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Neurosciences

What is Neurology ?

Neurology is primarily concerned with disorders of the nervous system and brain. The neurological disorders include diseases involving autonomic, central and peripheral nervous systems. It may also include muscles, blood vessels and nerves. Neurological diseases include diseases of peripheral muscles and nerves, neuromuscular junctions and spinal cord. Disorders of spinal cord, nerves and the brain commonly treated by neurologists include –

  • Epilepsy
  • Tremor
  • Stroke
  • Parkinson’s disease
  • Amyotrophic lateral sclerosis
  • Heartache
  • Pain
  • Alzheimer’s disease
  • Sleep disorders
  • Spinal cord and brain injuries
  • Multiple sclerosis
  • Peripheral nerve disorders

Pediatric Neurology

Pediatric Neurology is specifically concerned with neurological problems in children who are under 18 years of age. It has been seen that large number of children are suffering from neurological diseases and epilepsy. The primary concern of a pediatric neurologist is to treat disorders of peripheral, central and autonomous nervous systems. Their primary role is to confront the unique symptoms of epilepsy in children.

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Symptoms of Neurological Disorders

  • Autistic disorders
  • Congenital anomalies of the brain and Hydrocephalus
  • Hyperactivity Disorder (ADHD) and Attention Deficit (ADD)
  • Headeches
  • Brain and spinal cord tumors
  • Seizure disorders
  • Concussion and head trauma
  • Balance and equilibrium
  • Metabolic-degenerative diseases of the brain
  • Neuromuscular disorders
  • Cerebral palsy
  • Tourette syndrome, tic disorders and movement disorders

Neurological Disorders in Children

  • Pain
  • Weakness
  • Tremor
  • Seizures
  • Headaches
  • Memory loss
  • Numbness

Neurological Diagnostic Tests

A patient has to go through a number of tests that include x-rays of the patient’s skull and chest, neurological exam, patient history and physical exam. These tests are done in order to determine specific neurological injury or disorder. Nuclear medicine imaging is also involved where little amounts of radioactive materials are used for examining organ structure and function. Whereas diagnostic imaging involves the use of electrical charges and magnets for examining human anatomy. Some of the common tests include –

  • Biopsy
  • Computed topography
  • Intrathecal contrast-enhanced CT scan
  • Cerebro fluid analysis
  • Discography
  • Brain scans
  • Angiography
  • Electromyography
  • Electronystagmography (ENG)
  • Electroencephalography (EEG)
  • Polysomnogram
  • Magnetic resonance imaging (MRI)
  • Thermography
  • Single photon emission computed tomography (SPECT)
  • Ultrasound imaging

What is Neurosurgery ?

Surgery involving the nervous system is termed as neurosurgery. Neurosurgery is a medical specialty that is primarily concerned with the treatment and diagnosis of the patients who are suffering from disorders or diseases of the spinal column, spinal cord, brain and peripheral nerves. Both pediatric and adult patients are included in neurological care. A neurological surgeon recommends surgical and non-surgical care depending upon the nature of the disease or injury.

What is Pediatric Neurosurgery ?

Pediatric neurology is primarily concerned with any disorder of the central nervous system such as spinal cord, brain, muscles and nerves in children. A pediatric neurologist treats and diagnosis conditions that include behavioral problems such as Attention Deficit Disorder (ADD), movement disorders such as cerebral palsy and seizure disorders such as epilepsy.

Symptoms of Pediatric Neurological Disorders

  • Seizures or Spasms
  • Concentration Issues
  • Poor Muscle Coordination
  • Muscle Tone Issues
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Pediatric Neurology Diseases and Conditions

  • Epilepsy:This condition is a brain disorder that results in recurring seizures. These seizures occur when the neurons or nerve cell clusters within the brain are sending incorrect signals.
  • Hydrocephalus: Hydrocephalus is the condition where there is excess accumulation of fluid inside the brain. This condition can be either present at the time of birth or congenital.
  • Spasticity : Spasticity is a condition of muscle disorder which is categorized by the inability to control the stiff or tight muscles. When the central nervous system causes an imbalance of the signals results in the condition of spasticity. This imbalance can be seen in those people who are suffering from traumatic brain injury, multiple sclerosis, cerebral palsy, spinal cord injury and stroke.
  • Brain and Spinal Cord Tumors: These tumors are found in the tissue within the bony spinal column or the skull that builds-up the central nervous system. These tumors can be found in any part of the body and occurs when the genes regulating cell growth become mutated or damaged.
  • Craniosynostosis: In this birth defect, one or more joints in between the bones of the skull close early or prematurely, prior to the formation of the brain in an infant. In this condition the head is misshapen and the brain cannot grow in its original shape.
  • Chairi Malformations: They are structural defects in the cerebellum ( a part of the brain which controls balance).
  • Vascular and Cerebrovascular Disorders: The flow of the blood inside the brain is referred to as cerebrovascular. When a part of the brain is permanently or temporarily affected by lack of blood flow or bleeding causes cerebrovascular diseases.
  • Pediatric Spinal Disorders: Pediatric spinal disorders treatment and diagnosis varies from adult spinal disorders. A large number of traumatic, developmental, neoplastic and congenital disorders can occur in pediatric age group.
  • Cerebral Palsy : Cerebral palsy is a set of disorders associated with functioning of brain and nervous system, affecting movement, learning, hearing ability in a child. It can be of various types like spastic, dyskinetic, ataxic, hypotonic and mixed.

