?

• Avoid loading heavy objects on the head or neck. Do not sleep on a high-pillow.
• For people with desk jobs, maintain a proper posture
• Lean back your head once in a while.
• Swimming is considered to be a relaxed exercise for cervical pain
• Perform general physical activities.
• Do not be inactive for a long period of time, take exercise

Diagnosis of Cervical Spondylosis

1. Physical Examination

• Testing the reflexes of the patient and checking for the presence of muscle weakness and deficits in the sensory nerve function is done.
• Tests are done to determine the range of neck movement
• Overall walking movement is checked

2. Imaging Tests

• X-Rays
• CT Scan
• MRI Scan
• Myelogram

3. Nerve Function Tests

• Electromyogram (EMG) records the passage of nerve signals in the body by measuring the electrical activity of the nerves.
• Nerve Conduction Study – the speed and strength of the signals sent by the nerve endings in the body are checked.

Treatment of Cervical Spondylosis

Spondylosis treatments mainly focus on how to cure cervical spondylosis permanently, give pain relief and lower the risk of extensive damage to your vertebrae.

Physiotherapy

• Physiotherapy for cervical spondylosis is a great way for pain relief. A trained physical therapist can teach all the exercises for cervical spondylosis.
• Neck traction: it uses weights to help increase the space between the cervical joints and reduce the pressure forming on the cervical discs and nerve roots.

Medications

Commonly administered medications for the treatment of Cervical Spondylosis are:

• Muscle relaxants
• Narcotics are used for severe neck pain
• Anti-seizure medications help to reduce pain caused due to damage of nerves
• Steroids: Used to reduce the occurrence of tissue inflammation and reduce pain
• Non-Steroidal Anti Inflammatory Drugs [NSAIDS]
• Antidepressants help in relieving severe neck and shoulder pain
• Certain homeopathic medicines also help

Home Remedies for Cervical Spondylosis

• Take enough rest
• Maintain a proper posture
• People who acquire spondylosis at an early age normally do so because of bad study habits
• Heat and cold treatment help provide relief and also works in relaxing the sore muscles of the neck and shoulders. Using a heating pack or a cold pack can be a good home remedy for cervical spondylosis
• Chiropractic manipulation that can help in order to control events of more severe pain due to cervical spondylosis. However the chiropractor must have the requisite skills of manipulating the neck
• Wearing a neck collar for cervical spondylosis helps limit movement and provides support for the neck and shoulders. However, these neck collars should not be worn for a longer period of time as it can cause muscle weakness.
• Several people opt for ayurvedic medicine for cervical spondylosis and Patanjali medicine for cervical spondylosis to cure their ailment

The Need for Cervical Spondylosis Surgery

Cervical spondylosis is not progressive even though patients might have to live with severe pain for long periods of time all their life as it is a chronic condition. Cervical Spondylosis Surgery is only advised by doctors in rare cases when other forms of treatment do not help to ease the pain. For people who suffer from a progressive loss of function in the arms, hands, and legs, surgery may be required to fix the defect at the source point. This is because any form of compression at the cord may result in permanent functional disability.

In cases of the surgery, the main goal is to remove the areas or sources that have been applying extra pressure to the spinal cord and nerve endings. Some extensive forms of surgery may also involve the insertion of implants or bone grafts to add stabilization. Doctors also perform a fusion of the degenerated discs as a cure for cervical spondylosis.

Road to Recovery and Aftercare

Cervical spondylosis is not uncommon among people who have crossed their 60s. Early diagnosis of this disease can help doctors recommend a conservative line of treatment to help ease the pain. Though this condition is not reversible, with proper care, home remedies, and lifestyle practices, patients overcome the stiffness and discomfort.

How to cure cervical spondylosis permanently?

This is a very difficult question to answer as has been mentioned, the treatment of cervical spondylosis is primarily aimed at pain relief cervical exercises by physiotherapy and medicines. Surgery in this condition is done only when there is a physical problem like a bone spur pressing on the spinal cord, or a herniated disc pressing on the nerves or a compressed disk ‘pinches’ a nerve or the spinal canal is narrowed, due to spinal stenosis. Samarth Neuro and Super-speciality Hospital in Miraj offers medical and physiotherapy treatment for cervical spondylosis. If required, surgery for cervical spondylosis can also be done at Samarth Hospital in Miraj, Maharashtra.

Spina Bifida Causes, Symptoms and Treatment

By Dr.Ravindra Patil

What is Spina Bifida?

Spina bifida is a birth defect in which an area of the spinal column doesn’t form properly, leaving a section of the spinal cord and spinal nerves exposed through an opening in the back. Spinabifida occurs in 1 per 2,000 live births.

Table of Contents

Myelomeningocele

The most common and serious form of spinabifida is called myelomeningocele, in which a part of the spinal cord and surrounding nerves push through the open bones (vertebrae) in the spine and protrude from the foetus’s back. In myelomeningocele, spinal cord and nerves protrude from the back in a sac that is exposed to the amniotic fluid. Continuous bathing of the fragile developing spinal cord in amniotic fluid over the course of gestation is thought to result in progressive neurologic injury.

