Orthopaedic Conditions That Require Spine Surgery

Spine surgery is a major surgery that is often the last option for most surgeons due to the complexity and risks involved. Any slight mistakes or accidents can cause permanent paralysis of the body depending on the affected nerves in the spine. Surgeons will often recommend alternative treatments such as medication and physical therapy and when left with no other choices will they opt for spine surgery. With such high risks involved, what are some orthopaedic conditions that require spinal surgery to be carried out?

Herniated disc

A herniated disc occurs when one of the spinal disc in the vertebrae slips or ruptures, causing the soft disc materials to flow out of the disc. When the disc flows out, the movement and material can pinch on the surrounding nerves, causing pain and numbness. A discectomy will need to be carried out to remove this herniated disc that is pinching onto the nerve. A modern evolution is the microdiscectomy which uses high definition microscope to see better and is minimally invasive, reducing the risk.

Foraminotomy

Foraminotomy is performed to relieve pressure from an affected nerve in the spine. This pressure is caused either by bone fragments, scar tissues or excess ligament development in the spinal area, causing it to press against the spine and causing pain and numbness. Foraminotomy will open up the back where the nerve roots leave the spinal canal, reducing the chances of pinching.

Spinal fusion

As the name suggests, spinal fusion aims to join 2 or more vertebrae together to prevent excessive movement which may pinch onto the nerves. Loose vertebrae can press against the nerves during movement, causing pain and numbness. It will also prevent the surrounding soft tissues from stretching. Spinal fusion is based on the simple logic of “if it doesn’t move, it doesn’t hurt”. Similarly to welding in metals, spinal fusion will fuse the vertebrae together. This process however will reduce some flexibility in the spine but this is very minimal.

Artificial lumbar disc replacement

Artificial disc replacement is a new surgical process that uses man-made biomaterials to replace the affected intervertebral disc. The purpose of the spinal disc is to cushion the shock and distribute it evenly. Since the spinal discs do not regenerate as easily as our skin, biomaterials will need to be used to restore flexibility and motion.

Above are 4 orthopaedic conditions that warrant the usage of spinal surgery. Although the risks are there, medical advances have significantly reduced the risks and recovery time. Nonetheless, the risks are still present and serious considerations must be made before deciding on such major surgery as this.

4 Habits to Help Reduce Risk of Orthopaedic Conditions

In sunny Singapore, we tend to engage in sporting activities throughout the year. As the amount of sports activities increases, the risk of orthopaedic injuries will increase likewise. Studies have concluded that 80% of orthopaedic conditions involved the upper extremities such as the arm, shoulders and elbows whereas 20% of them involved the lower extremities such as the knee and ankle. Injuries will prevent us from continuing to be involved in our favourite activity for a period of time and this can be frustrating. What are some good habits to help you reduce the risk of orthopaedic injuries? What are some precautions you should take?

Warming up

Our body is not in the most ideal state for action most of the time. If you do a sudden sprint, you can expect to pull your hamstring and cause pain and discomfort. Therefore, proper warming up is crucial to reduce the risk of injuries. You need to prepare your body for an intense activity but doing an action that is less intensive for a few minutes to allow your body to adapt. Warming up provides heat to the body which will help to loosen up the tissues in your body such as the ligaments and tendons.

Wearing protective gears

Contact sports often require the usage of protective gears to protect you. For example, soccer requires the compulsory usage of shin guards. Although shin guards can hinder running movements and cause discomfort to players, they are useful in preventing injuries to the shin. Also, rugby players wear uniform with padding at the shoulder region to prevent injuries when they are tackled down. While players are better off without these protective gears, they know that they cannot do without them.

Knowing when to stop

Knowing when to stop is the difficult thing for most athletes out there. There is only a thin line between stupidity and bravery. Some players think that they can finish the game despite being injured via the usage of pain relieving sprays. However, the exact extent of injury is unknown and it could be a serious one which will cause more serious complications if further aggravated.

Cooling down

Cooling down sessions help to decrease the heart rate in a controlled manner and relax the muscles. Exercising causes the body’s temperature to be increased and a proper cool down session will revert back to the normal body temperature down and prevent the building up of lactic acid which will cause muscle soreness.

Knowing when to stop is probably the most difficult yet important decision you should make. Observe the 4 habits mentioned above and you will definitely have your risk of injuries significantly decreased.

Stiff Neck – An Underlying Spine Disorder?

