Spinal Fusion surgery in India is now being provided to the patients from all over the world with latest facilities and globally benchmarked healthcare services administered by surgeons and physicians trained in international medical practices. Indian hospitals are well equipped to provide a comprehensive range for spinal fusion. Spinal Fusion surgery in India is provided at hospitals having a team of highly-trained doctors of international repute and research analysts working together to develop newer treatment approaches and using them for effective patient cure and care. With the use of advanced medical technology and newly invented techniques the recovery time after surgery is shortened and within very short period time frame patients becomes fit and return back to work.

What is Spinal Fusion?

Spinal fusion is a process using bone graft to cause two opposing bony surfaces to grow together. In medical terminology, this is called arthrodesis. Bone graft can be taken from the patient (termed autologous bone) during the primary surgical procedure or harvested from other individuals (termed allograft bone). Another option for some patients is bone morphogenetic protein (BMP). BMP stimulates the body to make bone.

Why Spinal Fusion is Performed?
Spinal fusion may be recommended for:
Treatment for spinal stenosis
After diskectomy in the neck
Injury or fractures to the bones in the spine
Weak or unstable spine caused by infections or tumors
Spondylolisthesis, a condition in which one vertebrae slips forward on top of another
Abnormal curvatures, such as those from scoliosis or kyphosis
Description of Spinal Fusion Surgery

Before you and your doctor agrees for Spinal fusion surgery as an option, your doctor will want to make sure that you’ve given nonsurgical treatments a reasonable trial. Also, your doctor may conduct a study called a diskogram, which is a special X-ray examination that involves the use of a dye. The dye, injected into a disk, serves to make it appear better on an X-ray. The injection of dye may also produce a pain similar to your ongoing back pain, which helps your doctor pinpoint that disk as the source of your pain. Spinal fusion surgery requires general anesthesia. The procedure may take from two to 12 hours, depending on how extensive the surgery is and the technique your surgeon uses. Spinal fusion surgery may involve a large incision or may be done using newer techniques with smaller incisions. To fuse the spine, your doctor needs small pieces of extra bone to fill the space between two vertebrae. This bone may come from your own body (autogenous bone), usually from a pelvic bone. Or, it may come from another person (allograft bone) by way of a bone bank. If the front of your spine is fused, the disk is removed first. Bone graft substitutes, such as genetically engineered proteins, are being developed as alternatives for using bones from your body or a bone bank. Sometimes, doctors also use wires, rods, screws, metal cages or plates. As with any surgery, Spinal fusion carries risks, including pain at the donor site for the bone, infection and nerve injury.

Recovery after Spinal Fusion Surgery

Expect to be in the hospital for several days after Spinal fusion surgery. You’ll also likely experience considerable pain and discomfort after Spinal fusion surgery, but your doctor will control pain with oral and intravenous medications. It takes from several weeks to several months to heal from Spinal fusion surgery, depending on your age, condition and what level of activity you plan to return to. The type of healing that needs to occur after Spinal fusion is comparable to recovery from a broken bone. The earliest that X-rays might reveal bone healing after Spinal fusion is about six weeks. Spinal fusion removes some spinal flexibility. This can be beneficial if movement and instability between spinal segments is what causes your pain. However, the fused spine needs to be kept in proper alignment. You’ll be taught how to move, sit, stand and walk in a manner that keeps your spine properly aligned. You may be able to start a physical rehabilitation program as early as about four weeks after spinal fusion surgery. This Spinal fusion procedure is usually very invasive. There are less invasive versions available, but even these still require more recuperation time than other spinal surgeries. Patients typically remain in the hospital for 3 to 6 days and will require extensive rehabilitation after release from the hospital. Activity is strictly restricted, to allow the bone graft to heal and form a solid bond. The patient must take it easy for 3 to 4 months and will not be fully healed for up to 1 year after Spinal fusion. Patients should plan on being out of work for 2 to 6 months after a Spinal fusion procedure, since recovering from back surgery is a long and difficult road.

Why India?

Spinal fusion surgery in India is provided at internationally recognized hospitals using most advanced technology or service. India is the largest medical tourism hub, quality of care and easy travel makes it a popular overseas health care destination for people who are seeking comprehensive cancer surgery abroad. Medical tourism in India works in collaboration with the best internationally renowned hospitals to make your treatment in India a successful and hassle free process. For more details on Spinal fusion surgery in India, visit us at http://www.forerunnershealthcare.com or mail your queries at enquiry@forerunnershealthcare.com or call us at +91-9371136499, +91-9860755000

