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    How Do You Treat foot drop ?     Question: My mother has nerve compression in her low back, which has resulted in foot drop of her right foot. What other options does she have besides surgery? Answer: To help our readers who aren't familiar with drop foot (sometimes called foot drop), this is a nerve and muscular disorder that prevents the patient from lifting the front of his or her foot. A person with drop foot will notice a change in their gait (known as steppage gait), and patients may also experience pain and/or numbness. Nerve compression that leads to foot drop is typically caused by a herniated disc in the lumbar spine, specifically at L4-L5; the fourth and fifth vertebrae in the low back. Most herniated discs get better with time and do not require surgery. There are many non-surgical treatments for herniated discs, including bed rest, exercises medication and  minimal invasive techniques. Unfortunately, with foot drop, the longer the nerve is compressed, the less chance for recovery. The nerves that elevate the foot, and are affected in foot drop, are the most sensitive nerves lumbar spine—and the least resilient. Now, you might wonder how nerve compression in your low back affects the nerves in your legs. The reason is that the nerves affected in foot drop begin in your low back and extend down to your legs and feet. When the nerve is compressed for very long, cells in the nerve become damaged and the nerve cannot transmit the signal to the feet. This nerve damage can be irreversible. Consequently, foot drop is often permanent, even if the nerves are decompressed surgically. Regardless, the duration of foot drop and the amount of compression should be evaluated by a surgeon.
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    What's Brachialgia? Any Pain condition start from your Neck region travel towards shoulder and may radiating down'to hand fingers, maybe associated with Nerves root's compression or Disc pathology from C1 to C7 like Disc Bulge, Protrusion, Extrusion etc.but commenest one is C4-5-6. Most of people's have myths about this problem-keep on saying it's Cervical Spondylitis or Cervical pain, they visit to doctors intially for relief, first doctors will ask them to get done X-ray, Cervical Spine .just after seeing x-rays he will advise you neck collar or pillow for couple of days or weeks. Without knowing what exact structure is involved in Neck Pain, wether it's Nerves, muscles, cervical vertebrae, vascular structure, artery or vein.how your doctor is commenting it's cervical Spondylitis or something else? How your doctor will see Nerves root's in X-ray? . Clinical findings* -patients may experience Tingling sensation Heaviness or burning sensation, spasms in area.of dermatome.in severe condition your power of limbs may affected, even patient feel difficulty in gripping or holding object. Investigation- X-ray Cervical Spine, MRI scan cervical, Doppler ultrasound arterial or venous.EMG, , NCV etc Treatment of Brachialgia* Medical treatment-analgesics muscles relaxant or rest for limited duration, some Physiotherapy if be needed but contraindications if neurological function with warning signs.present . Every medical treatment has its own limitations with time frame. Surgical options* If conservative treatment has been non responsive to medical treatment. May opt for-Epidural injections for Pain relief as directed by your Pain physician or Neurosurgeon. Etc. Nucleoplasty procedures, Laser procedures, Disc Fix Discectomy, Laminectomy etc Never mind if you are feeling any Pain condition associated with Unwanted paresthesia Numbness Spasms Tingling sensation etc must consult with Pain physician or Neurosurgeon.but keep on trial with medicine by any physician or therapist or unwanted exercise may be catastrophic events if spinal cord vital functions compromise.. anything unwanted action there may have deleterious effects.
