Myelomeningocele

By Dr.Ravindra Patil

Myelomeningocele is one of the forms of spina bifida and described as a sac containing liquid and nerve tissue protruding from the back. It occurs when there is an incomplete closure of the spinal cord during the first month of pregnancy.

Myelomeningocele generally occurs during embryonic development due to incomplete closure of the spinal neural tube during the first month of pregnancy. It ultimately leads to an exposed neural tissue or meninges with a fluid-filled sac that protrudes at the affected vertebral level.

Myelomeningocele can cause several neurological deficits and complications which are dependent on the involved vertebral site. It can lead to devastating morbidity and multiple disabilities; hence, the prognosis is often worse if diagnosed late or left untreated.

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Causes

Causes of myelomeningocele are many and include environmental, maternal, and genetic factors.

• Environmental factors include exposure to radiation, different types of pollution, pesticides, organic solvents, and teratogens.
• Maternal factors are numerous and include irregular maternal nutrition, low folic acid supplementation, caffeine and alcohol consumption, smoking, the use of anticonvulsants, in addition to certain maternal illnesses such as diabetes, obesity, hyperthermia, and anxiety. However, most of the cases of myelomeningocele are sporadic in origin and occur in a non-genetic pattern.
• Some genetic factors might increase the risk of occurrence, for instance, the presence of chromosomal anomalies of trisomy 18 or 13 and patients with an affected twin or first-degree relative.

Epidemiology

It is the branch of medicine which deals with the incidence, distribution, and possible control of diseases and other factors relating to health. The prevalence of myelomeningocele is approximately 0.8 to 1 per 1000 live births worldwide.

Physical Findings

In the new-born found to be suffering from myelomeningocele, there is a sac extending from the vertebral column, covered with meninges, filled with cerebrospinal fluid and neural tissue. The clinical symptoms are dependent on the site of the spinal lesion at the vertebral column. The higher the level affected, the more deficits occur, and the worse the future of the patient.

Complications in children with Myelomeningocele

Myelomeningocele is one of the most prevalent causes of neurogenic bladder in children.

Patients can have a life-long functional disabilities like paraplegia, sphincter dysfunction, motor and sensory impairments. Some might experience abnormal sexual development in adulthood.

Renal, respiratory, and cardiac complications are common causes of death in patients with spina bifida and Myelomeningocele.

A cerebellar tonsillar herniation [where a part of the small brain protrudes through foramen magnum] may occur in myelomeningocele. Other complications are hydrocephalus and syringomyelia. There are many more complications.

The degree of neurological impairment predominantly depends on the affected spinal cord level.

Evaluation

The diagnosis of myelomeningocele is possible in the first trimester of pregnancy when the foetus in inside the mother’s womb by ultrasonography. It is non-invasive, safe and effective. A careful examination of the foetal spine myelomeningocele if present. Test of the amniotic fluid may show higher levels of alpha-fetoprotein.

Other features of spina bifida that are visible through ultrasound include hydrocephalus, microcephaly, small-shaped cerebellum, and abnormal cranial bones.

Fast MRI gives a better visualization of the spine and neural elements as well as other organ systems associated with myelomeningocele and spina bifida.

Surgery on the foetus before birth

Once the diagnosis has made, early surgical repair of the spinal lesion is essential in preventing further deficits and neurological damage. Surgery before the birth of the baby has been proven to be more effective than surgery on the new-born to reduce the occurrence of complications in life of the children.

Surgery after birth

The myelomeningocele sac is everted and placed within the dural canal. The closure of the fascia then achieves the repair. Small-sized lesions are coverable by primary repair. However, the closure of large-sized myelomeningoceles could require either a flap or graft repair. Radiological imaging is done to exclude other associated anomalies.

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.

Early diagnosis better

Delayed diagnosis of myelomeningocele is associated with poor future of the child and lower rates of survival. Moreover, delayed and neglected management has links to various complications such as lifetime dependence, immobility, functional disability, muscle weakness, bladder, and bowel dysfunction etc. The presence of other disorders, such as hydrocephalus, increases the mortality rate in patients with myelomeningocele.

Complications

Complications of myelomeningocele are either surgical or non-surgical.

Surgical complications include infections at the site of the lesion, bleeding, delayed wound healing, re-tethering of the spinal cord, and cerebrospinal fluid leakage.

Non-surgical complications are:

• Neurological complications: Hydromyelia, Arnold-Chiari II malformation, hydrocephalus, seizures, paraplegia, motor, and sensory impairments.
• Musculoskeletal complications: scoliosis, muscle weakness.
• Physical complications: Immobility, delayed walking.
• Psychological complications: Depression, suicide, intellectual disability.
• Social complications: Educational problems, dependence, and unemployment.
• Sexual complications: Erectile dysfunction, impotence, and fertility problems.
• Other complications include obesity, renal failure, in addition to cardiac and respiratory diseases.
• Latex allergy: most patients with spina bifida have a sensitivity to latex allergenic protein.

Postoperative and Rehabilitation Care

Postoperative care primarily depends on the type of surgical procedure. If surgery is done before birth and foetal delivery is preterm, the baby should stay at a specialized neonatal intensive care unit in a latex-free environment. Subsequently, coordinated medical care should be followed to prevent other complications related to prematurity or foetal surgery.

Although foetal surgery gives better results than postnatal surgery, patients and mothers are at a higher risk of complications during and after the surgery.

To preserve the functional neurological level and improve the quality of life, long-term rehabilitation care is required.

Key Learning Points

Early surgical intervention before or within 24 to 48 hours after birth is essential to prevent more damage. It can improve the quality of living if followed by integrated medical care.

Nevertheless, children might require frequent medical evaluation and hospital visits to address their needs and complaints. Early medical management for children complaining of learning and cognitive disabilities in schools can help them prepare for their future education. Parents should be aware that the child might show a particular area of disability.

Having a child with spina bifida would increase the risk of having another affected child in subsequent pregnancies. To avoid the risk of another affected pregnancy, genetic counselling should be required before conception.

Increasing Healthcare Team Outcomes

Premarital and antenatal counselling should be a consideration for high-risk individuals. Regular antenatal examination and visits are essential to follow foetal development and address possible foetal and maternal complications.

Increasing awareness about spina bifida is significant to improve the outcomes of patients in their society. The good news is: 94% of spina bifida adults have finished a high school degree, and about 62% have completed a college degree in the USA.

Hence, there are no boundaries for patients to learn or be part of their community.

However, ignorance about the disease and its possible complications in addition to delaying therapeutic interventions and not providing adequate medical services would lead to more difficulties in the future and impact the quality of life.

Vertigo and Dizziness

By Dr.Ravindra Patil

Dizziness

Overview

Dizziness is a term used to describe a range of sensations, such as feeling faint, woozy, weak or unsteady. Dizziness that creates the false sense that you or your surroundings are spinning or moving is called vertigo. Dizziness is one of the more common reasons adults visit their doctors. Frequent dizzy spells or constant dizziness can significantly affect your life. But dizziness rarely signals a life-threatening condition.

Treatment of dizziness depends on the cause and your symptoms. It’s usually effective, but the problem may recur.

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Symptoms

People experiencing dizziness may describe it as any of a number of sensations, such as:

• A false sense of motion or spinning (vertigo)
• Light-headedness or feeling faint
• Unsteadiness or a loss of balance
• A feeling of floating, wooziness or heavy-headedness

These feelings may be triggered or worsened by walking, standing up or moving your head. Your dizziness may be accompanied by nausea or be so sudden or severe that you need to sit or lie down. The episode may last seconds or days and may recur.

