Category: Sciatica and key hole spine surgery

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How can spondylolisthesis be diagnosed?

Spondylolisthesis is a condition resulting in a painful experience including low back pain and other symptoms as well. It can be very painful in some patients and quite bearable in others depending on the severity of the condition. The symptoms may aggravate if the nerves passing are pinched causing altered sensations in the affected part. Early diagnosis and proper treatment and precautions are key to leading a healthy life.

Methods that are considered when seeing a patient with Spondylolisthesis are described in this article by Dr. Kalyan Bommakanti who is well-known as the Best neurosurgeon in India.

The healthcare provider starts off the process by asking about the symptoms first. This correlation of the signs and symptoms gives an idea about the condition.

Further investigation is done through physical examination, in which several movements and special tests are performed on the affected area to differentiate it from other possible conditions.

Straight leg raise is performed while the patient is lying supine resulting in pain. At the lumbosacral region, a prominent Step off sign is seen indicating the slippage of the vertebra. Range of motion at the lumbosacral region i.e. flexion and extension are limited.

Several imaging tests are also advised to make sure of the condition.

X-rays of the lumbosacral region are done to see if the vertebra is displaced and how much is the displacement. Other than X-rays a CT scan or MRI may be advised to observe the spinal contents in more detail to see whether the nerves are compressed or not and how much damage has happened to the discs and the nerves.

Based on these investigations, the condition of the patient is usually categorized as Grade I or II determining less serious condition usually cured without any surgery, and Grade III or IV as high grade and more serious which can require surgery as the only treatment option. The healthcare provider makes a final diagnosis and starts the treatment as required.

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Health Latest and Advanced Equipment Sciatica and key hole spine surgery

What symptoms does Spondylolisthesis cause?

Due to any congenital or degenerative cause, one of the vertebrae slips out of its position onto the one that is beneath it. This causes increased pressure on the lower vertebra resulting in pain and functional limitations. It can also affect the spinal nerves passing through the area involved by compressing them. The severity of the condition depends on the cause and the region.

In order to understand Spondylolisthesis in detail, India’s best neurosurgeon Dr. Kalyan Bommakanti has explained various symptoms that may result from this condition.

The symptoms usually caused by Spondylolisthesis are as follows:

1.Low back pain:

The most common symptom seen is low back pain. The patient may experience pain when the affected segment is touched or when extension is done at that region. Flexion can be a relieving factor.

2. Muscle tightness and instability:

The spine is the stability center of the body. When there is any malalignment of a segment, it causes problems in the related areas too. All the muscles in the region are connected with each other. When the lumbar spine is affected, along with the lumbar area it will also cause muscle tension and tightness in the buttock area and in one or both the legs. Hamstrings tightness is very common in this condition, resulting in trouble in walking or standing. Pain may usually increase with activity.

3. Altered sensations:

Due to excessive pressure exerted on the nerve fibers, there can be sensations altered in one or both legs resulting in numbness or tingling sensation.

4. Bowel or bladder incontinence:

In severe and rare cases, if the displacement is extreme and the nerves controlling bowel and bladder functioning are pinched, it may result in incontinence or even loss of control.

Sometimes, the symptoms are not as severe so the patients don’t take it seriously. But in both cases, professional consultation and evaluation must be done in order to avoid any damage in the future.

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Health Sciatica and key hole spine surgery Surgical Procedures

What is Spondylolisthesis?

The word Spondylolisthesis originated from the Greek words spondylos meaning spine or vertebra and listhesis meaning slipping or movement. This slipping of the vertebra causes spinal instability. The vertebra moves out of its place more than it does normally. It causes low back pain that can be severe or moderate depending on the condition.

An overview of Spondylolisthesis is explained in this article by India’s best spine surgeon Dr. Kalyan Bommakanti.

Spondylolisthesis can be a very painful condition depending on the cause and the severity. A vertebra slips out of its place more than usual affecting mainly the one vertebra that is beneath it. Spondylolisthesis can be graded by Meyerding Classification which tells the degree of slippage of the vertebra. It can be caused by spondylosis or any degenerative condition. Adults and especially female and obese are found more prone to this. The facet joints grow posteriorly causing instability of the vertebra. This instability leads to the slipping of the vertebra over the underneath one. It occurs mostly in the lumbar spine.

When the vertebra slips over the other vertebra, it puts pressure on it hence it also causes narrowing of the spinal canal. The pressure exerted on the spinal canal causes impingement of the nerves passing through it. This compression or pinching may lead to low back pain or leg pain. It can cause several symptoms such as low back pain, muscle stiffness, pain radiating to the legs, buttock pain, and hamstrings tightness which can lead to difficulty in walking. The symptoms may aggravate upon activity.

As this condition is quite painful, it can be treated in therapeutic or surgical ways. Precautions and exercise can also help in acute cases. If it is not diagnosed and treated on time, it may cause some serious complications such as sensational loss or loss of bladder or bowel movement.

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BLOG&NEWS Sciatica and key hole spine surgery

What are Intradural-extrmedullary and extradural spinal cord tumors?

Spinal cord tumors are the tumors inside or in the lining of the spinal cord enclosed in the vertebral column. These tumors may be benign or metastatic. These tumors are classified on the basis of their location and size.

