Every third person in the world has had a problem with the spine at least once in their life – most often caused by disc disease. Spinal diseases are associated with temporary, reversible disability of the individual – physical and emotional. The temporary disability creates serious problems not only for the sufferer, but also for the family, the employer and the economy in general. In existing medical practice, spinal problems are most commonly resolved by outpatients visiting a neurological office, where the sufferer usually makes two visits within 15 days. Further Medical Imaging , EMG examinations are required. The physiotherapist is often then included, while in some cases further consultation and examinations are needed. In total, the patient’s visits to the doctor are 2-3.
The spine center offers another approach to spinal problems. At the spinal center, the patient is observed daily, similar to hospital treatment. Decisions to appoint additional diagnostic and therapeutic technics are made on a daily basis, which is the most effective approach possible. This is the modern thinking that has caused these diseases to not be treated in the hospitals and left for outpatient care. In order to create such a center certain basis is needed – a neurological office, Medical Imaging Examinations – X-ray, CT / MRI and Physiotherapy. The equipment is specific – in addition to the usual diagnostic and therapeutic apparatus, it is advisable to have an osteodensitometer, planograph, EMG, computer perimeter, spinal decompression system, massage equipment and systems. The medical staff at the spine center include a neurologist and a physiotherapist as permanent participants and consultants are recruited as needed.
The chronic recurrent course of these problems requires the involvement of a team of specialists for follow-up and treatment. Most often it involves a neurologist, physiotherapist, sometimes a neurosurgeon, rheumatologist, otoneurologist, and orthopedist.
⦁ The lead specialist is a neurologist. He assesses both the patient’s objective condition at the onset of the disease and its changes during treatment. Specific programs are used for this purpose. In addition to the neurological status, it is necessary to evaluate the corpulence – weight, BMI, circumference of the waist, the condition of the soles, posture incl. the shape of the spine, and the patient’s gait.
⦁ In determining the diagnostic algorithm, in addition to the usual methods of x-ray (static or stato-dynamic images), CT, MRI, EMG, planography, computer perimetry, otoneurological examination, osteodensitometry, sometimes whole-body bone scintigraphy, thermovision are performed.
⦁ The neurologist determines the choice of treatment regimen – home / out-patient, often in bed; analyzes the performance and assesses the need for consultation with an ophthalmologist, otoneurologist, neurosurgeon / orthopedist, ENT, endocrinologist, rheumatologist and dentist. The information obtained allows us to make a near-term, short-term prognosis of the disease.
⦁ It is imperative to make the patient aware of his or her health problem in order to ensure the patient’s full participation in the healing process. To this end, we use scientific explanations, training videos and diagrams.
⦁ NSAIDs (diclofenac, ibuprofen, meloxicam, coxibs, etc.) are usually considered when choosing a drug treatment; strong analgesics, including narcotic drugs in severe pain syndromes; B-vitamins; muscle relaxants; corticosteroids; anesthetics; local revulsive, etc. combinations.
⦁ Depending on the severity of the disease and the presence of other health problems, the route of administration of the medicines – by mouth, injection / intramuscular or intravenous / and with suppositories – is determined. The most important point in the acute phase is occupied by paravertebral blockages with topical anesthetics and corticosteroids – the frequency and number of which are determined by the achieved therapeutic effect, which naturally necessitates dynamic follow-up of outpatient treatment.
The chronic phase often requires the use of prolo-therapeutic methods – the injection of irritating harmless substances provokes an immune response that results in the deposition of collagen. Plasma therapy – a local injection of one’s own plasma, which in the past was done with one’s own blood (auto-chemotherapy) has a similar effect. Until recently, mesotherapy combinations were also applied (novoplex). Ozone therapy is not widely used because of its slow and insufficiently visible results.
⦁The physiotherapist is included in the team usually in the first days of initiating drug treatment. In the beginning, the need for therapeutic massage (manual and by devices) and conventional apparatus treatment (magnet, ultrasound, wave and electrotherapy) is determined. The team then decides whether to use chiropractic and manual therapy techniques.
⦁ The team determines the role and place of reflexology in the treatment – acupressure, acupuncture, laser puncture, shiatsu, sujook and others.
⦁ The application of spinal decompression – computer-controlled extension of the cervical or thoracolumbar departments of the spine is a complementary method in the initial phase of the disease, which is successfully used to prevent and maintain the good shape of the spine.
⦁ Patient education is important for both the definitive recovery from a spinal accident and the prevention of a new one, and includes:
a / sleeping needs and shedule, bedtime and waking up;
b) proper sitting, driving and using a computer;
c / physical exercise rules;
d / prevention and healthy living;
e / selection of therapeutic gymnastics in the home;
f / selection and use of orthoses;
g / rules and choice of balneotherapy
⦁ Shortening the duration of the spine problem
⦁ Reduction of physical and emotional suffering
⦁ Reducing the duration of temporary disability
⦁ Direct economic effect of the team approach
⦁ Informing and educating the patient.
⦁ Prevention of spinal problems
THE ACTIVE PATIENT’S ATTITUDE TOWARDS THE HEALING PROCESS PRESUMES UNDESTANDING THE NATURE OF THE DISEASE, WHICH CAN BE DONE BY STUDING INFORMATION BELLOW.
Get acquainted with the nature of the pathological changes causing your disease:
Clinical manifestations of cervical spondylosis include pain in the neck, shoulders, and arms (possibly to the palm of the hand) as nerve roots are pressed. If the cervical disc herniation presses the spinal cord, problems with walking (due to spasticity, i.e. increased muscle tone) and urinary incontinence may occur.
