Pediatr Neurosurg. 2002 Mar;36(3):119-27.

Occurrence of split cord malformation in meningomyelocele: complex spina bifida.

Kumar R, Bansal KK, Chhabra DK.

Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical
Sciences, Lucknow, India.

OBJECTIVE: To describe the clinical features and surgical outcome of a combined
anomaly, i.e. split cord malformation (SCM) with meningomyelocele (MMC), and to
propose an addition to Pang's classification of SCM to accommodate a combined
form of anomaly. METHODS: We retrospectively analyzed 16 cases of such a
combination, out of a total of 106 cases of spinal dysraphism treated and studied
prospectively for outcome at our center. The clinical profile and outcome of
these cases are described. RESULTS: All cases had SCM and MMC. Nine patients were
males, and the mean age of presentation was 3.9 years. Twelve patients had Pang's
type I SCM and the other 4 were of type II. The MMC sac was lumbar in 11 cases.
In all the patients, SCM was present either at the same level as the MMC or one
to two segments above it. Nine patients had motor weakness, 6 had hypoesthesia, 4
had urinary incontinence and 3 had trophic ulcers. Nine patients had
neuroorthopedic syndrome. All cases, except 3 (who were operated on at birth, at
which time 'superficial surgery' was performed without relevant imaging),
underwent repair of the MMC and excision of the spur/septum at the same sitting.
The 3 cases who had undergone superficial surgery, however, were operated on for
SCM following investigation at our center, obviously at a second sitting. After
an average follow-up of 7.2 months, 4 patients showed improvement in motor
weakness, 5 in hypoesthesia and 3 in urinary symptoms, whereas trophic ulcers had
healed in all cases. CONCLUSION: With respect to the occurrence of SCM at or
above the level of an MMC, we feel it is apt to screen the entire spinal/neuraxis
by MRI in children with MMC. We labeled this combined pathology 'complex spina
bifida', and feel it is necessary to make a minor modification to Pang's
classification to accommodate the pure/combined anomalies together. Copyright
2002 S. Karger AG, Basel

Published in THE HINDU News Paper on 28th Apr, 2005. Written by Dr. R. KRANTHI VARDHAN, Chief Physician & Managing Director, Dr Kranthi�s Institute of Ayurvedic Sciences & Research, THE KERALA AYURVEDIC CARE, Speciality Panchakarma Centre, Basheerbagh, Hyderabad-500029. Andhra Pradesh. India.. Ph: 092461 66636, 098666 66055.

What is neck pain?

Pain in the neck can be due to injury, a mechanical or muscular problem, a trapped nerve caused by a bulge in one of the discs between the vertebrae, or from arthritis of the neck.

It can range from very mild discomfort to severe, burning pain.

If the pain is 'acute' - sudden and intense it is called a crick in the neck or muscular rheumatism.

If the pain has lasted more than three months, it is termed 'chronic' neck pain.

Neck pain is a very common condition and is more frequently seen in women than men.

Most people will experience pain in the neck at some point in their life.

What causes neck pain?

Many things can trigger neck pain. These include:

Trauma or injury

Worry and stress

Falling asleep in an awkward position

Prolonged use of a computer keyboard.

For most people, no specific reason for the pain can be found. However, in some cases it is possible to make a precise diagnosis. The underlying problem could be Slipped disc, brittle bones (Osteoporosis) , Cervical Spondylosis, deformed natural curvature of the spine (Scoliosis) and, very rarely, structural damage due to Tumours or Infection. Finally, road traffic accidents involving whiplash injury may result in acute or chronic neck pain that takes several months to improve.

What does neck pain feel like?

General pain located in the neck area as well as stiffness in the neck muscles.

The pain may radiate down to the shoulder or between the shoulder blades.

It may also radiate out into the arm, the hand, or up into the head, causing a one-sided or double-sided headache.

The muscles in the neck are tense, sore and feel hard to the touch.

Acute pain can give rise to abnormal neck posture in which the head is forced to turn to one side
The pain at the base of the skull may be accompanied by a feeling of weakness in the shoulders and arms.

There may be a prickly or tingling sensation in the arms and fingers.

How does the doctor make a diagnosis?

In most cases, a neck problem can be diagnosed by carrying out a thorough examination that may include all or some of the following:

Testing the movement of the neck.

Testing for trapped nerves.

Examination of the muscles.

Examination of the movement of the joints of the spine, neck and hands.



How is neck pain treated?