Health sector Reforms in Andhra Pradesh

    A review on Health sector reforms in India   The health sector reforms in India were started way back in 1970s .The Govt. of India identifies the need HSR and stated in the eighth five year plan. The Eighth Five Year Plan (1992-1997) was the first plan document to state the need for re-structuring of economic management systems, following the macro developments of the 1990s. During this period in the health sector, the concept of free medical care was revoked and people were required to pay, even if partially, for the health services (1). The Ninth Five Year Plan (1997-2002) emphasized the need to review the response of the public, voluntary and private sector health care providers as well as the population themselves to the changing health scenario, to reorganize health services to bring about greater efficiency and effectiveness and to introduce health system reforms to enable the population to obtain optimum care at affordable cost The Ninth Plan sought to increase the involvement of voluntary, private organizations and self-help groups in the provision of health care and ensure inter-sectoral coordination in implementation of health programmes and health-related activities as well as enable the Panchayati Raj Institutions (PRI) in planning and monitoring of health programmes at the local level so as to bring about greater responsiveness to health needs of the people and greater accountability; to promote inter-sectoral coordination and utilise local and community resources for health care(2) .The Tenth Five Year Plan (2002-2007) touches upon reforms at primary, secondary and tertiary level(3).                         Politics influence health systems in significant manner. The goals, priorities, and the strategies, variations in the commitment are largely decided through the political contingencies. There are competing demands on the health systems. The evolution of the health systems is largely shaped by the culture, history, and norms. Client satisfaction is very high. As per NFHS-2 data, an overwhelming majority of clients are satisfied by the services delivered by the public systems. May be the expectations are low or may be our people are so courteous. But on the hand, we have the report from Transparent International, ranked the health system in India is the most corrupt system (4)   The Government has taken several steps for improving the public health care institutions and Strengthening the primary health care infrastructure. However, the situation is compounded by severe resource constraints – financial, technical and human power related, which has resulted in policy makers as well as programme managers at differing levels being faced with difficult choices. In such a situation, attempts are being made through various reform initiatives to ensure that the health needs of the people are met One of the major reform initiatives underway is the Secondary Health System Strengthening Project funded by the World Bank in seven states (Andhra Pradesh, Karnataka, Punjab, West Bengal, Maharashtra, Orissa and Uttar Pradesh). The projects include strengthening FRUs/CHCs and district hospitals so as to improve the availability of emergency care services to patients, to reduce overcrowding at district and tertiary care hospitals, construction works, procurement of equipment, increased availability of ambulances, drugs; improvement in quality of services following skill up gradation training in clinical management, changes in attitudes and behavior of health care providers; reduction in mismatches in health personnel / infrastructure; improvement in hospital waste management, disease surveillance and response system. It is essential to assess both progress and problems in implementation of the reforms in each state and to appropriately modify the content and pace of implementation. Such an overview and analysis of all related issues is necessary to provide evidence to policy makers and other stakeholders in terms of the various dimensions and impact of health sector reform.(5) In the Indian Constitution, health is a state responsibility. During Adjustment, many state governments in India had recourse to Health Systems Development Project loans from the World Bank for carrying out health sector reforms (HSR), of which one of the key policies has been to raise public spending on health care from the abysmally low levels seen up to then. The Health Systems Development Project seeks to develop strategic management capacity; strengthen performance, accountability, and efficiency; and build implementation capacity. Further, it seeks to improve clinical service quality by renovating and expanding district, sub district, and community hospitals and improving access to services. In all seven reforming states, around 15% of the total project cost is borne by the state governments. All the project documents note the low levels of funding for secondary hospitals in the reforming states. This is attributed to the small share of overall public spending allotted to health, the limited portion of total health spending going to hospitals, and, within this, a skewed distribution of funds in favour of the tertiary hospitals. After analysis of the problems of the health sector, the governments of the reforming states have agreed-using terminology ranging from “assurances” to “commitments”-to several undertakings. These are: (i) to enhance the overall size of the health budget; (ii) to redress imbalances in public expenditure between secondary and tertiary care levels; (iii) to safeguard the operations and maintenance components of current expenditure allocations for the secondary health-care sector; (iv) to charge user fees for selected services; and (v) to address workforce issues. The Health Systems Development Project initiated in the seven states recognizes the need for enhanced public spending on health and identifies it as the foremost policy reform to be pursued. Nevertheless, such assurances and conditions have not succeeded in enhancing health sector budgets in states implementing HSR. Worse, HSR has not been able to arrest the decline in the share of health spending within total government spending. The Indian system is especially complicated, as the larger tax resources are controlled by the central government but the major responsibility for health-care spending is bestowed on the states (6).Andhra Pradesh is the first state to go with the HSR.               Health sector reforms in Andhra Pradesh   The state of Andhra Pradesh was formed on 1st November, 1956 under the States’ reorganization scheme. It is the fifth largest State with an area of 2, 76, 754 sq. km, accounting for 8.4 % of India’s territory and also the fifth most populous state with a Population of 75 crores. The state has varied physiographic features ranging from high hills, undulating plains to a coastal deltaic environment. Administratively, Andhra Pradesh is divided into 23 districts, 79 revenue divisions, 1123 mandals, about 27000 villages and 264 towns. AP’s economy grew at 7.2% during 2006-07 — the fourth consecutive year of 6% plus growth. The latest poverty headcount ratio stands at 16%, compared to 23% for India . the third-highest credit rating among the major Indian states; the third best investment climate in the country; and the fourth-lowest corruption level among Indian states Andhra Pradesh was the first Indian state to receive a multi-sector Bank operation – the Andhra Pradesh Economic Restructuring Program for US$ 550 million in 1997 – aimed at helping the state accelerate policy and institutional reforms across a wide range of sectors under a common fiscal framework. It is also the only Indian state where the Bank has disbursed three budget support operations – the First Andhra Pradesh Economic Reform Loan (APERL-1) in March 2002, the Second APERL in February 2004, and the Third APERL in January 2007 – that sought to support the state’s development program.(12) Within AP there are regional, social and gender disparities. Health outcomes are worst among Sc

heduled Castes (16% of population) and Scheduled Tribes (7% of population), especially those living in underserved areas in North tribal and South drought prone districts, and for women. Effective delivery of quality basic health services is hampered by demand and supply side issues, including poor health infrastructure and staffing.(15)     The reform history in health sector in the State can be traced to Andhra Pradesh First Referral Health System Project, one of the first World Bank aided health system projects in the country. This project, launched in 1995 had been implemented by AP Vaidya Vidhana Parishad (APVVP). Agencies like World Bank and DFID are supporting the reform process in the State. The Bank supported the AP Economic Restructuring Project which included improvement of primary health care as one of the component.(7) The priority reforms focus on improved access to quality and responsive health services, strengthened governance and management in health sector, improved institutional mechanisms for community participation and systems for accountability; and strengthened financial management systems.(15)  The government of Andhra Pradesh [GoAP 1999] Vision 2020 document identifies a seven-point set of priorities for health sector reform: providing universal access to primary healthcare; encouraging private investment in tertiary healthcare; focusing on specific programmes to promote family planning; focusing on improving health levels in disadvantaged groups and backward regions; ensuring a strong prevention focus; enhancing the performance of the public health system; and formulating a state information education and communication (IEC) programme to broadcast information on preventive healthcare.(13) The Government of Andhra Pradesh is embarking on a major health sector reforms to improve health care delivery in the State. D.F.I.D. has expressed its willingness to support these initiatives with a grant of 100 Million pounds over the next five years (2006-2011). The reform initiative will include measures to improve the effectiveness and accountability of public health services, measures to focus on community centric preventive healthcare system and enhance access to quality healthcare for the poorer sections of the population(14) DFID will provide up to £40 million health sector budget support to the DoHMFW, GoAP, over 3 years 2007 – 2010. The sector support will build synergy with National Rural Health Mission (NRHM) which is a health sector reform program of the central government for decentralisation, pro-poor focus, strengthening service delivery(15)     The health sector support will be provided over three years (2007-08 – 2009- 10). It aims at increased use of quality health services, especially by the poorest people and in underserved areas.(16) The main outputs will be: a) Improved access to quality and responsive services, especially in remote and interior areas; b) Governance and management of health sector strengthened; c) Institutional mechanisms for community participation and systems for accountability in functioning; and Financial management systems strengthened and improved public expenditure on health.   The performance of health services would be measured against(17)

* greater effectiveness and improved outcomes of existing programs;
* improved efficiency in the allocation of resources;
* greater access and equity; and
* consumer satisfacfion

Reforms underway in health sector   The major reforms underway are classified under these categories and the activities are noted below and we will look each of them in detail    (I) Reorganization and restructuring of existing government health care system

Establishment of Andhra Pradesh Vaidya Vidhana Parishad Strengthening of referral institutions and fixing of service norms Improvement in drug supplies Formation of Andhra Pradesh Health, Medical & Housing Infrastructure Development Corporation (APHM&HIDC) Strengthening of PHCs as 24-hour MCH centers Establishment of Comprehensive Obstetric & Neonatal Care (CEmONC) centres

(II) Changes in health system organisation, delivery and Management

Formation of Hospital Advisory Committee/ Hospital Development Societies for all PHCs and FRUs/ teaching hospitals Provision of free travel bus passes to pregnant women for antenatal check ups Public Private Partnership

(III) Changes in financing methods

Sukhibhava Scheme (Improvement of Institutional Delivery Services Scheme) User fees

(IV) Reforms related to human resources

Integration and responsibilities of functionaries for planning, implementation and monitoring of programmes of HM & FW department

(V) Involving community in health service delivery and Provision

Women Health Volunteers Scheme

(VI) Reforms to quality of care

Performance indicators for grading the PHCs Performance rating of secondary hospitals