Causes of Dizziness

Dizziness has many possible causes, including inner ear disturbance, motion sickness and medication effects, poor circulation, infection or injury.
Inner ear problems that cause dizziness (vertigo): Your sense of balance depends on the combined input from the various parts of your sensory system. These include the following:

• Eyes, which help you determine where your body is in space and how it’s moving
• Sensory nerves, which send messages to your brain about body movements and positions
• Inner ear, which houses sensors that help detect gravity and back-and-forth motion
• A viral infection of the vestibular nerve
• Meniere’s disease: excessive build-up of fluid in your inner ear.
• People who experience migraines may have episodes of dizziness

Circulation problems that cause dizziness

You may feel dizzy, faint or off balance if your heart isn’t pumping enough blood to your brain. Causes include:

• Drop in blood pressure
• Poor blood circulation

Neurological conditions that cause dizziness

• Parkinson’s disease
• Multiple Sclerosis
• Dizziness can be a side effect of certain medications such as anti-seizure drugs, antidepressants, sedatives and tranquilizers and blood pressure lowering medications
• Anxiety disorders like panic attacks and a fear of leaving home or being in large, open spaces

Other causes of Dizziness

• Low iron levels (anaemia)
• Low blood sugar (hypoglycaemia)
• Carbon monoxide poisoning
• Overheating and dehydration

Risk factors

Factors that may increase your risk of getting dizzy include:

• Older adults are more likely to have dizziness
• A past episode of dizziness

Complications

Dizziness can increase your risk of falling and injuring yourself. Experiencing dizziness while driving a car or operating heavy machinery can increase the likelihood of an accident.

Diet and Nutrition Deficiencies for Pediatric age

By Dr.Ravindra Patil

Diet

Right from birth, a healthy diet consumed throughout the life-course helps in preventing malnutrition in all its forms as well as wide range of non-communicable diseases (NCDs) and conditions. But rapid urbanization/globalization, increased consumption of processed foods and changing lifestyles has led to a shift in dietary patterns. Nutrition deficiency refers to the inadequate intake or absorption of essential nutrients needed for optimal growth and functioning of the body.

People are consuming more foods high in energy, fats, free sugars or salt/sodium, and many do not eat enough fruits, vegetables and dietary fibres such as whole grains. So, these all factors are contributing to an imbalanced eating.

A balanced diet is one which contains variety of foods in such quantities and proportion that the need of all nutrients is adequately met for maintaining health, vitality and general wellbeing and makes a small provision for extra nutrients to withstand short duration of deficiency.

The major food issues of concern are insufficient/ imbalanced intake of foods/nutrients.  One of the most common nutritional problems of public health importance in India are low birth weight, protein energy malnutrition in children, chronic energy deficiency in adults, micronutrient malnutrition and diet related non-communicable diseases. Health and nutrition are the most important contributory factors for human resource development in the country.

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According to WHO

• Infants should be breastfed exclusively during the first 6 months of life.
• Breast-milk alone is not enough for infants after 6 months of age. Complementary foods should be given after 6 months of age, in addition to breast-feeding.
• Feed low-cost home-made caloric and nutrient rich complementary foods.
• Infants cannot eat large quantities of food at a single time so they should be fed small quantities at frequent intervals (3-4 times a day).
• The food should be of semi-solid consistency so that the infants can swallow it easily. A balanced diet is the key to protect your child against nutritional deficiencies.
• Observe hygienic practices while preparing and feeding the complementary food for infants, because babies are prone to infections.
• Avoid junk foods for babies.

Diet for a Growing Child

Children who eat a balanced diet lay the foundation for a healthy and active lifestyle and this further lowers the risk of long term health issues. Childhood is the most critical time for growth as well as for development of the mind and to fight infections. So, it is very essential that the children get a good dose of energy, proteins, vitamins and minerals. It is very important to follow that hygienic practices are followed while preparing and feeding the complementary food to the child; otherwise, it might lead to diarrhoea.

Good food choices are:

• Milk, cheese, yoghurt.
• Vegetables like spinach, broccoli and celery which are rich in calcium is a must.
• Give them a daily intake of energy rich foods as whole grains (wheat, brown rice), nuts, vegetable oils, vegetables like potatoes, sweet potatoes, fruits like banana.
• Proteins are essentials for muscle building, repair and growth and building antibodies. So give them diet which has meat, eggs, fish and dairy products.
• Vitamins for the body to function properly and to boost the immune system. A variety of fruits and vegetables of different colours should be added in child’s food.
• Vitamin D helps in bone growth and is essential for absorption of calcium. Sources are sunlight and a small amount from some food items like fish oils, fatty fish, mushrooms, cheese and egg yolks.
• Teenage girls experience more physiological changes and psychological stress than boys because of onset of menstruation. Therefore, teenage girls should eat diet which is rich in both vitamins as well as minerals to prevent anaemia.
• Give plenty of fluids during illness. A child needs to eat more during and after episodes of infections to maintain proper nutritional status.
• The child must drink one to two and a half litres of water to hydrate its body. It is preferred to have water/buttermilk/lassi/fruit juices/coconut water over soft drinks and other packaged drinks.

Nutritional Deficiencies

Many diseases and morbid conditions result from nutritional deficiencies. Nutritional deficiencies are prevalent worldwide. Deficiencies may lead to long term chronic health problems such as rickets, iron deficiency anaemia, goitre, obesity, coronary heart disease, type 2 diabetes, stroke, cancer and osteoporosis.

Common Nutritional Deficiencies in Children

Iron Deficiency

Children need iron for a wide variety of bodily functions. It is a part of haemoglobin, a protein that carries oxygen from their lungs to the rest of their body where it assists their muscles in the storage and use of oxygen. Without enough iron children can develop anaemia which can lead to lethargy and improper cognitive functioning among other debilitating conditions. Meat, pork, poultry, seafood, beans, peas, lentils, dark green leafy vegetables, dried fruits, iron-fortified cereals, breads and pastas can all be quite rich in iron.

Vitamin D Deficiency

Vitamin D is essential for the absorption of calcium along with iron, magnesium, phosphate and zinc in the gastrointestinal tract. Adequate intake of this vitamin is necessary for optimal bone growth. Vitamin D deficiencies are more common in those children who have limited exposure to sunlight. Children can receive Vitamin D by eating fish and foods fortified with Vitamin D such as certain dairy products, soy milk, and cereals. Liver and egg yolks are also known to be rich in Vitamin D.

Zinc Deficiency

Zinc is a mineral essential to childhood growth, digestion, sex hormone development, and a strong immunity. A deficiency can negatively impact everything from hair, skin, and nails to cognitive functioning and the height of your child. Zinc can easily be added to your child’s diet through the introduction of sesame seeds, pumpkin seeds, squash seeds, cashews and peanuts, in addition to seafood, meat, cooked beans, peas and lentils.

Calcium Deficiency

Deficiency leads to poor teeth and bones, muscle dysfunctions, heart problems, blood clotting irregularities, enzyme dysfunction and so on. Children require a high calcium intake. Sources are milk and milk products, dark leafy green vegetables, soy, tofu, fish, almonds, seeds, and fortified cereals.

Vitamin A

Vitamin A deficiency (VAD) is common in poorer societies. Night blindness is one of the first signs of VAD, as the vitamin has a major role in phototransduction. Complete blindness can follow if the deficiency is more severe. Sources are yellow, red and green (leafy) vegetables, such as spinach, carrots, sweet potatoes and red peppers. Yellow fruit, such as mango, papaya and apricots.