Ayurveda suggests the following choice of treatment:

Diet management

Intensive muscle training, yoga, pranayama & other stress releaving exercises

Ayurveda & Keraliya Panchakarma Therapies for a period of 7/14/21/28 days according to the severity of the disease which includes Shiro dhara (pouring continuous stream of medicated oil, buttermilk etc on the fore head and doing a gentle & soothing head massage), Shiro vasti (A special technique of bathing the head in medicated oils using a special cap like apparatus), Abhyangam ( A whole body massage with specific herbal oils, achieves deepest healing effects by naturally harmonizing Body, Mind, Soul and the Senses), Nadi Swedam (medicated steam bath), Nasyam (administration of medicated oil through the nose, cleanses accumulated Kapha toxins from the head and neck region), Elakizhi (herbal leaf bundle massage), Shastika Sali Pinda Swedam/ Navarakizhi (A highly effective rejuvenation technique using a special type of rice that is cooked, tied into boluses and dipped into an herbal decoction and warm milk, then skillfully massaged all over the body), Pizhichil (medicated oil bath), Greeva vasthi (a treatment done on to the neck to decrease cervical spinal compression). etc.

What medication is given?

Medicines used in this treatment includes Thailams, Churnams, Asavams, Aristams, Ghrithams, Lehyams etc prepared from ayurvedic herbs like Rasna, Nirgundi, Dasamoola, Aswagandha etc based on severity, stage of the disease, age, prakruthi of the patient. Vata hara, Brumhana Oushada Ahara Vihara are also advised to these patients.

People with weak neck muscles are more prone to neck problems and in such cases, an exercise programme to strengthen the neck is a good idea. Pranayama and other neck exercises releaves the stress in the neck.

Future prospects:

This depends on the underlying cause of the pain. The prognosis is generally good, provided the patient remains active and obtains the correct treatment without delay.


Dr. Kranthi�s Institute of Ayurvedic Sciences & Research, THE KERALA AYURVEDIC CARE, Speciality Panchakarma Centre, Skyline Theatre Lane, Basheerbagh are the pioneers in Kerala ayurveda panchakarma- established in 1999 with an aim of providing genuine health care to those suffering from the neck & the back pains. They are instrumental in successfully treating the chronic ailments like Sciatica, Slip disc, Neuro muscular diseases, Cervical & Lumbar Spondylosis, Degenerative disc diseases and severe Spinal conditions. Contact Dr. Kranthi Vardhan, Chief Physician & Managing Director on 98666 66055 / 92461 66636/ 66101140 all days from 8 am - 8 pm.

Published in THE HINDU News Paper on 10th Feb, 2005. Written by Dr. R. KRANTHI VARDHAN, Chief Physician & Managing Director, Dr Kranthi�s Institute of Ayurvedic Sciences & Research, THE KERALA AYURVEDIC CARE, Speciality Panchakarma Centre, Basheerbagh, Hyderabad-500029. Andhra Pradesh. India. Ph: 092461 66636, 098666 66055.

What is Meru Dandam? What is its Significance?

The Spine, Meru Dandam, in Ayurveda is a remarkable combination of strong bones, flexible ligaments and tendons, large muscles and highly sensitive nerves. It is designed to be incredibly strong, protecting the highly sensitive nerve roots, yet highly flexible, providing for mobility on many different planes. Most of us take this juxtaposition of strength, structure and flexibility for granted in our everyday lives�until something goes wrong. Once we're in pain, we're driven to know what's wrong and what it will take to relieve the pain and prevent a recurrence.

Why are we usually subjected to Neck & Back Pains?

This spine has a natural S shaped curvature and has two weak portions one at the cervical and the other at the lumbar regions. Any excess pressure in these areas increases the incidence of severe spinal damage. The first symptom to be observed usually is the neck and the back pain followed by the weakness, numbness, radiating pain, discomfort and finally disability.

What are the structures of the spine that produce Neck & Back Pain?

Many different structures in the spine are capable of producing back pain or neck pain, including:
The large nerve roots that go to the legs and arms may be irritated
The smaller nerves that innervate the spine may be irritated
The large paired back muscles may be strained
The bones, ligaments or joints themselves may be injured
The disc space itself can be a source of pain.

What are the Causes of Spinal Damage?

Irregular spinal postures, lifting heavy weights, increased car and motor driving, using dangerously uncomfortable chairs, stress, age, obesity etc. increases the pressure in these sensitive structures of the spine which ultimately leads to Cervical Spondilitis, Slip Disc- in the cervical region & Lumbar Spondilitis, Sciatica, Disc Prolapse, Degenerative Disc- in the lumbar regions and Osteoporosis in general.

Where can you get the solution for your Spinal Problem?

Whether your back is tender, or you have a 'slipped' disc, or you wake up with a stiff neck, or any damage on to the spine; Ayurveda has answers for you!

What is Ayurveda?

Ayurveda, The Science and Art of Life, is the oldest system of Indian medicine. It is not only the ancient science of preventative health & healing but also a philosophy of living. Ayurveda mainly cures by removing the root cause of the disease.

What is Meru Chikitsa?

