Untitled

[ipscindia]

Stem cell therapy for Osteoarthritis knee

Among the chronic Joint pains, hip and knee osteoarthritis (OA) is the most prevalent and is a leading cause of pain and disability in most countries worldwide.

The prevalence of arthritis increases with age and is associated with heavy occupational activities.

242 million people worldwide have symptomatic and activity-limiting arthritis of knee.

Knee Osteoarthritis affects sleep, mood, and quality of life. Pain- both chronic pain and episodic- can result in depression and other mood disturbances, functional disabilities, and work limitations.

OA significantly limits a person’s ability to self-manage other chronic diseases like diabetes and hypertension.

Osteoarthritis knee also, increases the risk of developing heart disease by 50%.

Traditional nonsurgical Osteoarthritis therapies have limited utility and the the treatment effect on disease is very low. Most of the therapies are aimed at controlling the symptoms but have minimal or no effect on disease progression or repair. On the other hand, surgeries such as Total knee replacement and partial knee replacement is unwarranted until the disease progresses to moderate or end-stage.

Stem cell therapy by the Interventional Pain specialist has shown some promising results and has shown disease modification to prevent knee joint destruction. Stem cell therapy for knee arthritis has shown reduction of pain and stiffness, improvement in physical function, maintains cartilage quality with minimal side effects. Cost of the procedure and affordability is a matter of concern and may not be suitable for the masses.

What is the best treatment for early arthritis of knee?

Exercises to strengthen the muscles, regular walks to maintain the flexibility, weight reduction to off load the knee joint and exercises to improve the general physical fitness. These interventions not only will reduce the symptoms but also helps in slowing the process of degeneration.

What are the stages of Osteoarthritis knee?

Stage 1: Minor. Pain on increased physical activities is the main symptom. Modification of the lifestyle, usually controls the symptoms and may even disease progression.

Stage 2 is Mild Osteoarthritis and Stage 3 is moderate arthritis: Disease modifying interventions by Interventional Pain specialist, can only prevent further progression at these stages. The earlier we intervene, the better are the results. Stem cell therapy is best at these stages.

Stage 4: Severe. At this stage, either Knee joint replacement or in patients who are not willing for knee replacement surgery or not medically fit for surgery, pain reduction can be achieved with cooled RF ablation technology.

Is walking good for osteoarthritis?

Walking is a fantastic option for many patients with knee arthritis because it is a low-impact activity that does not put undue stress on the joints. Furthermore, walking can increase the knee's range of motion and keep it from becoming overly stiff.

What exercises should we not do with osteoarthritis knee?

You may need to avoid activities that put too much strain on the joints, such as running and sports that involve jumping, quick turns, or sudden stops.

What blood tests can detect early arthritis?

Osteoarthritis is a degenerative condition and can not be detected with blood tests. Some blood tests are required to rule out other types of arthritis.

Does stem cell therapy work on knee arthritis?

Stem cell therapy has shown some promising results and has shown disease modification to prevent knee joint destruction. Stem cell therapy for knee arthritis has shown reduction of pain and stiffness, improvement in physical function, maintains cartilage quality with minimal side effects.

Is stem cell treatment better than knee replacement surgery?

Stem cell is used in the early stages only to prevent the disease progression but if the osteoarthritis is already in advanced stages, knee replacement is a better option. When knee replacement is not possible, pain specialist may advise you for Cooled RFA of knee joints to reduce the pain.

How painful is the stem cell injection in the knee joints?

Not painful at all. The pain specialist do these procedures under local anaesthesia and under Ultrasound or Fluoroscopy Guidance.

How many stem cell injections are required for OA knee joint?

With the current advanced technology, only one single stem cell injection is required.

How long does it take for knee stem cells to work?

Some patients report feeling better in as little as a couple of days. Stem cells takes some time to act and repair the damaged cartilage and may have full effect in 4-6 weeks time. During this period, your pain specialist will prescribe some medications to control your pain.

Do I need to take rest after the stem cell procedure? Just one to two days of restricted physical activity is sufficient. From the 3rd day, you may start your routine activities. Avoid jogging, running, and strengthening exercises for at least 7-10 days. Avoid overloading (excess force on the affected joint), shearing (pivoting and twisting), or compression on the injected joint.

[ipscindia]

What is a spinal cord stimulator (SCS) ?

Spinal cord stimulator is an implanted device that sends low levels of electricity directly into the spinal cord to relieve pain. Spinal cord stimulators consist of thin wires ( electrodes) and a small pacemaker-like battery pack ( generator). The electrodes are placed between the spinal cord and the vertebrae (epidural space), and the generator is placed under the skin, usually near the buttocks or abdomen. Spinal cord stimulators allow patients to send the electrical impulses using a remote control when they feel pain. Both the remote control and its antenna are outside the body.

Q What exactly does a spinal cord stimulator do?                      

Spinal cord stimulator targets multiple muscle groups directly from the spine and  alter how the brain senses pain. A spinal cord stimulator replaces the sensation of pain with light tingling feeling.

Q What conditions are spinal cord stimulators used for?

Spinal cord stimulators are used often when most  pain treatment options have failed to provide sufficient relief. Spinal cord stimulators may be used to treat or manage different types of chronic pain, including : Back pain, especially back pain that continues even after surgery (failed back surgery syndrome) ,Post-surgical pain, Arachnoiditis ,Heart pain untreatable by other means ,spinal cord injuries, Nerve pains (like diabetic neuropathy , and cancer-related neuropathy from radiation, surgery or chemotherapy),Peripheral vascular disease, CRPS -Complex regional pain syndrome, Post amputation pain and Visceral abdominal pain and perineal pain.

Q Is SCS a major surgery?

No , SCS is not a major surgery. A SCS placement is done in  two phases- a trial period in which the  Interventional pain specialist  implants  temporary wires inside the epidural space of the spine  to find out how the device  may provide the pain relief. This trial procedure requires only a small incision in your lower back to place the electrodes. The generator/battery remains outside the body, typically on a belt, worn around the patients  waist. Pain relief is  evaluated over a week. The trial is considered a success if the patient  experiences a 50% or greater reduction in pain level. Thereafter intervention is scheduled to permanently implant the device. Most patients can go home same day as their procedure . In most cases, incisions heal within about 2-4 weeks after the procedure.