Folic Acid or Folate Deficiency

Folate deficiency anaemia is the result It is characterized by the appearance of large-sized, abnormal red blood cells (megaloblasts), which form when there are inadequate stores of folic acid within the body.    Feed your child dark green leafy vegetables (turnip greens, spinach, romaine lettuce, asparagus, Brussels sprouts, broccoli), Beans, seafood and Peanuts to prevent folate deficiency.

Vitamin B12 Deficiency

Vitamin B₁₂ is important in the normal functioning of the nervous system and in the circulatory system in the maturation of red blood cells in the bone marrow. The only source is animal-derived foods or from supplements. Foods containing vitamin B₁₂ include meat, clams, liver, fish, poultry, eggs, and dairy products. Many cereals are fortified with the vitamin.

Spinal Deformity

By Dr.Ravindra Patil

What Is a Spinal Deformity?

A spinal deformity occurs when your spine deviates by more than 10 degrees from “healthy” curvature. But, what does this mean exactly?

Contrary to popular belief, your spine isn’t 100% straight. But oddly, your spine is also straight! How do we explain these two opposite statements?

The fact is that your spine consists of a series of gentle arcs. Your lumbar spine, or lower back, swoops slightly inward and your thoracic spine, or upper back, bends subtly forward. The inward curve of your lower back is known as lordosis and the outward curve that runs between your shoulder blades is known as kyphosis. These curves are seen when looking at a person’s spine from the side.

But, when looking from the front, your backbone should look like a straight pillar. (Hence, doctors often refer to the spine as the “vertebral column.” Column is something which is very much straight and vertical.

The curves of the spine are so adjusted that the curves and straight stretches of your spine make symmetry possible. Thus, your head sits directly over your pelvis because the lordosis of your lower back and the kyphosis of your upper spine balance each other out.

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Spine abnormal curvature

If one of these curves, lordosis and kyphosis, becomes greater or lesser than the other, then problems can emerge. We refer to this as sagittal imbalance, because the head and pelvis no longer fall within the same, or sagittal, plane. The sagittal plane is an imaginary plane that divides the human body equally into right and left sections.

Thus, too much backwards thrusting of the hips is lordosis and too much forward stooping in the upper back is known as kyphosis. These are two major spinal curvature deformity types.

Similarly, the spine can also tilt sideways, that is from the midline of the body, doctors refer to this problem as coronal imbalance or scoliosis. The coronal plane is an imaginary plane that divides the human body equally into the front portion and the back portion. Unevenness in the “coronal” plane (we can view the coronal plane when we look at a human body from the front) causes asymmetry in the trunk of the body. This can include uneven hips and shoulders or one-sided bulging of the ribs.

Spinal Deformities

As has been mentioned, any deviation from the sagittal curvatures of the spine, or any deviation in the coronal plane of the spine can be called spine deformities. There are many types of deformities of the spine.

What are the Symptoms of a Spinal Deformity

Spinal deformities can range in seriousness from mild to moderate or severe. However, in every spine deformity, pain is always present.

If you have pain or deformity in any region of the spine, you don’t have to live with the symptoms of spinal deformities or spinal pain any longer. A qualified and trusted surgeon, like Dr Ravindra Patil, of Samarth Neuro and Multi-speciality hospital even in a small city like Miraj can help you get relief from your painful symptoms and in some cases, your deformities can be corrected.

Spinal deformity types

As has been mentioned, the spinal deformities can change either the correct curvature of the spine or the correct uprightness of the spine. In addition, in some cases the vertebra can collapse because of osteoporosis and it may lead to shortening of the spine.

Scoliosis deformity

It is an abnormal side-to-side arc in the spine. If your spine curves to the right, then you have dextroscoliosis. If your spine curves to the left, then you have levoscoliosis. However, often, adult and paediatric patients with scoliosis will have more than one twist in their spine, that is the spine may curve in both right and left arcs.

Kyphosis

This occurs when the upper back develops a forward hump, sometimes referred to as hunchback. The shoulders will round forward, the head will jut out, and the torso will appear to slouch or droop over.

Lordosis

This often occurs as a side effect of kyphosis. Hyper-lordosis, or swayback, causes the lower back to swoop inward and the abdomen to jut outward.

Flatback Syndrome

This condition develops when the spine loses its natural curvature. This may sound benign. After all, the spine has become “straight.” But, flatback syndrome can cause patients to pitch forward, creating serious issues with walking.

Ankylosing Spondylitis

This form of arthritis can cause the spinal vertebrae to fuse together. When this occurs, your spine loses its mobility and your posture locks into one position.

Spondylolisthesis

Also known as a slipped vertebra, this condition can be caused by a birth defect in the spine. In the severest cases, a slipped vertebra can slide entirely off of the spinal column, a condition also known as spondyloptosis.

What Causes Spinal Cord Deformities?

Doctors sort spinal deformities into different groups according to their causes. Although many issues can cause spinal deformities, the most common include:

• Congenital: Some forms of spinal deformity develop before a child is born. Genetics and mishaps in the womb can cause this.
• Paediatric: Other forms of spinal deformity become more obvious in childhood. Scoliosis, for instance, often emerges between the ages of 10-12. Specifically, growth spurts may cause this jump in rates.
• Postural: Poor posture in key periods of spinal growth can cause the upper back to round forward. To fix this issue, muscle-strengthening and posture lessons may be needed.
• Neuromuscular: Certain disorders, like cerebral palsy, can alter muscle activity. As stiff muscles pull on the spine, the back and neck can lose their natural shape.
• Adult or Degenerative: Wear and tear on the spine can cause the discs in your back to degenerate. Weak vertebrae can fracture and develop a wedge-shape that leads to kyphosis. And, ligaments that support the spine can harden, pulling your back out of alignment.
• Traumatic: Injuries, like sudden blows to the back, can knock vertebrae out of place, altering the curvature of your back.
• Iatrogenic: This word refers to spinal issues, like flatback syndrome, that develop as the result of a failed spinal fusion.
• Idiopathic: When a spinal deformity develops for an unknown reason, the condition is said to be idiopathic. The majority of scoliosis cases, for example, are classified as idiopathic scoliosis.

Spinal deformities are serious conditions. They can destroy your self-esteem and prevent you from completing your day-to-day tasks. And, they can cause a lot of pain.

Fortunately, many forms of conservative therapy and surgical treatment are effective at managing pain and reversing your condition. If your condition requires treatment, you will begin by exploring non-surgical treatment options. These may include scoliosis bracing or physical therapy.

If your condition does not improve with these methods, then you may need spinal deformity surgery. Operative treatments for spinal deformities achieve correction in three main ways. They straighten and hold the spine in a better position (spinal fusion). They remove bone (osteotomy). Or, they use fusionless systems to encourage your spine to grow in a more ideal way.

For getting such surgeries done, you need not go to major cities. Such surgeries can be done in speciality centres like Samarth Neuro and Superspeciality hospital in Miraj, where the chief neuro and spine surgeon Dr Ravindra Patil has treated many such cases.

If the brain clot is large the surgeon may need larger access to the blood clot, requiring a different procedure called a craniotomy. During a craniotomy, the neurosurgeon will remove a section of the skull an opening and then remove the blood clot. When the procedure is complete, the surgeon will replace the section of bone and close up the soft tissue using sutures or staples.

