Our internationally trained Neurosurgeons, employing a combination of the following modern technologies and techniques can investigate and determine the root causes of your back pain.

Neurology & Neurosurgery Facilities & Equipment

• Spiral CT Scan
• MRI
• Diffusion Imaging
• SPECT
• Carotid & intra cranial Doppler
• Baclofen intrathecal pump
• Neuroelectrophysiological studies
• Digital EEG
• Needle EMG
• Nerve conductions
• Evoked potentials
• Repetitive nerve stimulation
• Autonomic functions
• Electrophysiological lab
• Stroke care unit
• Specialised Speech and Language unit

Once the root causes of pain have been identified they will discuss the options available to you including pain management, back braces, physical therapy or surgery. Some of the specialised procedures offered include:

• Major spinal surgery for the lumbar disc includes Microdiscectomy, disc replacement, etc.
• Anterior cervical disectomy and fusion for cervical disc problems
• Surgery of cervical spine including fusion and disc replacements
• Surgery of degenerative spine disorders like spondylolisthesis, instabilities, etc.
• Treatment of Spine Trauma
• Scoliosis correction and deformity correction of the spine
• Stabilisation of fractures of dorsal, lumbar and cervical
• Spine with neurodeficit
• Major spinal surgery for the lumbar disc prolapse and spinal fusion for spondylolisthesis
• Osteomyelitis
• Cervical corpectomy for cervical myelopathy and selective posterior rhizotomy for cerebral palsy

Arthritis and Your Spine: Introduction
Millions of people suffer from arthritis. In fact, arthritis affects approximately 80% of people over the age of 55 in the United States. It is estimated that by the year 2020, over 60 million people will suffer from this often-disabling problem.

Arthritis is actually a term for over 100 rheumatoid disorders. Common forms include :

• Osteoarthritis
• Rheumatoid Arthritis
• Ankylosing Spondylitis
• Juvenile Arthritis
• Psoriatic Arthritis
• Systemic Lupus Erythematosus

Quick Anatomy Lesson - The Spine
The spine is made up of individual bones called vertebrae, which provide support for the spine. These vertebrae are connected in the front of the spine by intervertebral discs that help support the spine and also allow it to move. The many ligaments and muscles that are attached to the back of the spine provide the power for movement.

Arthritis occurs when the cartilage in the joints is worn down as a result of wear and tear, aging, injury or misuse. Osteoarthritis, the most common form of arthritis, also includes loss of cartilage, overgrowth of bone and the formation of bone spurs. This causes the bones under the cartilage to rub together, causing pain, swelling and loss of motion of the joint. Osteoarthritis can occur in any joint but most often occurs in the hips, knees, hands or the spine.

In medical terms, the bone spurs are called osteophytes. Osteophytes may be found in areas affected by arthritis such as the disc or joint spaces where cartilage has deteriorated. The body's production of osteophytes is a futile attempt to stop the motion of the arthritic joint and deal with the degenerative process. It never completely works. The evidence of bony deposits can be found on an x-ray. A bone spur may cause nerve impingement at the neuroforamen. The neuroforamen are passageways through which the nerve roots exit the spinal canal. Sensory symptoms include pain, numbness, burning and pins and needles in the extremities below the affected spinal nerve root. Motor symptoms include muscle spasm, cramping, weakness, or loss of muscular control in a part of the body

Osteoarthritis and the Spine
In the spine, osteoarthritis can cause stiffness and pain in the neck or in the lower back. Cervical arthritis (also called cervical spondylosis) affects the upper spine and neck. Lumbar or lumbosacral arthritis affects the lower back and pelvic area. Ankylosing Spondylitis is another type of spinal arthritis.

Who Gets Arthritis and Why?
Some people are more at risk for developing arthritis than others. The following are some factors that contribute to a person's risk of developing arthritis :

• Age: arthritis is more common in people over the age of 50
• Overused joints from work or sports related activities
• Injury or trauma to the bones (like fractures)
• Obesity: excessive weight places stress on joints
• Family history
• Gender: women are twice as likely to get arthritis
• Chronic illness such as diabetes, cancer or liver disease
• Weakened immune system
• Infections such as Lyme disease.

Spinal Arthritis : Symptoms
How Do I Know if I Have Arthritis in My Spine?
Generally, the signs and symptoms of arthritis include inflammation, stiffness and pain in the joints. In the spine, symptoms may also include one or more of the following :

• Back pain that comes and goes
• Spinal stiffness in the morning such as after getting out of bed or after activity. Often this pain decreases with rest or, for some, after exercise
• Pain, tenderness or numbness in the neck
• Lower back pain that runs down into the buttocks, thighs, or pelvic area, sciatica
• Pain or tenderness in the shoulders, hips, knees or heels
• A crunching feeling or sound of bone rubbing on bone
• Weakness or numbness in legs or arms
• Limited range of motion, difficulty bending or walking
• Spinal deformity

Diagnosis
If your back pain is severe, it is a good idea to visit your doctor. He or she will ask you about the history of your pain. Be sure to talk to your doctor about when the pain started, when it feels better or worse, how long it lasts and what you have done to relieve the pain. Also, make sure you inform your doctor about any other health problems you are experiencing or have had in the past.

