骨質疏鬆症是怎樣形成？

現今醫學未完全了解骨質疏鬆症的成因，但是醫生確實知道許多能引致疾病的因數。

老化 － 每個人都隨著年齡增長而失去骨質，在三十五歲後骨質的流失會比建立為多。大體上，你的年齡愈大，你的總骨質便愈少，而你患上骨質疏鬆症的風險也愈大。 

遺傳性 － 有骨折的家族歷史，身體纖瘦，白皮膚，加上有高加索或亞洲血統，你患骨質疏鬆症的風險便會增加。遺傳性可幫助解釋為什麼一些人會在年輕時便患上骨質疏鬆症。 

營養和生活方式 － 營養不良，缺乏鈣質的飲食習慣，與及缺乏運動都與骨質疏鬆症有莫大關係，抽煙和酗酒更是一樣。

藥物治療和其他疾病 － 骨質疏鬆症與一些藥物治療有關，例如類固醇。一些疾病，如甲狀腺問題，也有關係。

參考資料: www.ispine.com.hk
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向自己的骨科醫生查詢，而不應單倚賴以上提供的資料。

脊椎疾病

脊椎畸型

脊椎畸型可因各種原因形成，包括先天性，自發性(原因不明)，外傷性，退化性及僵直性脊椎炎等。無論何種脊椎畸型之結構必然為三度空間之變形，故所用以矯正脊椎畸型之手術方法，必需能提供三度空間之矯正力，才可充份矯治脊椎畸型。國際脊椎中心 (ISC) 所研發成功之三度空間脊椎畸型矯正手術，已成功治癒超越1200例各種脊椎畸型，其特點為安全，簡單，快速，矯正幅度大等優點。

下背痛

人類由爬行演進至站姿行走，骨骼結構中唯一沒有跟隨著演進的部位即是腰椎部位。是故此部位是人類骨骼結構中最弱的部位，也就難怪下背痛是人類第二大疾病，僅次於感冒。下背痛的原因很多，有可能是肌肉肌腱扭傷或發炎、臟器疾病引發，也有可能是腰椎本身之疾病而產生如骨刺、椎間盤突出、脊椎腔狹窄、退

化等均可導致下背痛，必需作臨床檢查才能確知病因，也才能正確治療。

坐骨神經痛

坐骨神經痛在醫學上乃一通稱，泛指各種原因導致之坐骨神經疼痛，此疼痛由腰臀部、大腿、小腿至足部，有時為鈍痛，有時為刺痛，通常在出力或咳嗽時會加劇，其原因有許多，凡可造成坐骨神經刺激或壓迫的均可導致成疾。一般常見的原因有椎間盤突出症、腰椎骨刺或腰椎滑脫症等，除臨床之表徵外，必需靠磁振攝影或電腦斷層顯像檢查才能確定診斷，也才能正確治療。

參考資料: www.zh.wikipedia.org , www.ispine.com.hk
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向自己的骨科醫生查詢，而不應單倚賴以上提供的資料。

預防背痛

先要建立標準的日常姿勢，藉由良好姿勢，可以設法降低背痛之產生。

 1. 站：應避免背部過度彎曲。正確的站姿是抬頭、挺胸、背部挺直、收縮小腹。如小腹突出或長時間穿高跟鞋，會使腰椎向前凸，增加腰椎的壓力，所以女性不宜穿一吋高鞋跟以上之鞋子。長時間站立，需讓腰椎休息，可將背部呈垂直線靠於牆上，腹部向內收，臀部向下，膝彎曲，或將一腳用矮凳抬高。如洗衣、洗碗、燙衣服的姿勢，都可以一腳用矮凳抬高。

 2. 走路：腳尖朝前，重心在足掌中心而不是內外側大小趾上。行走姿勢是最深切影響全身直線架構的。通常足掌內外八字的人，都會有輕或重的腰酸背痛。

 3. 坐：採坐姿時，翹腳且腹部用力，讓背部保持平直。坐椅為支撐背部腰椎部分，應使用外型適當的坐椅以直背硬椅為宜。並應避免彎腰駝背在過於舒適的椅子而使頸部、背部肌肉不當受力。正確的坐姿是兩腳平踏地面，背部平靠椅背，臀部坐滿整個椅子。

駕駛員的姿勢儘量將背及腰部靠在座椅上，座椅靠背的角度約115度為宜。由於椅子太高，兩腳懸空時，會使腰椎向前凸，可在腳下放小矮凳。當由坐姿站起來時，須將臀部先向前移動，然後再站起來。應避免過度向前彎腰站立。

