Spire esp Study by Dr Jwalant S Mehta - PowerPoint PPT Presentation

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Spire esp Study by Dr Jwalant S Mehta

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Scoliosis that is diagnosed in children between their birth and age 3 is defined as Infantile Idiopathic Scoliosis. It accounts for 1% of total Scoliosis cases of which 60% of them are males. – PowerPoint PPT presentation

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Title: Spire esp Study by Dr Jwalant S Mehta

1
Why does the back ache?
Jwalant S. Mehta MBBS, MS (Orth), D Orth, MCh
(Orth), FRCS (Tr Orth) Consultant Spine Surgeon
Clinical Secretary 44 785 0211939
www.mehtaspine.co.uk Email
info_at_mehtaspine.co.uk
2
Outline of the talk
Why does the back ache?

Working definitions
Scope of the problem
The flags!
Pathologic and clinic basis
How you could approach this problem

Clinical Secretary 44 785 0211939
www.mehtaspine.co.uk Email
info_at_mehtaspine.co.uk
3
Outline of the talk
Why does the back ache?

When do we operate
When can we safely defer operating
When not to operate

Clinical Secretary 44 785 0211939
www.mehtaspine.co.uk Email
info_at_mehtaspine.co.uk
4
Use and abuse our backs

Sitting habits
Smoking
Diet
Lack of exercise
Excessive screen time

Clinical Secretary 44 785 0211939
www.mehtaspine.co.uk Email
info_at_mehtaspine.co.uk
5
Low back pain

Major Health and socio-economic issue
Time off work in the economically active
Point prevalence 58 - 84

Clinical Secretary 44 785 0211939
www.mehtaspine.co.uk Email
info_at_mehtaspine.co.uk
6
Low back pain

Site
Below12th rib
Above Gluteal fold
Cause
Specific (Cause suspected)
Non-specific (??)
Severity
Acute lt 6 weeks
Chronic gt 3 mo

Clinical Secretary 44 785 0211939
www.mehtaspine.co.uk Email
info_at_mehtaspine.co.uk
7
Low back pain
Mechanical Root entrapment Serious conditions
Clinical Secretary 44 785 0211939
www.mehtaspine.co.uk Email
info_at_mehtaspine.co.uk
8
The flags!
Clinical Secretary 44 785 0211939
www.mehtaspine.co.uk Email
info_at_mehtaspine.co.uk
9

Previous cancer
50
Unexplained weight loss
Failure to improve

Clinical Secretary 44 785 0211939
www.mehtaspine.co.uk Email
info_at_mehtaspine.co.uk
10
Clinical Secretary 44 785 0211939
www.mehtaspine.co.uk Email
info_at_mehtaspine.co.uk
11
Clinical Secretary 44 785 0211939
www.mehtaspine.co.uk Email
info_at_mehtaspine.co.uk
12
Imaging options

MRI
CT scans
SPECT scans / Bone scans
Erect radiographs

Clinical Secretary 44 785 0211939
www.mehtaspine.co.uk Email
info_at_mehtaspine.co.uk
13
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14
MRI in 98 asymptomatic volunteers
36
all discs normal
52 bulge at 1 level
27
disc protrusion
38 gt 1 disc abnormal
1
disc extrusion
Clinical Secretary 44 785 0211939
www.mehtaspine.co.uk Email
info_at_mehtaspine.co.uk
15
MRI in asymptomatic persons
Disc prolapse
L5S1 degenerative changes
20 36
lt 60 gt60
27 52
M 20 - 30 M 31 - 58
Boden JBJS 1992
Savage ESJ 1994
Clinical Secretary 44 785 0211939
www.mehtaspine.co.uk Email
info_at_mehtaspine.co.uk
16
VOMIT

Victim

Of
Medical
Imaging
Technology

Clinical Secretary 44 785 0211939
www.mehtaspine.co.uk Email
info_at_mehtaspine.co.uk
17
Pain generators

Inter-vertebral discs
Facet joints
Vertebral body failure
Spinal malalignment

Clinical Secretary 44 785 0211939
www.mehtaspine.co.uk Email
info_at_mehtaspine.co.uk
18
Inter-vertebral disc
Disc
Clinical Secretary 44 785 0211939
www.mehtaspine.co.uk Email
info_at_mehtaspine.co.uk
19
Clinical Secretary 44 785 0211939
www.mehtaspine.co.uk Email
info_at_mehtaspine.co.uk
20
Cellular pathology leading to disc degeneration
Clinical Secretary 44 785 0211939
www.mehtaspine.co.uk Email
info_at_mehtaspine.co.uk
21
Micro Macroscopic changes in the degenerate disc
Clinical Secretary 44 785 0211939
www.mehtaspine.co.uk Email
info_at_mehtaspine.co.uk
22
The degenerative cascade
Clinical Secretary 44 785 0211939
www.mehtaspine.co.uk Email
info_at_mehtaspine.co.uk
23
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24
The motion segment

Inter-vertebral disc
End-plate cartilage, bone
Facet joints
Passive restraints Ligaments

25
Disc height and degeneration
26
Disc v facet arthritis
27
Discogenic v Facetogenic
Flexion
Extension
28
Facet arthritis
29
Facetogenic back pain

Back pain
Thigh pain
Worse on extension
Pain on getting out of bed
Pain on arising from sitting

30
Spondylolysis
31
Lumbar canal stenosis

Narrowing of the spinal canal
Neural compression
Directional compression
Constitutional shape

32
Degenerate spondylolisthesis
33
Treatment options
34
Treatment options with positive benefit

Manipulation / Massage
NSAIDs
Multi-disciplinary rehabilitation
Exercise / Stay active
Back schools

Acupuncture

Cochrane review
35
Treatment options with no benefit

Passive therapies

Radiofrequency ablation

Injections

Supports

TENS

Bed rest

Traction

Cochrane review
36
Facet joint blocks
37
Nerve root blocks Epidural injections
38
Discography
39
Treatment options
40
Lumbar decompression
41
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42
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43
Treatment options
44
Postero-lateral fusion
45
Inter-body fusion
46
Minimally invasive surgery
47
Exploring expectations and treatment options
48
Age or Mileage

Changing expectations from life
Longevity
Doing more.
..for longer!

49
Truncal mal-alignment
50
Life is a kyphosing event
51
Spectrum of pathology

Osteoporosis
Discs and facet joints
Failure of the spinal column

52
Degenerate deformity

Loss of ability to stand upright
Mechanical dis-advantage
Asymmetric degeneration
Spinal column collapse

53
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54
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55
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56
Pelvic compensation

Sacral slope (SS)

Pelvic tilt (PT)

Pelvic incidence (PI)

57
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58
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59
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60
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61
Clinical Secretary 44 785 0211939
www.mehtaspine.co.uk Email
info_at_mehtaspine.co.uk
62
PRE
POST
63
When to refer