Ayurveda deals almost in all branches of medical science. �meru chikitsa� is one of them, that has been developed thousands of years ago. The term �meru chikitsa� (meru means �Spine�, therapy is �application�) places chief emphasis upon the Spine and its associated structures thus maintaining proper health of an individual.

Meru chikitsa-The Spinal Care is an ancient ayurvedic therapy based on the vedic principles & philosophy. This natural healing therapy deals with spine proper and its nerves, muscles, joints and blood & lymphatic channels. Authorities in the field believe that the body is co-ordinated by three different humors or energy forces i.e.; Vata, pitta and kapha. This therapy helps in restoring and balancing the energy forces of the body that regulates the physiological equilibrium to perform better function of the body mind soul & the senses.

How does Meru Chikitsa work?

Meru chikitsa is a complete system of healing, incorporating mechanical, psychological, bio-force, and biochemical aspects of the spine along with the nerves. It discovers the root cause of the disease and treats the same in an integrated manner. The disorder of the bodily organs causes an imbalance in the biochemical forces leading to the development of diseases. These therapies activates or deactivates the organs, through pressure or massage on the nerve channels to stimulate or depress the blood, & other body fluids and the nerve currents so as to restoring the balance and harmony of the body thus helping the body regain its equilibrium.

What happens in the session?

The initial consultation involves taking the total health history of the patient. A visual analyze is carried out by examining the eyes, color of the tongue, nails, skin, etc. Once the verbal and visual analyze are completed, further investigation involves examining the tender points (marma points). Focusing on these marma points the ayurvedic physician discovers the malfunctioning of the organs. Based on these investigations, a final picture is drawn about the patient's condition in relation to the three biochemical forces; vata pitta kapha. The dis-alignment of spinal vertebrae and musculo skeletal system is mainly concentrated and special attention is paid to the patient's food habits and life style. With full history and investigation the ayurvedic physician determines the amount of treatment required. Usually the treatment period is 7/14/21/28 days according to the severity of the disease.

What Therapeutic Methods are applied?

The Treatment usually involves a series of ABHYANGAM, SWEDAM, NASYAM, ELAKIZHI, NAVARAKIZHI, KATI VASTHI, KASHAYA VASTHI & ANUVASANA VASTHI etc. Marma chikitsa along with Vatahara chikitsa and Brumhana chikitsa are given utmost importance.

What are the Applications?

It is used as a therapy for chronic as well as acute diseases of the spine. It does not merely concentrate on particular malfunctioning of a system or disease, but deals broadly with the whole body especially the spine.

What Ayurveda / Meru Chikitsa does is...

Apply scientific and holistic approaches to Treatment.
Assist the body in restoring its natural equilibrium, thus enabling self healing
Treat the whole human system and not only the apparent illness.
Treat with no side effects.
Provides immediate healing of some ailments,others may need relatively longer duration.
Advocates a Natural way of living as the preferred way of living.


About The Kerala Ayurvedic Care:

Dr. Kranthi�s Institute of Ayurvedic Sciences & Research� The Kerala Ayurvedic Care, basheerbagh, hyderabad, Aim at medical evaluation, treatment of all the chronic ailments including the Spinal Disorders. We, from the past 9 years are providing the Care, Comfort, Cure and Hope to all the suffering patients.

Our Mission Statement :

To Improve the Quality of Life for those with Spine Disorders; To advance the understanding and Treatment of those conditions through Research, Prevention and Education; and To deliver the finest quality Spine Care in a Friendly and Compassionate Environment, Treating every patient with the same Care and Respect we would demand for ourselves.

For Appointments, Please Contact:

Dr. Kranthi Vardhan at The Kerala Ayurvedic Care, Skyline Theatre lane, Basheerbagh, Hyderabad. Ph: 98666 66055 / 92461 66636 / 66101140 on all days from 8am �8pm strictly with a prior appointment.

Take Great Care and Avoid Straining that Delicate Structure called the �Spine�.

Published in THE DECCAN CHRONICLE News Paper on Thursday 15th Nov,2007 Written by Dr. R. KRANTHI VARDHAN, Chief Physician & Managing Director, Dr Kranthi�s Institute of Ayurvedic Sciences & Research, THE KERALA AYURVEDIC CARE, Speciality Panchakarma Centre, Basheerbagh, Hyd-29. Andhra Pradesh. India. Ph:092461 66636 098666 66055.

In the past, a patient suffering from Disc problems may have been prescribed Pain killers / Medications, Instructed to refrain from physical activities, referred for Physiotherapy, received Steroidal Shots or Injections, and when they weren�t progressing, they were sent for Spinal Surgery. Frankly speaking only 5% of Back pains require Surgeries, the other 95% can be dealt with Conservative & Curative Ayurveda Panchakarma Chikitsa.