    1.Reorganization and restructuring of existing government health care system   A)Andhra Pradesh Vaidya Vidhana Parishad   AP, has created the Andhra Pradesh Vaidya Vidhana Parishad (APVVP) by enacting an Act in the Legislative Assembly in 1986(8) This was done with the objective to lay greater emphasis on development of both preventive as well as curative health care  and to strengthen necessary linkages at appropriate levels to ensure comprehensive medical and health care services. APVVP has undertaken World Bank assisted Andhra Pradesh First Referral Health Systems Project (APFRHSP) in 1994 for a period of seven years. This has been one of the major projects undertaken by APVVP. The objectives of the project included improvement of efficiency in the allocation and use of health resources through policy and institutional developments and enhanced performance of health system by improving the quality, effectiveness and coverage of health services at the first referral level.   B)Strengthening of referral institutions and fixing of service norms   basic service norms for various categories of hospitals under the administrative control of APVVP have been fixed thereby creating a hierarchy of hospitals according to services and facilities. This system of service norms and referral linkages had been developed with a view to optimise utilisation of resources, avoid duplication and wastage of resources, regulate patient flow and reduce cost of treatment by reduction of patient burden at tertiary hospitals. the district hospital has been prescribed to provide services in eleven specialties for which 9 civil surgeon specialists, 18-20 civil assistant surgeons, 54-84 paramedical staff and other supporting staff have been Posted. C)Improvement in drug supplies To ensure regular supply of drugs at all times and in all situations, a system of three sources of drug supply has been put in place for the hospitals under APVVP: (a) centralised drug procurement system under which the institution has been allotted drugs worth a particular amount based on bed strength (Rs 2000 per bed per quarter); (b) an emergency provision for drugs (Rs 100 per bed per month) has been made to every institution from where emergency procurement of drugs is made; (c) drugs which are in short supply and for which regular rate contract suppliers are not available have been stocked at the office of District Coordinators of Health Service. Under the APFRHSP, const-ruction and repair of 160 hospitals including 81 CHCs, 58 area hospitals and 21 district hospitals had been undertaken.(10)         D)Formation of Andhra Pradesh Health, Medical & Housing Infrastructure Development Corporation (APHM&HIDC)   a separate corporation has been set up in 1987 exclusively for developing housing and other infrastructure for medical and paramedical staff and constructing sub centers, PHCs, hospitals, dispensaries, clinics and other health care centers One of the major projects undertaken by APHM&HIDC has been the World Bank assisted India Population Project-VIII launched for improving the medical care facilities in urban slums in

74 municipalities.   E)Strengthening of PHCs as 24-hour MCH centers   In a move to make available maternal and child health care at all times, 470 PHCs in backward districts have been designated as round the clock Mother and Child Health Centre (earlier called women health centres). One staff nurse, one ANM and three support staff have been appointed in each centre on contractual basis. Staff nurses have been trained to conduct normal deliveries and refer emergency cases. Additional facilities like telephone and vehicle have been provided to the PHCs in order to assist communication and transport for referral of emergency cases. Provision has been made to conduct fortnightly specialist clinics of gynaecology and paediatrics in these centres to detect high risk pregnancies and neonates for referral to FRUs.   F)Establishment of Comprehensive Obstetric & Neonatal Care (CEmONC) centres   The State Government has decided to establish 108, CEmONC centres spread across every district so that pregnant mothers requiring emergency care do not have to travel more than 40-50 kms to receive specialist care. Training of MBBS doctors in anaesthesia, neonatal care and blood transfusion is also planned to support this scheme.   2)Changes in health system organisation, delivery and Management A)Formation of Hospital Advisory Committee/ Hospital Development Societies for all PHCs and FRUs/ teaching hospitals   Hospital Development Societies have been constituted in all tertiary hospitals under the control of Directorate of Medical Education.(18) and after implementing NRHM rogi kalyam samithi at every PHC were formed to ensure the adequate participation of local institution,with an aim to improve effective and efficient services with allowed flexible financial powers. These societies are examples for decentralization . Activities of the society include maintenance of the hospital (including sanitation & water supply, electricity, building & civil works and equipment), purchase of drugs & medicine supplies and equipment. The government has set norms and limits for undertaking these works which are to be adhered to by the Society. The ‘system works’, observed an Unicef team which assessed the impact of RKS towards the end of 2000. The system, however, is not without any lacunae. For, it was pointed out that “overall control of the local RKS bodies remain in the hands of the collector and if he is not interested in health care then the whole thing might just drift(13)   B)Provision of free travel bus passes to pregnant women for antenatal check ups(19)   The Government of Andhra Pradesh has started an innovative scheme in order to enable pregnant women in rural areas to avail antenatal check ups at the nearest PHC/area hospital or FRU. It has tied up with the State Road and Transport Corporation to issue free transportation bus tickets pass to be utilised for three visits. The ANM issues the bus passes to the pregnant women on her house visits.       C)Public Private Partnership(20)   ·         Management of Urban Health Centers by NGOs   Under the World Bank assisted Andhra Pradesh Urban Slum Health Care Project (APUSHCP), 192 urban health centers (UHCs) have been established in 74 municipal towns in 21 districts covering 1848 slums. After withdrawal of support by the World Bank, the project has been funded by the state government since 2002. The outcomes of the project show marked improvement in ANC coverage, institutional deliveries, post natal care and immunisation in the slum population.   ·         108 emergency services                           Govt. has tied up with satyam computers to provide emergency transportation which proved to a most successful programme and many states are following the same like Gujarath. The objective of 108 Ambulances is to save people in life emergency . One ambulance is given for three mandals. Each ambulance fitted with equipment worth Rs.17 lakhs renders its services in life emergencies, road and fire accidents (22)   ·         Rajiv arogya sree    The innovative Govt. insurance scheme to serve people of  poor from the serious ailments now attracting the nation as this programme succeeded. this scheme provides financial support to families of BPL upto 2 lakhs per anum for treating serious ailments. it is proposed to cover the entire state by 2nd October 2008 with the govt. paying the insurance premium for all the beneficiaries .an amount of rs.450 crores are provided to implement the scheme during 2008-09. (21)       3)Changes in financing methods   A)Sukhibhava Scheme(23)   Under the Scheme, a cash assistance of Rs.300 (Rs 200 towards transportation charges and Rs 100 for food and incidental expenses) is paid to pregnant women belonging to below poverty line families who come to government hospitals/APVVP hospitals/ teaching hospitals/PHCs/CHCs for delivery serv-ices. This assistance is payable only to those women with no living children or with one living child.   B)User fees:-   If user fees are charged their main use may lie in optimization of expenditure patterns and better allocation between facilities and within facilities(24). Reddy and Vandemoortele (1996), based on a comprehensive review of user financing of basic social services carried out for UNICEF, point to three other discouraging features of user fees: (1) user financing can result in a sharp reduction in the utilization of services, particularly among the poor; (2) gender biases, seasonal variations and regional economic disparities can aggravate the effects of user financing on equity; (3) user financing  quires adequate capacities, effective decentralisation and continued government support; and (4) user financing can undermine political support for the goal of universal coverage of basic social services. In 2001, the Commission on Macroeconomics and Health (2001) also reached a similar conclusion that user fees end up excluding the poor from essential healthservices, in 2005, the Millennium Project’s recent Report to the UN Secretary General (2005) titled “Investing in Development – A Practical Plan to Achieve the Millennium Development Goals” also forcefully argues for abandoning user fees. The health sector in India has acquired a notorious reputation for inefficiency and corruption at all levels. There is little accountability in both the public and private sectors. Quality standards are practically non-existent as are performance measures and honest reporting. A recent report on human resources for health brought out by Harvard University’s Global Equity Initiative (2004) argues that it is people – health workers alone – who can produce an effective health system and deliver good ealth.(25) 4)Reforms related to human resources Integration and responsibilities of functionaries for planning, implementation and monitoring of programmes of HM & FW department At district level, District Health Coordination Committee (DHCC) has been constituted to ensure proper planning, implementation and monitoring of all programmes/activities of HM&FW Department in the district.  The Committee has been entrusted with the primary responsibility of planning, finalizing, implementing and monitoring the District Health Action Plans and institutionwise health plans in a participatory manner including all concerned officials, other concerned departments and NGOs.   5)Involving community in health service delivery and Provision  