Q Can we live a normal life with spinal cord stimulator device ?

1-2 weeks after the procedure one can return to work, bath and swimming is fine with a permanent, implanted generator, but not with a temporary stimulator.

Q Can I drive and travel with SCS device ?

SCS should be powered off  while driving or operating heavy machinery, as sudden changes in stimulation levels can cause distraction.

Q How long does the battery of spinal cord stimulator last?

The longevity of the battery life varies between different brands and depends on device model and hours of usage per day . Overall performance of a rechargeable battery device  comes 5 to 9 years.

Q What are the precautions after spinal cord stimulator placement ?

After surgery, the  incision may be painful which may require some painkiller medications. Avoid climbing,  stretching or  twisting , bending movements  which could pull at the incisions. Dressings  over the incision sites, can be removed after about 3 days. lighter activity is recommended for about 2 weeks after surgery. Do not lift objects more than 2.5 kgs weight.

Q What is the pain relief expected with spinal cord stimulator?

The pain relief with spinal cord stimulator varies among different patients .For some it may control the pain completely requiring no pain medications at all while for others it may relieve pain and reduce the medication dose requirement.

Q Does  paresthesia with spine stimulators disturb sleep?

Spinal cord stimulation can improve overall quality of life and sleep. It is typically used along with other pain management treatments, including medications, exercise, physical therapy and relaxation methods.

Q Can I undergo MRI with SCS device?

No, MRIs are not always safe for those with spinal cord stimulation devices. Some newer devices are compatible with certain MRI machine models and scan locations. If the device is  NOT MRI compatible, MRIs can cause serious injury. interfere with or harm your stimulator mode .Before undergoing any scan, always let your doctor, nurse or technician know you have a spinal cord stimulator. SCS in  power off mode is safe to undergo, X-rays and CT scans .

Q Can I have normal sexual life with neuromodulator devices like spinal cord stimulator?

Yes ,one can have completely normal sexual life while using neuromodulatory devices like SCS, infact there have been reported cases of patients treated for sexual dysfunction with SCS.

Q I have paraplegia, can spinal cord stimulator, improve my motor functions?

Recent studies have  demonstrated impressive improvements in muscular control of standing and stepping, restoring hand and arm function after spinal cord injury. Though further research and data needs to be collected to conclude it.

Q Can Neuromodulation devices cure the disease?

Neuromodulation has shown promising results in the treatment of Obstructive sleep apnoea, neurogenic bladder , schizophrenia, faecal incontinence, depression and sexual dysfunction.

[ipscindia]

Endoscopic Discectomy is a minimally invasive spine interventional technique

Endoscopic Discectomy is a minimally invasive spine interventional technique that utilizes an endoscope to treat herniated disc, protruded disc or disc bulge, extruded, or degenerative discs that are a contributing factor to leg and back pain.

Since we don’t have to cut the muscles and bones to open the entire spine, spine endoscopy has shown to be a boon for patients with spine problems. With the advancement in technology using 3 Chip camera and 4K monitors, now we can see each and every structure inside with more clarity and thus can avoid injury to important structures. At IPSC, we have best of the equipment’s for your safety and efficacy of the procedure.

What is an Endoscopic Discectomy?

Endoscopic Discectomy is a minimally invasive spine surgery technique that utilizes an endoscope to treat herniated, protruded, extruded, or degenerative discs that are a contributing factor to leg and back pain. Spine endoscopy or Endoscopic discectomy is required for cases of slipped disc or disc bulge where your protruded disc is compressing the nerves.

What is sciatica? How my low back problem contributes to the pain in legs?

Our lower back has multiple bones called vertebrae and in between two vertebrae, there is a cushion called intervertebral disc. Around the disc, there are nerves which start from the spinal cord and goes down to the legs.

When the disc ruptures or bulges out, it compresses the nerve and your pain starts going down to your legs which is called radiculopathy or sciatica.

What is the cost of Endoscopic Discectomy in India and what are the pros and cons of undergoing this procedure for an athlete?

The cost of the procedure varies from Centre to centre. At specialized centre like IPSC India in New Delhi, it cost 1.5 Lac INR.

Advantages are: By selectively removing that bulging part, we relieve the nerve off the pressure. Patients are awake throughout the procedure and this adds safety to the procedure as we can detect any touching to the nerve while removing the disc.

What is the post operative success rate for TFED ( Transforaminal Endoscopic Discectomy)?

More than 70% of the patients usually don’t need any additional procedure. In some cases even after removing the disc, there may be some swelling on the nerves left which can be dealt with a minor procedure after 2 weeks. Although reherniation is  rare, but it is possible if we don't take proper precautions after endoscopic discectomy. IPSC protocol usually advise 4 weeks of lumbar support belt after the procedure, along with some restriction of activities like prolonged sitting, forward bending, and weight lifting.

Is it ok to do pull ups after a discectomy of L5-S1 Disc Herniation?

It takes 4-6 weeks for the disc to become normal. From the skin, you won’t feel anything but the inside tissue takes time to heal. Although, we encourage patients to start walking after 1-2 days of rest, but certain precautions like forward bending, lifting heavy weights, pushing heavy objects, sudden twisting movements, are must.

What is the purpose to perform endoscopic spine surgery ?

The purpose is to remove the pressure off the nerve which have compressed the nerves because of disc herniation and bulge. Prolonged compression of the nerve may lead to permanent loss of the functions of the nerve.

What are the signs of compressed nerve?

You may feel pain and paraesthesia, pins and needles. There may be loss of sensation in some part of the leg and at times, even weakness in the lower limbs.

How is decompression achieved in percutaneous endoscopic lumbar discectomy surgery?

We make a small hole on the skin under local anaesthesia and infiltrate the entire track up to the disc with local anaesthesia. Patients are awake throughout the procedure and this adds safety to the procedure as we can detect any touching to the nerve while removing the disc.