Today, you may not have to live with that pain anymore. We at THE KERALA AYURVEDIC CARE, SCIATICA & SPINAL RESEARCH INSTITUTE, Basheerbagh, Hyderabad have successfully Treated Lower Back Pain resulting from herniated, bulging, or degenerative discs. Our Meru Chikitsa (Ayurveda Neuro Therapy) enables patients to return to more active lifestyles.

We are dedicated to improving the health and function of our patients by combining Traditional Ayurveda Panchakarma Chikitsa with modern technology to deliver an unprecedented level of service. Till to date we have treated more than 33000 patients with Spinal conditions like:

� Herniated Discs
� Bulging Discs
� Degenerative Disc Disease
� Sciatica Syndrome
� Spondylosis (Cervical /Lumbar/ Ankylosing).

Our commitment is To Improve the Quality of Life for those with Spine Disorders; To advance the understanding and Treatment of those conditions through Research, Prevention and Education; and To deliver the finest quality Spine Care in a Friendly and Compassionate Environment, Treating every patient with the same Care and Respect we would demand for ourselves.

For Appointments, Please Contact Dr. Kranthi R Vardhan, Chief Physician & Managing Director, The Kerala Ayurvedic Care, Sciatica & Spinal Research Institute, Basheerbagh, Hyderabad-29. Ph: 92461 66636 / 98666 66055 / 66101140 on all days from 8am � 8pm strictly with a prior appointment.

Take great care and avoid straining that delicate structure called the �Spine�.

Cervical spondylosis refers to common age-related changes in the area of the spine at the back of the neck. With age, the vertebrae (the component bones of the spine) gradually form bone spurs, and their shock-absorbing disks slowly shrink. These changes can alter the alignment and stability of the spine. They may go unnoticed, or they may produce problems related to pressure on the spine and associated nerves and blood vessels. This pressure can cause weakness, numbness, and pain in various areas of the body. In severe cases, walking and other activities may be compromised.
As it runs from the brain down the back, the spinal cord is protected by ringlike bones, called vertebrae, stacked one upon the other. The vertebrae are not in direct contact with one another, however. The intervening spaces are filled with structures called disks. The disks are made up of a tough, fibrous outer tissue with an inner core of elastic or gel-like tissue.
One of the most important functions of disks is protecting the vertebrae and the nerves and blood vessels between the vertebrae. The disks also lend flexibility to the spinal cord, facilitating movements such as turning the head or bending the neck. As people age, disks gradually become tougher and more unyielding. Disks also shrink with age, which reduces the amount of padding between the vertebrae.
As the amount of padding shrinks, the spine loses stability. The vertebrae react by constructing osteophytes, commonly known as bone spurs. There are seven vertebrae in the neck; development of osteophytes on these bones is sometimes called cervical osteoarthritis. Osteophytes may help to stabilize the degenerating backbone and help protect the spinal cord.
By age 50, 25-50% of people develop cervical spondylosis; by 75 years of age, it is seen in at least 70% of people. Although shrunken vertebral disks, osteophyte growth, and other changes in their cervical spine may exist, many of these people never develop significant problems.
Osteophyte formation and other changes do not necessarily lead to symptoms, but after age 50, half of the population experiences occasional neck pain and stiffness. As disks degenerate, the cervical spine becomes less stable, and the neck is more vulnerable to injuries, including muscle and ligament strains. Contact between the edges of the vertebrae can also cause pain. In some people, this pain may be referred--that is, perceived as occurring in the head, shoulders, or chest, rather than the neck. Other symptoms may include vertigo (a type of dizziness) or ringing in the ears.Cervical spondylosis can cause cervical spondylitic myelopathy through stenosis- or osteophyte-related pressure on the spinal cord.
Homeopathy cures cervical spondylosis permanently. Cases which do not get relief anywhere they get cure in Homeopathy. Homeopathy has vast range of more than 208 medicines for cervical spondylosis.It Takes 4 to 8 weeks in recent cases and longer time in more old cases to be cure. Homeopathic Medicines are prescribed on basis of individual symptom group, Modalities of pain and movements. Mild exercises are always advised with medicines. All the symtoms of cervical spondylosis and the individualising totality of the patient are considered to select the homoeopathic medicines.commonly indicated medicines are:Kalmia latifolia ,Lachnanthes tinctoria ,Rhus toxicodendron ,Cimicifuga racemosa, Bryonia alba , Magnesium phosphoricum , Nux vomica Gelsemium sempervirens , Calcarea fluorica , Phytolacca decandra Rhodium oxydatum nitricum , Strychninum purum , Belladonna Fel tauri, Ignatia amara , Kalium Nitricum, Rhododendron chrysanthum Silicea terra, Sulphur, Thuja occidentalis, Conium maculatum, Asarum europaeum, Causticum, Ammonium carbonicum, Calcarea carbonica Kalium Carbonicum, Paris quadrifolia, Menyanthes trifoliata