Stiff neck causes pain and discomfort when attempting to move your neck. It is often due to injury to the soft tissues and ligaments at the neck region. It is usually accompanied by pain and soreness in the neck, shoulder and arm. Symptoms can last for quite a fair bit of time and it can be relieved using medication or a warm compress. For cases whereby the symptoms go away in a couple of days, there isn’t much of an underlying issue. Stiff neck can occur when you wake up after having slept in an awkward position for a long time. Sometimes, stiff neck can be an indication of an underlying spinal disorder.

We must first know the basic anatomy of our neck. Our neck is divided into 2 regions namely the anterior and posterior. There is a part of our spine that moves through our neck and that is the cervical spine which is effectively made up of 7 vertebrae. Any slight problems in our spine can ultimately lead to neck pain since they are interlinked. There are 2 common spinal disorders which are Cervical Herniated Disc and Neck Arthritis.

Cervical herniated disc is one of the leading causes for neck pain and indicates an injury to the cervical spine. Pain in the neck is caused by the disc pinching onto the cervical nerve, causing pain to flow down the nerve pathway down to the neck. Some patients may also experience numbness at the neck region.

Another common cause is due to cervical osteoarthritis which is a degenerative joint disease or otherwise known as neck arthritis. Cervical osteoarthritis are characterised by the presence of bone spurs which may impinge onto a nerve. When impingement happens, the pain will radiate down the nerve onto the neck region, creating in neck pain similar to the cervical herniated disc.

It can also be due to cervical spondylosis which is another degenerative disease that is increased by previous injuries. Cervical spondylosis can result in neck pain and stiffness and is due to the wear and tear of the cartilage and bones of the cervical vertebrae.

There are many causes for stiff neck and it could indicate an underlying spinal disorder due to the mechanism for both neck arthritis and cervical herniated disc. The best way would be to seek a doctor immediately if you frequently encounter a stiff neck.

Age-related Orthopaedic Conditions

Age related orthopaedic conditions frequently decreases the ability to remain mobile, cause discomfort and pain and reduces the ability to lead a quality lifestyle, requiring alterations to daily activities. Ageing is a process which is spontaneous and cannot be avoided. However, age-related problems can be avoided if proper nutrition and care is provided.

Osteoporosis

Osteoporosis is a skeletal disorder indicated by low bone mass and deterioration of bone tissues. Osteoporosis can be grouped into systemic and local. Local osteoporosis is due to fractures, rheumatoid arthritis, tumours, muscular paralysis or tendon ruptures. Our bone is frequently undergoing remodelling, forming new bone cells in the process. However, osteoporosis causes an imbalance between this bone forming, causing low bone mineral density and poor quality of bones which are easily fractured.

Osteoarthritis

Osteoarthritis is another orthopaedic problem associated with ageing. Degeneration of ligaments and joints can cause arthritis. Patients suffering from arthritis suffer immense pain. They can also have deformed joints and even loss of motion. Osteoarthritis can happen in any synovial joints, but it occurs most often in frequently used parts of the body such as the hands, feet, knee and hips.

Carpal tunnel syndrome

Carpal tunnel syndrome can occur in elderly patients. This is due to the irritation of the median entrapment nerve compressing on the carpal tunnel. Rheumatoid arthritis can trigger carpal tunnel syndrome as well due to the inflammation of the flexor tendons, causing compressive stresses on the carpal tunnel.

Cervical spondylosis

Narrowing of the intervertebral foramina disc can cause irritation at the cervical nerve roots. This is often between the C4/5 vertebrae and can cause stiffness and sensory-motor impairment. Patients can also frequently experience a triad of tenderness over the neck area.

Genu valgum

Genu valgum or knock knee is often due to osteoarthritis in the knee. Osteoarthritis will cause deformation to occur on the knee, causing them to touch each other while straightened, and increasing asymmetrical wear on the cartilages at the medial and lateral joints. Genu valgum will lead to an increase in pain during activities and stiffness.

Plantar Fasciitis

Plantar Fasciitis is a medical condition that affects the feet and it causes extreme pain that is amplified after periods of inactivity. The pain is likened to as being stabbed repeatedly in the feet. The onset of pain is largely due to long periods of immobility of the feet such as a long day of using the computer. As the activities around the leg increases, the pain will decrease.

Degenerative orthopaedic conditions are common in the elderly. However, most of the conditions can be improved through physiotherapy or by leading an active lifestyle, working out the limbs and joints more often. When things get serious, pain relief medication may need to be consumed to maintain the level of pain in a tolerable range.

