How Can I Prevent Back Pain During My Pregnancy?

To optimize your chances of keeping back pain at bay, there are a variety of preventive measures you can take:

·         First, maintain a reasonable activity level and — under your doctor's supervision — incorporate exercises that gently stretch and strengthen your back and abdominal muscles. "Keep moving!" advises Dr. Peters. "The ability and motivation to remain active is very important during this time."

·         If you spend your days behind a desk, take advantage of opportunities to get up and stretch your legs — and back — while getting your work done.

·         Maintaining good posture as your body changes is also important. As your center of gravity shifts forward, minimize the strain on your lower back by standing as straight as possible, keeping your shoulders back and your buttocks tucked under. When sitting, keep your feet slightly elevated, if possible. Choose a chair that supports your back — use a small pillow if necessary — and change positions frequently.

·         Be mindful of body mechanics. If you need to pick something up, don't bend over and lift using your back. Instead, squat using your knees, keeping your back straight as you lift. Avoid positions that require bending or twisting. Listen to your body — if something hurts, don't do it!

·         Don't be a slave to fashion. If you're hooked on high-heeled shoes, kick the addiction — at least for a few months. Cute "sensible shoes" do exist — just look for low heels and good arch support. Your clothing can also be back-friendly — look for maternity pants with a low, supportive waistband. Later in your pregnancy, you may want to use a support belt under your lower abdomen.

·         It may seem like the impossible dream at this point in your life, but do try to get a sufficient amount of sleep. Practice relaxation techniques, and keep stress to a minimum. Sleep on your side rather than your back, keeping your knees bent. Place pillows around your abdomen for support, if needed.

Reference: www.back.com., www.ispine.com.hk

The information provided aims to provide educational purpose, if you have the described conditions as above, please consult your neurosurgeon.

Why Does My Back Hurt?

There are a number of reasons you can develop back pain during pregnancy. "It's a multifactorial issue," Dr. Peters says. "Hormonal alterations in soft tissue and even bone tissue play a part, along with changes in weight, spinal alignment, and activity level."

The hormones that are released during pregnancy allow joints and ligaments in the pelvic area to become more pliant and loose, in preparation for the birthing process, Dr. Peters explains. The downside of this softening is that it can affect the natural support your back normally receives, particularly as the weight of your baby increases.

A growing baby also causes your center of gravity to shift. Abdominal muscles stretch and weaken, making it more difficult to maintain good posture and further challenging your natural spinal alignment. "In the third trimester, for example, the forward flexion of the hips brings the pelvis and sacrum forward as well, contributing to a 'swayback' effect in the lumbar spine," Dr. Peters says. "Increasing breast tissue can also accentuate this shift in spinal realignment. Some of these tissue and mechanical alignment alterations are good for the body, in order to distribute weight gain to the middle of the body where, structurally, it's the strongest. But in a woman whose structure is weak where stress is magnified, low back pain can be the result."

Common patterns of pregnancy-related back pain include pain in the lower back, or lumbar spine, and pain that feels like it's centered even lower in the body, in the back, or posterior, of the pelvic area. If pressure is placed on the sciatic nerve or presses on a spinal disc, pain may extend through the hips, buttocks and legs.

Reference: www.back.com.

The information provided aims to provide educational purpose, if you have the described conditions as above, please consult your neurosurgeon

Managing Back Pain During Your Pregnancy

Along with morning sickness, food cravings and weight gain, back pain can be a common complaint during pregnancy. There are a few things you can do, however, to prevent pregnancy-related back pain or manage your discomfort once it starts.

Preparing for a baby's birth can be an exciting time. But as any woman with a dog-eared copy of What to Expect When You're Expecting knows, a certain amount of physical discomfort is normal during pregnancy and, well, to be expected. Back pain is a common complaint in the months leading up to delivery, especially during the final trimester, but there are a few things you can do to manage your back pain so that you can keep the focus on what's most important — getting ready to welcome your new baby!

It's Not Just You...
According to the American Academy of Physical Medicine and Rehabilitation, more than 50% of pregnant women report low back pain at some point during their term; some studies have found the incidence to be as high as 70%. "The incidence of low back pain in pregnant women is well over double the incidence of back pain in those who are not pregnant in the same age group," says orthopaedic surgeon John G. Peters, MD, medical director of Medtronic, Inc., the world's leading spinal device company.

According to the American Pregnancy Association, women most frequently report low back pain later in their pregnancies, as the baby grows larger and heavier; however, some women also start feeling low back pain early in their term. Women who may be most at risk for developing back pain during their pregnancies are those who are overweight (though studies are inconclusive on this), or who experienced back pain prior to becoming pregnant. Women who lack flexibility and strength in their back and abdominal muscles and those carrying more than one baby also may be more susceptible.

Reference: www.back.com.