Treatment includes patient training, placement of rigid cervical collar, physio- and kinesio-therapeutic procedures that are pain-relieving.
Surgical treatment is considered if, despite conservative treatment, the complaints continue, become progressive, or neurologic symptoms are detected.
Clinical manifestations most commonly include pain and changes in sensitivity, burning sensation, ribs, loss of mobility, and sensitivity in the lower limbs.
Treatment with kinesitherapy may have a positive therapeutic effect.
Surgical treatment is considered if the complaints continue or become progressive. Endoscopically remove the disc or part of it that causes compression.
The factors contributing to the occurrence of lumbar disc herniation in young people are most often the lifting of heavy objects or forced movements in the lumbar region. In the elderly, smaller in volume and strength but repeated forced movements in the lumbar region can lead to disc herniation over time.
Clinical manifestations in patients most commonly include lower back pain that extends down to the legs and feets. In more advanced cases, problems such as tingling and weakness can be added. In cases that are untreated, neurological symptoms such as “sagging foot” may occur – loss of its dorsal (upper) surface movement into the ankle and urinary incontinence.
The main purpose of treatment for disc herniation is to eliminate the pain to ensure that patients return to their normal daily routine.
Treatment begins with bed rest, drug therapy and training.
Kinesiotherapy procedures help to strengthen and balance the tone of supporting the spine muscle groups. This seeks to distribute the body mass more evenly so that the load on the disk can be partially reduced.
Epidural injections and blocks can be used to eliminate the pain of patients.
Surgical treatment is to remove a portion of the herniated disc to release the pinched nerves. It is undertaken in cases of loss of strength and sensitivity in the legs and feet and after insufficient effect of the conservative treatment carried out.
In addition to the traditional “open” surgery, microscopic and endoscopic methods of surgery can be applied, depending on the clinical and imaging findings.
In appropriate patients, prosthesis of the disc will allow preservation of spinal motility and elimination of pain. Maintaining mobility helps to avoid the degenerative problems that can occur with the development of the disease.
Depending on the degree of slippage, the indentation in the spinal canal formed by the body of the underlying vertebra narrows the canal and can compress the spinal cord, leading to pain, insensitivity and burning sensation in the legs.
Lumbar slip is categorized into the types: (*) associated with aging; (*) postoperatively; (*) related to congenital problems.
The type of spondylolisthesis (“lumbar sliding”) associated with aging develops due to tendon wear within and around the spine. This problem often occurs after the age of 40 and is called “degenerative spondylolisthesis”. Degenerative lumbar slippages are often complicated with narrowing the spinal canal.
Symptoms include back pain and hips pain; tingling, muscle tension, leg weakness, difficulty walking; enlarged lumbar bend. Although rest can temporarily relieve these symptoms, pain is usually exacerbated when standing, walking, and other activities.
Sudden (acute) lower back pain can occur after physical activity or trauma, and may occur without a specific cause. Most people (80%) experience an episode of such pain at least once in their lives, and it is often difficult to determine its genesis.
Mechanical lower back pain (the most common type) is often the result of overload of lumbar muscles, muscle fibers and tendons, or of pressure. In differential diagnosis, disc herniation is considered.
Acute pain spontaneously subsides over time and completely disappears within approximately 2 weeks (in 50% of cases). In 30% of people, recurrent episodes of pain occur.
In therapeutic terms, in order to maintain normal locomotor activity, it is recommended to tolerate acute pain in the lower back. The consideration is that muscle movements increase blood flow, reducing inflammation and muscle tension.
Conservative treatment includes paracetamol and other painkillers. Various physiotherapy procedures (deep or superficial heating, transcutaneous electrical nerve stimulation, etc.), massage therapy, and kinesitherapy complexes can lead to temporary relief of pain.
In most cases, rapid pain relief is possible. Detailed medical examination is mandatory, especially in cases where the pain lasts longer than six weeks.
Vertebral fractures give a cuneiform vertebra. They damage the adjacent discs by putting enormous pressure on the intervertebral joints and changing the geometry of the corresponding spine section – prerequisites for damaging the neural structures in the neighborhood.
In adolescents, vertebral fractures are often caused by a high-force injury, such as a fall from a high or a car accident.
In adults, with osteoporosis, a fracture can occur from ordinary trauma and even without trauma (spontaneous fracture).
Fractures and displacements of the cervical (cervical) vertebra can cause respiratory distress (which can lead to death) or complete paralysis of the arms and legs; lumbar vertebrae fractures and displacements can lead to paralysis of the legs and complaints of urinary or faecal incontinence.
Generally, the first complaint of patients with vertebral fracture is pain accompanied by muscle spasms.
If vertebral fracture is accompanied by nerve and vascular injury, complaints may include tingling, loss of sensitivity in the palms, hands and / or feet, loss of strength, urinary and faecal incontinence, and difficulty in urinating or defecating. The transportation of patients with such a complicated fracture should only be undertaken after they have been placed in a suitable posture, preventing the risk of a higher degree of dislocation that would further damage the spinal cord or spinal cord, determining a possible fatal outcome of the injury.
Treatment of spinal injuries is usually surgical and aims to restore and strengthen the anatomical physiology of the spine.
“Dr. GREENBERG” SPINE CENTER OFFERS THE NECESSARY CONDITIONS, SPECIALIZED EQUIPMENT AND EXPERTISE, TO PROVIDE A SPECIALIZED COMPLEX AMBULATORY TREATMENT OF THE SPINAL MEDICAL CONDITIONS