Event Date:

7th March 2014

OSSAPCON (Orthopaedic Surgeon Society of Andhra Pradesh Conference) 2014

VENUE: SVS Medical College, Mahabubnagar, Telangana



Dr Udai Prakash being felicitated by Dr Harish Bhende


Dr Udai Prakash! talking on Hip Replacement Surgery

Biologic treatment for chronic painful conditions like heel pain, tennis elbow and sporting injuries

Biologic treatment for chronic painful conditions like heel pain, tennis elbow and sporting injuries

In April 2014, Dr Udai Prakash was invited to Delhi to be a founding member of the Indian Biologics Orthopaedic Society (IBOS). In May 2014, he was invited to chair various scientific sessions at the International Biologics Orthopaedic Meeting (IBOM2014) in Mumbai. The idea behind such meetings is to exchange knowledge and also to collaborate in research with the leaders in this growing field within orthopaedics. There is much excitement in the orthopaedic community as many biological solutions to age old problems like plantar fasciitis (heel pain), tennis elbow, cartilage and other sporting injuries become more widely available. Whilst some treatments like cartilage transplant and stem cell therapy require specialist training, others like PRP (platelet rich plasma) therapy for conditions like plantar fasciitis and tennis elbow require minimal training but do require an in-depth knowledge of the theory behind.

At Udai Omni, we follow international guidelines in management of the above conditions. Any patient undergoing treatment will be part of a bigger cohort that will be closely and scientifically followed up.

Back Pain: Treatment and Care

Back Pain: Treatment & Care

By Dr. Raghava Dutt Mulukutla, Consultant orthopedic and spine surgeon. He holds an experience of over 32 years, his expertise include spinal deformity surgeries, scoliosis and back pain management.

“If you are one of the few lucky ones who have not yet suffered from low back pain,do not be too happy. Second only to common cold, low back pain is increasing in incidence the World over. Almost 80-90% of population is affected by this problem in urban areas and is the commonest cause of absenteeism from work for people under 45 years of age in the Western World. Most suffer for a few days to weeks and in others it becomes a chronic problem with umpteen visits to various specialists,homeopaths,Auervedic massage treatments, acupuncture, magnetotherapy,Rieki etc. In India friends, neighbours, barbers, medical shop owners ,grand mothers are all specialistst have their own special remedies to offer and stories to tell. And of course that consultation with the foreign doctor – when I went to USA……… and the stories go on!

Who is at risk?

Almost 90% have a mechanical reason for their back pain, and in 10% various diseases and disorders are responsible for low back pain. Many risk factors have been identified : lifting weights beyond a workers physical capability, repeated bending and twisting in awkward positions , prolonged sitting especially in slouched position is well known to produce low back pain. Obesity, cigarette smoking, lack of physical exercise, weak abdominal and back muscles are some of the very potent factors in causing low back pain.

What causes back pain?

The very fact that we are born as humans – our upright posture places tremendous stress and strain on the back.

  • bad posture
  • prolonged sitting : IT industry/ executives
  • Weak abdominal and back muscles
  • weak bones ( osteoporosis )
  • smoking
  • driving 2 wheelers with bad shock absorbers
  • over weight
  • lack of exercises during and after pregnancy
  • un-accustomed bending forwards and lifting weights


Let’s get to know some of the common conditions that cause low back pain:

THE SLIPPED DISC: The human spine consists of individual bones called vertebrae separated by discs- which simply put is a jelly surrounded by fibrous tissue. When the discs get damaged or degenerated, it slips backwards and presses on the spinal cord and nerves causing pain in the lower back or along the leg – known typically as sciatica.

Slipped Disc
Arrow pointing to the slipped disc, pressing on the spinal cord

Non surgical management:

Over 90% of patients with slipped discs do not require surgery and get better with rest, physiotherapy and medication. You do not have to sleep on floor or hard beds. A firm bed is all that is required, and rest for more than one week is not advisable. There is no need for strict bed rest and you can move about if pain permits. Exercises should be commenced after the pain subsides and your physiotherapist would be the best person to teach you the exercises to strength the back and abdominal muscles.

The Surgery

Traditional surgeries such as laminectomy have no place in the management of disc prolapse. Surgeries such as Fenestration, Microscopic surgery or Endoscopic microdiscectomy(Key hole surgery) offer the best results. The minimally invasive surgeries do not weaken the back muscles and return to work is much quicker.