Other types of spina bifida

Other types of spinabifida include myeloschisis, lipomeningocele and myelocystocele. Open neural tube defects such as myelomeningocele and myeloschisis are treatable by foetal repair. Closed neural tube defects such as lipomeningocele and myelocystocele are not treatable by foetal repair.

Causes of spina bifida

Myelomeningocele has genetic and micronutrient causes. Mothers who have had a baby with spinabifida have up to a 4 percent risk of recurrence in subsequent pregnancies.

Spina bifida symptoms

The myelomeningocele lesion can occur at any level on the developing spine, but most are found in the lumbo-sacral region. Depending on the lesion’s location, myelomeningocele may cause:

• Bladder and bowel problems (incontinence)
• Sexual dysfunction
• Weakness and loss of sensation below the defect
• Inability to move the lower legs (paralysis) and other cognitive impairments
• Orthopaedic malformations such as club feet or problems of the knees or hips
• Generally, the higher the defect is located on the spine, the more severe the complications.

In many cases, the brain develops an Arnold-Chiari II malformation, in which the hindbrain herniates or descends into the upper portion of the spinal canal in the neck. This herniation of the hindbrain blocks the circulation of cerebrospinal fluid, causing hydrocephalus (accumulation of fluid in the brain), which can injure the developing brain. Ventricular shunting (placement of a thin tube into the ventricles of the brain) is used to drain fluid and relieve hydrocephalus.

Hindbrain Herniation and Ventricular Shunting

Ventricular shunting is done to treat hydrocephalus. It involves placement of a thin tube into the ventricles of the brain to drain fluid and relieve hydrocephalus. The other end of the tube is usually put in the peritoneum [abdomen] of the patient for continuous drain.

Evaluation and diagnosis of spina bifida

As with other birth defects, most myelomeningoceles are discovered by routine ultrasound evaluation between 16 and 18 weeks into the pregnancy. Sonographic features suggestive of myelomeningocele include a cystic mass anywhere on the spine. Abnormally high alpha-fetoprotein (AFP) will support the diagnosis.

Other evaluation methods for suspected spinabifida are:

• High-resolution level II ultrasound — to confirm the diagnosis and determine the location of the lesion, and to assess for any other birth defects such as club feet
• Ultrafast foetal MRI — to confirm presence of the Chiari II malformation and to screen for evidence of any other neurologic abnormalities
• Foetal echocardiogram — to determine any problems with the heart
• Amniocentesis — to confirm the presence of elevated amniotic fluid alpha-fetoprotein (AFAFP) levels and acetylcholinesterase (AChE), which indicate open neural tube defects
• Maternal serum alpha-fetoprotein (MSAFP) test — to confirm elevated AFP levels in the mother’s blood

After evaluation, a multidisciplinary team works together to review test results, confirm the diagnosis, explain spina bifida treatment options and potential outcomes, and answer all the patient’s questions.

Treatment

The two main spina bifida treatment options are foetal surgery during pregnancy or surgery on the baby right after birth.

Deciding whether prenatal or postnatal spinabifida repair is appropriate is influenced by several considerations, including gestational age, the level of the myelomeningocele lesion on the spine, presence of the Chiari II malformation, and a number of important maternal health factors.

Spina bifida surgery after birth

If postnatal spina bifida surgery is recommended or selected, your pregnancy is monitored and a caesarean delivery is planned at 37 weeks.

Traditional spina Bifida treatment takes the form of surgical repair 24 to 48 hours after birth. Your child will undergo general anaesthesia. A paediatric neurosurgeon removes the MMC sac, if one is present, and closes the surrounding tissue and skin over the defect to protect the spinal cord. After surgery, your baby will receive care in the Neonatal Intensive Care Unit (NICU).

Spina bifida surgery before birth

Because spinal cord damage is progressive during gestation, prenatal repair of myelomeningocele may prevent further damage. Scientific studies have demonstrated that prenatal repair can offer significantly better results than traditional postnatal repair.

• It reduced the need to divert fluid from the brain using ventricular shunting
• Reduced the incidence or severity of neurological effects such as impaired motor and sensory function of the legs
• Improved mobility and improved the chances that a child will be able to walk independently
• Reversed the hindbrain herniation component of the Arnold-Chiari II malformation

Foetal surgery for spinabifida is a complex and challenging procedure, requiring the most expert, comprehensive care for both mother and foetus. The surgical team’s level of experience and all aspects of care surrounding the operation are of paramount importance.

If your unborn baby has been diagnosed with myelomeningocele, the surgery is performed between 23 weeks and 25 weeks of gestation.

Spina bifida prognosis

Rarely, children can die due to complications associated with Chiari II malformation or hydrocephalus. Many patients require shunts (85 percent), and 45 percent of shunts develop complications within one year.

Follow-up care

Children operated for spina Bifida require comprehensive long-term follow-up, from the time of repair through adolescence. It is team work of a paediatrician, nurse, social worker, physical therapist, neurosurgeon, orthopaedic specialists, urologist and genetic counsellor.