Women Health Volunteers Scheme

  One of the key components of the National Rural Health Mission is to provide every village in the country with a trained female community health activist – ‘ASHA’ or Accredited Social Health Activist. Selected from the village itself and accountable to it, the ASHA will be trained to work as an interface between the community and the public health system. Following are the key components of ASHA(26) A woman, usually a daughter-in-law of a house who has studied upto 7th class and preferably from SC/ST community has been selected as WHV by the Gram Panchayat Health Committee. The selected WHV has

been given one month training in health care aspects of pregnancy, antenatal, delivery, post natal and new born care, immunisation, diarrhoea, acute respiratory infections, first-aid and treatment of minor ailments. The training has been provided at Telugu Mahila Pranganams for three weeks and one week field level training at PHCs. Academy of Nursing Studies has been designated as the nodal agency for providing training to WHVs.   6)Reforms to quality of care   A)Performance indicators for grading the PHCs   One of the components of World Bank assisted AP Economic Restructuring Project is improvement of primary health care. In order to improve the quality of primary health care services, a system of performance rating has been developed to rate PHCs and CHCs. The grading has been accorded A to C in descending order   B)Performance rating of secondary hospitals   A performance rating system for secondary hospitals under APVVP has been  introduced. The indicators related to general services (outpatients, inpatients, bed occupancy), emergency services (emergency-OP, emergency-IP, emergency major operations, emergency minor operations), clinical services (major/minor operations, tubectomy, deliveries) and diagnostic services (X-ray, ECG, lab tests and USG) have been developed for the purpose. Normative targets for each type of hospital (district hospital, area hospital, community health center) have been fixed against which the performance is measured and rating assigned. Highest grading is A while lowest grading is C.(27)   Conclusion:-   Introduction of user charges and subcontracting of services to the private sector are the main elements of health sector reforms. The health sector reforms are only a part of drastic reforms in other major sectors undertaken as a part of Andhra Pradesh Economic Restructuring Project (APERP) and the overall impact on the health conditions of people and their access to medical care depend more on the changes proposed outside the health sector. For instance, while exempting the white ration card holders i.e. the poor from the user charges in the government hospitals, it proposes to drastically reduce the number of white card holders to half in the state. The net affect would be to reduce the percent of population eligible for free treatment.(29)   On the other hand the success of 108 EMRI services and overwhelming response from Rajiv Arogya sree scheme are the examples for HSR success. Just like every thing has gots its own pros and cons HSR should be done in such a way where the need exist and according to necessities .   Referances:-   (Note:-most part of the article was taken from ref.no 28 otherwise reference specified)

(Government of India, Eighth Five Year Plan, (1992-1997) Planning Commission, New Delhi.) (Government of India, Ninth Five Year Plan, (1997- 2002) Planning Commission, New Delhi ) ( Government of India, Tenth Five Year Plan (2002-2007) Planning Commission, New Delhi) ( D. Agarwal Health Sector Reforms: Relevance in India, Indian Journal of Community Medicine Vol. 31, No. 4, October-December, 2006) Health Sector Reforms in India, Initiatives from Nine States ( http://www.idrc.ca/en/ev-118491-201-1-DO_TOPIC.html.The international development research centre) http://www.worldbank.org.in  (The Andhra Pradesh Vaidya Vidhana Parishad Act 1986 (Act No. 29 of 1986 with Amendaments upto 31.03.1989  Dr. MCR Human Resource Development Institute of Andhra Pradesh (Undated). “Andhra Pradesh Vaidya Vidhana Parishad Departmental Manual”  6http://www.aponline.gov.in/apportal/departments/ departments.asp?dep=16&org=98 GoAP (2006), Response to Questionnaire on Health Sector Reforms from MOHFW, GoI. http://www.worldbank.org.in/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/INDIAEXTN/0,,contentMDK:20970681~pagePK:141137~piPK:141127~theSitePK:295584,00.html#Ongoing_projects Grish kumar,promoting PPP in health services,EPW commentary,july19,2002  (G.O.Ms.No.130, HEALTH MEDICAL AND FAMILY WELFARE (K2) DEPARTMENT. Dated the 24th April, 2006)  ANDHRA PRADESH HEALTH SECTOR REFORM PROGRAMME (APHSRP) Terms of reference for Technical Cooperation (TC) to DoHMFW, GoAP  PRESS INFORMATION BUREAU GOVERNMENT OF INDIA, HEALTHCARE PROJECT IN AP FUNDED BY DFID, New Delhi, March 5, 2008) http://lnweb90.worldbank.org/oed/oeddoclib.nsf/DocUNIDViewForJavaSearch/0CFD6217A8A5BDA2852567F5005D32BD  G.O.Ms.No.403, dated Sept 7th 1998  GoAP (2006), Response to Questionnaire on Health Sector Reforms from MOHFW, GoI. Power Point Presentation of Govt of AP at the 2nd Regional Workshop on Health Sector Reforms: Experiences of Select States at Hyderabad, 14-15th February 2005 and ECTA Working paper 2002/61 Public-Private Partnership: Operational Framework used in Andhra Pradesh and Assam http://www.scribd.com/doc/2208678/AP-Budget-Speech  http://pibhyd.ap.nic.in/er27070702.pdf  Dept. of Health Medical Family Welfare, GoAP (undated), “Sukhibhava (Improvement of Institutional Delivery Services Scheme): Implementation Guidelines to PHC/Hospital  http://mohfw.nic.in/NRHM/Documents/CRM_report_full_report_version.pdf   (A.K.Shiv Kumar,,Budgeting for health ,some considerations) Economic and Political Weekly April 2, 2005  http://mohfw.nic.in/NRHM/asha.htm#abt http://health.ap.nic.in/apvvp/apvvp_stat.html  (http://www.whoindia.org/linkfiles/health_sector_reform_hsr_vol_ii_-_andhra_pradesh.pdf)  (Impact Of Health Sector Reforms On Hospital Services In Andhra Pradesh – A Study Of Trends In The Structures Of Provision And Utilisation Pattern)(centre for economic and social studies) (http://www.cess.ac.in/cesshome/research6b.html)

Endoscopic spine treatment in India is the next big thing to come packaged with medical  tourism. India promises spine-surgery tourism for anything from micro disectomy surgery,lumbar herniated disc surgery,cervical spine surgery,thoracic spine surgery to lumbar spine surgery. Largely cost-driven and banking on international goodwill of Indian medicos, the initiative is hoping to benefit both hospitality and healthcare industry. It is tying up with hospitality industry and service providers to help these tourists improve their looks in five star comforts. Furthermore, the high concentration of expatriate Indian medical staff working abroad particularly in the US and UK gives patients confidence in healthcare. Endoscopic spine treatment in India is not critical surgery, so tourists from the US, UK and Canada likes to combine it with travel.

