Patient with severe back deformity operated at Jaipur hospital

Doctors at a city hospital, while performing a complex surgery of spinal cord treated a patient with severe deformity of the back. Raman (name changed), a resident of Ajmer, was only 12 years old when his body started bending and became like a bow over the years. 

For the past nine years, he could neither see the front nor walk straight and could not lay in bed. HCG Hospital doctors have had success in fixing this serious and rare case of this complex disease of the spine called Ankylosing spondylitis.

“It was a very rare and complex case. Such cases of severe kyphosis appear in one in 100,000 patients. It was a challenging and risky operation, in which we straightened the spine preserving the nerves and fixed it with screws & rods,” Dr Pravin Gupta, spine surgeon at HCG Hospital, said. “Patients of Ankylosing spondylitis disease are fairly common (around 1 in 100) but such a severe deformity affecting activities of daily living is quite rare (1 in 1 lac). In the state, it can be called the first case of its kind,” said Dr Pravin.

As per doctors, Ankylosing spondylitis is an autoimmune inflammatory disease and often comes at the age of 20-30 years, but in this case, the symptoms started at the age of 12 as there was positive family history. The patient’s life became hell as his body was completely crooked all the time. He could not stand or walk straight. It was also difficult for him to even sleep. Making his condition more severe, the acute pain became permanent at his hip joints also. “We took this case as a challenge and with advice from our orthopedic team, it was decided to go for a surgical procedure with Pedicle Subtraction Osteotomy and fixation process. After about 10 hours long surgery, we successfully cut the spinal cord and fixed the deformity of the back,” said Dr Pravin. 

Doctors told that if the patient was not treated in such a severe condition, then he can develop paralysis, the joint of the knee and hip would have been completely damaged, there can be breathing problem due to severe kyphosis, and problems with digestive problems.

EXPERT OPINION

As per doctors, Ankylosing spondylitis is an autoimmune inflammatory disease and often comes at the age of 20-30 years, but in this case, the symptoms started at the age of 12 as there was positive family history. The patient’s life became hell as his body was completely crooked all the time. He could not stand or walk straight. It was also difficult for him to even sleep. Making his condition more severe, the acute pain became permanent at his hip joints also. “We took this case as a challenge and with advice from our orthopedic team, it was decided to go for a surgical procedure with Pedicle Subtraction Osteotomy and fixation process. After about 10 hours long surgery, we successfully cut the spinal cord and fixed the deformity of the back,” said Dr Pravin.

Source : DNA, 21 Nov 2018 

Surgery corrects acute spine curvature in 14-year-old girl - Gurugram

City-based doctors gave a 14-year-old Iraqi girl, suffering from an acute 105º curvature in her spine, a breath of new life. They put 23 screws in the bone around her spine during the 16-hour surgery to correct the curvature using two rods, after releasing the bones at multiple points. Six units of blood had to be transfused into her during the surgery.

Living with her deformity, called ‘scoliosis’ in medical terminology, for the past 10 years, Moza (name changed) faced difficulty in breathing, as the curvature pressed on her internal organs like lungs, impeding her normal growth. After the surgery, Moza said, “I feel completely different. I’m 3cm taller now. I can wear whatever I want without worrying about people staring at my back.” Hitesh Garg, head of spine surgery at the city hospital where the operation was carried out, said scoliosis is a condition where the spine initially grows in a ‘S’ shape for few years, before starting to rotate, making the ribs stick against and compressing the lungs. “Lung compression makes breathing difficult, ultimately leading to growth retardation and in extreme cases, death,” he added.

Moza said she wanted to get rid of this intense deformity that caused her major social embarrassment. Of late, she had also started getting breathless, which prevented her from playing. Doctors in Iraq started expressing concern about her growth and life expectancy.

About the surgery, Dr Garg said Moza’s case was challenging as she was just 14 years old and had to undergo a complex surgery that could lead to paralysis or life-long incontinence. Due to the complexity and long duration of the surgery, doctors decided to carry it out in two phases, five days apart. “Stage 1 involved loosening of contracted structures, while Stage 2 was the major corrective surgery. We used nerve monitoring and navigation-assisted technology to make the surgery safe,” said the doctor. Consultant spine surge

Consultant spine surgeon Himanshu Tyagi further explained, “In Stage 1, we opened the chest and loosened the vertebrae from the diaphragm, a complicated process that involves handling lungs and major blood vessels of the chest.