Blood clot in brain surgery recovery is going to depend on the patient’s personal health factors. Besides most patients will spend a few days in ICU and about a week in wards or a private room. After discharge from hospital there will be activity restrictions for a few weeks. For craniotomy, recovery will take longer. The patient must educate himself/herself about the condition and further treatment.

Says Dr Daniel Hanley, M.D., professor of neurology at the Johns Hopkins University School of Medicine: “We’ve gone from what’s usually an 80 percent death rate in patients with this condition to an 80 percent survival rate!”
That is very good news indeed. So although getting a blood clot in brain due to an injury or a brain clot inside the cerebral artery are very serious conditions, there is a fairly large chance of recovery.

Blood clot in the brain surgery

By Dr.Ravindra Patil

Blood clots are good because they prevent blood loss. Clotting is a mechanism to prevent blood loss. If we sustain a wound, the blood clots and our bleeding stops.

However, sometimes the blood clots at the wrong places, like inside arteries or veins. If this happens in the arteries of the brain or the heart, it stops blood flowing to parts of brain or the heart. This causes cerebrovascular stroke or a heart attack respectively.

Or, there may be internal bleeding [called haemorrhage] and that causes space occupying lesions and sometimes this collection of blood pushes the brain to one side.

Luckily all the above conditions are treatable.

A blood clot in brain may refer to two separate entities. One is when a blood clot forms in the brain arteries, called cerebral thrombosis. It happens because of blood clotting inside cerebral arteries. Sometimes, a small blood clot can travel from another place [usually the lungs] and lodge itself in a brain artery. This is known as cerebral embolism. In Both the above conditions lead to cerebrovascular stroke or simply stroke. It is an extremely serious and life threatening condition.

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How are brain clots inside brain arteries treated?

Thrombectomy is a procedure to remove a blood clot from a blood vessel. It can be used for some people who’ve had a stroke. Blood clots in the brain can cause ischemic strokes. Thrombectomy can remove the clot and help blood to flow normally again.

Craniotomy and Burr-Hole surgery

The other type of clot in the brain may be due to head injury, which causes haemorrhage inside the brain. Depending on where the bleeding occurs, it is known as SDH [sub dural haemorrhage] or SAH [sub arachnoid haemorrhage] or EDH [epidural haematoma]. Such haemorrhage is also a very serious condition.

Both types of conditions of the above may need intervention in the brain or surgery to remove the blood clot or haemorrhage or dissolve the blood clot. In thrombosis and embolism the blood clot can be dissolved and they can be treated without surgery, as explained below.

Are ‘blood clot in brain’ and ‘brain clot’ the same?

Brain clot usually means a blood clot in the brain. The brain itself does not ‘clot’, blood does clot after injuries or as a result of diseased conditions. Hence ‘brain clot symptoms’ and ‘blood clot symptoms’ will be basically the same.

Is blood clot in brain dangerous?

Of course it is dangerous. It may lead to raised intracranial pressure, paralysis or death. Or it may lead to temporary or permanent loss of functions of certain areas of the body or certain motor activities like speech and movement etc.

What is the treatment of blood clot in brain?

Blood clot in brain treatment depends on the type of blood clot. If the clot is within the blood vessels, the clot can be dissolved by medicines like Alteplase, Streptokinase or Urokinase. Such clots can also be sometimes removed with DSA [digital subtraction angiography] procedures.

If there is blood clot in the brain as a result of injury [cerebral haemorrhage], craniotomy surgery or burr-hole surgery are done. In this type brain surgery for blood clot, the skull may be opened in different ways. The clot is removed, and the flap of the skull is replaced.

Reason for blood clot in brain

Blood clotting in brain in never a natural phenomenon. It is a sign of serious disease. A blood clot in the brain is typically the result of injury. The chance of a blood clot in the brain increases with age. The risk with factors that increase bleeding, such as anticoagulant medications and excessive alcohol intake.

Is Blood clot in brain treatment without surgery possible?

Treatment without surgery in any disease is always the most preferred option. In case of cerebral thrombosis or cerebral haemorrhage, blood clot dissolving enzymes are used to dissolve blood clots. They are called rTPA, Alteplase, Streptokinase or Urokinase.

However, cases of SAH or SDH or EDH can be treated only by removing the blood collection or blood clot by craniotomy or burr-hole surgery.

What happens after a blood clot in brain surgery?

During a craniotomy, the neurosurgeon removes a section of the skull in order to access the clot. The clot is then drained, and the section of the skull is secured back in place. Recovery after blood clot brain surgery will depend on a number of factors, including age, overall health and the reason why the clot developed in the first place.

How to treat blood clots in the brain?

There are two surgical methods to treat blood clots in the brain. These are burr-hole drainage and craniotomy. While performing burr-hole drainage, the neurosurgeon may create a hole within the skull followed by an incision to drain the blood clot. The area is then closed using sutures.

Symptoms of blood clot in brain

In cases of SDH, EDH or SAH, the intracranial pressure may increase. This leads to blood clot in brain symptoms like headache, blurred vision, feeling less alert than usual, vomiting, changes in behaviour, weakness or problems with moving or talking and lack of energy or sleepiness. Other brain blood clot symptoms may be drowsiness and confusion.

Surgery for Blood Clot in the Brain

What is the treatment for blood clot in brain? When there is a subdural hematoma in the brain, it can press on the delicate tissue of the brain, leading to damage and/or symptoms. This is one reason it is important to undergo treatment and prevent further complications.

Brain clot treatment

If the brain clot is large the surgeon may need larger access to the blood clot, requiring a different procedure called a craniotomy. During a craniotomy, the neurosurgeon will remove a section of the skull an opening and then remove the blood clot. When the procedure is complete, the surgeon will replace the section of bone and close up the soft tissue using sutures or staples.

Recovery after Brain Blood Clot Surgery

Blood clot in brain surgery recovery is going to depend on the patient’s personal health factors. Besides most patients will spend a few days in ICU and about a week in wards or a private room. After discharge from hospital there will be activity restrictions for a few weeks. For craniotomy, recovery will take longer. The patient must educate himself/herself about the condition and further treatment.

What are the chances of surviving a blood clot on the brain?

Says Dr Daniel Hanley, M.D., professor of neurology at the Johns Hopkins University School of Medicine: “We’ve gone from what’s usually an 80 percent death rate in patients with this condition to an 80 percent survival rate!”

That is very good news indeed. So although getting a blood clot in brain due to an injury or a brain clot inside the cerebral artery are very serious conditions, there is a fairly large chance of recovery.

Head injury and stroke treatment in Miraj

Reading the above may mislead the reader in thinking that treatment for stroke or cerebral haemorrhage after paralysis or a head injury may be possible only in large cities. It is not so. Even in tier two cities like Miraj all the above treatments are possible. Samarth Neuro and Super speciality hospital emergency department can handle such serious patients. If there is need for surgery, it can be done under the supervision of Dr Ravindra Patil, the chief neurosurgeon in Samarth Hospital.

Back Care for Sick Patients

By Dr.Ravindra Patil

What is back care?

Before we understand back care, we must understand what are pressure sores or bedsores. Back care procedure is done to prevent pressure sores.

Pressure sores are also called pressure ulcers or decubitus ulcers or bedsores. They are injuries to the skin and underlying tissue resulting from prolonged pressure on the skin. Bedsores most often develop on skin that covers bony areas of the body, such as the heels, ankles, hips, tailbone and back of the head.

People who are at risk of bedsores have medical conditions that limit their ability to change positions. They are bed ridden or chair ridden. They are forced to spend their time in a bed or chair.