Endoscopic spine procedures

There are many spinal conditions that are treated at the Laser Spine Institute (LSI). All procedures are uniquely designed and developed to provide patients with the best possible medical care.

There are four primary spine procedures performed on patients:

Foraminotomy

Laminotomy

Percutaneous Endoscopic Discectomy

Facet Thermal Ablation

Spinal Fusion

The type of procedures that are performed depends on the pathology that the surgeon is treating. Conditions such as foraminal narrowing caused by bulging discs, herniated discs, scar tissue, bone spurs, thickening of the ligament and facet hypertrophy can be treated with a foraminotomy.

Recently in India the rise in has seen spine surgery because the  costs has  dropped  by up to 90%, making world class treatments affordable for everyone and you also get to enjoy a free holiday as well! If you have always wanted a lumbar discectomy or another procedure you can now afford the look you have always dreamt about, as cosmetic surgery costs have tumbled. In India endoscopic spine treatment cost is combined with surgery on par with anywhere in the world and this is one of the fastest areas of growth in medical tourism in India.

To know more about endoscopic spine treatment in India :

http://www.dheerajbojwani.com

Submit your case details at :

contact@dheerajbojwani.com

Electro Chlorinators are one of the smarter ways of purifying the water. These are on of the most cost-effective and safe method for purification of water. You would find these in various Thermal Power Stations, Municipal Corporations, Public Health Departments, along with Chemical and Paper Pulp Industries. These Electrically Heated Evaporators are normally used for Chlorine, Sulfur Dioxide or Ammonia, where only electricity is available as a viable heating source.

Electro Chlorinate holds various advantages over others as far as water purification ability is concerned. These are mighty effective on microbes like bacteria or viruses, which can cause harmful diseases. Moreover, these also reduce the smell caused by hydrogen sulfide. Chlorinators can also break down bacterial slimes and destroys algae, which results in complete removal of iron from water. These can even help in avoiding potentially dangerous handling and storage problems, which are related with dis-infection practices.

Electro Chlorinators works as a disinfection alternative. A small water system, it carries an edge over its traditional counterparts.  A major advantage that this type of chlorinators holds is that it requires only salt, water and electricity. It also provides the power of chlorine sans any scare of handling or storing any hazardous material. Moreover, the total operating cost is lower than conventional chlorinator methods as on-site generation of sodium hypochlorite allows the operator to produce as per the actual requirement. In addition, the sodium hypochlorite, which is generated on-site, does not degrade like commercial sodium hypochlorite. It can even handle water purifications of well water, in which mainly sodium hypochlorite (also known as bleach) and calcium hypochlorite chlorinators are used.

Electro Chlorinators ensure continuous production system. It has an electrolyzer chamber in which, the fresh water enters through a Rotameter. It also has a brine tank from which, brine is pumped through a metering pump and is injected into the pipe carrying fresh water. The salt solution gets converted to Sodium Hypochlorite in the electrolyzer chamber and then fills into storage tank. The chamber is also provided with a temperature sensor, which indicates whether, the Sodium Hypochlorite is exceeding the present temperature limit or not. If it exceeds, then the electrolyzer switches off and starts again only when the temperature limit is back to normal.

The entire processes in the Electro chlorinators are automatic with multiple interlock. It also has a cooling chamber, which is connected to the Electrolyzer to cool the Sodium Hypochlorite produced. Moreover, he storage tank can also vent out the produced Hydrogen with a forced draft fan and vent pipe.

With all these features, Electro Chlorinators has proved its worth in the field of water purification.

Medical tourism provides medical treatment package like spinal decompression surgery in India for surgical as well as non – surgical healthcare to International patients combined with recuperative holidays. Skyrocketing health care expenses has become an issue of concern world over and people find themselves constrained to make compromises to their personal health. MEDICAL TOURISM – MEDICAL TREATMENT ABROAD is the answer!!! People are seeking alternatives and now find more affordable healthcare options overseas with savings unimaginable. State-of-art internationally accredited health care facilities, very experienced physicians, exceptional surgical services at a fraction of the cost. Medical tourism is broadly defined as ‘Cost-Effective’ private medical care in collaboration with the tourism industry for overseas patients needing specialized treatment. Medical institutions are providing for an estimated 20,000 to 30,000 doctors and nurses each year complimented with medical facilities driven by advanced technology and high-quality procedures like spinal decompression surgery in India at par with hospitals in developed nations such as US or EU and at a price that could be a fraction of what you would spend in your country.

What is spinal decompression surgery?

Decompression is a surgical procedure that is performed to alleviate pain caused by pinched nerves (neural impingement). In this type of back surgery, a small portion of the bone over the nerve root and/or disc material from under the nerve root is removed to give the nerve root more space and provide a better healing environment. Several conditions may cause neural impingement, including spinal stenosis, a disc herniation, isthmic spondylolisthesis, degenerative spondylolisthesis, or (rarely) a spinal tumor.

Symptoms of spinal decompression include:

Pain

Numbness

Tingling

Weakness

Unsteadiness

In severe cases, pressure on the spinal nerves can cause paralysis and problems with bladder and/or bowel function.

With globalization increased number of people are traveling to another countries to get treated abroad, here quality is the primary factor however cost involved in obtaining quality health care attention that could be surgical or non-surgical procedures is another most important determining factor. Constraints such as high costs and long waiting lists for treatment or surgery have prompted people to look at effective options. Developing countries, significantly India is turning out to be a favorite health treatment destination among people in developed countries like US, UK, etc. as India offers high quality treatment at fractional costs with minimal waiting period. Healthcare and tourism may seem contradictory but people have been traveling to distant lands for rejuvenation packages.  The effort now is to institutionalize and re-route patients to hospitals for medical treatment for all kind of healthcare areas to the extent of super specialty fields like spinal decompression surgery in India in the medical science.

To know more about spinal decompression surgery in India:

http://www.dheerajbojwani.com

Submit your case details at:

contact@dheerajbojwani.com

Overview:

When binding documents with Unibind it is important to choose the right size of spine to match the thickness of your pages.
If you choose a spine that is too small then the pages won’t fit into the steel channel. On the other hand if you use a spine that is too large the pages will be loose and your bound presentation will look funny.
One way to choose the right size spine is to simply take a ruler and carefully measure the thickness of your book in millimeters. However, this can be tricky.
The Unibind Spine Measurer is designed to make this process easier so that you always choose the right size of spine for your document.