 4. 躺：躺臥時，床舖的選擇非常重要，太軟太硬的床對腰椎都會造成壓力。最好選用木板床上墊一層褥子或榻榻米。枕頭高度正好讓頭與肩膀平行，雙肩自然舒適彎曲放置在身前床面上。切不可以手枕著頭而睡，因會造成背肌過度伸展。正確睡姿是側睡，雙膝微彎，兩腿間夾一個枕頭。

如果要仰臥，就要在膝下墊個枕頭，這樣可以減少腰椎前凸。俯臥會使腰椎向前凸而增加腰椎之壓力故應避免。

參考資料: www.painless.idv.tw
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向自己的骨科醫生查詢，而不應單倚賴以上提供的資料。

Coping skills are extremely important in the management of chronic back pain

Medications used for treatment of pain are multiple and varied. They fall into several different categories. Both non-narcotic and, rarely, narcotic pain medications may be used in the treatment of chronic back pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) are helpful with pain control and may help reduce inflammation. Muscle relaxants can also help with chronic pain and may enhance the effects of other pain medications. Nerve stabilizing drugs (antidepressants and antiseizure medications) are used to treat nerve-mediated pain. All these medications have different side effect profiles and interactions, and should be carefully monitored by a physician.

Coping skills are extremely important in the management of chronic back pain. Chronic pain directly affects all areas of a patient’s life. Pain affects mood, and a patient’s mood affects his or her ability to cope with pain. Pain also affects how patients interact with other people. For this reason, teaching patients appropriate coping skills for dealing with anxiety, depression, irritability and frustration can be invaluable. Involvement of a trained pain specialist, psychologist or psychiatrist greatly enhances the treatment of chronic back pain.

Procedures ranging from minimally invasive injections to surgery may be used to manage chronic pain. Sometimes, implantable devices, such as a spinal cord stimulator, are beneficial in managing chronic pain. The patient, with the help of his or her physician, should discuss the potential risks and benefits of any procedures considered. A second opinion may provide additional information or alternative approaches to managing your condition.

Complementary medicine also offers a variety of treatments, often helpful in the treatment of chronic pain. These treatments include acupuncture, dry needling, nutritional therapy, use of magnets and many others. It is important for a patient to discuss these treatments with his or her treating physician, to ensure that there are no harmful effects and that they do not interfere with other treatments being prescribed.

Reference information: http://www.knowyourback.org, www.ispine.com.hk

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.

What treatments are available?

Treatments for chronic back pain can vary greatly depending on the type and source of the pain. If a treatable source of the pain is found, then the underlying process can be addressed. When the underlying cause is either not specifically identifiable or not amenable to treatment, then the symptoms are treated. The goals of the treatment are to reduce pain, improve quality of life and increase function.

There are several different general categories of treatment that are usually recommended for chronic back pain. These categories include physical therapy, medications, coping skills, procedures and alternative medicine treatments. The treating physician will tailor a program involving a combination of these options to address the patient’s needs. Involvement of a physician with special training in chronic pain management may be advisable in some cases.

Physical therapy includes patient education, and patient training in a variety of stretching and strengthening exercises, manual therapies and modalities (ice, heat, transcutaneous electrical nerve stimulation [TENS], ultrasound, etc.). Active therapies which the patient can continue on his or her own (such as exercise and strengthening) usually have the most permanent and long lasting effects. A home exercise program (HEP) is usually in place before the patient is discharged from therapy. Exercise and strengthening are designed to increase stability and strength around the structures in the back that are being stressed. These techniques also work to avoid deconditioning that results from decreased activity. Exercises are tailored specifically to the patient and the type of back pain being addressed.The goal of educating the patient is to prevent progressive loss of activity because of fear of movement.

Reference information: http://www.knowyourback.org, www.ispine.com.hk

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.

How is chronic low back pain diagnosed?

As mentioned earlier, chronic low back pain is defined as back pain that lasts greater than three months. During the evaluation of chronic back pain, the goal is to rule out any injuries or disease processes that place the patient at risk of further injury if not treated or addressed. In addition, a specialist will consider diagnoses that can be treated in order to reduce the pain. A good patient history and a thorough physical examination by a well-trained physician are the most important aspects of the evaluation. Serious injuries and illnesses can often be diagnosed or ruled out based on the history and physical exam alone. Lack of a definite diagnosis does not necessarily mean more testing is needed. Needless tests do not add anything to what the physician has already discovered in his or her physical examination and review of previously performed studies and treatments. In fact, unnecessary testing is not only expensive to the patient, but can expose the patient to unnecessary risks or radiation.

If the treating physician feels that more testing is needed based on the patient’s history and physical exam findings, he or she will discuss this with the patient. Testing may include blood tests, radiography (X-ray imaging), bone scans, computed tomography (CT) scans, magnetic resonance imaging (MRI), diagnostic injections, electromyography (EMG) and many other specialized tests.