Through this small hole we insert the spine endoscope which is fitted with camera. Through this camera we can see inside, on our screen. Once we reach the herniated material or the bulging part of the disc, we start removing it without disturbing the normal disc and other tissues.

Do we need any rods and screw fixation with Endoscopic spine procedure?

Since we don’t cut the bones and other important tissues of the spine  to reach the bulging part of the disc, no rods and screw and fixation is required after endoscopic discectomy.

Is this procedure 100% safe?

No Interventional procedures are 100% safe. Though the chances of complications are rare but the chances of infection, bleeding and nerve trauma are there. All these complications can be managed, if they do happen. As compared to open surgery, endoscopic spine procedure is much safer for slipped disc and sciatica.

[ipscindia]

Spine Endoscopy: Endoscopic Discectomy for slipped disc and sciatica

Endoscopic Discectomy is a minimally invasive spine interventional technique that utilizes an endoscope to treat herniated disc, protruded disc or disc bulge, extruded, or degenerative discs that are a contributing factor to leg and back pain.

Since we don’t have to cut the muscles and bones to open the entire spine, spine endoscopy has shown to be a boon for patients with spine problems. With the advancement in technology using 3 Chip camera and 4K monitors, now we can see each and every structure inside with more clarity and thus can avoid injury to important structures. At IPSC, we have best of the equipment’s for your safety and efficacy of the procedure.

Frequently asked questions

Q. Do all disc problems need spine endoscopy?

A. No! Spine endoscopy or Endoscopic discectomy is required for cases of slipped disc or disc bulge where your protruded disc is compressing the nerves. When the disc compresses the nerve, your pain will start going down to your legs which is called radiculopathy or sciatica.

Q. For how long we can avoid this procedure?

A. Usually we advise conservative treatment in the form of medications, physiotherapy in selected cases and some exercises after examining the patient. If the condition is not urgent, we usually wait for 2-4 weeks. But, in cases where the disc herniation is large and compressing the nerves, it is advised to get it removed as soon as possible. Compression of the nerves for longer duration, may lead to irreversible damage to the nerve. In these cases, patient may develop foot drop or muscle weakness or some neurological deficit.

Q. If I already have some numbness or weakness in the lower limb, can we still go for endoscopic discectomy?

A. If there is a major loss of function like loss of bladder and bowel control, loss of limb movements, sense less leg, in such cases we do open surgical discectomy.

In patients with some numbness or tingling, we can safely go for endoscopic discectomy.

Q. Do you remove the complete disc from that level

A. No. We only remove the protruded part of the disc. By selectively removing that bulging part, we relieve the nerve off the pressure.

Q. Is there any chance of re herniation of disc?

A. Although rare, but it is possible if we don't take proper precautions after endoscopic discectomy. We usually advise 4 weeks of lumbar support belt after the procedure, along with some restriction of activities like prolonged sitting, forward bending, and weight lifting.

Q. Do u cut the bones and muscles to reach the disc?

A. No. That is not required in the endoscopic procedure. Infact, we preserve even the normal disc which is close to protruded disc. This prevents the collapse of the disc in future.

Q. Can this procedure be done under local anesthesia?

A. Yes. We make a small hole on the skin under local anesthesia and infiltrate the entire track up to the disc with local anesthesia. Patients are awake throughout the procedure and this adds safety to the procedure as we can detect any touching to the nerve while removing the disc.

Q. What are the complications

A. Complications are possible but rare with this technique as compared to open surgery. The possibility of nerve injury, bleeding, and infection at the site are there and in most cases are manageable.

Q. Is endoscopic discectomy covered under medical insurance?

A. Yes, it is covered but one day admission is required for insurance purpose. At IPSC, for non-insurance patients we do this procedure as a day care and we discharge them after 4-6 hours of observation.

Dr (Maj) Pankaj N Surange MD, FIPP, FIAPM

Director, IPSC India                        Hon Secretary, Indian Society for the study of Pain, National

[ipscindia]

SPINE INTERVENTIONS: Minimally invasive Pain and Spine Interventions #MIPSI

Spine Interventions, also called keyhole SPINE procedures are minimally invasive procedures where we don't have to open the spine to treat the disease. The special endoscope and other instruments are used to treat painful spinal disorders. Special X-Ray called fluoroscopy is used to visualize the spine from outside. With Spine Interventions, we can avoid more than 70% of spine surgeries. Most of the procedures are day care procedures or need just one day of admission.

Q. What all disorders can be managed with minimally invasive spine interventions.

Spine endoscopy is used to treat slipped disc and sciatica,

Biacuplasty or disc annuloplasty  is used for discogenic pain and to repair the disc tear

Vertebroplasty and Kyphoplasty for osteoporotic compression fractures of spine and spinal metastases of cancer,

Neurolytic procedures for cancer pain,

Radiofrequency ablation for joint pains,

Regenerative interventions for sports injuries and arthritis,  

Cooled radiofrequency for osteoarthritis knee pain, osteoarthritis hip joint pain and osteoarthritis shoulder joint pain.

Q How safe are these procedures?

A. As compared to surgery, safety is the biggest advantage. We don't have to open the spine, no bone cutting is required, hardly any blood loss. And the patient can go back home the same day. Most of the procedures are done under local anaesthesia and that adds safety to the procedures.

Q. How many days of rest are required after these procedures? Can I join my office after the procedure?

A. Usually, bed rest is not required. The patient can be discharged the same day and the patient can resume duties after the 3rd or 4th Day. Most of the non- endoscopy procedure patients can resume their duties even after one day of rest.

Q. Can these procedures also helps in pinched nerves or slipped disc and sciatica?

A. Yes, depending on the size of the disc herniation, we select the percutaneous procedure. In large herniations or big disc bulge, we remove the herniated portion of the disc or joint with spine endoscopy. For smaller herniation, some percutaneous procedures like, disc decompressor, laser discectomy, ozone discectomy or ozonucleolysis are selected.