Strengths / Features:

The Unibind Spine Measurer is small, lightweight and portable. It is constructed of a heavy duty clear plastic and only weighs a few ounces. It has a small hole in the side to help you grab onto it and it can comfortably fit into your pocket.
Although it would be nice if Unibind would include this tool in the box with their binding equipment it is nice to see that this tool is so inexpensive. With a price tag of about five dollars, it is priced so that any size of organization can afford it.
The spine measurer is simple to use. All you need to do is assemble the book that you want to bind and slide it into triangle shaped spine measurer. When the pages of your book won’t go any further then you look at the markings on measuring device and round up. It is that easy.
The Unibind spine measuring device even has dual measurement markings to help you make sure that you choose the right size of spine. You can measure the book by looking to see where the pages of your documents meet with triangle. You can also look on the back side of the unit to see how high your stack of paper measures. The dual measurement features are nice for checking your measurements before ordering spines or covers.

Weaknesses / Limitations:

The Unibind spine measurer is nice, small and convenient. However, it is also easily misplaced or lost. The fact that it can easily fit in a pocket and only weighs a few ounces is great until someone mistakenly walks away with your measuring tool. Many organizations choose to have two or three of these on hand just in case one mysteriously disappears.
In order to use this tool you really need to have your document assembled and ready to bind. Unfortunately, many organizations order their supplies before they assemble their documents. There isn’t really any simple solution to this problem. If you need to order supplies before you know what you will want to bind you can always use your spine measurer as a guideline or create mock-ups of your deliverables and measure those.
The only other limitation of the Unibind spine measurer is that it is only as accurate as the person who is using it. If you use too much force and push your pages into the document you may not get an accurate reading. You want your pages to be snug when insert them and somewhat compressed. Just don’t cut it too close otherwise it may be hard to get all of the pages into your steel spine.

Recommendation:

With a price tag of only five dollars this is a great little device that every Unibind owner should have.
It is simple to use, durable, portable and can help you make sure that you order and use the right size of spines for your documents.
Just be careful that your spine measurer doesn’t walk away or end up in someone’s desk somewhere and you will be fine.

A common condition that is found in persons of all ages and in all countries around the world, low back pain, for so many reasons, seems to come out of nowhere to reek havoc on our daily lives. The degree of pain experienced among low back pain sufferers runs the gamut from mild to increasingly severe levels.

Over time many experiments have been conducted to find out which treatments really work best at providing pain relief. Below I have listed a few ways that can be beneficial in finally finding relief.

Heat Wrap Therapy For Your Back Pain

One of the most popular low back pain treatments is exercise therapy. The problem with this type of therapy is that most who undergo this treatment experience pain. Some will complain of pain during the exercise, while others will feel some form of discomfort afterwards. To alleviate this problem and to help you get the most out of your exercise, the use of heat wrap therapy has been made to help make your activity comfortable for to benefit from. Using a heat therapy wrap will significantly lessen your pain during exercise.

The McKenzie Method

The McKenzie method is one latest low back pain treatments being used today. More than just a series of exercises, the McKenzie method is a combination of physical therapy and exercises used to lengthen the spine. The method is based on algorithms that are used to clarify the spinal problem so that adequate treatment can be obtained. Many pain centers today are utilizing this form of therapy in their treatment programs. Although doctors do recognize this as valuable form of treatment, further consultations must be made before starting this type of program.

Prolotherapy: A Non-Surgical Alternative

A medical techniques used for treating low back pain, Prolotherapy is a technique that helps to stimulate the bodies natural healing process. The treatment involves a series of injections that produces inflammation in the troubled area. Meant to provide permanent relief, if you are facing spinal surgery, this may be an alternative solution for your back pain. Prolotherapy would also be highly effective in combination with other types of pain management programs.

Electrotherapy Stimulation

Of all the low back pain treatments available today, electrotherapy is perhaps the most controversial. Not limited to it s on the back alone, electrotherapy stimulation produces significant results in other types of pain. How it works is endorphins, the natural pain killer of the body, are released through a series of electrical currents being passed on to the skin to block the nerve signals which transmit the pain. Controversial as it may be, many have found great relief through electrotherapy.

Finding alternative back pain treatments may be the key to finally finding relief from your troubling pain. Remember to always seek the advice of a doctor before starting any kind of pain management therapy.

Health coaching is a collaborative and personalized program that focuses on improving health and wellness. Health Coaching builds an individual’s capacity to achieve short- and long-term health and fitness goals. Participants in a health coaching program interact one-on-one with their health coach by telephone, instant messenger, email and online journal.

Frequently Asked Questions About Health Coaching

What is health coaching?

Health coaching is a collaborative and personalized program that focuses on improving health and wellness. Health Coaching builds an individual’s capacity to achieve short- and long-term health and fitness goals. Participants in a health coaching program interact one-on-one with their health coach by telephone, instant messenger, email and online journal.

Unlike personal training or counseling, YOU, the client, are the expert when working with a health coach. Whether you’re working toward general wellness or a more specific health-related issue, a health coach will focus on enhancing your quality of life. Our health coaches guide, motivate, provide customized resources, and help you to set achievable goals. Health Coaches do not diagnose, prescribe, or give advice. Instead health coaches use their expertise to provide you with tools, not opinions.

The role of a health coach is unique. A health coach will not just ask you if you have done your crunches for the day UNLESS that is what you want your health coach to do. Instead, the health coach is there to help you identify and achieve whatever goals you set for improved vitality by coordinating the many resources available to you through this and other programs.

Do I have to have a serious health issue to benefit from a health coach?

No. We know that no two people are exactly the same and your health status may vary from day to day. Health coaches help you to assess your level of health and well-being and to work on the issues at hand. Your health coach will provide the human touch to motivate you toward setting and achieving your goals through a personalized plan of action. However, if you do have a serious health issue, your health coach can help. If you need to modify your lifestyle due to an issue such as diabetes, high blood pressure, high cholesterol, and/or musculoskeletal injuries, a degreed and highly trained expert health coach can assist.

Who are the health coaches?

Our health coaches are high-level, seasoned professionals, experienced in behavioral change and in serving moderate-risk and sedentary, high-risk and high-stress populations. All Health Coaches hold degrees in Exercise Science, Health Education, Exercise Physiology, Counseling and Health Education, Counseling and Education, and each health coach has a minimum of a bachelor’s degree and at least 3 years of experience. In addition, 80 percent of our health coaches also hold a graduate degree in a related field.

I’m not sure health coaching is right for me. How do I decide?

If you would like someone to provide support, guidance and motivation that can help you achieve personal health and lifestyle goals, you will benefit from your relationship with a health coach.

How much time will health coaching take?

The time you devote to health coaching is entirely at your discretion. Communication between you and your Personal Health Coach will be as often as needed and will be determined on an individual basis. You will be paired with a health coach who will remain with you throughout your entire health coaching process. Communication between you and your health coach may occur every day, just once per week, or even less whether it is by email, journal or a combination of both.

If you would like to spend more time learning about your challenge and your solutions you have come to the right place. Through the health coaching program you will have access to a comprehensive library of lifestyle education and resource materials that will be hand selected by your health coach specifically for you. These resources come from nationally acclaimed resource providers.

What is health coaching?

Health coaching is a collaborative and personalized program that focuses on improving health and wellness. Health Coaching builds an individual’s capacity to achieve short- and long-term health and fitness goals. Participants in a health coaching program interact one-on-one with their health coach by telephone, instant messenger, email and online journal.

Sacroiliac joint pain

 Sacroiliac (SI) joint pain has gained a lot of attention in the last ten years as an underappreciated cause of back pain with some studies indicating it is responsible for 15% to 40% of low back pain. The increased attention is due to the increasing knowledge of the SI joints intimate role in pelvic stability.  I hope more physicians consider SI joint pain in their differential after reading this article.