Often, the exact cause of the pain is still not well defined at the end of the evaluation. Nevertheless an evaluation is successful if it has ruled out those processes that place the patient at risk if they are not treated.Reference information: http://www.knowyourback.org , www.ispine.com.hk

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.

What is Chronic Low Back Pain?

Low back pain is considered to be chronic if it has been present for greater than three months. Chronic low back pain may originate from an injury, disease or stresses on different structures of the body. The type of pain may vary greatly and may be felt as bone pain, nerve pain or muscle pain. The sensation of pain may also vary. For instance, pain may be achey, burning, stabbing or tingling, sharp or dull, and well-defined or vague. The intensity may range from mild to severe.

Many times, the source of the pain is not known or cannot be specifically identified. In fact, in many instances, the condition or injury that triggered the pain may be completely healed and undetectable, but the pain may still continue to bother the patient. Nevertheless, even if the original cause of the pain is healed or unclear, the pain felt by the patient is real and the treating physician knows this.

Chronic low back pain may be the result by many different conditions. It may start from diseases, injuries or stresses to a number of different anatomic structures including bones, muscles, ligaments, joints, nerves or the spinal cord. The affected structure sends a signal through nerve endings, up the spinal cord and into the brain where it registers as pain.

A number of different theories have developed to try to explain chronic pain but the exact mechanism is not completely understood. In general, it is believed that the nerve pathways that carry the pain signals from the nerve endings through the spinal cord and to the brain may become sensitized. Sensitization of these pathways may increase the frequency or intensity with which pain is perceived. A stimulus that is usually not painful, such as light touch, can be amplified or changed by these sensitized pathways and experienced as pain. Sometimes, even after the original injury or disease process has healed, sensitized pathways continue to send signals to the brain. These signals feel just as real and sometimes worse than the pain caused by the original injury or disease process

Reference information: http://www.knowyourback.org, www.hongkong-orthopaedics.com

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.

Tumor Removal and Cervical Spine Fusion – successful stories

I was suddenly in severe, constant pain. Simply getting out of bed each day required a heavy dose of hydrocodone. Unable to perform any task that required sustained attention, I had to rest often and was never comfortable. I was even having difficulty urinating. My quality of life was terrible.

At least this time I had an explanation for my symptoms. I learned that a rare and aggressive cancer, hemangiopericytoma, was causing the recurring tumors that were pressing on my nerves.

Since I had a great deal of scar tissue from my previous surgeries, my then-doctor recommended a non-invasive radiation treatment rather than surgery. I was hesitant about this new technology and sought another opinion. I was referred to ordered X-rays, examined me and said he would be able to remove the tumor surgically, even with the extensive scar tissue.

In a 15-hour surgery, the tumor was removed and, because of the previous surgeries, vertebrae in my neck had to be fused and reinforced with pins and plates. I was in a hard body brace for seven weeks. After the removal of the brace, I underwent six weeks of radiation at a hospital near my home.

Unbelievably, I was able to suspend the pain medication immediately after surgery. Each day I became a little stronger and able to do more. Today, I am able to do most activities, including walking three miles a day, volunteering at a local high school and building wooden boats, which is my passion.

 

Reference information: http://www.knowyourback.org

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.

Spine Navigation Surgery – Procedures

Prior to surgery, patients undergo a series of CT scans. Once the images are downloaded into the navigation system, orthopaedic surgeon would perform a calibration process that is critical for the surgical outcome. Then Orthopaedic surgeon can then perform surgeries based on a 3-D anatomical picture of the patient. Orthopaedic surgeon insert a probing instrument through a small incision in the patient, and then the probe transmits signals back to the system. The system software integrates the patient’s CT scan with data from the digital camera probe, and then displays a real-time view on-screen of exactly where the instruments are positioned - throughout the procedure.

Spine Navigation Surgery – Pros & Cons

1.    In the traditional orthopaedic surgeries, screws are placed using a freehand technique or by fluoroscopy, which uses X-rays to capture an image on a television screen of the process of screw placement. Both patients and the staffs of operating room can be exposed to radiation and must use lead clothing for protection. The spine navigation surgery employ a special camera on a computer that uses infrared light to track a surgical instrument in 3D space that can reduce the X-ray exposures.

2.    Spine navigation surgery is performed on a 3D anatomical instead of 2D that can help orthopaedic surgeon to guide their instruments for precise screw placement

3.    The matching / calibration process is critical for surgical outcomes and experienced techniques are necessary.

4.    The benefits of spine navigation surgery must be weighed against potential complications from the surgery. Potential risks and complications include: anesthesia, infection, blood loss, nerve injury, possible re-operation and continued pain. Patients should consult with their orthopaedic surgeon for further details.

Reference information: www.ispine.com.hk

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.