Depending on the location of the lesion and outcome after surgery, follow-up care may also include:

• Clean intermittent catheterization
• Bowel management
• Lower extremity bracing
• Physical therapy evaluation and guidance to outside physical therapists and early intervention
• Pressure sore management
• Referral to appropriate psychosocial and financial resources
• Consultation with other subspecialties including ophthalmology, nephrology, nutrition and feeding specialists, and plastic surgery

The Spina Bifida team works closely with each child’s primary care paediatrician and school, and helps families access appropriate community services. Ongoing follow-up is critical when it comes to improving outcomes and advancing treatment for patients with myelomeningocele.

Spina Bifida can lead to a variety of social and emotional challenges and lifelong quality-of-life issues. Hence proper diagnosis during pregnancy is essential.

Spina bifida occulta

Spina bifida occulta is the mildest type of spinabifida. It is sometimes called “hidden” spinabifida. In this birth defect, there is a small gap in the spine, but no sac comes out of the back. The spinal cord and the nerves usually are normal.

At Samarth Neuro & Super Speciality Hospital in Miraj, we are dedicated to providing expert care, ensuring the well-being and quality of life for individuals facing this condition.

Atlantoaxial Dislocation

By Dr.Ravindra Patil

This condition occurs in the neck when the first two cervical vertebrae move away from their positions. Luckily this is a very rare condition. But if ever it occurs, it may have serious implications. The patient may suffer quadriplegia, that is, paralysis of all the body below the neck. But before we understand what is atlantoaxial dislocation, we must understand the anatomy of the cervical spine, and especially the first vertebra of the spinal column, called the ‘atlas’, and the second vertebra, which is called the ‘axis’. The two vertebrae, the atlas and axis, are joined at what is called the atlantoaxial joint.

Table of Contents

Anatomy of the Cervical Spine

The cervical spine is the upper portion of the vertebral column, lying between the skull and the thoracic or chest vertebrae. It has seven vertebrae, two of which are given unique names:

• The first cervical vertebrae (C1) is known as the atlas.
• The second cervical vertebrae (C2) is known as the axis.

The cervical vertebrae, seven in all, are different from the other vertebrae and are a bit more delicate. We will focus on the first two cervical vertebrae.

Atlas vertebra

The atlas is the first cervical vertebra and lies between the skull and the axis vertebra. It differs from the other cervical vertebrae considerably.

Axis vertebra

The axis lies between the atlas and the third cervical vertebra. It articulates with the atlas through the medial atlanto-axial joint. This joint allows for rotation of the head independently of the torso.

The axis also articulates with the atlas to form the two lateral atlanto-axial joints.

Ligaments of the cervical spine

There are six major ligaments in the cervical spine. The ligaments are strong tensile connective tissue which hold the vertebrae together.

Injuries of the cervical spine

Injury due to vertical fall
A vertical fall onto an extended neck e.g. diving into excessively shallow water can compress the lateral masses of the atlas between the occipital condyles and the axis. This causes them to be driven apart, fracturing one or both anterior/posterior arches.
If the fall occurs with enough force, the transverse ligament of the atlas may also be ruptured.
Hyperextension (Whiplash) Injury
A rear-end traffic collision or a poorly performed rugby football tackle can both result in the head being whipped back on the shoulders, causing whiplash. In minor cases, the anterior longitudinal ligament of the spine is damaged which is acutely painful for the patient.
Atlantoaxial Subluxation
The worst-case scenario for these injuries is that dislocation or subluxation of the atlas and axis occurs. Subluxation means a slight misalignment of two vertebrae in relation to each other. It is the cause of many health problems. This often happens at the axis vertebra level, where its body of moves forward with respect to the third cervical vertebra. Such an injury may well lead to spinal cord damage. Quadriplegia or death may occur. More commonly, subluxation occurs at the lower levels of the cervical spine.
Hangman’s Fracture
Hangman’s fracture refers to a fracture of the bony column of the axis vertebra. It typically occurs as a result of high velocity hyperextension and distraction of the head. Such an injury is likely to be lethal as rupture the spinal cord may occur, causing deep unconsciousness, respiratory failure and cardiac failure.
Fracture of the Dens
Occurs in the axis vertebra. These fractures are often unstable and are at high risk of avascular necrosis. As with any fracture of the vertebral column, there is a risk of spinal cord involvement.
Dislocation of the Atlanto-Axial Joint
Atlanto-axial Dislocation or Fracture can cause severe spinal cord compression resulting in significant neurological injuries of upper spinal cord and lower medulla oblongata. Patient may suffer paralysis of all four extremities (quadriplegia). Severe neck pain is spread over back of the neck and arms. Patient will also have continuous chronic pain.
Atlanto-axial dislocations (AADs) may be classified into four varieties depending upon the direction and plane of the dislocation i.e. anterior-posterior, rotatory, central, and mixed dislocations. However, from the surgical point of view these are divided into two categories i.e. reducible [RAADs or Reducible Atlanto Axial Dislocations] and irreducible [IAADs or Irreducible Atlanto Axial Dislocations].