In this article, the best spine surgeon Dr. Kalyan Bommakanti has explained the Intradural-extramedullary and extradural spinal cord tumors.

  1. Intradural-extramedullary tumors:

The outermost layer of the spinal cord is the dura sheath. The tumors developed in this sheath but outside the spinal cord are the intradural-extramedullary tumors. Usually, these tumors are benign. The symptoms may include weakness and pain.

Intradural-extramedullary tumors are further divided into the following sub-types:

i. Meningiomas:

These spinal tumors are formed in the membranes covering the spinal cord. These tumors are more common in women than men and appears usually in the back in the upper portion. They may be cancerous or not, but usually, they are not cancerous. As the tumor grows, symptoms like pain, weakness, numbness, or bowel/bladder incontinence can be seen.

ii. Neurofibroma:

A Neurofibroma occurs in the outer layering and the nerves of the spine. Usually, it accompanies a condition called neurofibromatosis. This condition is responsible for causing spinal tumors. The growth rate of these tumors is slow.  

iii. Schwannoma:

This type of spinal cord tumor is caused by Schwann cells, these cells produce myelin sheath for the protection of the nerves. It may be congenital. In most cases, they are non-cancerous however they may grow in size and put pressure on the spinal cord. It may result in symptoms like pain, weakness, or numbness.

2. Extradural tumor:

A tumor that is formed outside the dura is known as the extradural tumor. Usually, they are metastatic and have spread from any other part of the body. These tumors also involve the vertebral column. Almost 55% of the spinal cord tumors occur in this part of the spine.

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BLOG&NEWS Sciatica and key hole spine surgery

WHAT ARE THE THINGS THAT AGGRAVATE SCIATIC PAIN?

Sciatic pain is caused by the impingement or inflammation of the sciatic nerve in the lumbar spine. It may cause pain, numbness, or muscle weakness in the lower back, legs, or foot. The intensity of pain may vary among individuals, and proper care and precautions must be taken to minimize the symptoms.

The best neurosurgeon Dr. Kalyan Bommakanti has explained different factors that may aggravate the sciatic pain:

1.Being obese:

Being overweight may be a cause of many health problems. The more the weight is, the more the strain and pressure are put on the body, especially the musculoskeletal system. Bones and joints are affected mostly by this, as they need to carry a heavy load hence resulting in weakness. The lower back is the place that is usually affected by it a lot, as there is a shift in the center of gravity due to excessive weight, resulting in putting pressure on the lumbar spine and causing disc herniation. It may eventually compress the sciatic nerve. To manage it or prevent it, it is advised to maintain a healthy weight.

2. Wearing uncomfortable shoes:

Wearing the wrong shoe may seriously disturb the biomechanics of gait pattern, unequal weight distribution, increased stress on the lower back, and aggravates the symptoms of sciatica. The increase of pressure in the lower back directly compresses the sciatic nerve.

3. Excessively loaded back pocket:

When you continue to sit for a prolonged time with an excessively loaded back pocket, it exerts direct pressure on the piriformis muscle under which the sciatic nerve runs.

4. Lifting weight with your back:

While lifting loads, the bending posture puts a lot of pressure on the lumbar discs. Due to excessive load, the vertebral discs may bulge out causing disc herniation ultimately compressing the sciatic nerve.

5. Pregnancy:

In pregnant women, it is common to experience piriformis syndrome due to the increasing fetus that results in the anterior shift of the pelvis resulting in the tightening of the piriformis muscle. Sciatic occurs as a secondary symptom of this syndrome.

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BLOG&NEWS Sciatica and key hole spine surgery

WHAT ARE THE VARIOUS TYPES OF SCIATIC NERVE PAIN?

Sciatica is a term used to describe pain caused by impingement or inflammation of the sciatic nerve. The sciatic nerve is the longest in the body. It originates from the lumbosacral vertebrae and travels along the route through the hips, buttocks, down each leg, and foot. The impingement of the sciatic nerve causes pain or numbness in any part where it supplies. Some people may experience pain in one part and numbness in another. It also supplies the muscles of these areas and may also cause muscle weakness and difficulty in movement.

These are various types of sciatica explained by the best neurosurgeon Dr. Kalyan Bommakanti:

1. Acute sciatica:

Acute sciatica has a sudden onset and the pain lasts for about 4-8 weeks. The intensity of pain is not severe and can be managed by self-treatment and gentle stretches at home. Usually, there is no need for medical treatment. But if ignored for a long period, acute sciatica may recur and may convert into chronic sciatic nerve pain.

2. Chronic sciatica:

This type of sciatica lasts for more than 8 weeks and the pain type is persistent.  Chronic sciatica cannot be cured by self-medication and you need to seek medical help. According to the severity and nature of the pain, either surgical or non-surgical interventions are made. It depends upon the pain type and the patient’s health status.

3. Alternating sciatica:

Usually, sciatica involves only one leg but sometimes it may affect both legs alternatively. This may indicate a degenerative disorder in the sacroiliac joint (the joint that connects the spine to the hips) such as sacroiliac arthritis.

4. Bilateral sciatica:

Bilateral sciatica is rare and affects both legs simultaneously when there is an impingement of both ends of the sciatic nerve. It may be caused by some degenerative changes in the vertebral discs or the vertebra. The intensity of pain in both legs may be variable. It may also be caused by the Cauda equina syndrome.

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