In Stage 2, we went from behind and put 23 screws in the bone around the spine to correct the curvature, using two rods after releasing the bones at multiple points.” “We were very scared about the procedure, as doctors in Iraq had warned us of its high risk, chances of paralysis and risk to her life. But as a father, it was an ordeal to see my child growing with a crooked back,” said Moza’s father. Another expert, H N Bajaj, head of ortho-spine surgery at the hospital, said the seriousness of a situation depends on the rigidity of the curve, ie, the patient’s age. “Correction becomes more tricky and risk of complications increase. Surgery may require accessing the spine from inside the thoracic cavity by deflating the lungs and bringing down the diaphragm, to get inside the abdomen, followed by the Stage 2 surgery from the back,” he added

Source : Times of India , 15 Nov 2018 

Dr. McCartney has been helping children with scoliosis for the past decade.

Optim Surgery center gives pro bono operations, physical therapy to Guatemalan siblings

For the past decade a Savannah surgeon has been traveling to Guatemala to help children with severe cases of scoliosis, a condition that causes curvature in the spine.

Just last year he operated on 15-year-old, Carlos Polanco, who has a genetic form of the condition. This year it was his sister's turn.

 At 11 years old Mia Polanco has never been to the United States or had major surgery but, her mother Jackie, has been here before. A year ago she was holding her son's hand as he recovered from the same surgery for the same condition.

"Finding out that it wasn't just Carlos that had scoliosis, I now had to make sure that Mia did not get as bad as he did, a lot of time passed, a lot of years where Carlos's back was just deforming and at the time i couldn't find a doctor that specialized in the condition that he had," said Jackie Mendoza, Mia's mom.

And then she found Dr. Donald McCartney. "Our surgery center is required to do a certain amount of indigent care or charity cases and we were behind our percentages at that point so it sort of rang a bell in my head you know i might be able to get this done at our surgery center and that's how that all came together," said Dr. McCarthy.

Mia, like her brother, has idiopathic scoliosis which, put simply, means the condition is genetic. Before surgery Mia's spine was curved and now with the help of an orthopedic implant, it's straight.

Until she returns home at the beginning of December mia will continue outpatient therapy here in savannah. "I would like to do a lot of things but I can't do anything yet because of my back for a month? actually it will be a year before I can swim and do what I want," said Mia.

Watching the recovery process is always hard but for Mia's mom says it's gotten better. "With Mia it has been easier, she's been so strong and i'm amazed because I thought she would cry a lot but she's such a strong strong girl and in reality I look up to her she has taught me so many things," said Jackie.

Mia says she get her strength from her mom."She helps me and tells me to relax and always looks for the good in everything. "I am so grateful for her. thank you mom--- I love you----, and if you ask her how she feels now, she said, "happy."

She will continue physical therapy until she returns home at the beginning of December. In the meantime she'll have several progress checks with Dr. McCartney.

For Video Link : https://www.wsav.com/news/local-news/optim-surgery-center-gives-pro-bono-operations-physical-therapy-to-guatemalan-siblings/1611761891

Source : WSAV3 , 21 Nov 2018 

Ishrat desperate for motorised wheelchair funding to go to high school

Ishrat Livingstone is 12 years old and wants nothing more than to attend high school next year. But the Vista Nova Primary pupil desperately needs a motorised wheelchair costing R52 000 to realise her dream.

Having been born with the rare disease Osteogenesis Imperfecta (OI), also known as brittle bones disease, she has faced considerable obstacles from birth. She has severe scoliosis as well as a pigeon (or barrel) chest, which causes her lungs to be compressed, making her breathe faster and subsequently tiring easily.

Her mother, Rageema Livingstone, said: "She has been completely wheelchair-bound for the past year as her bones have started to thin to the point where one can no longer distinguish between rod and bone in her left femur.

"Standing causes fractures and pain in her legs. She therefore requires assistance in going to the toilet and moving around outside her chair. 

"Even though she is 12, she is very tiny and still fits into 6- to 7-year-old clothes. We have to take extra care and precautions in taking her anywhere as she also cannot travel for long periods as she has backache due to scoliosis.

"A lot of extra things are required to provide more comfort for her. However, we can only see to the basics as I am a stay-at-home mom due to her constantly being in hospital as companies do not understand the frequency of breaks as well as the extended recovery times."