Surgical Treatment

For RAAD, Posterior fusion is done. Screws are fixed across joints and vertebral bodies and wiring is done. Often, IAAD is due to inadequate extension in dynamic X-ray study which may also be due to spasm of muscles.

The above is a very simplistic explanation of a very complex surgical process. Various different methods are there to treat AAD [atlanto-axial dislocation]. However, it will be too complicated for non-medical people to understand, hence it is not described in detail.

The surgeries require high precision. That is why hospitals like Samarth Neuro and Multispeciality Hospital located in Miraj are able to conduct such complex surgeries. Because Samarth Hospital has surgical navigation system which is the only way to manage such complex injuries.

While it may seem to the reader that the complexity of atlanto axial subluxation or dislocation is being exaggerated, it should be remembered that if the surgery goes wrong even slightly, the patient may suffer quadriplegia or even death. There is only one chance for the perfect surgery. Otherwise the patient may suffer with failed surgery.

Hence the use of surgical navigation, which pinpoints the exact locations where the initial incisions are to be taken and the exact spots where screws and wires are to be fitted so as to prevent injury to the spinal cord and the spinal nerves coming out between vertebrae.

Medical Care

There are no are medicines for atlantoaxial instability (AAI), subluxation or dislocation. Because of the chronicity of the instability at the time of presentation in most cases, corticosteroids have little, if any benefit. Neurologic problems do not get better with corticosteroids. In fact they may cause side effects. In the acute traumatic setting, corticosteroids remain controversial. Guidelines provided by the American Academy of Neurological Surgeons (AANS) include level I evidence against the use of corticosteroids or gangliosides in the acute trauma patient.

Unless symptoms of spinal cord compression occur, AAI requires no treatment. Once symptoms arise, cervical spine stabilization is indicated until surgical stabilization is performed.

What are the symptoms of rotatory atlantoaxial dislocation?

Main symptom is torticollis. It is painless, and often, there are no neurological symptoms. Rotatory atlantoaxial dislocation can be subdivided into reducible or irreducible types. Reducible type rotatory atlantoaxial dislocation is classified as one where the dislocation reduces on dynamic images or after institution of cervical traction. The torticollis is painless, and often, there are no neurological symptoms. Rotatory atlantoaxial dislocation can be subdivided into reducible or irreducible types. Reducible type rotatory atlantoaxial dislocation is classified as one where the dislocation reduces on dynamic images or after institution of cervical traction.

What is the treatment for occipitoatlantal dislocation?

For Type II lesions associated with occipito-atlantal dislocation and/or when the diagnosis was delayed for more than 14 days, a posterior atlantoaxial or occipito atlantoaxial arthrodesis [fusing the two bones of the joint for ever] was recommended. Other lesions are all treated with posterior arthrodesis after reduction.

How to treat rotatory atlantoaxial instability?

Holding and manipulation of the spinous process of axis, posterior arch of atlas, and the facets of atlas and axis can result in reduction of the rotatory dislocation.

To summarise

As has been mentioned, Atlantoaxial Dislocation or subluxation is very rare. It is not so easy to understand the complex disease condition for most people. Samarth Neuro and Multispeciality Hospital has the infrastructure and surgical teams to treat Atlantoaxial Dislocations.

Symptoms of Cervical Vertigo

By Dr.Ravindra Patil

People are surprised to know that there is a condition called cervical vertigo. In most peoples’ mindsets, vertigo or vertigo problems never seem to be connected with the neck. Most people think vertigo is because of weakness. It is not so. It may be similar to the symptoms of nervous system disorders. Some times they may be similar to common vertigo problems. But mostly pain in the neck and vertigo or dizziness.  It is important to identify and get your cervical vertigo diagnosed as early as possible so as to start treatment early.

People with cervical vertigo have both neck pain and dizziness. Other symptoms include vision issues, nausea and lack of coordination. Several different things can cause the condition, such as inflammation, joint issues and trauma. Cervical vertigo is a treatable condition that usually goes away with physical therapy and inner ear exercises.

Table of Contents

What is cervical vertigo?

Cervical vertigo – also called cervicogenic dizziness – is a condition that causes both neck pain and dizziness. It’s related to certain neck conditions. Cervical vertigo can also occur following a cervical spine injury. Though, in most cases, symptoms don’t appear until months or years after the initial trauma.

Your cervical spine – or, your neck – plays a key role in balance and coordination. So, when this area of your spine is inflamed, arthritic or injured, it can make you feel dizzy, lightheaded and unsteady.

What is the difference between vertigo and cervical vertigo?

Vertigo refers to the sensation of spinning, even when you’re not moving. Cervical vertigo is a specific type of vertigo in which dizzy sensations are related only to neck injury or inflammation.

Which people suffer from cervical vertigo?

Anyone can develop cervical vertigo. But the condition is much more common in people with:

• Severe head trauma.
• Arthritis of the neck (cervical spondylosis).
• Herniated disks.
• Whiplash injuries.

What are the symptoms of cervical vertigo?

Cervical vertigo symptoms vary from person to person. They may include:

• A sensation of floating.
• Light-headedness.
• Lack of coordination or unsteadiness.
• Balance problems.
• Posture changes.
• Visual symptoms, such as rapid eye movement and visual fatigue.
• Nausea and vomiting.
• Neck pain or tightness.