Q. My MRI shows a tear in the disc. Can this be a cause of my back pain?

A. Disc tear or Annular tear is the most common cause of chronic back pain. Patients with annular tear will have pain after sitting for some time. They also feel pain and stiff back in the morning. Forward bending aggravates their pain. Now, with disc repair procedure, disc Annuloplasty or Biacuplasty where cooled RF (Coolief) is used to repair the damaged portion of disc without opening the spine.

Q. Are these spine interventions covered under medical insurance?

A. Yes, most of the procedures are covered under medical insurance. Currently, it is mandatory to admit the patient for one day in the hospital for insurance coverage. Soon, spine interventional procedures will also come under day care procedures.

Q. How long should we wait before for the conservative treatment before we decide for MIPSI procedures ? Usually we wait for 4-6 weeks for the conservative treatment to show their results. But, if the symptoms have not improved or have aggravated, we advise these interventional procedure. Prolonged wait may lead to the chronic pain states and are more difficult to manage.

[ipscindia]

IPSC - Best Spine Hospital In India, Pain Clinic In Delhi and Bangalore, Pain Management

IPSC is one of the best Spine Hospital In India. We have specialist team in our pain hospitals in Delhi and Bangalore.

[ipscindia]

What is the most common cause of facial pain?

Some of the common causes of facial pain are:

Trigeminal Neuralgia

temporomandibular-disorders (TMJ) that cause pain and movement problems in jaw joints and muscles

Dental problems or dental abscess.

Herpes shingles on face

What are the common symptoms of #facialpain?

While experiencing any form of facial pain, there can be different sensations on face depending on what is causing it. More often than not, it may be due to nerve damage, muscle weakness, or headaches. Symptoms one may experience are:

Short periods of stabbing, shooting and tingling pain.

Pain during activities like brushing your teeth, washing your face, shaving, or putting on makeup. 

Pain that can last a few seconds up to several minutes.

Recurrent attacks, followed by periods of lull.

Pain generally on one side of your face.

Frequent, worsened attacks over time.

Pain mostly in your cheek, jaw, teeth, gums, and lips.

What causes one-sided facial pain?

Most common causes of one-sided facial pain are Trigeminal neuralgia, Dental issues, Temporomandibular (TMJ) dysfunction.

What is atypical facial pain?

For decades, atypical facial pain (AFP) represented a group of disorders that included most of the facial pain disorders that did not fit into the category of classic trigeminal neuralgia. As understanding of the pathophysiology of the many facial pain disorders increased, a new classification for facial pain was developed that reflected this new knowledge. Thus, terms that were unnecessarily general were abandoned in favor of terminology that was more specific. Currently, AFP is reserved for facial pain of psychogenic origin.

Does facial nerve pain go away?

Yes, most of the facial pain can be treated and pain can be controlled. It’s important to diagnose the condition by a Pain specialist and treat it accordingly.

What is trigeminal neuralgia?

The trigeminal nerve is one of 12 pairs of nerves attached to the brain. It has three branches that communicate sensations from the top, middle, and lower areas of the face, as well as the oral cavity, to the brain. 

Trigeminal neuralgia is a chronic pain disorder that affects the trigeminal nerve, also known as the fifth cranial nerve. It is a type of neuropathic pain, which is a pain associated with nerve lesions or injuries.

Most typical form of trigeminal neuralgia is type 1, or TN1, which causes attacks of sudden and severe facial pain. The pain can last between seconds and minutes. Attacks can occur one after another in cycles lasting as long as 2 hours.

Type 2, or TN2, is the atypical form of the disorder and is characterized by a constant pain that people have described as aching, stabbing, and burning at a lower intensity than TN1. A person may experience both types of pain, sometimes at the same time, which can be incapacitating.

Living with trigeminal neuralgia can be very difficult. It can have a significant impact on a person's quality of life, resulting in problems such as weight loss, isolation and depression.

What causes neuralgia to flare up?

Pain attacks in trigeminal neuralgia can be triggered by:

eating

drinking

brushing teeth

talking

wind blowing across the face

touching the face, such as when shaving

What can be mistaken for trigeminal neuralgia?

Trigeminal neuralgia can be mistaken for Dental issues, patients usually get dental treatments with no relief. It can also be mistaken for TMJ disorder.

Can Multiple sclerosis (MS) cause facial pain?

Yes, MS causes damage to myelin, the protective coating around nerve cells. Trigeminal neuralgia may be caused by myelin deterioration or the formation of lesions around the trigeminal nerve and cause facial neuropathic pain.

What is the treatment of Trigeminal neuralgia?

Treatment depends on the cause of Trigeminal neuralgia, age of the patient and associated co-morbidities.

Early and mild cases of Trigeminal neuralgia can be treated with Medications and are infact the first line of treatment.

Overtime, pain becomes resistant to medications or dosage increase, may cause medication related side-effects. The patient may need Intervention in that situation. This non-surgical intervention is called as Radiofrequency ablation or Radiofrequency neuromodulation of Trigeminal nerve.

Even minimally invasive surgery carries risks and should be considered a last resort. Here surgical decompression is done to relieve pressure off the Trigeminal nerve.

For how long should I wait for medicines to act for trigeminal neuralgia?

Time needed for medication to act depends upon the chronicity and severity of the Trigeminal neuralgia. The duration can range from 1 to 4 weeks.

What are the side effects of Medication?

Commonly experienced side effects include dizziness, drowsiness, forgetfulness, unsteadiness, and nausea. In addition, carbamazepine and other drugs prescribed for TN do not always remain effective over time, requiring higher and higher doses or a greater number of medications taken concurrently, and some patients experience side effects serious enough to warrant discontinuation.

What is the safer technique for trigeminal neuralgia?

A safe non-surgical treatment option for Trigeminal neuralgia is Radiofrequency ablation or Radiofrequency neuromodulation of Trigeminal nerve.

This involves a pain specialist using heat to destroy part of the nerve that causes pain. With the help of X-ray, a small hollow needle is passed through the cheek into the nerve and uses a heating current passed through electrodes to destroy nerve fibers. This procedure may not require complete anaesthesia and can be done as a day care procedure.

What are the potential complications of Radiofrequency ablation or Radiofrequency neuromodulation of Trigeminal nerve?