SPINAL STENOSIS: As we get older , the spinal canal gets narrowed due to arthritis and degeneration of tissues in the spine-resulting in pressure on the nerves. Typically the patient may experience low back pain, buttock pain and leg pain. Patients find it difficult to walk for long distances and have to rest after walking for a few minutes. He/she can resume walking once the pain subsides. Majority of the patients get better with change in life styles, physiotherapy and epidural steroid injections in to the spinal canal. Modern surgical techniques once again give lasting relief in those who do not get better with non operative treatments.

SPONDILOLYSTHESIS: This is slipping of one vertebra over the other, resulting in pressure on the nerves and again is responsible for back pain and sciatica. In those who do not get better with non operative measures, surgery offers good relief from pain.

OSTEOPROSIS: Again a common condition in women, is responsible for significant back pain and vertebral fractures. Exposure to sunlight, physical exercise, balanced diet, go a long way in managing this problem. In those who suffer from fractures, minimally invasive procedures such as Vertebroplasty : which is injection of synthetic material (bone cement) under local anaesthesia gives excellent results.

OTHER CONDITIONS: Curvature of spine (hunch back-scoliosis, TB, Cancers and tumors and a variety of disorders can affect a human spine. Prompt consultation and investigations would help in diagnosis and treatment.

Who should be consulted for spine surgery? 

Orthopaedic surgeon or Neuro surgeon? That is the doubt in almost everyone’s mind. Traditionally both operate on Spines.Today we have a sub-speciality – Spine Surgery. Spine surgeons are specially trained to perform spine surgeries and it would not be too long when Neuro surgeons would be operating only on Brain and Orthopaedic Surgeons on bone and joints and Spine surgeons alone would be performing Spine surgeries.

Information on the Internet: Beware! Not all information on the net is accurate and current. Newer technologies that appear on the net, are like fashions that keep changing and are industry driven.

Are Spine Surgeries safe?

Spine surgery is complicated and needs expertise. One need not worry too much about the complications and a well planned and well executed surgery in an understanding and cooperative patient gives excellent results.

Is there an age limit?

No! Today we perform spine surgeries on infants to aged persons and age certainly is no bar.

The second opinion?

 When in doubt take a second opinion. But seeing too many doctors is quite confusing”

For a healthy back

Correct your posture – do not slouch
Get out off your chair every 20 minutes – stand or walk for a few minutes
Getting out of chair is more important than buying expensive chairs
Exercise regularly –  yoga/walking/swimming/sports
Quit tobacco

Patient dilemma: Following the doctor’s orders as opposed to a relative’s or friend’s opinion

Sometimes it seems like patients have already made up their minds before they arrive at my clinic. To my surprise they are told by friends and relatives to not follow Doctors’ orders!

My biggest rivals seem to be friends and family of my patients and not other doctors in the city. This I have concluded after about two years of my practice in Hyderabad.

Here is a typical scenario:
Doctor: “Mrs K you have very severe arthritis in your knee. You’ve tried many tablets and treatments from local quacks as well as doctors and none of them work for you. You are now in a wheelchair because you cannot walk more than a few steps. I think you will benefit from a knee replacement”
Mrs K: “Oh doctor, I don’t want surgery. They say that knee replacement is a failure. They say that my knee will not bend after surgery. They also say that I won’t be able to walk after surgery. Please give me some very good tablets”
Doctor: Mrs K, are these people who are guiding you orthopaedic surgeons?
Mrs K: No doctor, these are just some members of my family?
Doctor: So Mrs K, why have you come to me? I am an orthopaedic surgeon. I am giving you a long term solution for your pain and you are educating me that I should not offer that solution. Then what do you want from me?
Mrs K: Just some very good tablets doctor!
Doctor: Ok, I’ll give you some tablets.
Mrs K: I don’t want painkillers doctor.
Doctor: Why?
Mrs K: Because they cause kidney failure and holes in the stomach!
Doctor: Ok, I can give you an injection that will lubricate your knee and may reduce the pain for a year.
Mrs K: No doctor, they say that injections are very bad for your knee. I don’t want an injection.
Doctor: Who are these people telling you these stories??
Mrs K: They are just some people who live in our area doctor.
Doctor: Please tell these people to treat you as I seem to be completely unqualified to manage your condition.

This is just an example of how citizens in this city refuse appropriate treatments from highly qualified doctors. How do we change this behaviour in our people?

On behalf of the medical fraternity, I request patients to take a discerning view, to not delay treatment and help the doctors do their job to the best of their ability.

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