Unlike other types of vertigo, cervical vertigo rarely makes you feel like you’re spinning. Instead, most people describe a lightheaded or “floating” sensation.
Furthermore, cervical vertigo symptoms overlap with symptoms of many vestibular (inner ear) disorders, including:

• Vestibular neuritis.
• Benign paroxysmal positional vertigo (BPPV).
• Acoustic neuroma.

For this reason, your healthcare provider will need to rule out other conditions before making a diagnosis.

What causes cervical vertigo?

Anytime your cervical spine develops an issue or sustains an injury, dizziness and other symptoms can occur. Experts are still researching cervical vertigo, but possible causes include:

• Neck trauma.
• Arthritis (cervical spondylosis).
• Atherosclerosis in your neck.
• Cervical degenerative disk disease.
• Poor posture.
• Injured disks.
• Joint issues.
• Muscle strain.

Regardless of what causes cervical vertigo, stress and anxiety can trigger your symptoms.

How is cervical vertigo diagnosed?

Because cervical vertigo can mimic symptoms of other conditions – such as BPPV, central vertigo and vestibular neuritis – your healthcare provider will need to rule out other issues. To do this, they’ll need to conduct many diagnostic tests, which may include:

• Magnetic resonance imaging (MRI).
• Magnetic resonance angiography (MRA).
• Spine X-rays.
• Vertebral Doppler ultrasound.
• Vertebral angiography.
• Evoked potential tests, which measure pathways in your nervous system.
• Many Vestibular tests to rule out inner ear (vestibular) conditions.

How is cervical vertigo treated?

Cervical vertigo treatment involves addressing the underlying condition. Be sure to follow your doctor’s specific guidelines. In addition, he or she may recommend physical therapy, vestibular rehabilitation, medication or a combination of treatments.

Physical therapy

Physical therapy exercises can help improve your balance and coordination, as well as your neck’s range of motion. A physical therapist can train you in proper posture and teach you stretching exercises to reduce your symptoms. In some cases, your healthcare provider might refer you to a specialist chiropractor for a chiropractic adjustment of your neck and spine.

It’s important to note that physical therapy can improve many cervical vertigo symptoms, but it can’t eliminate dizziness. For this reason, your healthcare provider may recommend vestibular rehabilitation as well.

Vestibular rehabilitation

Vestibular rehabilitation encompasses a number of exercises designed to improve your balance and reduce dizziness. These cervical vertigo exercises are tailored to your needs and may include training in:

• Eye movements.
• Neck movements.
• Balance
• Walking

The specialist can teach you how to do these cervical vertigo treatments at home.

Medications

Medications may also be a part of your cervical vertigo treatment plan. These medications may include:

• Muscle relaxants to reduce neck tightness.
• Pain relievers to ease discomfort.
• Drugs to reduce dizziness.

Which doctors treat cervical vertigo?

Cervical vertigo is usually treated by a neurologist – a doctor who specializes in diseases of the brain, spinal cord and nerves. He can be a neuro-physician or a neurosurgeon.

Can cervical vertigo be prevented?

You can’t always prevent cervical vertigo, especially if it’s the result of a car accident, sports injury or other traumatic events. However, physical therapy exercises can help keep your neck muscles strong. In turn, this can decrease pressure on your cervical disks and reduce your risk of developing cervical vertigo later on.

What can I expect if I have cervical vertigo?

Most of the time, cervical vertigo is quite manageable. But proper diagnosis and treatment are essential. You’ll probably need testing to rule out other, more serious conditions.

Once a diagnosis is established, your doctor will recommend personalized treatment to ease your symptoms. Depending on the cause and extent of your condition, you may need physical therapy, vestibular (inner ear) therapy or medication.

How long does cervical vertigo last?

Episodes of cervicogenic dizziness can last between several minutes to several hours. The condition itself can last several years, and people may experience periodic flare-ups.

Keep in mind, cervical vertigo symptoms can appear months – or even years – after a traumatic incident.

When should I see my doctor for cervical vertigo?

If you have neck pain, dizziness or other cervical vertigo symptoms, plana visit with your doctor as soon as possible. Because cervicogenic dizziness can mimic other, more serious health conditions, prompt diagnosis and treatment are key.

What questions should I ask my doctor?

If you suspect you might have cervical vertigo or a related health issue, here are some questions to ask your healthcare provider:

• What’s the main cause of my symptoms?
• Could any other factors cause my symptoms?
• Is this issue short-term or long-term?
• Will I need testing?
• Which tests will I need?
• How long will it take for a proper diagnosis?
• What are my treatment options?
• Are there ways to manage my symptoms at home?
• Could my symptoms go away without treatment?

Dizziness and neck pain are both uncomfortable symptoms that can interfere with day-to-day living. But when they occur together, they can make even the simplest tasks seem impossible. Your doctor can determine what caused cervical vertigo and tailor a treatment plan to manage your symptoms. With care and diligence, you can minimize your symptoms and vastly improve the quality of you

Lumbar Spondylosis

By Dr.Ravindra Patil

It is a painful condition of area of the lower back above the buttocks. But first let us understand each term clearly. Let us see ‘Lumbar’ means and what ‘Spondylosis’ means.