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    How Spine Endoscopic surgery is better then conventional spine surgery? advantage of minimal invasive spine surgery?advantages of endoscopic discectomy at a glance:best Spine Centre in Jaipur now admitted advantage of Minimal Invasive Spine Surgery. endoscopic spine technique now become choice for your patient, Best Spine Doctor of Jaipur with their experience after a hundreds of succesful slipdisc cases.finally a detail observation was noticed. *very high success rate > 95% *very low infection rate < 0, 01% *The intervention can be carried out under local anesthesia – no general anesthesia is required! as far as possible *In most cases patients are pain free immediately after surgery! even more often just after procedure patient feel great relief. *As there is almost no tissue damage, the intervention is much less cumbersome and the risk of complications is very low *No bony instability, as the structures that stabilize the spine – the ligaments and facets joints – remain intact and unhurt . This is a main difference to microscopic surgery technique. *Less wound healing pain as well as higher stability, as back muscles are not cut or torn.few days are enough to heal your wound. *very less infection risk, as access is through a small cutaneous incision (3-7mm). *Less scarring in the region of the nerve roots! *just two hours after the intervention you will be able to walk without pain. *Short hospital stay: you can go back home the day after the intervention * after a few days to weeks you may resume your usual daily activities. *Short recovery times: after one or two weeks you can go back to work, *after 6 weeks you may resume your usual sports activities. Little scarring
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    What Causes Neck Pain? dr sanjay sharma interventional pain physician says Your neck is made up of vertebrae that extend from the skull to the upper torso. Cervical discs absorb shock between the bones. The bones, ligaments, and muscles of your neck support your head and allow for motion. Any abnormalities, inflammation, or injury can cause neck pain or stiffness. Many people experience neck pain or stiffness occasionally. In many cases, it’s due to poor posture or overuse. Sometimes, neck pain is caused by injury from a fall, contact sports, or whiplash. Most of the time, neck pain isn’t a serious condition and can be relieved within a few days. But in some cases, neck pain can indicate serious injury or illness and require a doctor’s care. If you have neck pain that continues for more than a week, is severe, or is accompanied by other symptoms, seek medical attention immediately. Causes of neck pain Neck pain or stiffness can happen for a variety of reasons.depend on pathology. Muscle tension and strain This is usually due to activities and behaviors such as: poor posture working at a desk for too long without changing position sleeping with your neck in a bad position jerking your neck during exercise Injury The neck is particularly vulnerable to injury, especially in falls, car accidents, and sports, where the muscles and ligaments of the neck are forced to move outside of their normal range. If the neck bones (cervical vertebrae) are fractured, the spinal cord may also be damaged. Neck injury due to sudden jerking of the head is commonly called whiplash. Heart attack Neck pain can also be a symptom of a heart attack, but it often presents with other symptoms of a heart attack, such as: shortness of breath sweating nausea vomiting arm or jaw pain If your neck hurts and you have other symptoms of heart attack, call an ambulance or go to the emergency room immediately. Meningitis Meningitis is an inflammation of the thin tissue that surrounds the brain and spinal cord. In people who have meningitis, a fever and a headache often occur with a stiff neck. Meningitis can be fatal and is a medical emergency. If you have the symptoms of meningitis, seek help immediately. Other causes Other causes include the following: Rheumatoid arthritis causes pain, swelling of the joints, and bone spurs. When these occur in the neck area, neck pain can result. Osteoporosis weakens bones and can lead to small fractures. This condition often happens in hands or knees, but it can also occur in the neck. Fibromyalgia is a condition that causes muscle pain throughout the body, especially in the neck and shoulder region. As you age, the cervical discs can degenerate. This is known as spondylosis, or osteoarthritis of the neck. This can narrow the space between the vertebrae. It also adds stress to your joints. When a disk protrudes, as from a trauma or injury, it may add pressure on the spinal cord or nerve roots. This is called a herniated cervical disk, also known as a ruptured or slipped disk. Spinal stenosis occurs when the spinal column narrows and causes pressure on the spinal cord or the nerve roots as it exits the vertebrae. This can be due to long-term inflammation caused by arthritis or other conditions. In rare instances, neck stiffness or pain occurs due to: congenital abnormalities infections abscesses tumors cancer of the spine When to see your doctor If symptoms persist for more than a week, consult with your doctor. You should also see a doctor if you have: severe neck pain without apparent cause lump in your neck fever headache swollen glands nausea vomiting trouble swallowing or breathing weakness numbness tingling pain that radiates down your arms or legs inability to move your arms or hands inability to touch your chin to your chest bladder or bowel dysfunction If you’ve been in an accident or fall and your neck hurts, seek medical care immediately.