Pathophysiology

SI joint dysfunction due to inflammation within the joint itself is called sacroilitis. Pain from within the SI joint is common in rheumatoid patients and spondyloarthropathies.

The other cause of SI joint dysfunction stems from instability of the SI joint.  Many experts feel that SI joint pain is a component of a larger problem of pelvic instability (1). Pelvic instability has traditionally been underappreciated as a cause of low back pain, buttock pain, groin pain, and leg pain. Physical therapists and doctors of osteopathic medicine have been teaching these concepts for years but only relatively recently has this dissemination of knowledge trended towards mainstream thinking among medical doctors.

The SI joint complex (the SI joint and its associated ligaments) is the major support structure of the pelvic ring and is the strongest ligament complex in the body.  The complex consists of interosseous sacroiliac ligaments, iliolumbar ligaments, posterior sacroiliac ligaments, and the sacrotuberous and sacrospinous ligaments. The SI joints are two of the three joints involved in the stability of the pelvic ring.  The pelvic ring is the meeting place of the force vectors from the upper body and the lower extremities.  The third joint in the pelvic ring is the pubis symphysis. Pelvic instability causes pelvic rotation which can also cause twisting of the pubis symphysis.  Coupling this with its anterior location appears to provide an explanation as to why patients with SI joint instability can also experience anterior groin pain. Anecdotal evidence for this is seen when patients undergo a successful SI joint intra-articular injection relieving all of their posterior back, buttock, and leg symptoms but the patient still has groin pain. Groin pain is almost never eliminated by SI joint injections unless pelvic symmetry is corrected.

 If the SI joints are unstable, it can lead to significant pain and discomfort over the SI joints as well as numerous referred areas.  If an individual affected by SI joint pain has pain only over his or her SI joint, he/she  should be considered lucky. Most often SI joint instability causes unnatural strain on the entire low back and pelvic region causing a sometimes confusing clinical picture. Pain referral patterns of SI joint pain are often confused with L5 or S1 radiculitis or radiculopathies.

Referral patterns of SI joint dysfunction (2)

SI joint dysfunction often presents with a confusing clinical presentation.

1.       Buttock pain 94%

2.       Lower lumbar pain 74%,

3.       Lower extremity pain 50%, with 28% of these lower extremity pains going distal to the knee

4.       Pain goes all the way into the foot 13%. Younger patients are more likely to refer pain distal to the knee.

5.       Groin pain 14%. 

Most patients with SI joint instability also experience pain over the buttock region due to secondary muscle spasm of the gluteus muscles and piriformis complex.  Lower extremity symptoms are explained by the piriformis muscles natural tendency to spasm or tighten over the sciatic nerve whenever the SI joint is out of alignment.  This spasm of gluteus and piriformis muscles can cause a mechanical crowding or impingement of the sciatic nerve as it exits just below the SI joint (see figure 1. note the intimate association of the piriformis muscle, SI joint, and sciatic nerve).  Patients often complain of buttock pain and radiation of pain down to the knee and even down to the foot. Not all back pain and leg pains are due to a pinched a nerve from an intervertebral disk herniation.  SI joint dysfunction very closely mimics S1 or L5 radiculitis’ or radiculopathies because of the above described sciatic nerve irritation or impingement.

Groin pain and abdominal pain are not uncommon with SI joint instability.  Often times the groin pain is mistaken as a urologic problem like pudendal neuralgia, prostatitis,  genitofemoral neuralgia, or sterile epidydymitis(1). This is likely either due to unnatural tension on the nerves and ligaments around the pubis symphysis or actual impingement of the pudendal nerve which lies between the sacrospinous ligament and sacrotuberous ligament. The distance between these two ligaments abruptly narrows when the Ilium and sacrum are out of alignment i.e. SI joint instability.

The typical history of SI joint dysfunction consists of lateral or bilateral low back pain almost always below the pelvic rim. Pain can also radiate into the hip, groin, pelvis, leg, and foot.  The most common location of pain is in the buttock with pain extending down to the knee. Females are much more affected than males though the ratio is unclear.  The mechanism of injury is a continuum from completely atraumatic events to more obvious trauma like motor vehicle accidents, childbirth, or falls. A little over one third of failed back surgery patients suffer from SI joint dysfunction. In my practice, I often see patients who lose a substantial amount of weight and then develop SI joint dysfunction.  The etiology of this is unclear. Women who have had multiple births also seem to have a higher incidence of SI joint dysfunction.  The symptoms may be acute or may present as a remote or cumulative injury with chronic waxing and waning of symptoms with slow progression over time.  Patients often experience some degree of temporary relief with manipulation.  Patients must change positions frequently to avoid pain.  This is called “Theater Party Cocktail Syndrome”. Patient’s legs can also feel like they’re going to give out, but with objective testing of motor strength, no dysfunction is found. This is called a “Slipping Crutch syndrome”. Patients usually have a difficult time sleeping and getting out of bed in the morning can be excruciatingly painful. Continued movement after waking up tends to improve the pain.

There are many provocative physical exam maneuvers used to help establish the diagnosis of SI joint dysfunction. Going through each one of these provocative maneuvers is beyond the scope of this article.  It is important to note that the predictive value of provocative SI joint maneuvers in determining SI joint dysfunction is only 60%(4).  The conclusion of a recent study by Slipman et al(5), was that physical exam techniques can at best enter SI joint dysfunction into the differential diagnosis of a patient’s low back pain.  Of the alleged signs of sacroiliac joint pain, maximum pain below L5 coupled with pointing to the PSIS or local tenderness just medial to the PSIS (sacral sulcus) has the highest positive predictive value (PPD) at 60%(4).

Diagnosis

The gold standard for making a diagnosis of SI joint dysfunction is a fluoroscopically guided SI joint injection. Fluoroscopy is needed to accurately and consistently inject the sacroiliac joint.  Only 12% of patients had intra-articular SI joint injections when fluoroscopy was not utilized (3).  Also important is to anesthetize the entire SI joint complex.  In my experience as an interventional pain physician this cannot be consistently done by palpation alone, especially in obese patients.  It is humbling to see anatomy change under fluoroscopic guidance. What you perceive with palpation is sometimes markedly different than the actual location of the struct

ure that you palpate.  Also vitally important is that these diagnostic injections are followed up with another physical exam while the patient is in the recovery room. Sending a patient home, having them follow up in several weeks, and then determining if this “diagnostic” injection was successful has consistently been shown to be an inaccurate way of establishing a pathoanatomic diagnosis.

Treatments

There is no one specific treatment for SI joint dysfunction which helps all patients.  The treatment varies if the dysfunction is intra-articular (inflammatory), or if it’s a lack of stability. Conservative treatment should first be tried including the manipulation by a qualified physical therapist or osteopathic physician to restore normal motion and balance,  home self-correction exercises,  a walking program (avoid heavy axial loading maneuvers), and core strengthening exercises (Pilates, Yoga, or guided physical therapy). Some patients also benefit from a quality SI joint support belt.  If conservative therapy is not helpful then I recommend a diagnostic SI joint complex injection.  The injection should include the SI joint ( intra-articularly) and the supporting ligaments with pain relief lasting for the duration of the local anesthetic and achieving greater than 75% pain relief. If there is any question about the positivity of this diagnostic test,  it should be repeated.

