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Cranio-Vertebral Junction Anomalies

Dr. Ravindra Patil on August 18, 2023

Cranio-Vertebral Junction Anomalies

Cranio-Vertebral Junction Anomalies

By Dr.Ravindra Patil

Anomaly

An anomaly is something that deviates from what is standard, normal, or expected. Cranio-vertebral junction anomalies mean any situation where there is some deviation from what is the ‘normal’ cranio-vertebral junction.

CVJ

The cranio-vertebral junction (CVJ) is present between the base of the skull and the upper region of the cervical spine. Any deviations or deformities in this region are known as cranio-vertebral junction anomalies. They can occur as congenital anomalies, developmental or secondary to other disease processes. Cranio-vertebral anomalies are classified into different types based on their causative factors.

The craniovertebral junction (CVJ) has unique anatomical structures that separate it from the cervical spine. In addition to housing vital nerves and blood vessels, the majority of head movements like flexion, extension, and looking sideways is accomplished at the CVJ.

The CVJ is a complex combination of osseous and ligamentous supports allow for stability despite a large degree of motion. To understand the anomalies of the CVJ, an understanding of anatomy and biomechanics in short is essential to understand the various anomalies and diseases that may affect this region.

The craniovertebral junction (CVJ) is the joint between the skull, atlas [first cervical vertebra], and axis [second cervical vertebra]. It is a complex area that houses vital nerves and blood vessels. This a joint has the most mobility as compared to any other joint of the vertebral column or the spine. The CVJ represents the transition between the brain and cervical spine. The majority of the spine’s rotation, flexion, and extension occur between the occiput, the atlas, and axis.

Table of Contents

Causes and risk factors of Cranio-vertebral Junction Anomalies

There are various factors associated with CVJ anomalies. Some of them include:
  • Skeletal structure abnormalities
  • Congenital systemic disorders such as Achondroplasia, Down syndrome, etc.
  • Infections
  • Metastatic Tumours effecting bones
  • Slow growing tumours in the CVJ
  • Rheumatoid Arthritis
  • Traumatic injuries by an accident, a fall etc.

Signs and symptoms of Cranio-vertebral Junction Anomalies

The signs and symptoms of CVJ anomalies vary based on the cause, severity and specific structures affected. However, some common signs and symptoms may include:

  • Neck pain
  • Headache in the back region of the head
  • Worsening head and neck pain with movement.
  • Decreased range of motion in the CVJ
  • Increased pain intensity while coughing or bending

Symptoms associated with spinal cord compression in the CVJ may include:

  • Weakness in arms, legs or both.
  • Numbness and tingling sensation on bending the neck.
  • Decreased sensations of heat, cold and pain in the legs/hands/feet.
  • Confusion and dizziness

Symptoms associated with brain stem dysfunction may include:

  • Sleep apnoea
  • Impaired balance and coordination (Ataxia)
  • Involuntary eye movements (Nystagmus)
  • Facial paralysis

Symptoms associated with lower cranial nerve dysfunction may include:

  • Difficulty in swallowing
  • Muscle weakness
  • Impaired hearing
  • Paralysis of soft palate and tongue atrophy
  • Diagnosis of Cranio-vertebral Junction Anomalies

CVJ anomalies are diagnosed based on medical history, physical examination and diagnostic imaging scans. Lateral view X-rays, CT scan and MRI are used to visualise the structural abnormalities in the CVJ. CT scan is the most common diagnostic tool used for CVJ anomalies. However, if further investigations are required, MRI and CT myelography are considered.

Treatment of Cranio-vertebral Junction Anomalies

Surgery is the treatment of choice for CVJ anomalies. The type of surgery and approach is decided based on some factors which include: traumatic causes, non-traumatic causes, reducible or irreducible lesions. Considering these factors, the basic surgical procedures involved are reduction, immobilization, decompression and fixation. Treatment may include any one of the procedures or a combination which is determined based on the nature, severity and risk factors of the disease.

Treatments

  • Full endoscopic cervical canal stenosis decompression
  • Spinal fixation
  • Craniovertebral junction surgeries
  •  

CVJ Fixation

Due to the complex anatomical nature as well as the significant mobility of the CVJ, fixation of this region remains at times a challenging decision and a difficult execution. A wide variety of fixation methods exist and may include a combination of the following: screws, rods, wires/cables, bone grafts, hooks, or plates. Furthermore, arthrodesis [surgical immobilization of a joint by fusion of the bones] is also a challenge as there is little space and bone surface for sufficient bone grafting.

