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बुधवार, 5 अक्तूबर 2011

Intervertebral disc prolapse (IVDP)


The most visited cases to Ayurvedic doctors and if we select the appropriate cases for treatment, success rate will be 100%!!!. Earlier this condition was identified as Sciatica syndrome (before MRI era, similar explanation in Ayurveda- GRIDHRASI), and now diagnosed under different headings depending up on the exact cause. Disc prolapse in turn may compress the nerve roots, spinal cord, or may reduce the spinal canal circumference resulting in canal stenosis. Symptoms will be different in all these cases. Another fact regarding IVDP is that almost 95% of cases resolve spontaneously by taking moderate rest for 3 to 6 weeks.

SELECTION OF CASE: After confirming the diagnosis of IVDP, we should be very careful in selecting the cases for Ayurveda treatment. Always try to avoid the below said cases for Ayurveda treatment.

1. IVDP with radiating pain with lower motor neurone paralysis in the affected limb (may be of toe-flexar and extensor movements, ankle etc) which constantly persists for more than three weeks without any improvement with Ayurveda treatment.
2. IVDP with canal stenosis which does not subside even after 3 week’s treatment. (The main clinical feature of canal stenosis is bilateral intermittent claudication along with other symptoms).
3. IVDP with upper motor neurone symptoms like urine retention, bowel incontinence, positive ankle clonus, exaggerated deep tendon reflexes, extensor plantar reflex (positive Babinski’s sign) etc. are surgical emergency. Here discectomy and other surgical treatment is treatment of choice. But we can consider Ayureda treatment in chronic cases where the damage has reached the irreversible phase.
4. If we can not see any improvement, or if the condition aggravates after 6-10 weeks of treatment, then also it is better to refer the patient for further management.

If we consider Differential diagnosis of IVDP
Lumbo sacral disc injuries
Lumbo sacral discogenic pain syndrome
Lumbo sacral facet syndrome
Lumbo sacral acute bony injuries
Lumbo sacral spine sprain/strain injuries
Lumbo sacral spondylolysthesis
Lumbar spondylosis
Pott’s spine
Neoplasms
Lumbar disc degeneration-usually seen in athletes
And also Sacro eleitis, peripheral vascular obstruction at superficial femoral artery level if bilateral sometimes mimic canal stenosis, etc.

TREATMENT:
Here aim of the treatment is
1. Healing of damaged disc (Mamsa Bhagna)
2. Reduce inflammation (vathahara)
3. Reduce pain (vedanahara)
4. Prevent recurrence

The initial approach is to heal the disc damage, inflammation and in turn radiating pain.
Here disc herniation should be considered as AVARAKA, Nerve root is AVRITHA and hence disc herniation should be treated first and the vathaja symptoms subsides.
In acute cases we prefer Inpatient treatment for 3 weeks, where success rate is excellent. Other moderate and mild cases can be managed in OP levels.

Panchakarma and other treatments:
1. Alepa- Whole body application with herbs having anti inflammatory property, vedanahara property. We also use some herbs which are specially used in Mamsa Bhagna in Kerala Ayurveda Practice. (All lipid soluble molecules can be absorbed through skin in very low rate. We observed many herbs having pain killer and anti inflammatory property when applied all over the body intermittently- It is just like sub coetaneous injection). But the only problem is development of skin allergy with potent drugs like Gunja phala. As per our observation Gunja phala is one of the best drug, even though toxic, we have not observed any toxic symptoms except skin allergy which is seen in almost 40% of patients after 4-10 days of external application. Skin allergy was totally reversible when we removed gunja phala from our lepa formula.
2. Pathra pindasweda or Shastikashali pindasweda Along with very mild massage to low back. (Avoid vigorous massage to low back in IVDP). Katibasti and other snigdha and ruksha swedana can also be adopted.
3. Basti Karma- usually for 5-7 days.
4. Total bed rest for 1st three weeks
5. Skin traction in selected cases if found necessary
6. Yogasanas for IVDP after 2nd or 3rd week depending upon the improvement. We avoid any type of Yogasanas in Acute phase. Yogasana is mainly to strengthen the paraspinal muscles and to improve blood supply to disc(stretching exercises).
7. Internal medicines. It is better to take internal medicines till patent recovers to expected level. Usually we suggest 6 months of treatment in majority of cases. Again the internal medicines should contain antioxidant rich combination for better healing, vedanahara drugs and anti inflammatory drugs.

In our hospital we have treated hundreds of IVDP patients in IP and thousands in OP level, and result is excellent.


Jayagovinda Ukkinadka

1 टिप्पणी:

  1. nice blog
    thanks for sharing information.
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