Your doctor will then examine your back. You may be asked to do a few simple exercises so your doctor can see if your range of motion has been affected. These exercises may include bending forward, side-to-side or backwards. You may also be asked to lie down and raise your legs. Be sure to tell your doctor when or if any of these exercises causes pain.

The symptoms of arthritis, especially in the spine, are similar to other spinal conditions. Therefore, it is important for your doctor to rule out other, possibly more serious problems. To do this, you may need to undergo a variety of tests such as :

• Blood Tests :
  These will help determine the type of arthritis.
  
  
• X-rays :
  These tests can show the structure of the vertebrae and the outlines of joints and can help determine if there has been any deterioration of cartilage.
  
  
• MRI (Magnetic Resonance Imaging) :
  This test gives a three-dimensional view of parts of the back and can show the spinal cord, nerve roots and surrounding spaces.
  
  
• Computerized Axial Tomography (CAT Scan) :
  This test shows the shape and size of the spinal canal, its contents and structures surrounding it. It shows bone better than nerve tissue.
  
  
• Bone Scan :
  This test uses injected radioactive material that attaches itself to bone. A bone scan can detect arthritis, but may not be able to differentiate it from other disorders. Therefore, bone scans are usually performed along with other tests.
  
  
• Myelogram :
  A liquid dye is injected into the spinal column and appears white against bone on an x-ray film. A myelogram can show pressure on the spinal cord or nerves from herniated discs, bone spurs or tumours.

What Do I Do Now?
If your doctor determines that you have arthritis in your spine, there are a number of treatment options. Keep in mind, there is no cure for arthritis, but you can treat the pain and discomfort using medications, physical therapy, exercise, heat/cold therapy and rest. Your doctor will talk to you about these options and together you can develop a treatment plan that works for you.

Arthritis is not a death sentence. In fact, many people who have arthritis continue to live active and productive lives. Educating yourself about your condition and managing your symptoms are the keys to not letting arthritis slow you down.

Chronic Pain
The chronic pain associated with arthritis can very seriously affect your quality of life. If left untreated, it can also lead to physiological problems such as muscle breakdown or weakness as well as psychological difficulties such as anxiety and depression.

Arthritis is a common cause of back pain.

Choices
But you don't have to live with pain. Today, there are a wide variety of treatments that can help relieve the pain and discomfort of arthritis. This article discusses some of the most common non-surgical treatments for arthritis, particularly for arthritis of the spine. Remember to talk to your doctor before starting any treatment plan.

Medications
People with arthritis today have numerous pain medications that can be used to relieve their pain. Some require a doctor's prescription, some do not. However, do not assume that just because a drug is available without a prescription or "over the counter", it is safe for everyone.

Talk to your doctor about which pain medications are best for you. Be sure to let your doctor know what other medications you are taking, even for other health problems.

Non-Prescription Medications
Acetaminophen (ie, Tylenol) - this is the drug of choice for mild to moderate arthritis pain because it has very few side effects and is relatively inexpensive. It is used to help relieve pain but does not reduce inflammation. Acetaminophen may cause liver problems in people who consume large amounts of alcohol.

Non-steriodal anti-inflammatory drugs, or NSAIDs (aspirin, ibuprofen, naproxen) - these medications are often used for moderate to severe arthritis pain. They treat pain as well as inflammation. Like acetaminophen, they are relatively inexpensive. However, many patients report stomach upset from NSAIDs. These drugs may also interfere with other medications or cause serious side effects. Talk to your doctor before taking any NSAIDs.

COX-2 Inhibitors (Celebrex®, Bextra®) - a new type of NSAID that may not cause stomach irritation. Works well for moderate to severe arthritis pain. These drugs are often more expensive than other NSAIDs.

Prescription Medications

• Opioids (oxycodone, morphine, codeine, meperidine) :
  May be used to for short-term treatment of severe or sudden onset of arthritis pain, however, they are rarely prescribed due to their addictive nature.
  
  
• Narcotic Analgesics :
  While acetaminophen is an analgesic, sometimes arthritis sufferers need additional pain relief. There are a number of narcotic analgesics available by prescription that may help. These include propoxyphene hydrochloride (Darvon®) and acetaminophen with codeine. Narcotic analgesics may cause serious side effects when used over long periods of time.
  
  
• Topical analgesics, ointments or creams :
  these are medications that are rubbed into the skin. They usually have fewer side effects since they only affect the area of the body where they are applied.
  
  
• Corticosteroids :
  These are not used for pain but are strong medications used for types of arthritis that include inflammation, such as rheumatoid arthritis.