Table of Contents

What is ‘Lumbar’ Spine?

It refers to that part of the spinal column which has five vertebrae and is located at the lower back but above the buttocks. Painful conditions occur in the lumbar spine because it carries the weight of the upper body and is prone to many stresses and injuries during routine work and severe hard exertions.

Understanding spondylosis

Spondylosis refers to the development of age-related arthritis that affects the spine. More specifically, it involves a number of different degenerative issues that affect the disks and joints of the spine. It may occur in any part of the spine, from the neck to the back to the lower back. In this article we focus on the lower back or the ‘Lumbar’ region. Hence we call it Lumbar Spondylosis.

Why does spondylosis occur? Over time, disks between two vertebrae [called intervertebral disks] may become dehydrated and become compressed, meaning their height is reduced as a result of dehydration. Thus, they provide less cushioning and can actually “crack,” which can lead to herniation. Herniation means a part of our body protrudes out of a normal or an abnormal opening.

Similarly, the cartilage in the spine’s joints can wear down, resulting in the formation of bone spurs.  

These arthritic changes can not only cause pain in the back but can also lead to a narrowing of the spinal canal (also known as stenosis), which may compress nerves. Nerve compression causes symptoms like pain and numbness, which slowly increases with the passage of time. Later there may be loss of vital functions like bladder and bowel control. Individuals with spinal stenosis may have neurologic symptoms in their extremities, such as numbness, tingling, or weakness radiating into their arms or legs. Loss of bladder or bowel control may lead to further complications. 

What causes spondylosis?

The most common cause of spondylosis is the cumulative joint stress that occurs as people age. It predisposes them to osteoarthritis, a common form of arthritis typically associated with progressive “wear and tear” on joint cartilage. 

Spondylosis may also arise as a result of previous trauma to the spine. For instance, patients who:

• Have had car accidents, falls, or other spinal injuries
• Play competitive sports
• Perform strenuous physical activity at work
• Have had a previous neck or back surgery

The lumbar region is most affected by spondylosis because of its exposure to mechanical stress.

What are the risk factors for spondylosis?

The risk factors for spondylosis include the following:

• Age 60 or older
• Osteoarthritis affecting other joints
• Physically demanding jobs that may require heavy lifting or bending
• High-level athletics
• Neck or back injury
• Previous spine surgery
• Obesity
• Smoking
• Physical inactivity

What are the symptoms of lumbar spondylosis?

Many with spondylosis do not have pain or neurologic symptoms. Some people may experience symptoms. They are:

• Neck or back pain that worsens when coughing or sneezing
• Decreased flexibility in and range of motion of the neck or back
• “Clicking” sounds from the spine
• Pain radiating from the lower back into the legs
• Numbness, tingling, or weakness in the arms or legs
• Unsteady gait
• Muscle spasms
• Headaches
• Bladder or bowel dysfunction in severe cases

How is spondylosis diagnosed?

A person can be diagnosed with lumbar spondylosis by a medical history, physical exam, and reviews of diagnostic tests. When providing your medical history, it is important to share any history of spinal injuries or previous surgeries. Physical activity information must also be shared.

Your doctor will observe your walking ability and assess the range of motion of your spine to determine if you have any pain or stiffness. Palpation of the neck and back can also help identify the location of any tenderness associated with spondylosis. Your neurologic function will also be evaluated, including your sensation, strength, and reflexes. Special tests may also be performed to check for any signs of nerve impingement (from a disk herniation, for example). 

Finally, imaging studies like X-rays, computed tomography (CT scan), and magnetic resonance imaging (MRI) may also be used to identify any arthritic changes in the spine. Lab tests may also be useful for ruling out more concerning diseases, such as an infection or cancer.

Differential Diagnosis

When a patient is suffering from low back pain, there are a lot of other possible diseases that have to be considered and ruled out:

• Rheumatoid arthritis
• Excessive exercise pain
• Ankylosing Spondylitis
• Coccyx Pain
• Spinal Masses
• Infection
• Discitis
• Lumbar Compression Fracture
• Mechanical Low Back Pain
• Overuse Injury

Lumbar Spondylosis’s degeneration can influence spinal alignment, potentially exacerbating pre-existing Spinal Deformities, emphasizing the need for comprehensive diagnosis and treatment.

How is spondylosis treated?

Different treatments are available to treat spondylosis, depending on the type and severity of symptoms. 

Treatments for milder spondylosis include:

• Activity modification, such as avoiding activities that cause pain
• Medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen and Diclofenac or Paracetamol
• Hot/cold compresses, massage, and traction
• Physical therapy, such as strengthening and flexibility exercises and ergonomic education
• Spinal injections, such as an epidural around nerves and facet joints

In more severe cases, surgery might be the best course of action. It may involve the following procedures:

• Decompression (laminectomy, discectomy), which involves the removal of bone spurs, disk herniations, and arthritis to relieve compression of the nerves and address neurologic symptoms
• Fusion, which is the formation of bone across adjacent vertebral bodies to stabilize the spine and relieve pain

Other Surgical treatment for Lumbar Spondylosis

• This surgery is used to relieve pain associated with a compressed nerve in the spine.
• Disk replacement.
• Interlaminar implant.
• Physical Therapy Management
• Educating the patient: may include reviews of lumbar anatomy, explanations of the concept of posture, ergonomics and giving appropriate back exercises.