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    Trigeminal Neuralgia Well known painful condition also known as Suicidal disease to Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. If you have trigeminal neuralgia, even mild stimulation of your face — such as from brushing your teeth or putting on makeup — may trigger a jolt of excruciating pain. You may initially experience short, mild attacks. But trigeminal neuralgia can progress and cause longer, more-frequent bouts of searing pain. Trigeminal neuralgia affects women more often than men, and it's more likely to occur in people who are older than 50. Because of the variety of treatment options available, having trigeminal neuralgia doesn't necessarily mean you're doomed to a life of pain. Doctors usually can effectively manage trigeminal Neuralgia with medications, injections or surgery. Radiofrequency ablation is best non surgical intervention.under fluroscopic guidance by any interventional pain physician.who is expert one to manage without opening your skull. Branches of the trigeminal nerve There are three branches of trigeminal nerve originated from ganglion. 1-Ophthalmic 2-maxillary 3-mandibular Trigeminal neuralgia symptoms may include Any single division or mixed pattern of one or more of these division. Episodes of severe, shooting or jabbing pain that may feel like an electric shock Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking or brushing teeth Bouts of pain lasting from a few seconds to several minutes Episodes of several attacks lasting days, weeks, months or longer — some people have periods when they experience no pain Constant aching, burning feeling that may occur before it evolves into the spasm-like pain of trigeminal neuralgia Pain in areas supplied by the trigeminal nerve, including the cheek, jaw, teeth, gums, lips, or less often the eye and forehead Pain affecting one side of the face at a time, though may rarely affect both sides of the face Pain focused in one spot or spread in a wider pattern Attacks that become more frequent and intense over time When to see a doctor If you experience facial pain, particularly prolonged or recurring pain or pain unrelieved by over-the-counter pain relievers, most often patient get Treatment from dentist, who knowingly or unknowingly derooted many teeth.made edentulous jaw.sometime patient goes to ENT surgeon, because of ear pain problem.but none has no definite roles in Pain management. Any Neurophysician or Pain physician is right doctors to consult for further management.but Pain physician not only facilate medical treatment.but he performed minimal invasive procedures like - 1-glycerol rhizolysis 2-Radiofrequency thermocoagulation 3-Ballon decompression 4-Gama knife therapy Causes- In trigeminal neuralgia, also called tic douloureux, the trigeminal nerve's function is disrupted. Usually, the problem is contact between a normal blood vessel — in this case, an artery or a vein — and the trigeminal nerve at the base of your brain. This contact puts pressure on the nerve and causes it to malfunction. Trigeminal Neuralgia can occur as a result of aging, or it can be related to multiple sclerosis or a similar disorder that damages the myelin sheath protecting certain nerves. Trigeminal neuralgia can also be caused by a tumor compressing the trigeminal nerve. Some patients may experience Trigeminal neuralgia due to a Brain lesion or other abnormalities. In other cases, surgical injuries, stroke or facial trauma may be responsible for trigeminal neuralgia. Triggers factors- A variety of triggers may set off the pain of trigeminal Neuralgia, including: Shaving Touching your face Eating food Drinking Brushing your teeth Talking/speech Putting on makeup Encountering a breeze Smiling/chewing Washing your face
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    Treatment Options for a Herniated Disc The primary goal of treatment for each patient is to help relieve pain and other symptoms resulting from the herniated disc. To achieve this goal, each patient’s treatment plan should be individualised based on the source of the pain, the severity of pain and the specific symptoms that the patient exhibits. What Happens when a Disc Herniate? While the spinal discs are designed to withstand significant amounts of force, injury and other problems with the disc can occur. When the disc ages or is injured, the outer portion (annulus fibrosus) of a disc may be torn and the disc's inner material (nucleus pulposus) can herniate or extrude out of the disc. Each spinal disc is surrounded by highly sensitive nerves, and the inner portion of the disc that leaks out contains inflammatory proteins, so when this material comes in contact with a nerve it can cause pain that can travel down the length of the nerve. Even a small disc herniation that allows a small amount of the inner disc material to just touch the nerve can cause significant pain. In general, patients usually are advised to start with a course of conservative care (non-surgical) prior to considering spine surgery for a herniated disc. Whereas this is true in general, for some patients early surgical intervention is beneficial. For example, when a patient has progressive major weakness in the arms or legs due to nerve root pinching from a herniated disc, having surgery sooner can stop any neurological progression and create an optimal healing environment for the nerve to recover. In such cases, without surgical intervention, nerve loss can occur and the damage may be permanent. There are also a few relatively rare conditions that require immediate surgical intervention. For example, cauda equina syndrome, which is usually marked