While radiofrequency ablation is less invasive, less risky, and requires less time in the hospital than surgery. It carries a risk of minor to severe post-surgical numbness, which can be temporary. If proper care is not taken during preparation of procedure it carries the rare general surgical risks of infection and excessive bleeding, as well as excessive nerve injury, corneal numbness, anesthesia dolorosa, and intracranial hemorrhage.

After how many days I will see the benefit of Radiofrequency ablation or Radiofrequency neuromodulation of Trigeminal nerve?

Immediately after the procedure, pain may increase for one to two days. You pain specialist will prescribe some medications to control this pain. The effect of Radiofrequency usually starts after 2 weeks and it may take 4-6 weeks for its complete effect.

Once the pain starts reducing, your pain specialist will start reducing your medications.

Dr (Maj) Pankaj N Surange MD, FIPP, FIAPM

Director, IPSC India                             Hon Secretary, Indian Society for the study of Pain, National

[ipscindia]

IPSC - Best Spine Hospital In India, Pain Clinic In Delhi and Bangalore, Pain Management

IPSC is one of the best Spine Hospital In India. We have specialist team in our pain hospitals in Delhi and Bangalore.

[ipscindia]

Vertebroplasty and Kyphoplasty for Osteoporotic spine fracture and spine metastasis

Advanced age, asthma, diabetes, emphysema, menopause, chronic steroid use and rheumatoid arthritis are all risk factors for osteoporosis. The resultant weakening of bones can lead to compression fractures of the spine causing severe pain, deformity, loss of height, immobilization, and in some cases, failure to thrive.

Historically, vertebral compression fractures have been treated either with conservative methods of cast or brace immobilization with long term bed resting or with major surgery. This surgery requires a long incision, screws and rods for fixation and is done under general Anaesthesia. These treatments are limited by long recovery times and disruption of daily life.

Now, these painful spine fractures can be treated with a Minimally Invasive, Non Surgical procedure known as VERTEBROPLASTY, an innovative alternative to traditional treatments which stabilizes fractures of the spine safely and effectively, often providing immediate pain relief.

Q. Do we have any non-surgical procedure to fix spine fracture?

Vertebroplasty or targeted cementoplasty is one of the most advanced procedure for immediate and significant pain relief in patients with spine fracture or compression fracture due to osteoporosis. Osteoporosis is a condition where the bones becomes porous and fragile and leads to fracture with even minor trauma or jerk.

Q. How complicated is this vertebroplasty procedure for compression fracture of spine?

The procedure is very safe in experienced hands. There are costly options available but they have not proved to be more safer than vertebroplasty.

This procedure is done in Local anaesthesia, so we can even avoid the effects of general anaesthesia and patient can be discharged same day.

IPSC India is pioneer in performing this procedure.

Q. Is vertebroplasty a major surgery?

The goal of a vertebroplasty procedure is to stabilize the vertebral compression fracture to stop its painful movements. Vertebroplasty is considered a minimally invasive surgery because it is done through a small puncture in the skin instead of an open incision.

Q. Which procedure is better for spine fracture, Vertebroplasty or kyphoplasty.

Vertebroplasty and Kyphoplasty, both the procedures are done to fix the compression fracture of spine vertebrae. In Kyphoplasty, we use balloon to create some space inside the vertebrae and then fill that space with cement. But this makes kyphoplasty a difficult procedure as compared to Vertebroplasty and requires general anesthesia. Most of the recent studies have shown that there is no difference in outcome between the two procedures. Cost of the procedure is also less as compared to Kyphoplasty which is done under general anesthesia and may require hospital admission.

Q. What are the advantages compared to Surgical Fixation?

 Vertebroplasty has several advantages:

Do not require general anaesthesia.

No need to open spine.

No need to put rods and screws.

No need of prolonged hospitalization.

All these reduces the risk of complications.

Q. How long does it take to recover from vertebroplasty?

Most people are able to walk after the procedure, but you may need to restrict yourself to home for 24 hours afterward to rest. Then you can slowly resume normal activity. Some patients, but not all, feel pain relief soon after vertebroplasty. These patients report that their pain is gone or is much better within 48 hours.

At times, due to involvement of other nearby structures, pain relief is not complete after the procedures. In such cases, your pain specialist may advise another procedure like facet joint block or facet denervation, or myofascial trigger point injection.

Q. Can we use vertebroplasty for old age and osteoporotic spine?

Yes! percutaneous vertebroplasty can be performed in spinal vertebrae that are not suitable for surgical fixation, for instance because of osteoporosis or because general anaesthesia may not be advised in patients who are very sick.

This procedure can also be performed in spine fractures due to spinal metastasis. Some cancers at some stages of cancer, spread to other areas like spine.  These spinal pathologies are very painful and at times lead to fracture of spine.

Q. How this procedure is performed?

The beauty of this procedure is its simplicity. “A small needle is advanced into the fracture using only local anaesthetic followed by the placement of bone cement into the fractured area. The cement hardens in about 10-15 minutes and remarkably the pain is gone.”

“After performing good number of vertebroplasties, I can confirm that this is one of the most significant procedures for the treatment for vertebral compression fractures,”

Q. How long does bone cement take to set?

The calcium phosphate cement flows into the spongy inside portion of the bone, filling in microfractures and other damaged areas, and it hardens in about 10 minutes' time.

Dr (Maj) Pankaj N Surange

Interventional Spine and Pain Specialist

Spine Endoscopist and Vertebral Augmentation Specialist Director, IPSC India, New Delhi Director, IPSC India training institute. Hon. Secretary, Indian society for study of pain

[ipscindia]

REGENERATIVE INTERVENTIONS FOR PAIN AND MUSCULOSKELETAL DYSFUNCTION

Dr.Tushar Munnoli

Spine and Pain Specialist

Associate Consultant, IPSC Bengaluru

Pain Management Specialist

What is Regenerative therapy?

Regenerative medicine may be defined as the process of replacing or "regenerating" human cells, tissues or organs to restore or establish normal function. This exciting field holds the promise of regenerating damaged tissues in the body by replacing it or by stimulating the body's own repair mechanisms to heal tissues or organs. 

