Orthopaedic Mount Elizabeth Singapore

Operation to Free Up the Nerves in Spinal Stenosis

September 9, 2016 by Tony Setiobudi

Spinal stenosis is a condition of nerve compression due to wear and tear that usually occurs in the lower back. The patients have calf or thigh pain or cramping feeling after walking a certain distance. Sometimes it is severe enough that force them to stop and sit down. When sitting the pain goes away very quickly. Majority of spinal stenosis can be treated without surgery. When is surgery indicated in spinal stenosis?

The purpose of surgery is to free up the nerve from compression. This surgery is routinely done by spine surgeons. Sometimes, implants are used if the spine is not stable or potentially unstable after surgery. This operation called decompression and fusion surgery. Otherwise, the surgery can be done without putting in implants or also known as decompression laminectomy.

Generally, the symptoms improve very quickly after the operation. The walking distance increases significantly. The patients can walk longer and feel more comfortable. If you have any queries please do not hesitate to contact us. We will be happy to assist you.

Author: Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho), Orthopaedic & Spine Surgeon, Mount Elizabeth Hospital (Orchard), Singapore

Hunched Back Correction in Ankylosing Spondylitis

September 6, 2016 by Tony Setiobudi

Ankylosing Spondylitis is a rare condition that affects the spine. In this conditions that spine bones joined up together to make the spine very stiff. Not only that, the spine usually becomes hunched.

With mild hunched back, the patient is able to do daily activities without much interruption. But when the hunched back is severe, the patient can no longer gaze straight ahead. Instead, the patient’s gaze is looking down. This makes walking difficult and dangerous. The patient can trip and fall very easily. With stiff spine injury to the back can cause some serious complications such as unstable spine fracture and spinal cord injury which may lead to paralysis.

When the hunched is severe and independent walking is no longer safe, operation to correct the hunched back (pedicle substraction osteotomy) is recommended. This is a major operation to make the posture more upright again.

There is strict selection criteria for this operation. It may not be suitable for a very old people with multiple medical problems. It is recommended for patients with good health who can tolerate major surgery and have good potential for rehabilitation.

Author: Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho), Orthopaedic & Spine Surgeon, Mount Elizabeth Hospital (Orchard), Singapore

Osteoporosis Screening | Treat It Before It breaks…

September 4, 2016 by Tony Setiobudi

Osteoporosis is common as the population is ageing. People don’t know that they have osteoporosis unless they do screening test. People with osteoporosis do not exhibit any symptoms unless they have fracture. By the time fracture occurs it is a little too late.

You can detect osteoporosis with a simple screening test called Bone Density Scan (BMD scan). It is recommended to do BMD scan for men and women above 50 or ladies after menopause. Early treatment can reduce the risk of osteoporotic fractures significantly.

You can approach your doctor regarding osteoporosis screening. Alternatively, Spring Hope Orthopaedic Spine Surgery provides screening for osteoporosis which includes BMD scan, Xrays and blood tests.

Author: Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho), Orthopaedic and Spine Surgeon, Mount Elizabeth Hospital, Singapore

If Your Back Pain does not Get Better with any Treatment ….

September 4, 2016 by Tony Setiobudi

You may have troublesome chronic back pain for a long time. You may have tried many things including Pain-killers, Physiotherapy, Chiropractic, Yoga, Pilates, Traditional Chinese Medicine, Acupuncture or other Alternative Medicines. If you don’t get better you need to see a specialist who have experience in this area.

Now the most important thing is to exclude any serious conditions such as spine tumor, infection or fracture. This requires a thorough examination and investigations.

After serious conditions are excluded, we can relax a little bit. Many times, the causes are related to your activities and life-style such as sitting or driving too long and lack of exercises. Often with proper education and understanding and a change of life-style, chronic back pain can get significantly better. Sometimes, simple measures such as standing every 20-30 minutes when you need to sit for a long time can improve your back pain significantly.

Chronic back pain requires a more regular follow-up. The treatment often requires multidisciplinary approach. The treatment modalities that you have tried may be appropriate but need to be coordinated appropriately together with medications. The treatment aims to reduce the pain so that you can carry on with your regular activities comfortably with minimal or no medication.

Sometimes, the back pain is associated with mechanical problems such as spinal instability or nerve compression. Strengthening the core muscle is the key to this problem. In severe cases, surgical intervention is required. Fortunately, when the problem is clearly associated with spinal instability or nerve compression, surgical treatment has high chance to solve the problem. But don’t worry because surgical treatment is reserved only as the last resort and most patients don’t need it.

In summary, if your back pain don’t get better after your maximum efforts to treat it, you should consult specialist that has adequate experience in this area.

Author: Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho), Orthopaedic and Spine Surgeon, Mount Elizabeth Hospital, Singapore

How to take Bisphosphonates? | Osteoporosis Treatment

September 3, 2016 by Tony Setiobudi

Osteoporosis Treatment Singapore | Bisphosphonate Medication

Osteoporosis Treatment Singapore and proper Bisphosphonate Medication

Fosamax and Actonel (bisphosphonate) are taken once a week (on the same day).
To be taken first thing in the morning with empty stomach 2 hours before eating or drinking anything other than plain water. If you take it with food or drink other than water, only a small amount of the medicine is absorbed.
You need to swallow the tablet with a full glass of water and sit upright for 30 minutes so that it does not irritate the esophagus.
Bisphosphonate is to be taken three to five years continuously after that it can be stopped for two years and the patients can continue to benefit from its use.

Calcium and vitamin D

You need to have adequate calcium and vitamin D in the blood when you take bisphosphonate.
Calcium and vitamin D are normally taken every day at a different time to the bisphosphonate.

What are the possible side-effects?

The most common side-effects (nausea, indigestion, tummy pain, diarrhoea or constipation) usually happen in the first month of treatment but usually go away after this.
Other common side-effects (joint and muscle pain) can happen a few days or a few months after you first start treatment and normally goes away after you stop taking a bisphosphonate.
Less commonly but more serious side-effects – inflammation or ulcers of the oesophagus or a narrowing of the oesophagus. If you have difficulty or painful swallowing, worsening heartburn or chest pain, you should stop the tablets and see your doctor.

You cannot take a bisphosphonate if:

You have low calcium levels in your blood
You have untreated vitamin D deficiency
You are pregnant or breast-feeding
Your kidneys do not work very well
You cannot sit upright or stand for 30 minutes after you have taken the tablet
You have problems with your oesophagus including narrowing of the oesophagus or Barrett’s oesophagus.

How do I keep my bones strong?

Regular weight-bearing exercise e.g. jogging, skipping, brisk walking, dancing
Stopping smoking
Limit alcohol intake
Eating adiet rich in calcium e.g. cow milk, cheese, green vegetables, broccoli, green beans, fish
Adequate sun exposure improves your vitamin D levels

Bone Mass Density & Bisphosphonate

The purpose of bisphosphonate therapy is to maintain the bone density.
Bone density scan (BMD) is the standard investigation to detect osteoporosis and monitor osteoporosis treatment.
BMD should be repeated yearly for monitoring.

Author: Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho), Orthopaedic and Spine Surgeon, Mount Elizabeth Hospital, Singapore

Osteoporosis Treatment Singapore and proper Bisphosphonate Medication

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