Bedsores can develop over hours or days. Most sores heal with treatment, but some never heal completely. We can take steps to help prevent bedsores and help them heal.

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Symptoms

Warning signs of bedsores or pressure ulcers are:

• Unusual changes in skin colour or texture
• Swelling
• Pus-like discharge
• An area of skin that feels cooler or warmer to the touch than other areas
• Tender areas

Bedsores fall into one of several stages based on their depth, severity and other characteristics. The degree of skin and tissue damage ranges from changes in skin colour to a deep injury involving muscle and bone.

Common sites of pressure ulcers

For people who need to stay in bed, bedsores may happen on:

• The back or sides of the head
• The shoulder blades
• The hip, lower back or tailbone
• The heels, ankles and skin behind the knees

Wheelchair bound people also may suffer pressure sores at pressure points.

When to see a doctor

If you notice warning signs of a bedsore, change your position to relieve the pressure on the area. If you don’t see improvement in 24 to 48 hours, contact your doctor. Seek immediate medical care if you show signs of infection, such as a fever, drainage from a sore, a sore that smells bad, changes in skin colour, warmth or swelling around a sore.

Causes of bedsores

Bedsores are caused by pressure against the skin that limits blood flow to the skin. Limited movement can make skin vulnerable to damage and lead to development of bedsores.

Primary contributing factors for bedsores are:

• Constant pressure on any part of your body can lessen the blood flow to tissues. Without a good blood flow, essential nutrients don’t reach the skin and it is damaged.
• For people with limited mobility, bedsores occur in areas that aren’t well padded with muscle or fat and that lie over a bone, such as the spine, tailbone, shoulder blades, hips, heels and elbows.
• Friction occurs when the skin rubs against clothing or bedding. It can make fragile skin more vulnerable to injury, especially if the skin is also moist.
• Shear occurs when two surfaces move in the opposite direction. For example, when a bed is elevated at the head, you can slide down in bed. As the tailbone moves down, the skin over the bone might stay in place — essentially pulling in the opposite direction.

Risk factors

Your risk of developing bedsores is higher if you have difficulty moving and can’t change position easily while seated or in bed. Risk factors include:

• This might be due to poor health, spinal cord injury and other causes.
• Skin becomes more vulnerable with extended exposure to urine and stool.
• Lack of sensory perception. Spinal cord injuries, neurological disorders and other conditions can result in a loss of sensation. An inability to feel pain or discomfort can result in not being aware of warning signs and the need to change position.
• Poor nutrition and hydration. People need enough fluids, calories, protein, vitamins and minerals in their daily diets to maintain healthy skin and prevent the breakdown of tissues.
• Medical conditions affecting blood flow. Health problems that can affect blood flow, such as diabetes and vascular disease, can increase the risk of tissue damage such as bedsores.

Prevention

You can help prevent bedsores by frequently repositioning yourself to avoid stress on the skin. Other strategies include taking good care of your skin, maintaining good nutrition and fluid intake, quitting smoking, managing stress, and exercising daily.

Back care steps which conscious patients must take

Consider the following recommendations related to repositioning in a bed or chair:

• Shift your weight frequently. Ask for help with repositioning about once an hour.
• Lift yourself, if possible. If you have enough upper body strength, do wheelchair push-ups by raising your body off the seat by pushing on the arms of the chair.
• Some wheelchairs allow you to tilt them, which can relieve pressure.
• Select small cushions or a mattress that relieves pressure.
• Use cushions or a special mattress called an ‘air bed’ to relieve pressure.
• Adjust the elevation of your bed. If your bed can be elevated at the head, raise it no more than 30 degrees. This helps prevent shearing.

Back care steps in nursing

In hospitals, an ‘air bed’ is given to patients who are immobile. Nursing care plays a vital role in preventing bedsores. Steps of back care in nursing are summarised below:

• Keep skin clean and dry. Wash the skin with a gentle cleanser and pat dry. Do this cleansing routine regularly to reduce the skin contact with moisture, urine and stool.
• Protect the skin. Use moisture barrier creams to protect the skin from urine and stool.
• Change bedding and clothing frequently if needed. Watch for buttons on the clothing and wrinkles in the bedding that irritate the skin.
• Inspect the skin daily. Look closely at your skin daily for warning signs of a pressure sore.
• When we sleep on our back, we keep on turning, but sick patients cannot turn. Try and turn them under the doctor’s advice.

These five steps of back care are crucial.

Back care procedure

Aim of back care is to:

• Stimulate the circulation and give general relief.
• Prevent bedsore
• Give comfort to the patient.

7 steps of back care massage

• Help the patient to turn on his abdomen or on his side with his back toward the nurse and his body near the edge of the bed.
• Raise the patient’s gown.
• Apply medicated lotions to the back to reduce friction.
• In rubbing the back use firm long strokes and kneading motions.
• The amount of pressure to exert depends upon the patient’s condition.
• Begin from the neck and shoulders then proceed over the entire back.
• Massage with both hands working with a strong stroke. In upward than in downward motions. Give particular attention to pressure areas in rubbing in the lotions.

Turn patient on his back and pull down the gown. These back massage steps in nursing should be regularly followed.

Hand Movements Used

Effleurage (stroking—is a long sweeping movement with palm of hand conforming to the contour of the surface treated, over small surface (on the neck) the thumb and fingers are used. Strokes should be slow, rhythmical and gentle with pressure constant and in the direction of venous stream.

Kneading—performed with the ulnar side palm resting on the surface and the fingers and thumb grasping the skin and subcutaneous tissues which move with the hand of the operator.

Friction—is performed with the whole palmar surface of the hand or fingers and thumbs over limited areas. This movement is a circular and kneading with pressure against the underlying part of tissue which cannot be grasped.

Back care ppt

Google is of such great help, just type ‘back care ppt’ and you will get many presentations explaining steps of back care.

Things to expect after brain surgery

By Dr.Ravindra Patil

Undergoing brain surgery is a major event in anybody’s life. In case you or your family member has to undergo brain surgery, it is useful to know something about brain surgery and how recovery happens after a brain surgery.

Brain Surgery can be a very traumatic experience, and it is common for many patients recovering from brain surgery to face depression, spells of dizziness, confusion and weakness post the surgery. It is very necessary that family members and friends talk to the patient and be empathetic towards them.

Brain surgery is done for many disease conditions like brain tumours, to treat cerebral haemorrhage, to treat trigeminal neuralgia, to treat epilepsy, to treat parkinsonism, to treat hydrocephalus and many other conditions. From the point of view of a patient or a care taker, these points are worth knowing.

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The wound

Brain surgery may be done by a craniotomy or burr-hole surgery. In both, the skin will be opened by an incision and closed by sutures or staples to close the wound. The sutures or staples have to be removed after a week or more.

Tube from brain to abdomen

In hydrocephalus, there is too much cerebrospinal fluid. Hence a surgery is done by placing a tube from the brain to the abdominal cavity so that excess cerebrospinal fluid is drained off to the abdomen.

The bone flap

In craniotomy if a part of the skull [called a bone flap] is removed, it is washed, sterilised and sealed in a plastic packing and stored with the name of the patient written on the package. The bone flap is attached to the skull after a few months. In some cases, the bone flap is preserved inside the abdomen of the patient himself/herself.