The information provided aims to provide educational purpose, if you have the described conditions as above, please consult your neurosurgeon.

Project Brings smile to cancer kid

 

“I am very lucky to get the operation free of cost,” she said, her eyes sparkling. Wei said she would like to go to school as soon as possible. Wei also added that she would like to become a doctor to take care of patients and reduce their pain.

One of the volunteer-doctors said the cost for acoustic neuroma removal surgery was HK$600,000. He said there were about 100 new cases of acoustic neuroma in Hong Kong each year. However, there are a few cases of giant tumor of more than four centimeters.

The majority of patients in Hong Kong were middle-aged men, he noted, and young patients like Wei were rare. Explaining acoustic neuroma, he said if the disease was found at a young age, the tumor would grow rather fast. He also said patients in Hong Kong with tumor less than two centimeters could opt for a follow-up therapy instead of surgery.

Dr. Joseph Lam Ming-kuen, specialist in neurosurgery who also took part in the free surgery, said the incidence of acoustic neuroma in Hong Kong had been increasing in recent years.

A higher incidence rate could be related to the fact that MRI scanning had become more common for people with loss of hearing on one side. Chief hospital manager of The Hong Kong Hospital, said: “Healing Heart Initiative” would provide free surgery to 10 poor patients in Hong Kong and mainland. Wei was the third person to have received the service, he added.

Reference: www.scmp.com.

The information provided aims to provide educational purpose, if you have the described conditions as above, please consult your neurosurgeon.

Hong Kong Project Brings hope to cancer kid

 

Seventeen years old Wei Qunqun from a poor farmer family in rural Shangdong Province, had acoustic neuroma (hearing-nerve cancer). But, thanks to the humanitarian efforts by “Healing Heart Initiative” Charity Program, she could undergo the surgery free of charge in Hong Kong.

A Hong Kong Hospital charity project “Healing Heart Initiative” and charity group Hear Talk Foundation paid Wei’s medical bills.

Since she was 13, acoustic neuroma badly affected Wei’s learning ability and left her almost crippled. Her hearing ability and sense of balance worsened two years ago. She always felt dizzy and could hardly walk.

The disease could have been fatal if the five-centimeter tumor continued to grow.

However, except for a tiny part that is close to her facial nerve, the tumor had been successfully removed last week by a team of volunteer doctors from Hear Talk Foundation. Wei is able to eat, think and walk and is currently undergoing physiotherapy. She will be released from hospital next week.

Reference: http://www.surgery.cuhk.edu.hk/neuro/default.htm

The information provided aims to provide educational purpose, if you have the described conditions as above, please consult your neurosurgeon.

Nerve Structure - Topography

There are 31 pairs of spinal nerves:        8 Cervical

12 Thoracic

5 Lumbar

5 Sacral

1 Coccygeal

Because of the large number of nerve roots needed to control the upper and lower extrem-ities, the spinal canal in the cervical and lumbar regions is larger than in the thoracic region.

Although there are seven cervical vertebrae, there are actually eight cervical nerve roots. The first cervical nerve root exits between the skull (C0) and C1. the 8th cervical nerve root exits at the same level as the corresponding vertebrae. For example, the L1 nerve root exits between L1 and L2.

The nerve roots branch off the spinal cord higher than their actual exit through the inter-vertebral foramen. This means that the spinal nerves must often pass downwards adjacent to the spinal cord before exiting through the intervertebral forament. This leaves the nerves exposed to risk of compression by protruding disc material. Therefore, it is possible to have a compression of the L5 nerve root at the L4-L5 disc space.

Reference: www.iscoliosis.com, www.brainspine.com.hk

The information provided aims to provide educational purpose, if you have the described conditions as above, please consult your neurosurgeon.

Ligament & Spine

The interspinous ligament connects each adjacent spinous process. The fibers extend from the base to the tip of each spinous process. Anteriorly, the interspinous ligament is adjacent to the ligamentum flavum; posteriorly, it is adjacent to the supraspinous ligament. in the cervical spine, the interspinous ligament becomes part of the ligamentum nuchae, a fibro-membranous ligament posteriorly and cranially to attach to the occiput.

The supraspinous ligament is a very strong band connecting the tips of contiguous spinous processes. It extends from c7 (vertebra prominens) to the sacrum. above c7 these fibers are part of the ligamentum nuchae.

The ligamentum flavum, also called the yellow ligament, consists of elastic fibers oriented vertically that extend from the anterior inferior surface of the lamina above to the superior posterior surface of the lamina below. Unlike the ALL and PLL, the ligamentum flavum is not continuous. There is a small space in the midline between the right and the left fibers. The ligamentum flavum tends to thicken as it progresses down the spine, beginning at the axis (C2) and extending to the sacrum.

Lumbosacral Ligaments

The iliolumbar ligaments extend from the transverse processes of L4 and L5 to the iliac crest.