Rageema added: "During my pregnancy my gynaecologist did not send me for abnormailty scans, even though he detected her femurs were shorter than normal. 

"This resulted in her being born two weeks early via emergency C-section with broken bones as no extra care had been taken when handling her at birth. Both her femurs were fractured as well as her ribs, and her arm was dislocated.

"Soon after birth she was diagnosed with Osteogenesis Imperfecta and we were informed she would not make it out of the hospital due to the severity of the OI. 

"Thankfully, an orthopaedic surgeon from the Red Cross arrived and had her transferred to the Red Cross Hospital, where she was rediagnosed with a less fatal type and has been under Red Cross care ever since.

"I have since started Brittle Bones SA (184-120), the only registered organisation for OI in SA. This year we have evolved into a national organisation with sections in Johannesburg and Durban, with the head office being in Cape Town. 

"I have also co-founded OI Africa along with Tarela Aghanti, the founder of OI Nigeria, to try and assist other countries in building support groups and organisations for OI.

"To raise funds for her as well as other kids in need of mobility devices we are hosting fund-raisers in the form of a supper on 23 November at the Taronga Road Hall. Tickets cost R200

"I am also baking boxes of biscuits and selling OI bracelets to raise whatever funds we can. My organisation relies solely on the support of the community to enable us to provide a better quality of life to all that have this incurable condition."

The banking details to assist Ishrat are: FNB; Account name: Osteogenesis Imperfecta; Account number: 62750335468; branch code: 250655.

Source : IOL , 9 Nov 2018

Overcoming the woes of a curved spine

Ms Nur Afifah is believed to have one of the most severe cases of scoliosis here (see X-rays above). After a 13-hour operation in April, she now has three metal rods and 19 screws in her spine, but she no longer battles excruciating pain every day and has learnt to accept her condition and be comfortable in her own skin.

Ms Jasmine Liew (in red dress), co-founder and president of Scoliosis Support Singapore, with (from left) Ms Nur Afifah Mohamed Ali, Ms Cheryl Lim and Meagan Ho. All four suffer from scoliosis - a sideways curvature of the spine.

Ms Nur Afifah is believed to have one of the most severe cases of scoliosis here (see X-rays above). After a 13-hour operation in April, she now has three metal rods and 19 screws in her spine, but she no longer battles excruciating pain every day and has learnt to accept her condition and be comfortable in her own skin. Ms Jasmine Liew (in red dress), co-founder and president of Scoliosis Support Singapore, with (from left) Ms Nur Afifah Mohamed Ali, Ms Cheryl Lim and Meagan Ho. All four suffer from scoliosis - a sideways curvature of the spine.

Support group for people with scoliosis grows from 10 members in 2005 to over 300 now

She had a spine so curved that even when she was standing upright, it seemed like she was bowing.

The weight of people's stares, coupled with her extremely hunched posture, made her look down towards the ground often.

Ms Nur Afifah Mohamed Ali, 28, is believed to have one of the most severe cases of scoliosis - a sideways curvature of the spine - here.

A curvature greater than 40 degrees is seen as severe; in 2014, Ms Afifah was told the top part of her spine had a 120-degree curvature while the bottom was 60 degrees.

After years of being called names like "hunchback", "old lady" and "camel", Ms Afifah has now regained 7cm and can walk a little taller at 1.55cm, thanks to a 13-hour operation at Singapore General Hospital in April this year.

She now has three metal rods and 19 screws in her spine. But the curvature has got better - at 100 degrees - and she no longer battles excruciating pain every day.

"I have learnt to accept my condition and be comfortable in my own skin," said Ms Afifah, a freelance photographer.

"Now I can literally stand up and answer to the bullies who used to make fun of me," she added.

Scoliosis was in the spotlight last month when Britain's Princess Eugenie bared a surgical scar in a low-back dress at her wedding and spoke about her experience with the condition.

For Ms Afifah, the journey to self-acceptance was a long one. Even after her surgery, she felt depressed and went for counselling.

DARING TO BARE

My parents always advise me not to wear clothes that will reveal the scar so I was not confident of showing it in public. But, gradually, I have begun wearing low-slung tops and not been so hung up about how others view me.

MS CHERYL LIM, an undergraduate who has had three operations to correct her spine. She was moved by Princess Eugenie's decision to display her back scar (above) at her wedding.

