Something new

[palak mehta]

 Dear Daradia Friends,

After attending lots of CMEs, Live Workshops, Interaction with Other Senior Spine surgeons, Ortho surgeons, Neuro Surgeons I came to know few new things in my practice. Here are some of the interesting facts which I am sharing.

1. Gore Sign: Pts who are having LL radiculopathy involving L5- S1 nerve root , They are having tenderness at sinus tarsi (for L5 radiculopathy) , tenderness posterior to lateral malleolus (For S1 radiculopathy).

Proposed theory: There is up regulation of sodium channels in peripheral part of nerve when it is compressed at spinal level. 

Example: Today 1 pt came to me with B/L LL radicular pain.Vas score was 9/10. SLRT was 10 degree.. My clinical diagnosis was L5-S1 radiculopathy .Significant tenderness was there at sinus tarsi. MRI was non conclusive with minimal disc bulge L4-5 and L5-S1 level. I did sinus tarsi block anterior to lateral malleolus with 3 ml of LA. Immediately within 2-3 min SLRT was 80 degree. Pain relief was > 80%. 

 To conclude the things , i will say this test is very simple, done in opd, it will help you to differentiate radiculopthy, minimally invasive,can be done without help of C-arm. it may help you for further planning the treatment.

Very soon i will be sending research paper on that.

2. Transforaminal Endoscopic Discectomy: 

   This procedure works nicely for patients having radiculopthy secondary to disc pathology, hypertrophied facet joint, lateral or central canal stenosis due to other pathology. 

In this intervention everything is done under vision , with help of endoscope. Endoscope is entered inside disc through kambini's triangle (which is having 9mm working diameter, while scope size is 6-7mm with 4 channels), all interventions like removal fragmented disc (from inside to outside) , foraminotomy, refashioning of facet surface 

( foraminoplasty) is done under vision. 

Very soon we will start doing this procedure at daradia pain clinic, Kolkata and pain care clinic, Ahmedabad.

By that time if any one interested can contact Dr Gore, Pune for training, as he working in this field for last 12 years.

3. Disc Herniation is of 4 type: Central, Paracentral causing compression on traversing nerve root

                                                   Foraminal, Extraforaminal causing compression on exiting nerve root.

4. Rami communicants leisoning works nicely for exclusive discogenic pain- the technique is little different than conventional lumber sympathetic chain leisoning.

Any one is having any query, i will be happy to discuss the things.

Regards to all.

Dr Palak Mehta, MD, FIPM, FIPP
Director: Pain Care Clinic, Ahmedabad.
Visiting Faculty and Consultant : Daradia Pain Clinic, Kolkata.
For Details Visit: www.paincareclinic.in
For more queries: in...@paincareclinic.in

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