What are the types of regenerative therapy for musculoskeletal conditions (Arthritis/Sports injuries)?

There are various types of Regenerative therapy:

1) Stem cell therapy

2) Platelet rich plasma (PRP) therapy or Growth factor concentrate therapy.

3) Prolotherapy.

Although these are different cell-based therapies, basic concept remains same – Regenerating or repair of damaged tissue.

What is the best type of regenerative medicine?

Not all regenerative treatments may be effective in relieving pain and/or dysfunction, and the decision is influenced by several factors, including the nature of patient’s condition, the location of pain, the degree of injury/tear and other underlying medical conditions.

The Interventional Pain and Regenerative medicine specialist at IPSC India evaluate patient’s acute or chronic pain condition, and prior medical history to determine which regenerative treatment option is best for them.

Who Is a Good Candidate for regenerative medicine therapy?

Anyone who suffers from Chronic pains and dysfunction due to age or injury can be a candidate for regenerative therapy.

Patients with:

Ligament or tendon injury (rotator cuff partial tears; ligament sprain and partial tear; plantar fasciitis; tendinopathies like Tennis elbow, Achilles tendinopathy)

Osteoarthritis or other joint problems

Suffer from torn or worn cartilage

Resistant to other non-invasive treatments, like physical therapy or medication

Want to explore options that might help avoid or delay joint surgery

Want to potentially improve healing following a surgical repair or procedure.

How does the regenerative medicine therapies work?

In earlier days for chronic musculoskeletal pain the traditional treatment included NSAIDs - Pain killer medications, Steroids - which would primarily focus on symptom management and thus masking the pain, waiting for an eventual surgery. Whereas regenerative medicine works on treating the source of pain.

Regenerative medicine therapies contain growth factors that can trigger cell reproduction and stimulate tissue regeneration or healing in the treated area. The PRP solution or stem cells or prolotherapy is injected into the target area, such as an injured knee or a tendon, these stimulate or speed up the healing process, shortening healing time for injuries, and thus decreasing pain. 

How long does it take for regenerative medicine to work?

Most people start to experience initial improvements within a few weeks after their treatment. The complete repair process inside the joint takes a bit longer — typically a couple of months.

How many procedures/sessions are required to see the benefits?

The number of Regenerative sessions vary and is influenced by several factors, including, the degree of injury/tear and region of the body.

Although usually, 1 session of Stem cell therapy or 3 sessions of PRP/Prolotherapy are required for wear and tear conditions like Arthritis. Whereas, ligament or tendon issues single session may suffice.

What are the side effects of Regenerative medicine?

Side effects are very rare with these interventions if administered by a trained specialist with help of image guidance.

The most common side effects are the same effects anyone might have with any type of injection — swelling, bruising and tenderness around the injection site. All of these possible side effects resolve within a few days to a week or so.

How long does stem cell therapy last?

That depends in part on the treatment site, the extent of the underlying injury, patient’s health and activity level, and other factors. Generally, the benefits of regenerative medicine for joint repair can last for a year or longer. If regenerative medicine therapies are complemented with physical therapy/exercises and rehabilitation the patients might benefit for years. In some cases, patients may have additional injections to extend those effects.

How the pain specialist doctor administers the stem cells/PRP/prolotherapy at the target location?

All procedures at IPSC are performed by expert interventional physicians using ultrasound guidance, fluoroscopy (real-time X-rays), or both to guarantee that we’re delivering cells into the precise location of your injury. Image guidance means that the doctor can see where the needle is going. Using these image guided techniques not only improves the procedural results and patient comfort, but also prevents potential complications.

Does Regenerative therapies need hospitalisation or Anaesthesia?

No. Usually, it is a day care procedure and done under local anesthesia. At IPSC: Pain and Spine hospital, we use ultrasound to localize the damaged tissue. This adds to the accuracy of the procedure and higher success rate.

Is the Regenerative medicine treatment allowed to be practised in India?

The government of India has heavily promoted research and development in regenerative medicine. In September 2022, StemOne – a cell therapy product for Knee Osteoarthritis was also launched after receiving a regulatory approval from the Drugs Controller General of India (DCGI) for the product.

Platelet rich plasma (PRP) therapy or Growth factor concentrate therapy are derived from patients own blood and hence these are not considered as drugs. The DCGI and FDA agencies have not initiated any rules or regulations for PRP preparation or providing therapy. Research for the different applications of PRP is promising and rapidly growing. Although the equipment used to produce PRP and the injections themselves has to be cleared by the FDA.

What is the role of regenerative cell therapy in Sports injuries?

Sports injuries may entail the repairing or replacement of damaged tendon, cartilage, and ligament tissues. Regenerative medicine is of particular interest in the treatment of sports injuries, as historical and recent evidence increasingly refute the commonly used treatments of anti-inflammatory medications and corticosteroid injections. The use of regenerative treatments using a patient’s own stem cells and growth factors to heal damaged tissues, in conjunction with aggressive/ comprehensive rehabilitation, may maximize the nonsurgical treatment of these various sports injuries. Another advantage of these techniques is that they don’t require a prolonged post-procedural recovery period. A patient can return to their daily activities in a short time. That is why regenerative medicine is ideal for athletes who cannot afford to stay out of sports for longer than several weeks.

Are stem cells allowed in India for Knee arthritis?

Drug Controller General of India (DGCI) had seven products of stem cell medications. Recently, September 2022, DGCI approved StemOne for Knee Osteoarthrtis. It is the first allogeneic cell therapy product to be approved for commercial use in India for Knee OA. The treatment comprises of a single intra-articular injection of StemOne in an outpatient procedure with no anaesthesia requirement.

Is regenerative therapy covered by insurance? Certain companies do cover PRP, though, the coverage depends on the condition or injury being treated. Most insurance providers do not cover it. Clinics/Hospitals that offer PRP consider it a “fee for service” type of treatment.

[ipscindia]

IPSC - Best Spine Hospital In India, Pain Clinic In Delhi and Bangalore, Pain Management

IPSC is one of the best Spine Hospital In India. We have specialist team in our pain hospitals in Delhi and Bangalore.