Radiofrequency Denervation

If the diagnosis has been established by an intra-articular SI joint injection and pain relief using conservative therapy affords no long-term pain relief, then consideration for other treatments can be made.  Radiofrequency denervation of an SI joint carries about a 65% success rate for patients who have failed other conservative therapies and only mild instability around the joint. The procedure involves the neurotomy of the lateral branch nerves that lay over the sacrum and innervate the posterior SI joint. The advantage of SI joint radiofrequency is that it is a very safe procedure with almost no documented morbidity.

Prolotherapy

Another treatment for SI joint pain is Prolotherapy.  Prolotherapy works by stimulating an inflammatory cascade which leads to fibroblastic activity thereby strengthening the entheses of ligaments and tendons. Prolotherapy on SI joints usually requires very strong Prolotherapy solutions.  In my experience, hypertonic Dextrose Prolotherapy only relieves 20 to 30% of most patients’ pain.  More aggressive prolotherapy usually reduces pain by 50% or greater in roughly 75% of patients. The greatest advantage of Prolotherapy is that it is provides a level of permanent relief.

SI joint Fusion

If the patient fails radiofrequency and prolotherapy, the last treatment option would be consideration for an SI joint fusion.  The outcome data on SI joint fusions is not highly favorable.  However, there are new minimally invasive SI joint fusions that have recently been approved by the FDA that appear promising. Patients with very diffuse pelvic pain and leg pains are not good candidates for fusion surgery. 

Spinal Tumor surgery in India is provided with best medical services, high quality equipment and modern technology by competent medical professionals.India has best medical specialist around the world as well as world eminent doctors and hospitals where all the services are provided to the patients.India harnessed its vast pool of skilled doctors and nurses along with the access to the most modern medical technology at par with the best in the world. India enjoys the advantage of a skilled medical workforce fluent in English. All medical procedures including hospitalization and recovery are the best as compared to America and Europe. Hospitals providing Spinal Tumor surgery in India adhere to global quality standards for treatment and surgery.

What is Spinal Tumor Surgery?

Spinal tumor rarely occurs and is either benign or malignant. Some tumors are known to metastasize (spread) via arteries, veins, the lymphatic system and directly. A Spinal tumor is a cancerous (malignant) or non cancerous (benign) growth that develops within or near your spinal cord or within the bones of your spine. Although back pain is the most common indication of a Spinal tumor, most back pain is associated with stress, strain and ageing — not with a tumor. In most areas of your body, non cancerous tumors aren’t particularly worrisome. That’s not necessarily the case with your spinal cord, where a Spinal tumor or a growth of any kind can impinge on your nerves, leading to pain, neurological problems and sometimes paralysis. A spinal tumor, whether cancerous or not, can threaten life and cause permanent disability. Yet advances in spinal tumor treatment offer more options than ever before.

Symptoms of Spinal Tumor

Depending on the location and type of Spinal tumor, various signs and symptoms can develop, especially as a tumor grows and impinges on your spinal cord or on the nerve roots, blood vessels or bones of your spine. Signs and symptoms may include:

Back pain, often radiating to other parts of your body and worse at night
Loss of sensation or muscle weakness, especially in your legs
Difficulty walking, sometimes leading to falls
Decreased sensitivity to pain, heat and cold
Loss of bowel or bladder function
Paralysis that may occur in varying degrees and in different parts of your body, depending on which nerves are compressed
Scoliosis or other spinal deformity resulting from a large, but non cancerous tumor

Treatment options for Spinal tumor

Surgery:  Even with advances in treatment, not all tumors can be removed completely. Surgical removal is the best option for many intramedullary and intradural-extramedullary tumors, yet large ependymomas at the end of the spine may be impossible to extricate from the many nerves in this area. Although non cancerous tumors in the vertebrae can usually be completely removed, metastatic tumors are less likely to be operable. When a tumor has spread to the spine, radiation alone is usually the treatment of choice. However, research has found that surgery combined with radiation may be more effective at preventing loss of nerve function in people who are healthy enough to tolerate an operation and who have tumors that have spread from an unknown location, have some evidence of nerve injury, have tumors resistant to radiation or have recurrent tumors that were previously irradiated.

Standard radiation therapy: This may be used following an operation to eliminate the remnants of Spinal tumors that can’t be completely removed or to treat inoperable tumors. It’s also often the first line therapy for metastatic tumors. Radiation may also be used to relieve pain or when surgery poses too greater risk.

Stereotactic Radio surgery (SRS): This newer method, capable of delivering a high dose of precisely targeted radiation, is being studied for the treatment of Spinal tumors. In SRS, doctors use computers to focus radiation beams on tumors with pinpoint accuracy and from multiple angles. This approach has been proved effective in the treatment of brain tumors. Research is under way to determine the best technique, radiation dose and schedule for SRS in the treatment of spinal tumors.

Chemotherapy: A standard treatment for many types of cancer, chemotherapy hasn’t proved beneficial for most Spinal tumors. However, there may be exceptions. Your doctor can determine whether chemotherapy might be beneficial for you, either alone or in combination with radiation therapy.

Other drugs: Because surgery and radiation therapy as well as tumors themselves can cause inflammation inside the spinal cord, doctors sometimes prescribe corticosteroids to reduce the swelling, either following surgery or during radiation treatments. Although corticosteroids reduce inflammation, they are usually used for short periods only to avoid such serious side effects as osteoporosis, high blood pressure, diabetes and an increased susceptibility to infection.

Recovery post Spinal Tumor Surgery

Recovery post Spinal Tumor surgery depends on patient’s health before surgery. The patient’s care is monitored by periodical office visits and re-evaluation by the treating physician. This is important because some tumors, benign or malignant, may reoccur. Usually when the treatment period has ended, the symptoms clear up. Analgesics are given to control post-operative pain and cancer pain. Cancer pain may be difficult to control (e.g. ‘break through pain’). A pain management specialist may provide assistance if conventional drugs (e.g. pill, skin patch) do not provide relief. Any surgery, radiation treatment or chemotherapy can drain the patient nutritionally. Therefore, a proper diet is important to regain strength, lost weight, and a measure of health. A professional nutritionist can provide guidance. Depending on the extent of the surgery and the patient’s medical status, a course of physical therapy may be prescribed. Through exercise and modalities the patient can build strength, endurance and flexibility.

Why India?

Hospitals providing Spinal Tumor surgery in India have Primary aim to facilitate the highest standard of quality medical treatment & patient care to international patients. India has originated as one of the most important hubs for medical tourism. Many people from the developed countries come to India for the rejuvenation and top-class medical expertise which is helping more and more Indian corporate hospitals to lure foreign patients, including patients from developed nations such as the UK and the US, for high end surgeries. As more and more patients from Europe, the USA and other affluent nations with high medical look for effective options, healthcare tourism in India is definitely on the cards for most of them and the fast growing Indian corporate health sector is fully geared to meet that need. To get more info on Spinal Tumor surgery in India, visit us at; http://www.forerunnershealthcare.com or mail your queries at enquiry@forerunnershealthcare.com +91-9371136499, +91-9860755000