She fears that her condition may worsen in the future, leading her to need a wheelchair or have breathing difficulties.

"The condition not only affected me physically, but also emotionally as I had to battle with insecurity and live with uncertainty," she said.

Her boyfriend broke up with her two years ago, saying he was sick of his friends always staring at her and her "whining" about being in pain.

Back in Primary 4, Ms Afifah, the youngest of three children, was already walking sideways due to the pain in her back. Her mother works as a cleaner, while her father, who also worked as a cleaner, died of a heart attack when she was 16.

But it was only in 2006 after her mother took her to the doctor that the then Secondary 4 student was diagnosed with scoliosis. She went through an eight-hour surgery to correct the 54-degree curvature in the bottom part of her spine.

After the surgery, she could walk without tripping or falling but her condition got worse over the years.

By 2013, doctors from several hospitals did not want to operate on her as her case was too complicated.

She was later found to have a cyst in the spinal cord and acromegaly, where the pituitary gland produces too much growth hormone during adulthood. This means she has abnormally large hands and feet - her shoe size is 42 - and the growth has affected her spine.

Dr Reuben Soh from Singapore General Hospital, however, was willing to treat her and undertook operations to correct her spine and remove part of her rib, which had been deformed by her condition.

Scoliosis Support Singapore, the only such group here, provides support to those with the condition.

Co-founder and president Jasmine Liew, 40, started the group with fewer than 10 members in 2005 and it now has more than 300. They organise twice-yearly sharing sessions, give talks and make follow-up calls to members who require more information or support.

"Back then, there was not much information and few people available to talk to about the condition," said Ms Liew, who also has scoliosis.

Ms Cheryl Lim, 20, an undergraduate who has had three operations to correct her spine, said she was moved by Princess Eugenie's decision to display her back scar.

She said: "My parents always advise me not to wear clothes that will reveal the scar so I was not confident of showing it in public. But, gradually, I have begun wearing low-slung tops and not been so hung up about how others view me."

Meagan Ho, 15, of Raffles Girls' School said her scoliosis has prompted her to advocate for people with the condition. "There are over 40 students with scoliosis in my school and so I formed a project group to raise awareness of the condition and promote treatment and good spine care," she said.

Likewise, Ms Afifah has tried not to let her spine get her down.

She has been volunteering with the Singapore Civil Defence Force, giving monthly public education talks on cardiopulmonary resuscitation (CPR) and first-aid skills for the past 10 years, even though she was rejected from becoming a full-time paramedic due to her condition.

She said: "I hope society will empathise and support people with scoliosis so that the condition will not take over their lives but they will still be able to live out their potential."

•KK Women's and Children's Hospital and Singapore General Hospital are organising a free public forum on scoliosis at Suntec City Convention Centre on Nov 24.




Source : Strait Times , Singapore - 11 ov 2018 

Mumbai: Teen To 'Sit' For Exams After Rare Spinal Condition Surgery

After surgery to fix rare spinal condition, 16-year-old is looking forward to sitting for exams without suffering excruciating pain

The teenager had a rare 90-degree hunch; (right) A fortnight after the surgery, he is already up and about

While most kids would do anything to avoid studying, 16-year-old Mukesh (name changed) can't wait to sit at his desk and pick up a textbook. He's dreamed of it for nearly eight years, even as a congenital disorder called kyphosis left his back severely hunched, making even the simple act of sitting excruciatingly painful.

Today, the teenager's face bears a look of relief and hope, as he is finally able to sit up straight after surviving a 13-hour-long surgery at Gokuldas Tejpal Hospital in Fort.

Difficult childhood
A fortnight after the procedure, he is already walking without physiotherapy or crutches, held up solely by willpower. This superpower is what has kept him going since he was seven, when he was discovered lost at Kalyan railway station.

Unlike many paediatric patients who have the support of their parents while battling medical conditions, Mukesh has spent the last eight years alone, being shuffled across three different state-run shelters. He was rescued by RPF officers and taken to a children's home in Bhiwandi. He had told them that his family lived under the Kalamboli bridge, but despite several attempts, social workers were unable to find his parents.

As far as he can recall, the pain started after he was injured in a fall in 2010, at the Bhiwandi shelter he was first taken to. "The pain continued to get worse. For the past couple of years, I haven't been able to sleep, and I would often walk around at night. The pain would force me to leave exams midway," he said.