[ipscindia]

Vertebral Augmentation for osteoporotic spine fractures

Dr. Swati Bhat

MD & Director (IPSC, South Zone)

Consultant, IPSC Bengaluru

Academic Head, IPSC Varsity and Training Institute

Neuro- Spine Interventional and Pain Specialist

What is osteoporosis?

Osteoporosis is a  condition in which the bones become brittle and fragile from loss of tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D. Most often it happens as we age.

How does osteoporosis lead to spine compression fractures?

Compression fractures are tiny breakages in the bones in our spine. As we age these bones are more likely to break due to loss of minerals that give strength to the bone. Over time, breaks in the spine bones cause its collapse ,called as compression fracture.

What is the difference between compression fracture of spine and wedge compression ?

Compression fracture  is commonly caused by osteoporosis. A compression fracture  causes a collapse  in the spine bone and typically results in a reduction of vertebral height  around up to 20% because of the fracture and can happen in any area of the spine but most commonly occurs in the thoracic spine.  A wedge compression  is the most common type of fracture which involves the  front part of the vertebral spine where the rest of the spine is unaffected as it is considered mechanically stable without causing any spinal cord damage.

Why osteoporotic fractures don’t heal on their own?

Osteoporotic patients differ from normal population  as they have  poor bone quality due to mineral composition,  content, and crystallinity. This could be lack of  growth factors, and framework cells, and agents promoting bone formation and bone strength .Due to these reasons fracture healing in osteoporosis becomes a complex process of bone regeneration where healing does not happen the way it happens in normal healthy individuals and fractures may take longer time to heal or may not heal at all.

What is diff b/w vertebroplasty and kyphoplasty and  which is safe ?

Vertebroplasty is a procedure where the doctor injects the cement into the cleft or the space created by the fracture. This is achieved by taking several shots under the x-ray guidance called fluoroscope that helps to visualize the extent and spread of the cement with in the spine bone. kyphoplasty is also undertaken to correct the fracture with a technical difference that there is a mesh with in the needle used for cement injection which is targeted towards the fracture and expands as the cement is filled inside 

What is the success rate of vertebroplasty ?

Vertebroplasty has more than 90% success rate to relieve pain , which happens almost instantly after the procedure. However it may vary slightly depending on how many fractures are present and factors like presence of other spine conditions. In long standing cases, other areas of the spine also start generating pain. In such cases, pain relief is significant immediately after the procedure but it may take some additional time to relieve the pain of muscles and the joints.

My fracture is an old fracture. Can I still undergo vertebroplasty?

Usually vertebroplasty should be performed with in 1 to 2 months of an acute fracture . However, MRI scans can reveal the condition of an older fracture that needs or may benefit from vertebroplasty.

How long does it take to heal from vertebroplasty and kyphoplasty?

Both vertebroplasty and kyphoplasty can be done percutaneously which means through skin, not requiring any surgical incision, cutting of muscles or  bones and causing any blood loss. The patient can walk back home the same day of the procedure. The Interventional pain specialist performing the  intervention will brief you on the Do’s and Do Not’s after the procedure in the immediate post procedure days.

What can you not do after vertebroplasty ?

You may be advised  to lie down in the bed after the procedure not allowing you to sit upright for 4-5 hrs. Bending or twisting the spine is avoided in the immediate recovery period for  few days .Lifting heavier objects is also avoided.

I have a spine metastasis. Can vertebroplasty cure my cancer spread?

Some cancers, such as lung, breast and thyroid cancer, often metastasize to the bones and spine leading to pain and collapse of the bones. In such patients, thermal ablation methods such as radiofrequency, microwave or cryoablation can be applied to the metastasis mass first, then vertebroplasty is performed through the same needle. The pain-reducing effects of both ablation and vertebroplasty may be increased when used together. But vertebroplasty cannot cure or stop the spread of cancer cells which may have its primary cancer source elsewhere.

How Painful is the procedure?

A percutaneous vertebroplasty can be a painful procedure but the procedure is performed under local anesthetic given at the skin deep down upto the bone where the fracture is to be corrected. This makes this extremely painless and safe as the risk of anesthesia is totally avoided.

Is vertebroplasty safe for elderly ?

Yes , it is completely safe for the elderly to undergo vertebroplasty .Elderly patients often have comorbid conditions like  diabetes, hypertension, cardiovascular and cognitive  problems which may make anesthesia extremely challenging requiring icu stay, prolonged hospitalization and recovery , but all of this can be avoided by doing percutaneous vertebroplasty .

What are the side effects  after vertebroplasty?

Cement leak is one of the complications which can be avoided by making proper assessment of the fracture before doing the procedure. This is often done by carefully examining the patient and checking the scans thoroughly , and maintaining caution during the cement injection .Minor complications like bleeding and infection can be avoided in almost all patients by following standard protocols before any intervention major or minor.

Can I go back home after vertebroplasty? Yes after checking your vital stability , you may go back home the same day of the procedure or the morning after.

[ipscindia]

IPSC - Best Spine Hospital In India, Pain Clinic In Delhi and Bangalore, Pain Management

IPSC is one of the best Spine Hospital In India. We have specialist team in our pain hospitals in Delhi and Bangalore.

[ipscindia]

IPSC - Best Spine Hospital In India, Pain Clinic In Delhi and Bangalore, Pain Management

IPSC is one of the best Spine Hospital In India. We have specialist team in our pain hospitals in Delhi and Bangalore.

[ipscindia]

IPSC - Best Spine Hospital In India, Pain Clinic In Delhi and Bangalore, Pain Management

IPSC is one of the best Spine Hospital In India. We have specialist team in our pain hospitals in Delhi and Bangalore.

[ipscindia]

Single Specialty Hospitals: Profits beyond Margins

 Introduction

We all expect and deserve affordable and high-quality #healthcare but despite good expertise, efforts and recourses, we experience a dearth of outcomes that are up to mark. With improved knowledge and understanding of the disease process, and remarkable advancements in technology new fields of medicine are coming up and they need to be taken to higher levels with the enormous clinical experience we have and further research. Focusing on a  particular system can make healthcare affordable, safer, easily manageable, and hence a highly efficient system. Customized solutions and specialized infrastructure may help in reducing the gestation period of chains of such specialty centers.