by progressive weakness in the legs and/or sudden bowel or bladder dysfunction, requires prompt medical care and surgery. Conservative Treatments options- For lumbar and cervical herniated discs, conservative (non-surgical) treatments can usually be applied for around four to six weeks to help reduce pain and discomfort. A process of trial and error is often necessary to find the right combination of treatments. Patients may try one treatment at a time or may find it helpful to use a combination of treatment options at once. For example, treatments focused on pain relief (such as medications) may help patients better tolerate other treatments (such as manipulation or physical therapy). In addition to helping with recovery, physical therapy is often used to educate patients on good body mechanics (such as proper lifting technique) which helps to prevent excessive wear and tear on the discs. If conservative treatments are successful in reducing pain and discomfort, the patient may choose to continue with them. For those patients who experience severe pain and a high loss of function and don’t find relief from conservative treatments, surgery may be considered as an option. The different conservative options for a lumbar herniated disc and a cervical herniated disc are described below. Lumbar herniated disc treatments Conservative approach to herniated disc treatment A combination of the following conservative treatment options can be used through at least the first six weeks of discomfort and pain: Physical therapy, exercise and gentle stretching to help relieve pressure on the nerve root Ice and heat therapy for pain relief Manipulation (such as chiropractic manipulation) Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen or COX-2 inhibitors for pain relief Narcotic pain medications for pain relief Oral steroids to decrease inflammation for pain relief Epidural injections to decrease inflammation for pain relief
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    What is TN? Trigeminal neuralgia (TN) is considered to be one of the most painful afflictions known to medical practice. TN is a disorder of the fifth cranial (trigeminal) nerve. The typical or “classic” form of the disorder (called TN1) causes extreme, sporadic, sudden burning or shock-like facial pain in the areas of the face where the branches of the nerve are distributed – lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. The pain episodes last from a few seconds to as long as two minutes. These attacks can occur in quick succession or in volleys lasting as long as two hours. The “atypical” form of the disorder (called TN2), is characterized by constant aching, burning, stabbing pain of somewhat lower intensity than TN1. Both forms of pain may occur in the same person, sometimes at the same time. Biology of TN The trigeminal nerve is one of 12 pairs of nerves that are attached to the brain. The nerve has three branches that conduct sensations from the upper, middle, and lower portions of the face, as well as the oral cavity, to the brain. (See Figure 1) More than one nerve branch can be affected by the disorder. Rarely, both sides of the face may be affected at different times in an individual, or even more rarely at the same time (called bilateral TN). Figure 1: Distribution of the 5th Cranial Nerve: Disorders of the Maxillary and Mandibular Branches Can Present as a Toothache Causing Patients to Seek Dental Treatment. fpa What Causes TN? TN is associated with a variety of conditions. It can be caused by a blood vessel pressing on the trigeminal nerve as it exits the brain stem, which prompts the wearing away or damage to the protective coating around the nerve (the myelin sheath). The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. People with TN avoid social contact and daily activities such as eating and talking because they fear an attack. Pain from TN is frequently very isolating and depressing for the individual. Depression and sleep disturbance may render individuals more vulnerable to pain and suffering. Thus, there are individual, family, and societal costs of TN. Diagnosis Issues TN diagnosis is based primarily on the person’s history and description of symptoms, along with results from physical and neurological examinations. Because of overlapping symptoms and the large number of conditions that can cause facial pain, obtaining a correct diagnosis is difficult, but finding the cause of the pain is important as the treatments for different types of pain may differ. Pharmacological treatment options include anticonvulsant medications used to block nerve firing and tricyclic antidepressants used to treat pain. Common analgesics and opioids are not usually helpful in treating the pain. The condition is progressive. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. Eventually, the pain-free intervals disappear and medication to control the pain becomes less effective. Patients opt to have surgery which may or may not be effective. Pain free periods after surgery vary. Sometimes surgery exacerbates the pain. Who is Affected? TN occurs most often in people over age 50, although it can occur at any age, including infancy. The incidence of newly diagnosed cases of TN in the United States population averages approximately 4.3 per 100, 000 individuals (per year) and the average for women is slightly higher than for men. If people have TN for an average of 8 years, then a rough estimate of prevalence in United States is 108, 000. The definition of a rare disease in the United States is one that affects fewer than 200, 000 at any one time. Thus, TN is a rare disease.
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