Rare congenital condition
On the other hand, Dr Dhiraj Sonawane, head of the Orthopaedic and Spine department at GT hospital, said, "One in 10,000 people suffer from kyphosis and it is usually either congenital, which becomes prominent during puberty, when the body grows, or is caused by tuberculosis. In this case, it appears to be congenital."

He added that it was a rare case, considering the severity of the condition. "His spine was curved at a 90-degree angle," said Dr Sonawane. The doctor said that had Mukesh not undergone the surgery, he was at risk of paralysis, in case of a fall. After consulting with spine surgeons from Singapore and the US, Sonawane conducted the surgery on October 26. "This kind of a surgery is usually done in two or three phases. But we decided to do it in one go to minimise the risk," he said, adding that he used cobalt chromium rods to hold the spine - the strongest material.

The hospital also borrowed a neuromonitoring system from Surat to monitor the proximity of the surgical instruments to the spinal cord. Mukesh will be kept under observation for a week before he is discharged.

Amit Gunjal, Mukesh's counsellor and a social worker with the Women and Child Development Department, had visited two other hospitals before he found a doctor willing to perform the procedure. Gunjal said the surgery could be life-changing for the boy. "We have never had cases where a child has received such a major surgery. He is a bright boy and he has an interest in studies. We are thrilled to see him up and about so soon. If he performs well in his Std X exams, he can be placed in an aftercare home, where he can continue his education till he turns 21," he said.

Excited about sitting for exams
Mukesh is a Std X student at Sri RK Abhang Vidyalaya in Ulhasnagar. He is looking forward to his board exams in March 2019, he said, adding, "I was not able to sit for a long time because of the pain. But now, I want to make sure that I study well and complete all my papers." Being able to sit for longer hours means that he can also better enjoy playing chess, a skill that has won him a couple of tournaments. He is also looking forward to reuniting with his friends at the children's home in Ulhasnagar.



Source : Mid Day , 10 Nov 2018 

73% Of Patients With Spine Problems Have Lower Back Pain, Here’s Everything You Need To Know

A recent series of papers by The Lancet has stated that the increase of disability due to lower back pain has increased so dramatically world over that it is now being called as the leading cause of disability worldwide. 

Lower back pain is estimated to be affecting 540 million people across the world at any given point in time, according to the study! It comes as no surprise then lower back pain is the fourth highest cause of disability in India? 

A survey from last year that evaluated patients who sought help for back or neck problems showed that almost three-fourth patients (73%) had lower back problems. Around 45% of the patients waited for seven weeks before seeking assistance

Every fifth patient was aged 16-34, indicating that spine-related problems were occurring earlier in people. The four-city survey showed that 18% of Mumbai’s patients were under 34. The 34-54 age group formed the biggest patient group in the survey, while the 75-plus group was barely 5%. The four-city survey was conducted by clinical director and senior spine specialist, QI Spine Clinic, Dr Garima Anandani.

Dr Garima Anandani, Senior Spine Specialist & Clinical Director, QI Spine Clinic throws light of the burgeoning issue of spine-related issues in the country.

What is a spine-related injury or problem and why has it picked up importance since the early 2000s? 

Your Spine is made up of Bones, Nerves, Discs & soft muscle tissues. 70% load of your spine is borne by the soft muscle tissues (mechanical components of the spine) while 30% is borne by the structural components (namely bones & discs). When there is excess load on the bones it caused problems like spinal injuries, disc degeneration, dis herniation (slipped disc) etc.

One of the main reasons for this excessive load? A sedentary lifestyle.

Since most people end up leading sedentary lifestyles and sitting more than 9 hours a day, spine problems have emerged as one the leading lifestyle diseases in India. In fact, according to WHO it is one of the leading causes of disability in the world affecting about 540 million people at any given time.

“Chronic back pain can be debilitating for any individual. Simple tasks like sitting , standing & walking feel difficult making them feel handicapped or dependent all the time. The psychological impact on the individual’s confidence and self-esteem is enormous as pain consumes the mind of the patient causing other mood issues,” says Dr Garima Anandani, Senior Spine Specialist & Clinical Director, QI Spine Clinic. 

A sedentary lifestyle combined by poor posture at work and while using gadgets contributes to the rise in such conditions. More than half of the people that come to us with severe back pain lead a sedentary lifestyle. The youth doesn’t understand how something as simple as sitting for long hours is harming them gravely.