Risk of infection

Like any wound, the wound of the brain surgery is likely to suffer infection if proper wound care is not taken. So before surgery, the scalp hair is shaven. The scalp is cleaned with soap and water and then various antiseptic solutions. After surgery the surgical wound is cleaned and covered with sterile dressing and bandage. Never let the bandage get wet. Best of all, never touch the bandage. Let the doctors and nurses do the dressing of the wound after surgery.

Risk of bleeding, the drain

After every surgery, there is a slight risk of internal bleeding. If blood accumulates inside the skull due to internal bleeding, it leads to many complications. To prevent collection of blood, drain may be kept in the wound or through a small hole away from the wound. This drain facilitates blood or fluid collection to be drained out.

But if your wound bleeds, it is best to visit the hospital immediately.

Personal hygiene

After getting discharged from the hospital after brain surgery, the patient’s body can be wiped with soapy water. Taking a bath is also safe, however, the patient may feel giddy and hence it is best to confine the patient to bed. Needless to state, the bandage or dressing on the head must never become wet. 

Medications

A course of antibiotics to prevent infection, pain killers to reduce pain, medicines to reduce acidity etc are usually prescribed. These must be taken regularly. Missing one dose doesn’t create a major problem, but not taking medicines at all must NOT be done.

Besides these meds, the patient must also take whatever medicines he/she took prior to the surgery. These may be for high BP, diabetes or any such long standing condition.

“He/she is not the same after surgery”

You may have heard the above about patients who underwent brain surgery. It may happen in some case. So be prepared for slightly disturbed memory or movements or such things after a brain surgery. Doctors still do not understand the temporary mental changes called delirium that actually are the most common brain disease and the least understood. It occurs after medications, illness, and surgery.

Mental Changes After Surgery and Medical Illness

The extremely common and little understood brain changes after surgery or illness includes confusion, delusions, and hallucinations. This is most often temporary, but might last hours, days, weeks, or even months. But, the more serious problems are those that develop cognitive problems and never recover. This can be quite subtle, but life changing. These include memory loss and lack of ability to concentrate that can last for years or be permanent.

Good news is that such things happen rarely. The neurosurgeon will explain the risks and benefits of surgery to the patient and his/her relatives fully before surgery. A patient undergoing surgery has to accept the possibility of risks to gain the benefits of surgical cure. One big problem is that people who need surgery are ill and that affects the brain. Hence it is not justifiable to blame the surgery for any cognitive or motor deficits after a brain surgery.

Our priority at Samarth Neuro and Super Speciality Hospital is to assist you in finding a treatment plan that is both suitable and affordable. Dr. Ravindra Patil, our chief neurosurgeon, possesses extensive expertise in performing various surgeries related to the brain and spine.

Causes of Brain Problems After Surgery

Does anesthesia affect the brain during surgery? What about the physical trauma of the surgery itself? Kidneys are affected by the surgery. If a surgery can damage other organs, it could also damage the brain. It is like a body wide inflammation. In the elderly, brain surgery may affect the brain.

How long does recovery need?

It takes approximately 12-18 months for the brain to heal after a brain surgery and slowly and gradually the patient will regain all his normal functions and get back to his daily routine. However, in that time they need the complete support and understanding of their families, as well may need help from therapists. This will help the patient in gaining back their independence as well as confidence in their abilities.

More tips to help you deal with a Brain Surgery patients

After brain surgery, a person may feel disoriented and have some speech or understanding disability for a while. Family members and friends are advised to take a pause when talking to the patient, so that he/she can easily understand the conversation. Speaking slowly is not recommended, as patients may recognize it and have an emotional outburst or feel hurt.

• While conversing with the patient, family members should keep reminding about the topic of conversation at different points to the patient, so that it is easier for him/her to participate in the conversation.
• Please do not react adversely in case of emotional outbursts, instead show love and patience to a person recovering from brain surgery.
• Make sure that the person recovering from brain surgery gets enough sleep and rest to recuperate.
• People interacting with a brain surgery patient should understand that the person’s ability to learn and remember may be reduced. It will improve daily, and any lapses in attention by the patient are not caused by any act of obstinacy. Your care and understanding will be essential for a person to recover.
• Family members should also make sure just to give enough care and not smother the brain surgery survivor. It is essential for them to regain their confidence and a sense of competence.
• Nurses create a nursing care plan for all patients, including those with head injuries, called the NCP for head injury patients.

Neuropsychological examination after surgery

Soon after brain surgery and 6 months later, and a year later, the patient should be taken to a neurologist and if necessary to a psychiatrist to see if he/she is recovering properly. Caregivers should watch out for emotional outbursts, like rage, uncontrollable laughter, withdrawal and depression. In case of such symptoms, it is advisable to take the patient for a check-up with a medical practitioner.

Had tumours in his spine twice: Surgical Navigation saved him

By Dr.Ravindra Patil

Chief Neurosurgeon of Samarth Neuro and Multispeciality Hospital [Miraj, South Maharashtra] Dr Ravindra Patil writes about how he could operate a difficult case with the help of surgical navigation.

Mr Mahantesh Shellikeri is from Belgaum. He had a rare disease called Neurofibromatosis. He had two tumours pressing on the spinal cord in his back and as a result he had lost the ability to walk in the past two months.

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Neurofibromatosis

Neurofibromatosis (NF) is a conditions in which tumours grow in the nervous system. There are three types of neurofibromatosis, type I (NF1), type II (NF2) and Schwannomatosis. The tumours in NF are generally non-cancerous.

Non-cancerous tumours are of course good as compared to cancerous tumours, of course, because they don’t grow rapidly and spread to other parts of the body. But Mahantesh’s bad luck was that he had NF tumours in in spinal cord. He had been previously operated in the lumbar spine for the removal of an NF tumour 13 years ago. The surgeon had removed the tumour at the level of the second lumbar vertebra [L2]. But sadly for Mahantesh, the neurofibromatosis tumours recurred! This time it was at the 12^th thoracic vertebra [T12] and first lumbar vertebra [L1].

Due to the regrowth of the tumour, Mahantesh developed weakness in both lower limbs. As the tumours grew, gradually he could not walk. His MRI scan showed multiple spinal tumours at the level of the T12, L1 and L2 vertebrae. So he was referred to a neurosurgeon. The neurosurgeon explained that the surgery was very risky as the tumours were small and would be difficult to locate exactly and during their removal Mahantesh was likely to suffer permanent weakness or paralysis of his lower limbs and partial or complete loss of bladder and bowel control.

And if Mahantesh was not operated soon, then too he was likely to suffer permanent weakness or paralysis of his lower limbs and partial or complete loss of bladder and bowel control!

There was another complication. Mahantesh’s wife has poliomyelitis. She is a differently abled and challenged person. She needs a stick to support herself when she walks. So if Mahantesh suffered paraplegia, she would not be able to help him survive.

Besides, the cost of surgery, if it were attempted, would be high.

Thus Mahantesh Shellikeri and his wife were indeed in a desperate situation. Their extended family helped them a lot during their helpless condition.

Many neurosurgeons were consulted for Mahantesh’s treatment. All explained to them that surgery is a risky step because there was a high chance of Mahantesh developing complete paraplegia and bladder plus bowel incontinence.

Chance referral

One of Mahantesh’s relatives is a doctor. He met Dr Somnath Kheradkar, who suggested my name for another opinion.

When Mahantesh and family they came to me, they were very apprehensive and did not have much hope. I reassured them, explained about the disease, although they knew so much.

It was clear to me that if Mahantesh was not operated soon, he would loose control over his lower limbs, bladder and bowel. The surgery was risky.