Diagnosis of Pediatric Disorders

  • Psychological and educational evaluations
  • Electromyography (EMG) and nerve conduction studies: This is done for measuring muscle responsiveness. Brief electrical impulses are applied to the skin at various sites.
  • Magnetic resonance angiography (MRA): MRI techniques are used for detecting the problems of veins, blood vessels and arteries.
  •  Angiography: In this, blood vessels images are produced including brain and other areas of the body.
  • Magnetic resonance imaging (MRI):  In this, magnetic field along with radio wave energy pulses is used for producing images of the structures and organs within the body.
  • Computer tomography (CT) scanning and 3D reconstruction CT: X- rays are used for creating cross-sectional images of the body.

Treatments for Pediatric Diseases

There are few non-invasive treatment procedures by which congenital vascular malformations, epilepsy, movement disorders and brain tumors can be effectively treated. Patients who are suffering from medically refractory epilepsy can be treated by using Ketogenic Diet Program.

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What is Neuro Spine Surgery?

Neuro Spine Surgery known as neurological surgery or neurosurgery, is primarily concerned with diagnosis, prevention and treatment of disorders that affect any part of the nervous system. The nervous system includes the brain, peripheral nerves, spinal cord and extra- cranial cerebrovascular system. The practice of neuro spine surgery is performed for correcting diseases and injuries of the spinal cord. The procedure relieves pain in the spinal cord and restores function of the suppressed nerves. Lower back and neck conditions are also corrected through this procedure.

Conditions Treated by Neuro Spine Surgery

Neuro Spine Surgery treat conditions related to the brain, peripheral nerves, spinal cord and extra-cranial cerebrovascular system. There are different procedures involved in Neuro spine surgery that focuses on specific conditions.

Neuro-spinal specialists can perform many types of surgeries to alleviate uncomfortable symptoms, correct misalignment, and repair spinal structures. Spine surgery may correct unhealthy abnormalities in the spinal cord, nerves, ligaments, vertebrae, and the discs between them. It can be performed in the cervical, thoracic, lumbar, and sacral portions of the spine and surrounding tissues. Some of the conditions include –

  • Fractures
  • Brain and Spine Tumors
  • Degenerative disc disease
  • Lumbar spinal stenosis
  • Cervical spinal disc disease
  • Surgical pain management
  • Herniated pain
  • Spine trauma care
  • Lumbar spinal stenosis

Types of Neuro and Spine Surgeries

  • Brain and Spinal Cord Tumors
  • Complex Spine Surgery
  • Minimally Invasive Neck and Back Surgery
  • Gamma Knife
  • Skull-based and Pituitary Tumors
  • Stereotactic Radiosurgery
  • Pain Management
  • Deep Brain Stimulation (DBS)
  • Spinal Decompression Rehabilitation Therapy (IDD)
  • Trigeminal Neuralgia
  • Hydrocephalus/ Arnold Chiari Malformation
  • Disc disease
  • Percutaneous procedures
  • Open and other interventional procedures
  • Spinal malformations
  • Spinal dysraphism
  • Spine reconstruction and fixation
  • Percutaneous vertebroplasty

Surgical Procedures of Neuro Spine Surgery

  • ALIF: Anterior Lumbar Interbody Fusion
  • Anterior Cervical Discectomy & Fusion
  • Cervical Posterior Foraminotomy
  • Dekompressor Discectomy
  • Endoscopic Carpal Tunnel Release
  • Intradiscal Electrothermal Therapy (IDET)
  • Laminectomy (Cervical) with Fusion
  • Lumbar Radiofrequency Neurotomy
  • SMicro Endoscopic Discectomy
  • Minimally-Invasive TLIF (Transforaminal Lumbar Interbody Fusion)
  • PLIF: Posterior Lumbar Interbody Fusion
  • Spinal Cord Stimulation (Paddle Lead)
  • Spinal Cord Stimulator Implant
  • Total Disc Replacement
  • Vertebroplasty
  • XLIF® Lateral Lumbar Interbody Fusion
  • Kyphoplasty
  • Laminectomy

Neuro & Spine Treatments

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Lumbar Spinal Stenosis Surgery

What is Lumbar Spinal Stenosis?

Low back pain is a very common problem these days. The prime cause of this pain is lumbar spinal stenosis. The narrowing of the spinal canal causes compression of the nerves that are moving from the lower back into the legs is termed as lumbar spinal stenosis. This condition can be seen in younger patients but usually it is seen as a degenerative condition in older people who are 60 or above. Due to aging, the disc becomes less spongy and results in reduced disc height. This also results in hardening and bulging of the disc into the spinal canal. Lumbar spinal stenosis can be categorized into two types- Degenrative (age-related) and the other is Congenital (present at birth). Degenerative is most common than congenital.