F

The scary part is the fact that people in young age group of 16-34, which make up 23% of the population in the country are suffering from some form of spine issue. 

Back Pain is growing at an average of 58% year on year. This is a 3% increase since last year. In fact, data shows that the rise in children with back pain has been 4X since 2015.

Qi Spine clinics’ director Dr Garima Anandani, who conducted the four-city survey said that “The report shows that back or neck pain patients neglect their pain or try other approaches that give temporary relief as pain usually returns. The rate of negligence at 45% is quite high.” She said this indicated lack of awareness.

A spinal deformity  can alter the shape of your child's back, rib cage, shoulders, and hips and can lead to back pain and poor self-image.

 In short, scoliosis not only has physical effects but serious mental and emotional repercussions on patients as well as their family members. There is a need for education and early detection. This is why QI Spine Clinic offers treatment for children below 15 at no cost.*”

Lack of awareness, poor nutrition, posture, lack of activity, smoking , being overweight are all key lifestyle-related contributors to back pain.

Dr S Mohanty, professor of orthopedics at KEM Hospital, Parel, said most people suffer from spine problems because of their lifestyle. “People have bad posture, eat junk food, put on weight and rarely exercise. Their muscles become weak due to their sedentary lifestyle, resulting in the spine getting inadequate support. Two other contributory factors are Vitamin D deficiency and osteosporosis,” said Dr Mohanty.

Urban schedules contribute immensely to the rising incidence of back problems, said Dr Mohanty. “Children start on an unhealthy lifestyle really early. They eat junk food because of convenience as their parents are working and not at home to monitor them,” he said. Children are so addicted to TV that they have their meals sitting in front of it. They don’t play outdoors. This sedentarism worsens as they get into adulthood, leading to spine-related problems earlier on.

Is lower back pain also connected to spine issues? 

Lower back pain is one of the most common complaint especially in women. Neck pain is an increasing complaint in working individuals and phone users. Apart from this there are many types of pains which originate in the spine but manifest as pain in the knee, arm, shoulder, hip etc. 

“It does not occur to many patients that this may be due to a spine problem. We have seen many such cases where patients were advised knee or hip replacement without doing a thorough analysis of the spine. If you have been advised surgery, do get a second opinion with a spine specialist before going under the knife"

What are type of spine injuries?

Muscle strains

- Structural damage

- Disc herniation / prolapse / extrusion

- Nerve compression / Sciatica

If treated in time 90% of these issues can be resolved non-surgically through spine rehabilitation. Delaying treatment increases the risk of surgery.

What are the obvious signs & symptoms and how to you recognize that you have a spine-related problem:

- Sharp or dull pain that is either constant or intermittent

- Pain that does not improve with rest

- Radiating pain that spreads from the lower back to the legs and even the toes

- Sustained cramping or tightening of the lower back muscles

- Numbness or tingling, especially in the feet

- Leg weakness that impedes mobility

If you experience radiating pain or loss of bowel movement, please consult a spine surgeon immediately.

COSME.NET

The problem we face when it comes to treating to spine-related injuries is lack of awareness and timely advice. 

 “Unfortunately, in India most spine conditions go untreated due to lack of sound advice. Pain killers and most home remedies focus on treating the symptoms of pain but do not focus on addressing the root cause of the problem. This ends up delaying the patients visit to the doctor. Most patients visit us when they are bedridden or crippled with pain. Many have gone through multiple failed surgeries until they have realised they could have solved the issue non-surgically if they have come to a spine specialist on time.” 

European, American and Australian guidelines recommend spine rehabilitation as the most effective way to treat back pain. Surgery is usually advised after conservative treatment like spine rehabilitation for more than 6 months has failed or the patient experiences loss of bowel control and other symptoms of neurological weakness. Self care is usually not advised for individuals in pain. A spine rehabilitation treatment plan is only advised after a thorough medical examination by the doctor.

Some of the precautionary measure you should take while you get treated for a spine-related injury include: 

- Walk more and stay active.

- Take breaks from sitting every half an hour.

- Avoid use of painkillers often. If pain comes back consult a spine specialist.

- Avoid smoking.

- Use a laptop stand at work.

- Treat back pain on time. 

Source : India Times , 25th Oct 2018