Advantage factor

But we had one advantage. At Samarth Neuro and Superspeciality Hospital where I work, we have surgical navigation system which is very useful in fine brain and spine surgeries. Mahantesh’s tumours were small and would require accurate removal. The surgical navigation equipment would help me pinpoint his tumours and remove only the tumours without damaging his surrounding spinal cord tissue. I would remove the least amount of vertebral bones and leave his spine intact.

I explained Mahantesh and family about the one almost magical and extremely tool that Samarth Hospital has, namely Surgical Navigation and how it would help me pinpoint the tumours and remove them accurately.

Mahantesh and his wife had many. I answered them all and cleared all their doubts. Then they became were hopeful. They were willing for surgery. But they had reservations about the cost.

But it was a special case. Nearly all neurosurgeons had refused to operate and almost all had advised that the risk of the surgery was far more than the benefits.

I was willing to take the risk of surgery only because of surgical navigation guidance system in Samarth Neuro and Super-speciality hospital where I work. That system would give me the almost magical advantage of doing accurate surgery without and permanent aftereffects.

Surgical navigation would help me find the tumour inside the spinal canal. Also, I could reduce the size of the incision. Besides knowing exactly where to cut and what to remove, the time of the surgery would be much reduced. This would result in less post operative pain and faster healing. The possibility of infection would also be somewhat reduced.

Without Navigation…

The surgery would have been very risky. Had I operated without navigation, I would have been forced to remove one or more levels of his vertebrae which in turn would cause complications during and after the surgery.

Day of surgery

Then we posted him for surgery at the earliest. We did the surgery at reduced charges as Mahantesh Shellikeri’s financial condition is weak. We had CT scan and MRI scan images of his neurofibromas. We started the surgical navigation system after feeding the CT and MRI images into its computer system. We fitted the trackers of the navigations system at exact locations.

Now we knew exactly where to cut and how to cut. Some of our surgical instruments have markers. Thus the markers fixed on the patients and some of our surgical instruments showed up clearly on the 3D screen of the surgical navigation system. With the help of these images and our skills we operated.

We localized the level of the tumour exactly. Then we removed the exact amount of the bone to excise the tumour. We opened the duramater [a stiff covering of the brain and the spinal cord] and I dissected that tumour carefully away from the spinal cord. Afterwards I removed both the tumours located between the T-12 and L-1 levels as also the tumour below the L-2 level.

We were able to remove both the tumours in a single surgery most important of all, the surgery was successful.

Then came the post-operative care. Apart from nursing care and doctors’ rounds came in a very important care giver, the physiotherapist. She motivated and guided Mahantesh to move his limbs as the pressure of the tumours on the nerves was relieved. Mahantesh was surprised that he could move his legs. Remember, he had lost the ability to move his lower limbs when he came to me.

From merely moving his lower limbs to being able to walk was a gradual journey for Mahantesh. But he accomplished it and was able to walk with the support of a walker. But we are moving ahead too fast.

First came Mahantesh’s discharge from Samarth Hospital. We discharge him on the seventh day after surgery.

Many months have passed since Mahantesh was discharged. His would was very small, thanks to navigation assisted surgery. So he did not require much wound dressing. His surgical wounds healed fast.

The Shellikeri couple lives in Belgaum and hence it is too far away for them to come for follow up visits. Local doctors in Belgaon take care of Mahantesh’s routine problems.

But Mahantesh’s wife Mrs Shellikeri called me once after many months to tell me that Mahantesh is progressing well.

With our efforts we were able help Mahantesh walk again. I hope to god that he does not get more episodes of Neurofibromatosis either on his spine or anywhere else.

The Shellikeri family is happy about the results.

Spine Fusion Surgery Cost in India

By Dr.Ravindra Patil

Any type of spine surgery is thought to be a very expensive surgery. It is true to some extent as spinal fusion surgery cost is high because it needs very highly skilled surgeons, state of the art operation theatres and above all, surgical navigation for accuracy. But all these give fairly good results in patients who could not be operated at all a decade ago, because the skillset and surgical navigation were not available then. So now although back surgery cost is high, results are better.

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Cost of Spinal Fusion Surgery

The average Spinal Fusion Surgery cost is very high in western countries.

India is known worldwide for its advanced medical facilities and promising technology for Low Cost of Spinal Fusion Surgery. Many of the best hospitals for Spinal Fusion Surgery can be found in India.

Spinal Fusion Surgery cost in India is much less when compared to any other countries. Also the cost of Spinal Fusion Surgery in India is substantially lower than other developed countries of the world.

Private back surgery cost is higher because Private back surgery cost means treatment in a private hospital

Various deciding factors could determine the price of Spinal Fusion Surgery in India. These can be broadly classified as Hospital, Medical Team or Patient Dependent factors.

Hospital Factors

Type of the hospital (Government/Trust/Private).

Use of insurance, type of insurance or self paid.

Accreditation of the facility

Reputation and brand value of the hospital.

Medical Team Factors

Technology / Approach Used

Surgery Type

Type of Anesthesia or Sedation

Qualification / Expertise of the specialist

Extent of the surgery needed

Patient Factors

Patient’s diagnosis

Patient’s general health

Room Category selected by the patient

Other treatment required by the patient in conjunction

What is the definition of spinal fusion?

Spinal fusion is a surgical procedure wherein one or more vertebrae are united to eliminate any motion between them. The approach is similar to welding. Spinal Fusion Surgery, only does not weld the vertebrae immediately during surgery. The bone grafts are placed around the spine during surgery. The body then heals the grafts over several months.

When are the indications of spinal fusion surgery?

There are several potential reasons to consider spinal fusion. These include treatment of a fractured vertebra, rectifying deformity, elimination of pain caused during motion, treatment of instability, and treatment of cervical disc herniations.

Not all spinal fractures need surgery, some fractures, particularly those associated with spinal cord or nerve injury, generally require fusion as part of the surgical treatment.

Another condition treated is instability, i.e. the abnormal or excessive motion between two or more vertebrae. It is commonly believed that instability can be a source of back or neck pain or cause potential irritation or damage to close by nerves.

Cervical disc herniations that require surgery usually need fusion as well. In this technique, the disc is removed by an incision in the front of the neck and a small piece of bone is inserted in its place.

How is the Spinal Fusion Surgery performed?

There are many surgical methods available to fuse the spine that involve placement of a bone graft between the vertebrae. The spine may be treated from the back (posterior), from the front (anterior) or by a combination of both. The anterior approach is more common. The ultimate objective of fusion is to obtain a solid union between two or more vertebrae.

A fusion may or may not involve use of supplemental tools like plates, screws and cages. Instrumentation is sometimes used to rectify a deformity, but is usually used to hold the vertebrae together to while the bone grafts heal. Whether the hardware is used or not, it is important that bone or bone substitutes be used to get the vertebrae to fuse together.

The bone may be taken either from another bone in the patient or from a bone bank. Fusion using bone from the patient has a long history of use and results in predictable healing. Smoking, medications you are taking for other conditions and your overall health can affect the rate of healing and fusion, too.

How long does it take to recover from spinal fusion surgery?

Immediate discomfort following a spinal fusion is generally greater than with other types of surgeries. Fortunately, there are excellent methods of postoperative pain control available, including pain medications and intravenous injections.

Another option is a patient-controlled postoperative pain control pump. Here the patient presses a button that delivers a predetermined amount of narcotic pain medication through an intravenous line.

Patients generally stay in the hospital for three to four days, but a longer stay after more extensive surgery is also possible. A short stay in a rehabilitation centre after discharge from the hospital is recommended for patients who underwent extensive surgery, or for elderly or debilitated patients.