 What defines Single Specialty Hospitals:

 A #single_specialty_hospital can be defined as a healthcare facility that provides end-to-end specialized care and treatment to patients suffering from a specific illness, along with all other supportive fields of medicine under a single roof ensuring enhanced comfort and patient satisfaction resulting in greater compliance to treatments.

They are more focused on planning the entire infrastructure,  budgeting execution and development based on specific  needs of  patients suffering from same set of  illnesses. A network of teams plunge into specialized care,  resource utilization, and #protocol_standardization to bring efficiency, quality care, and value-added for money. With an increasing incidence of #lifestylediseases, the demand for high-quality and specialized care centers is increasing in Tier II and III cities. This gives an opportunity to smaller hospitals to expand across borders as fraternal units leading to the development of Healthcare chains.

What makes #single_specialty_hospitals more attractive to the entire spectrum of healthcare

 Capital Requirement:

Specialties offering day care and short stay procedures and surgeries are ideal to scale up as single specialty units. In order to attain higher profitability, they can shift the focus from bed occupancy to number of procedures. The number of In-patient beds required is lesser and hence smaller infrastructure requirements and lower capital expenditure. The CAPEX of a large multispecialty hospital, on high real estate costs, and the requirement of high support infrastructure, could amount to INR 80 lakh-1.0 crore per bed. Whereas, we can reduce this exorbitant cost to almost one-third at the same time ensuring higher productivity per bed.

 Working Capital:

The efficiency of staff increases when they are engaged in a particular set of work. Such staff with refinement over a period of time turns into a specialist staff. In addition to the clinical acumen, they get trained to handle the administrative work related to their field.

Specialist doctors with administrative qualities and keen management skill development can amicably fit into administrative roles. This decreases the need to hire additional administrative heads to manage the #hospital, which in turn decreases the running expenditure to the organisation. 

Easy management:

With Speciality doctors, understanding their patients demands the best, and taking an administrative role serves an additional advantage. This aids in preparing the marketing strategies, simplifies management issues, and results in  faster decision making and prioritizing budget investments in technology and equipment yielding high quality services .

 End to End solution: Brand in itself

Better education and awareness has lead to the development of preference among patients for seeking  a specialist doctor even for minor ailments. This also gives them more autonomy to choose the modality, if multiple modes of treatment for a particular disease are available under a single roof.

Easy and multiple searches also bring the brand to the top of the search engines.

Investors friendly business model

Over the last decade, especially with the second wave, more than USD 625 million in the capital has been invested by Private Equity and Venture Capital to single specialty hospitals specializing in Oncology, Ophthalmology, Gynaecology, Paediatrics, Orthopaedics, and single-specialty day cares specializing in IVF, Nephrology, and Dentistry. The rising investment in single specialty hospitals is due to an easily comprehensible financial model. Financial viability and better returns on investment expected by #healthcareinvestors is the core strength of, single specialty projects in terms of the #healthcaremarket. Breakeven is early and due to less complexity in the model, scalability is faster. Niche or early investors can make an early exit with better returns on their investments.

 Academics and research opportunities.

Doctors working in #single_specialty_hospitals get the opportunity to develop skills and individual talent. The expertise and practice in managing a highly specialised  field not only makes them more efficient at targeted delivery but also reduces the complication rates. A multidisciplinary team approach under one roof gives them a holistic view of managing cases expanding the horizon of a single specialty. It ceases the development of a defensive practice that may arise out of peer specialties nevertheless doctors enjoy more professional autonomy. With physicians, nurses, and technicians all working in a union, fellows have better access to the volume of the cases and the latest medical advancements, and the opportunity to do research work.

 #Value_based_healthcare

The model of #singlespecialtyhospitals is expected to be more successful with specialties involved in day care or short stay procedures. #minimallyinvasive #painmedicine, and #spine, and #joint interventions usually do not require admissions and most of the procedures can be done in daycare settings. This increases the turnover time and more procedures can be performed yet in a low-cost infrastructure. Typically 15-25 bedded hospitals are sufficient for specialties where admissions are required to perform #minimallyinvasivesurgery procedures. Asset light infrastructure, low operation cost, and larger volumes lead to decreased cost of the treatment. Experienced and well-trained staff and doctors, not only increase the efficacy but can also perform faster with precision. This adds to the quality of care services. Standardization of protocols helps in replicating the same models and maintaining the quality in every single unit.

Every opportunity comes with its own challenges

The ability to offer a customized solution for a specific requirement by a #singlespecialty coupled with specialized infrastructure and specialist doctors is driving the growth in the Single specialty chain of hospitals. Standardized protocols and infrastructure can be replicated but the biggest challenge would be supply of doctors, trained best to handle and manage cases independently.

 Summary

● Single specialty hospitals are the need of the world fulfilling the demands of the customers for specialized care that is affordable and up to the best quality

● They provide huge opportunities for doctors to utilize their skills and knowledge to work out their growth independently at a relatively younger stage.

● A super-Specialized center of excellence may be a good option for all the research and referral needs of the chain of hospitals.

● Promoters’ vision plays a vital role. Building a brand, promoting the best practices, and building a solid foundation helps in the early growth and faster replication.

● Training and creating more experienced physicians with some additional training on healthcare management will help in scaling up the model and reaching tier 2 and 3 cities fast. ● Single specialty hospitals are not just a profitable business to the promoters and investors but also provides affordable and best quality and specialized services to the need of the patients. They also help doctors to establish themselves at a much younger stage and grow in their respective fields.

[ipscindia]

MIPSI procedures are going to be game changers in the healthcare Industry

IPSC - Best Spine Hospital In India, Pain Clinic In Delhi and Bangalore, Pain Management

IPSC is one of the best Spine Hospital In India. We have specialist team in our pain hospitals in Delhi and Bangalore.