4 Common Orthopaedic Injuries in Elderly people

According to studies, orthopaedic injuries are the leading cause of injuries in elderly people. Common injuries include fractures to the hip, pelvic, spine, shoulder and forearm, head injuries and soft tissue injuries. In the elderly especially, there has been an observed pattern to orthopaedic injuries. Firstly, it is the fear of injuries followed by the actual injury and subsequent medical attention and the eventual loss of mobility and the need for specialised care. Let’s discuss about some of the common orthopaedic injuries in the elderly so that we can all try to prevent it from happening to our loved ones at home.

As we live in an ageing society, the risk of injuries is at a higher scale compared to previously. In this day and time, 30% of those hospitalised are the elderly. Ageing causes the weakening of the musculoskeletal system and the inability to maintain an independent function.

Fractures

Fractures happen more commonly in the elderly for many reasons. Firstly, there is a reduction in bone mineral which leads to eventual fractures of the spine and wrist. This is significantly in post-menopause females. Next, the vision of the elderly is not that great compared to the young and healthy ones. With an impaired vision, it is inevitable that unexpected events will occur. This coupled with weak bone structures are the best combination for fractures.

Dislocations

The shoulder joint is the most easily dislocated mainly due to the extreme flexibility property. This is also the increased risk of dislocation due to the breaking of a fall using a shoulder. Severe pain is often experienced immediately and a depression will usually be formed in the lateral shoulder. Shoulder dislocations will require a period of immobilisation for at least a period of 6 weeks.

Osteoporosis

Osteoporosis is a bone disease characterised by low bone mass and decreased bone density. It occurs due to the inability for new bone formation to catch up with existing bone loss and an eventual weakening of the bone. This is especially common in the elderly due to the inefficiency of bone forming due to ageing as our bone mass peaks at 30 years of age and starts to go into decline after that.

Osteoarthritis

Osteoarthritis is the most prevalent type of degenerative disease and occurs more commonly in the elderly. Osteoarthritis affects the synovial joints as well as the spine, finger, ankle and knee joints. Osteoarthritis will have a negative impact on the daily activities of the patient and simple chores such as tying shoelaces or button a shirt may seem to be a tedious task to accomplish.

Orthopaedic injuries are the main culprit of injuries in elderly patients due to a combination of factors such as impaired vision which leads to falls and subsequent fractures and dislocations. Although degenerative diseases are mostly unavoidable, preventive steps can be taken when you are still young such as the intake of sufficient calcium before bone mass peaks to prevent complications when you are old. Stay happy and healthy folks!

Patellar Dislocation: Causes and Prevention

Patellar or kneecap dislocations are injuries that occur with significant regularity, especially in young and active teens. Most injuries occur laterally and are accompanied by severe pain and swelling. The immediate remedial action following a patellar dislocation is to relocate the kneecap back to the trochlear groove. This is often performed without you even knowing it as it automatically pops in when u straighten you leg.

Patellar dislocations can happen for various reasons, ranging from contact to non-contact scenarios. An athlete involved in impact or contact sports can suffer from it due to a sudden change in direction, causing a twisting action on the kneecap and a subsequent dislocation. This is classified as non-contact since it does not involve a third party. One of the pre-requisites for this to happen is the existence of a weak knee ligament to hold the knee properly in place. Another method is a direct impact onto the knee, causing a much more serious injury. This will cause the surrounding muscles and tissues to be damaged rather heavily as well.

Patellar dislocations can be prevented by performing simple strengthening exercises. Strong knee muscles can help to significantly reduce the recovery time, experience lesser pain and be at a lower risk of injuries. There are 4 main muscle groups in the knee that should be targeted and they are the front thigh muscles, back thigh muscles, buttock muscles and lower leg muscles. The front thigh muscles or quadriceps muscles straighten your leg whenever they contract and they help to ensure that your patellar is in the proper position at the thigh bone. It also works hand in hand with the hamstring muscles. The back thigh muscles which are the hamstring muscles help in knee flexion, extension, transfer of energy and forward propulsion. Strong hamstring muscles can help to perform all these roles much more effectively and prevent injuries. The buttock muscles or gluteal muscles help to bend and flex the hip joint to allow us to perform actions such as walking, jumping and running with ease. A weak gluteal muscle will result in the inability to provide the explosive power and lead to a higher risk of injuries. Last but not least are the lower leg muscles or the calf muscles. It runs from the back of the leg all the way until the ankle. Strong calf muscles help to lift the feet up with minimal effort and support the knees and hips. Since the entire body weight is acting on the calf muscles, weak ones will cause the knee and hip muscles to have to take over this role and increase the risk of injuries.

Patellar dislocations are nasty injuries that will cause a lot of discomfort and disrupt to daily activities. Studies have shown that the risk of recurrent dislocations is high once a patellar dislocation occurs and this will result in problems if you wish to continue playing sports.