The fusion process varies in each patient. The healing process after fusion surgery is similar to that after a skeletal fracture. During this time, the patient’s activity is generally restricted. Substantial bone healing does not usually take place until three or four months after surgery.

Many a times spinal decompression surgery cost and healing time is compared with spinal fusion surgery cost. It must be understood that both are far different. Spinal decompression surgery does not need bone fusion and healing like spinal fusion surgery.

How many patients underwent Spinal Fusion Surgery in India in the last 5 years?

Private back surgery prices will vary from place to place. Scoliosis surgery cost is also of interest to many patients who have suffered kyphosis or scoliosis. Cost of spinal decompression surgery is also queried.

In recent years, India has emerged as a medical hub for patients looking for affordable, accessible and efficient low cost Spinal Fusion Surgery Treatment. Some of the best Spinal Fusion Surgery hospitals in the world are found in India. The country is known for offering advanced medical facilities at the most reasonable cost. An average increase of 15 to 20 percent annually has been observed in the number of patients in the last 5 years. The Indian Spinal Fusion Surgery hospitals deliver advanced health care and highest quality services backed by elaborate infrastructure and lower treatment cost

Here are the approximate figures of the patients underwent Spinal Fusion Surgery in the last 5 years in India

Year	2013	2014	2015	2016	2017
Surgeries	4800	6000	7500	9600	10800

What are our special services offered to international patients?

At Samarth Neuro and Super Speciality Hospital we help arranging your treatment in a way that will suit you and be affordable for you. Chief neurosurgeon at Samarth Neuro and Super Speciality Hospital Dr Ravindra Patil is vastly experienced in all types of spine and brain surgeries. Spine fusion surgeries are done there as required.

Congenital Brain and Spine Anomalies

By Dr. Ravindra Patil

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What are congenital brain and spine malformations?

Congenital means present at birth.

These conditions may be mild and without symptoms or may be serious, requiring treatment. In some cases, surgery may be recommended to:

1. Address the child’s or the patient’s symptoms.
2. Correct the form and function of the brain and spine structures.
3. Maximize cognitive and motor
4. Prevent development of neurological deficits.

Congenital abnormalities, called malformations, are conditions affecting the form and function of the nervous system. There are numerous variations of congenital malformations of the bone and soft tissue of the head and spine, including neural tube defects, such as spina bifida, encephaloceles, Chiari malformations and arachnoid cysts.

Some congenital malformations are mild, and some are severe but correctable with surgery by a pediatric neurosurgeon.

Types of some of the Congenital Brain and Spine Malformations are as follows:

Chiari Malformations

This is a condition in which portions of the brain, called the cerebellar tonsils, protrude through the bottom opening of the skull into the upper spine, which can put pressure on the brain or spinal cord. Chiari malformations may block the flow of cerebrospinal fluid, leading to hydrocephalus.

Treatments often focus on removing portions of the bone and soft tissue to relieve pressure on the spinal cord and brain, as well as providing new pathways to drain cerebrospinal fluid. Surgeons use different methods for treating these malformations, including decompression, with or without cutting open a small part of the dura mater [thick membrane covering the brain].

Encephaloceles

Encephaloceles are a type of neural tube defect characterized by the brain being exposed to the outside instead of being covered by the skull and skin. It can lead to infections and hydrocephalus.

Surgical treatment of this condition involves removing bone and soft tissue, draining cerebrospinal fluid, and surgically repairing or closing the encephalocele.

Children who have developed hydrocephalus as a result of an encephalocele will require treatment for that condition, often with a cerebrospinal fluid shunt. Shunting is the placement of a tube into the open area (ventricle) of the brain that allows cerebrospinal fluid to drain to the child’s abdomen or other location where it can be safely reabsorbed into the body.

Arachnoid Cysts

Arachnoid cysts are the most common type of brain cyst. They are congenital (present at birth) lesions that occur as a result of the splitting of the arachnoid membrane. The cysts are fluid-filled sacs, not tumors, appearing in one of the three layers of tissue covering the central nervous system.

Surgical treatment of this condition involves draining the cyst by drilling a small hole or by opening the skull and making small openings in the cyst to open the natural fluid pathways in the brain. This process is called fenestrating.

What are Spinal Deformities?

A spine deformity occurs when your spine varies by more than 10 degrees from ‘healthy’ curvature. But, what does this mean exactly?

Contrary to popular belief, your spine isn’t 100% straight and vertical. The spinal shape has curvatures, but the end result is that it is vertical! Our spine consists of a series of gentle arcs. Our lumbar spine, or lower back, swoops slightly to the back, and our thoracic spine, or upper back, bends subtly forward. The backward curve of your lower back is known as lordosis and the forward stoop that runs between our shoulder blades is known as kyphosis. Lordosis and kyphosis are spinal curvature deformities. Both are abnormal curvatures of the spine.

But, when viewed head-on, our backbone should look like a straight pillar. Hence, it is also called the ‘vertebral column’.

Moreover, the curves and straight stretches of your spine make symmetry possible. Your head sits directly over your pelvis because the lordosis of your lower back and the kyphosis of your upper spine balance each other out. If one of these curves becomes greater or lesser than the other, then problems can occur. We refer to this as sagittal imbalance, because the head and pelvis no longer fall within the same, or sagittal, plane.

Too much swaying backwards can be thought of as ‘lordosis’, and too much forward stooping in the upper back is ‘kyphosis’.

Likewise, when the spine tilts away from the midline of the body, doctors refer to this problem as coronal imbalance or scoliosis. Unevenness in the ‘coronal’ plane (the view from head-on) causes asymmetry in the trunk of the body. This can include uneven hips and shoulders or one-sided bulging of the ribs.

Diagnosis of Congenital Brain and Spine Malformations

If a child is born with any of the above malformations, a thorough evaluation by a paediatrician or neurologist is needed to diagnose the problem and recommend a plan for addressing it.

After a thorough physical and detailed family and patient history, your doctor may order imaging of the brain and/or spine through an MRI scan. If the MRI scan shows any evidence of these malformations, a neurosurgical consultation is a must to plan the best treatment.

Congenital Brain and Spine Malformations Treatment

A multidisciplinary approach is often beneficial for addressing children with congenital brain and spine malformations. Neurosurgeons, craniofacial plastic specialists and geneticists, among others, may be called upon to develop your child’s treatment plan and determine what kind of surgery may be appropriate.

If a congenital brain or spine malformation is mild and not causing any signs or symptoms in your child, the neurosurgeon may recommend observation, which means regular visits and testing to monitor your child’s condition.

If your child does undergo surgery, follow-up care is extremely important in tracking the progress of your child’s recovery. Your paediatric neurosurgeon will schedule follow-up appointments to ensure your child is making the best recovery possible.

Spinal treatments are focused on both correcting the functional shortcomings as well as the structural defects of the spine.

Congenital brain and spine defects treatment in Miraj, Maharashtra

Samarth Neuro and Super Speciality hospital has facilities to surgically treat some of the above brain and spine deformities present since birth. Abnormal curvature of the spine can be corrected to some extent.

Chief Neurosurgeon at Samarth Hospital Dr Ravindra Patil has considerable experience in treating such defects. Besides, as his hospital is located in a tier two city, the cost of treatment is considerably less than in major cities of India. Patients from foreign countries may find going to Miraj for treatment of brain and spine diseases from Dr Ravindra Patil considerably cost effective.