Other non-surgical treatment modalities include

• Lumbar Back Support: Can be beneficial for patients suffering from chronic LBP. It occurs to limit spine motion, stabilize, correct deformity and reduce mechanical forces. There is no consensus if it may function as a placebo or really improve pain and functional ability.
• Special type of taping is done on the back to prevent moment in certain directions, but again it is thought to give more of a placebo effect of pain relief.

Clinical Bottom Line

Lumbar spondylosis can be described as a degeneration of the lumbar vertebrae.

• It is a form of low back pain and is an important clinical, social, economic and public health problem affecting the worldwide population.
• It is a disorder with many possible causes and many definitions.
• Clinical diagnosis of lumbar spondylosis is done by MRI, CT, SPECT and X-ray and a general examination of the spine.
• Mild cases are managed with medicines.
• Severe cases need surgery.
• The physical therapy has an important role, and may include lumbar traction, manipulation of the spine, massage therapy, TENS, back school and Lumbar back supports.
• The choice of therapy depends on the individual wishes and the surgeons advice.

Lumbar Spondylosis’s degeneration can influence spinal alignment, potentially exacerbating pre-existing Spinal Deformities. This complexity was underscored when a patient, who had tumours in his spine twice, faced a critical situation. Here, surgical navigation emerged as a crucial factor in saving him. This advanced technique seamlessly complemented the comprehensive approach discussed earlier, highlighting the intricate nature of spinal health management.

Outlook for people with spondylosis?

Fortunately, most individuals with spondylosis will not experience symptoms and may never even realize that they have arthritis in their spines. However, for those who experience pain or neurologic changes due to nerve compression, safe and effective treatments are available.

Gastric Vertigo: Can Stomach-ache and Vertigo Occur Together?

By Dr.Ravindra Patil

The answer, surprisingly, is ‘yes’.

Can ‘gas’ (meaning a bloated feeling in the stomach) cause dizziness? Yes, it can. Stomach conditions can indeed cause dizziness. Hence it is sometimes referred to as ‘Symptoms of Gastric Vertigo’. A gastric problem is sometimes associated with dizziness. Let us see gastric problem symptoms and their association with dizziness.

Abdominal pain can be caused by a wide variety of conditions like infections, food poisoning, ulcers, or some cancers.

Abdominal pain, or stomach aches, and dizziness often go hand in hand. In order to find the cause of these symptoms, it’s important to know which one came first, the stomach problem, or the dizziness.

Pain around your stomach area can be localized or felt all over, affecting other areas of the body. Many times, dizziness comes after abdominal pain as a secondary symptom.

Both are often thought to be the same, however they are different. While dizziness is a range of feelings that make you feel unbalanced or unsteady.  You feel as if the room or the world is revolving around you. Dizziness is often because of minor causes and is transient. While it is a condition that often needs medications and other therapies. Both can be symptoms of many diseases. But dizziness is never thought of as a disease. Dizziness is only a symptom. While in some cases, it is thought of as a disease.  

Table of Contents

Symptoms of Vertigo

Let us start with abdominal pain and its different types. It can be:

• Sharp pain
• Dull aching pain
• Gnawing pain
• Ongoing pain
• On and off pain
• Burning pain
• Cramp-like pain
• Episodic, or periodic pain
• Consistent pain

Severe pain of any type can make you feel lightheaded or dizzy. Stomach aches and dizziness often go away without treatment. You may feel better after getting some rest. Either sit or lie down and see if you notice a difference.

But if your abdominal pain and dizziness also accompany other symptoms, such as changes in vision and bleeding, it can be a sign of an underlying medical condition.

Make an appointment with your doctor if your symptoms are caused by an injury, interfere with your day-to-day activities, or are getting progressively worse.

In rare cases, chest pain can mimic abdominal pain. The pain moves to your upper stomach area even though it starts in the chest.

Visit a hospital emergency room immediately if you feel:

• An abnormal heartbeat
• Light-headedness
• Chest pains
• Shortness of breath
• Pain or pressure in your shoulder, neck, arms, back, teeth, or jaw
• Sweaty and clammy skin
• Nausea and vomiting

These are symptoms of a heart attack and require immediate medical attention.

Possible causes of abdominal pain and dizziness

Surprisingly, there are many conditions which cause abdominal pain or discomfort and dizziness. Some of them may seem to be not so important, but remember, this data is collected over years of study and compilation. Some of these conditions are medical emergencies and need immediate care.