The lumbosacral ligament is a thick, fibrous band that extends from the anterior-inferior aspect of the trans-verse process of L5 to the lateral surface of the sacrum.

The are two types of SACROILIAC LIGAMENT:

• short sacroiliac ligaments: Composed of horizontal fibers extending from the sacrum to the posterior part of the iliac bone
• long sacroiliac ligaments: Composed of fibers extending vertically from the sacrum to the posterior superior iliac spine

Reference: www.knowyourback.com.

The information provided aims to provide educational purpose, if you have the described conditions as above, please consult your neurosurgeon.

Lower Cervical, Thoracic, and Lumbar Ligaments

The important ligamentous structures of the lower cervical, thoracic, and lumbar spine are discussed below.

The ANTERIOR LONGITUDINAL Ligament (ALL) is composed of thick, longitudinally oriented fibers extending from the axis (C2) anteriorly to the sacrum. The ALL is broader at the level of each vertebral body than at the level of the discs where the fibers adhere to the annulus fibrosus. The ALL attaches to each vertebral body superiorly and inferiorly at the levels of the endplates.

The Intertransverse Ligaments extend from the inferior surface of the entire length of the transverse process to the superior surface of the adjacent transverse process.

The Costalligaments connect the heads of the ribs to the vertebrae.

The POSTERIOR LONGITUDINAL LIGAMENT (PLL) is weaker than the ALL. Its fibers are also longitudinally oriented, but are less dense. It runs from the axis (C2) caudally to the sacrum. The PLL is narrow at the levels of the vertebrae, but the fibers extend laterally at the disc levels. These fibers may help to contain herniated disc material. Like the ALL, the PLL is attached to the vertebra at the superior and inferior margins, and to the annular fibers of the intervertebral disc.

Reference: www.neuropainhk.org

The information provided aims to provide educational purpose, if you have the described conditions as above, please consult your neurosurgeon.

Spine, Nerve structure - Meninges

Within the spinal canal, the spinal cord is surrounded by the EPIDURAL SPACE. This space is filled with fatty tissue, veins, and arteries. The fatty tissue acts as a shock absorber and keeps the spinal cord from contacting the bony tissue of the vertebrae.

The brain and spinal cord are covered by three layers of material, called Meninges. The main function of these layers is to protect and feed the delicate neurological structures.

The DURA MATER is the outermost meningeal layer and is made up of strong connective tissue. Also called the DURA, it is gray in color and generally easy to identify within the spinal canal. The dura extends around each nerve root and becomes contiguous with the EPINEURUM, a membrane covering the spinal nerves

The SUBDURAL SPACE is a very small space between the dura and the next meningeal layer, the ARACHNOID. The arachnoid layer is highly vascularized with a web of arteries and veins that give the impression of a spider wed. It is thinner than the dura and is subject to injury.

Below the arachnoid is the SUBARACHNOID SPACE, which is filled with CEREBROSPINAL FLUID (CSF). The CSF helps to protect the nerve structures by acting as a shock absorber. It also contains various electrolytes, protect, and glucose. A spinal tap can be inserted into the subarachnoid space to retrieve CSF for various chemical analyses.

The innermost lining of the meninges is called the PIA MATER. It is closely adhered to the spinal cord and the individual nerve roots. It is highly vascular and supplies blood to the neuro-logical structures.

Reference: http://www.back.com/

The information provided aims to provide educational purpose, if you have the described conditions as above, please consult your neurosurgeon.

Nerve structure of spinal cord

The Spinal cord functions as a sophisticated network that carries information from the outer elements of the body (skin, muscles, ligaments, joints) through the sensory tracts, to the central “computer,” the brain. Data are processed there, and new information, such as muscle control, is sent out through the motor tracts of the spinal cord. Part of the Central Nervous System (CNS), the spinal cord is located immediately below the brain stem and extends from the foramen magnum to L1.

The spinal cord is a firm but delicate structure that contains both gray and white matter. Compression, distraction, or other manipulation can result in significant injury to the spinal cord.

At L1 the spinal cord terminates as the Conus Medularis. Below L1, the thick but flexible dural sac (also called the thecal sac) contains the spinal nerves collectively known as the CAUDA EQUINA. Also contained within the cauda equina is the FILUM TERMINALE, which extends from the conus medularis to the coccyx and acts as an anchor to keep the lower spinal cord in its normal shape and position.

The individual nerve roots of the cauda equina are suspended in cerebrospinal fluid. At this level, it is possible to pass a needle safely into the thecal sac for evaluation of spinal fluid or injection of various materials such as drugs, anesthetics, or radiologic substances.

Reference: www.back.com, www.brain-spine.com.hk, http://www.necksurgery.com

The information provided aims to provide educational purpose, if you have the described conditions as above, please consult your neurosurgeon.