Fixation of the CVJ to the skull can be accomplished via small burr holes and wire or a combination of screws and plates, which allows for fixation to the cervical spine through connection of rods or additional plates in the spine. Bur holes with wire are not currently used as often, as the screw/rod/plate constructs have shown to be bio-mechanically superior in terms of screw pullout strength and stiffness.

The screws used in the CVJ are generally a larger diameter than those used in the cervical spine. They have a smaller pitch and blunt tips to prevent piercing the dura mater [a thick tissue layer covering the brain and the spinal cord].

Fixation in the cervical spine can be a combination of a number of methods as well, usually with the intention of connecting to the occiput fixation. The screws used in the cervical spine are generally polyaxial and placed into the lateral masses of the vertebrae.

Generally, the skull and the first cervical vertebra [atlas] segment is not fixated alone due to the large moment arm created by the cranium on C-1. However, there are situations in which the occiput and atlas can be fixated using the above listed devices, like screws, rods, wires and so on.  Sometimes a bone graft is placed in between the posterior arch of atlas and the base of the skull. Successful fusion rates of such surgeries have been reported up to 89%, but the patient’s head is not immediately stable after surgery. Such patients are required to remain in a halo neck fixation for 12 weeks.

Another option involves the use of fixing screws across joints. Similar to the above construct, this is usually reserved for isolated Skull-Atlas instability and is not easily incorporated into multisegment constructs. This technique increases stiffness in rotation but is poor in flexion-extension. Thus, this technique is used in conjunction with supplemental fixation to allow for sufficient stability.

Skull to Atlantoaxial Segment fixation

The occiput to atlantoaxial region is classically difficult to fixate as both the occipitoatlantal and atlantoaxial segments are highly mobile in flexion and extension, and additionally the atlantoaxial segment is very mobile in axial rotation. Any number of combinations of the previously mentioned techniques can be used. Occipitocervical fixation constructs consist of points of fixation along the skull, atlas vertebra and axis vertebra, with connection to some type of longitudinal element. These longitudinal elements span the segments in the CVJ and allow them to be rigidly fixated.

The above description may seem to be very complex to the lay reader. However, all efforts have been made to removed complicated medical words and use as simple words as possible.

To develop a strong CVJ construct, the longitudinal elements should be able to have multiple points of fixation along the junction, interface with all of the fixation points, have the ability to interface with the thickest regions of bone in the suboccipital region, and have the ability to be crosslinked.  Various types of longitudinal elements are available and may include rods, structural bone grafts, reconstruction plates, and hybrid devices combining plates and rods in preformed shapes. As with all spinal instrumentation, it is critical to choose the type of longitudinal element that best suits the individual patient’s needs based on the goal of surgery and the patient’s anatomy.

Samarth Neuro and Multispeciality hospital in Miraj, Maharashtra, has the infrastructure and team of doctors headed by neurosurgeon Dr Ravindra Patil to accomplish such complex surgeries. Besides as the hospital is located in a tier 2 city, the overall cost of such surgeries is much less in Samarth Hospital of Miraj as compared to surgeries done in large metropolitan cities.

Spina Bifida Causes, Symptoms and Treatment

Dr. Ravindra Patil on August 5, 2023

Spina Bifida - Samarth neuro and super speciality hospital

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

Dr. Ravindra Patil on August 2, 2023

Atlantoaxial dislocation

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.

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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

Dr. Ravindra Patil on July 20, 2023

Symptoms of Cervical Vertigo

Symptoms of Cervical vertigo - Samarth

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: 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

Dr. Ravindra Patil on July 3, 2023

Lumbar Spondylosis -Samarth

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?

Dr. Ravindra Patil on June 12, 2023

Vertigo - Samarth

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.

Meningomyelocele

Dr. Ravindra Patil on June 9, 2023

Myelomeningocele - Samarth

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.

Table of Contents

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

Dr. Ravindra Patil on May 17, 2023

Vertigo and Dizziness​

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.

Table of Contents

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

Dr. Ravindra Patil on April 28, 2023

Nutrition Deficiency- Samarth

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.

Table of Contents

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.

Spine Deformities

Dr. Ravindra Patil on April 24, 2023

Spinal Deformity

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.

Table of Contents

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.

Samarth Neuro and Superspeciality Hospital has 100+ beds & specializes in emergency surgery for neurological issues/disorders & diagnostics.

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