What are the symptoms of Lumbar Spinal Stenosis ?

The symptoms of lumbar spinal stenosis can be seen when the back of a person is in extension and also when he stands up straight or walk. By leaning forward or sitting may provide some relief to the patient. The following symptoms can radiate through the lower back into the legs –

  • Dull cramping Pain
  • Difficulty with balance
  • Stiffness
  • Pins and needle sensation or uncomfortable tingling sensation
  • Weakness Numbness

What causes Lumbar Spinal Stenosis ?

The most common cause of spinal stenosis is Arthritis. The condition of arthritis develops when the disc degenerates and also water content decreases. The water content is very high in young adults and children. The natural aging process results in drying up of the water and also weakens the disc. Due to these reasons, the disc spaces collapses and loses its space height. Other conditions can also affect lumbar spinal stenosis which decreases the space of the vertebral foramen or spinal canal such as –

  • Different metabolic disorders that result in Paget’s disease of bone.
  • Tumor which is an unusual enlargement of the structures which makes the spinal canal.
  • Infection

Diagnosis of Lumbar Spinal Stenosis

The complete physical examination and history of a patient is evaluated. The severity of the condition and the presence of numbness or weakness can be determined with the help of patient’s physical exam. Patients having lumbar or cervical stenosis are required to take tests of either CT scan or MRI scan with myelogram. Sensation and abnormalities in strength can be evaluated by a neurological exam. Also nerve conduction studies or electromyogram (EMG) may be required for identifying irritation or damage of the nerves due to continuing compression from spinal stenosis. This also helps in determining the involved nerves.

Surgical Treatment Lumbar Spinal Stenosis

Patients who are facing weakness and pain are considered for the surgery. Some patients also find it difficult to walk for a long time without sitting. Spinal fusion and Laminectomy are the two surgical approaches for lumbar spinal stenosis. Both these surgical approaches have resulted in great relief from pain.

  • Spinal Fusion: When arthritis has advanced to spinal instability then spinal fusion or stabilization and decompression are suggested. During spinal fusion surgery, 2 or more vertebrae are fused or healed together. In order to fuse the vertebrae, a bone graft is taken from the hip bone or pelvis. The motion in between the vertebrae is eliminated by fusion. Also the slippage can be prevented that gets worse after surgery. While fusing the bones together, screws and rods can also be used for holding the spine in place. The usage of screws and rods help in fusing the bones quickly and also speeds up recovery.
  • Laminectomy: The bone spurs, ligaments and bone are removed which are responsible for compressing the nerves. Laminectomy, also referred to as decompression, may also be done as open surgery where a single large incision is used for accessing the spine. Minimally invasive procedure can also be used for performing the procedure of laminectomy. Many small incisions are made for performing minimally invasive method.

Nonsurgical Treatment for Lumbar Spinal Stenosis

There are many treatment options that provide relief from pain and also restore function. Nonsurgical methods offer relief from the symptoms of lumbar spinal stenosis

  • Lumbar traction: For some patients, lumbar traction has proved beneficial but at the same time it has limited results.
  • Steroid injections: The most powerful anti-inflammatory is cortisone. The injections of cortisone in the epidural space or around the nerves may reduce pain as well as swelling. These injections should not be taken for more than three times in a year. Cortisone injections will reduce numbness or pain in the legs.
  • Anti-inflammatory Medications: Anti-inflammatory medications are used for decreasing swelling or inflammation around the nerve that provides relieve from pain. Non-steroidal anti-inflammatory drugs (NSAIDs) are used for 5-10 days for eliminating inflammatory effect.
  • Acupuncture: In order to treat less severe cases of lumbar stenosis, acupuncture is considered as very helpful. Acupuncture has been regarded as a very safe nonsurgical treatment.
  • Physical Therapy: The symptoms can be managed by performing physical therapies such as massage, abdominal strengthening, stretching exercises and lumbar strengthening.
  • Chiropractic manipulation: This is a very safe nonsurgical method. If a patient is suffering from disc herniation or osteoporosis then extra care should be taken. In the cases of disc herniation or osteoporosis, manipulation of the spine can result in injuries or can even worsen symptoms.

New Advanced Surgical Approaches for Lumbar Spinal Stenosis

  • Minimally Invasive Decompression: This can be done by making small incisions. The benefits of this procedure are faster recovery period and reduced hospital stay. This is because less injury is caused to the surrounding soft tissues.
  • Interspinous Process Devices: These devices are considered as a minimally invasive surgical method for treating lumbar stenosis. In the middle of spinous processes into the back of the spine, a spacer is fitted. The purpose is to keep the nerve space open by spreading the vertebrae apart. The success of this procedure depends upon the selection of an appropriate candidate in whose pain returns upon standing.

Benefits of Lumbar Spinal Stenosis

Relief from pain is one the major benefit of lumbar spinal stenosis surgery. The other benefit is that patients who have mild lumbar spinal stenosis surgery are able to return to their home on the same day and begin routine activities after some days. The recovery in the case of mild stenosis treatment is much faster as compared to open surgical procedures. The mild decompression procedure is considered as a low-risk and safe treatment.