• Appendicitis
• Ectopic pregnancy
• Pancreatitis
• Food poisoning
• Gastrointestinal bleeding
• Fertilizer and plant food poisoning
• Toxic megacolon
• Intestinal or gastric perforation
• Abdominal aortic aneurysm
• Peritonitis
• Gastric cancer
• Addisonian crisis (acute adrenal crisis)
• Alcoholic ketoacidosis
• Anxiety disorder
• Agoraphobia
• Kidney stones
• Hypoglycaemia (low blood sugar)
• Ileus (The inability of the intestine to contract normally leading to a build-up of food material)
• Chemical burns
• Stomach flu
• Abdominal migraine
• Drug allergy
• Indigestion (dyspepsia)
• Premenstrual syndrome (PMS)
• Painful menstruation
• Peripheral vascular disease
• Isopropyl alcohol poisoning
• Endometriosis
• Motion sickness
• Excessive exercising
• Dehydration

What can cause abdominal pain and dizziness after eating?

Postprandial hypotension

It means low blood pressure after a meal. If you feel abdominal pain and dizziness after eating, it may be because your blood pressure hasn’t stabilized. This sudden drop in blood pressure after a meal is called postprandial hypotension.

Normally, when you eat, blood flow increases to your stomach and small intestine. Your heart also beats faster to maintain blood flow and pressure in the rest of your body. In postprandial hypotension, your blood decreases everywhere but the digestive system. This imbalance of postprandial hypotension can cause:

• Dizziness
• Stomach pains
• Chest pains
• Nausea
• Blurred vision

This condition is more common in older adults and people with damaged nerve receptors or blood pressure sensors. These damaged receptors and sensors affect how other parts of your body react during digestion.

Gastric ulcers

Ulcer means discontinuity of skin or mucous membranes which leaves a raw open area of the tissue beneath. A gastric ulcer is an open sore in the lining of your stomach. Stomach pain often occurs within a few hours of eating. Other symptoms that normally accompany gastric ulcers include:

• Mild nausea
• Feeling full
• Pain in the upper abdomen
• Blood in stools or urine
• Chest pains

Most stomach ulcers go unnoticed until a serious complication, such as bleeding, occurs. This can lead to stomach pains and dizziness from blood loss.

When to seek medical help?

Always seek immediate medical attention for any pain that lasts seven to 10 days or becomes so problematic that it interferes with your day-to-day activities.

Also, see a doctor if you’re experiencing abdominal pain and dizziness along with:

• Changes in vision
• Chest pain
• A high fever
• Neck stiffness
• Severe headache
• Loss of consciousness
• Pain in your shoulder or neck
• Severe pelvic pain
• Shortness of breath
• Uncontrolled vomiting or diarrhea
• Vaginal pain and bleeding
• Weakness
• Blood in your urine or stool

In addition, take an appointment with your doctor if you experience any of the following symptoms for more than 24 hours:

• Acid reflux
• Blood in your urine
• Headache
• Heartburn
• Itchy, blistery rash
• Painful urination
• Unexplained fatigue
• Worsening symptoms

This information is only a summary of emergency symptoms. Common sense must prevail to decide if you abdominal pain and dizziness are minor conditions or may be signs of serious conditions.

How are abdominal pain and dizziness diagnosed?

Your doctor will perform a physical exam and ask about your medical history to help make a diagnosis. If you explaining your symptoms in detail,it will help your doctor determine the cause.

For example, upper abdominal pain may be a sign of a peptic ulcer, pancreatitis, or gallbladder disease. Lower right abdominal pain can be a sign of kidney stones, appendicitis, or ovarian cysts.

Be mindful of the severity of your dizziness. It’s important to note that light-headedness feels like you’re about to faint, whereas it is the sensation that your environment is moving.

Experiencing it is more likely to be an issue with your sensory system. It’s usually an inner ear disorder rather than a result of poor blood circulation.

Differential Diagnosis

Myelomeningocele although easily diagnosed because of the sac protruding from the back, can be confused with many other birth defects like these:

• Terminal myelocystocele
• Sacrococcygeal teratoma
• Caudal neural tube defect
• Tail remnants:
• Rhabdomyosarcoma
• Curarinos syndrome
• Neuroenteric cyst
• Caudal regression syndrome

The above are rare and complicated disorders best handled by specialists.

How are abdominal pain and dizziness treated?

In some cases, abdominal pain and dizziness resolves without treatment. This is common for food poisoning, stomach flu, and motion sickness. Sadly, it is not the case always.

Treatments for abdominal pain and dizziness vary depending on the primary symptom and underlying cause. For example, a gastric ulcer may require medicine or surgery. Your doctor can recommend a specific treatment course to treat the condition.

Try to drink lots of fluids if vomiting and diarrhoea accompany your stomach pains. Lying or sitting down can help as you wait for symptoms to improve. You can also take medication to reduce stomach pains and dizziness.

How can I prevent abdominal pain and dizziness?

Tobacco, alcohol, and caffeine are linked to abdominal pain and dizziness. Avoiding excess consumption can help lessen these symptoms.

Drinking water during intense exercise can also help reduce stomach cramps and dehydration. It’s recommended to drink at least 4 ounces of water every 15 minutes when you are in the heat or exercising.

Also, be careful not to over-exercise to the point of vomiting, losing consciousness, or injuring yourself.