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Spire ESP Study by Dr Jwalant S Mehta

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

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Spire ESP Study by Dr Jwalant S Mehta

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  1. Why does the backache? JwalantS.Mehta MBBS, MS (Orth), D Orth, MCh (Orth), FRCS (Tr &Orth) Consultant SpineSurgeon Clinical Secretary: +44 785 0211939 www.mehtaspine.co.uk Email: info@mehtaspine.co.uk

  2. Outline of thetalk: ‘Why does the backache?’ • Workingdefinitions • Scope of theproblem • Theflags! • Pathologic and clinicbasis • How you could approach thisproblem Clinical Secretary: +44 785 0211939 www.mehtaspine.co.uk Email: info@mehtaspine.co.uk

  3. Outline of thetalk: ‘Why does the backache?’ • When do weoperate • When can we safely deferoperating • When not tooperate Clinical Secretary: +44 785 0211939 www.mehtaspine.co.uk Email: info@mehtaspine.co.uk

  4. Use and abuse ourbacks • Sittinghabits • Smoking • Diet • Lack ofexercise • Excessive screentime Clinical Secretary: +44 785 0211939 www.mehtaspine.co.uk Email: info@mehtaspine.co.uk

  5. Low backpain • Major Health and socio-economicissue • Time off work in the economicallyactive • Point prevalence: 58 -84% Clinical Secretary: +44 785 0211939 www.mehtaspine.co.uk Email: info@mehtaspine.co.uk

  6. Low backpain • Site: • Below12thrib • Above Glutealfold • Cause: • Specific (Causesuspected) • Non-specific (??) • Severity: • Acute: < 6weeks • Chronic: > 3mo Clinical Secretary: +44 785 0211939 www.mehtaspine.co.uk Email: info@mehtaspine.co.uk

  7. Low backpain Mechanical Root entrapment Seriousconditions Clinical Secretary: +44 785 0211939 www.mehtaspine.co.uk Email: info@mehtaspine.co.uk

  8. Theflags! Clinical Secretary: +44 785 0211939 www.mehtaspine.co.uk Email: info@mehtaspine.co.uk

  9. Previous cancer • 50+ • Unexplained weightloss • Failure toimprove Clinical Secretary: +44 785 0211939 www.mehtaspine.co.uk Email: info@mehtaspine.co.uk

  10. Clinical Secretary: +44 785 0211939 www.mehtaspine.co.uk Email: info@mehtaspine.co.uk

  11. Clinical Secretary: +44 785 0211939 www.mehtaspine.co.uk Email: info@mehtaspine.co.uk

  12. Imagingoptions • MRI • CTscans • SPECT scans / Bonescans • Erectradiographs Clinical Secretary: +44 785 0211939 www.mehtaspine.co.uk Email: info@mehtaspine.co.uk

  13. MRI in 98 asymptomaticvolunteers 36% all discsnormal 52% bulge at 1level 27% discprotrusion 38% > 1 discabnormal 1% discextrusion Clinical Secretary: +44 785 0211939 www.mehtaspine.co.uk Email: info@mehtaspine.co.uk

  14. MRI in asymptomaticpersons Discprolapse L5S1 degenerativechanges 20% 36% <60 >60 27% 52% M 20 -30 M 31 -58 Boden JBJS1992 Savage ESJ1994 Clinical Secretary: +44 785 0211939 www.mehtaspine.co.uk Email: info@mehtaspine.co.uk

  15. VOMIT • Victim • Of • Medical • Imaging • Technology Clinical Secretary: +44 785 0211939 www.mehtaspine.co.uk Email: info@mehtaspine.co.uk

  16. Pain generators • Inter-vertebraldiscs • Facetjoints • Vertebral bodyfailure • Spinalmalalignment Clinical Secretary: +44 785 0211939 www.mehtaspine.co.uk Email: info@mehtaspine.co.uk

  17. Inter-vertebraldisc ‘Disc’ Clinical Secretary: +44 785 0211939 www.mehtaspine.co.uk Email: info@mehtaspine.co.uk

  18. Clinical Secretary: +44 785 0211939 www.mehtaspine.co.uk Email: info@mehtaspine.co.uk

  19. Cellular pathology leading to discdegeneration Clinical Secretary: +44 785 0211939 www.mehtaspine.co.uk Email: info@mehtaspine.co.uk

  20. Micro & Macroscopic changes in the degeneratedisc Clinical Secretary: +44 785 0211939 www.mehtaspine.co.uk Email: info@mehtaspine.co.uk

  21. The degenerativecascade Clinical Secretary: +44 785 0211939 www.mehtaspine.co.uk Email: info@mehtaspine.co.uk

  22. The motionsegment • Inter-vertebraldisc • End-plate: cartilage,bone • Facet joints • Passive restraints:Ligaments

  23. Disc height anddegeneration

  24. Disc v facetarthritis

  25. Discogenic vFacetogenic Flexion Extension

  26. Facet arthritis

  27. Facetogenic backpain • Back pain • Thigh pain • Worse onextension • Pain on getting out ofbed • Pain on arising fromsitting

  28. Spondylolysis

  29. Lumbar canalstenosis • Narrowing of the spinalcanal • Neuralcompression • Directionalcompression • Constitutionalshape

  30. Degeneratespondylolisthesis

  31. Treatmentoptions

  32. Treatment options with positivebenefit • Manipulation /Massage • NSAID’s • Multi-disciplinaryrehabilitation • Exercise / Stayactive • Backschools • Acupuncture Cochranereview

  33. Treatment options with nobenefit • Passivetherapies • Radiofrequencyablation • Injections • Supports • TENS • Bedrest • Traction Cochranereview

  34. Facet joint blocks

  35. Nerve root blocks Epiduralinjections

  36. Discography

  37. Treatmentoptions

  38. Lumbardecompression

  39. Treatmentoptions

  40. Postero-lateralfusion

  41. Inter-bodyfusion

  42. Minimally invasivesurgery

  43. Exploring expectations and treatmentoptions

  44. Age orMileage • Changing expectations from life • Longevity • Doing more……. • ……..for longer!

  45. Truncalmal-alignment

  46. Life is a kyphosingevent

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