• Left untreated, vertebral osteomyelitis can lead to permanent neurologic deficits, significant spinal deformity, or death. (medscape.com)
  • Later, Galen related this infectious process to spinal deformity. (medscape.com)
  • However, this procedure did not allow access to anterior abscesses and contributed to spinal instability , which often resulted in progressive deformity. (medscape.com)
  • Late spinal deformity was prevented with spinal fusion and instrumentation. (medscape.com)
  • Spinal Tuberculosis, also known as Pott's Disease, is a spinal infection caused by tuberculosis that can lead to osteomyelitis, kyphotic deformity, and spinal mechanical instability. (orthobullets.com)
  • 2. What kind of deformity will appear with spinal tuberculosis? (medicaltrend.org)
  • Neurologicalimpairment and spinal deformity are the major concerns with spinal tuberculosis. (edu.pk)
  • Destruction of the anterior endplates ensues with anterior collapse leading to a wedge deformity seen clinically, as well demonstrated in this case, as the spinal deformity known as a gibbus. (uab.edu)
  • Here, we present an exceedingly rare case of BCG vaccine-induced L1-2 spinal tuberculosis with extensive vertebral body destruction and deformity. (surgicalneurologyint.com)
  • 8 ] Nevertheless, we chose temporary percutaneous instrumentation, without decompression, debridement, fusion arthrodesis, or anterior reconstruction, given the nonfixed nature of his focal deformity. (surgicalneurologyint.com)
  • In adolescents, pulmonary function may improve after surgical correction of the spinal deformity and indirect improvement of chest wall dimensions and mechanics. (vermaspine.com)
  • If left untreated, this infection has high morbidity leading to spinal deformity, paraplegia, and even death. (nih.gov)
  • Some cases are recognized during routine screening for spinal deformity at school. (msdmanuals.com)
  • The disease may end up with spinal deformity and neurological complications like arachnoiditis, intramedullary tuberculoma and epidural abscesses 5 . (jmedcasereportsimages.org)
  • Around the turn of the 20th century, the problem of progressive spinal deformity and disability caused by spinal tuberculosis (Pott disease) had become a focus of clinical inquiry. (medscape.com)
  • 1] The success of the Harrington rod system with deformity correction led to its subsequent use for treatment of overt spinal instability (eg, post-traumatic instability). (medscape.com)
  • In their widely-quoted work, White and Panjabi defined spinal stability as the ability of the spine under physiological loads to limit patterns of displacement so as to not damage or irritate the spinal cord and nerve roots and, in addition, to prevent incapacitating deformity or pain due to structural changes. (medscape.com)
  • In addition, once such patients develop PSVA, they often experience unbearable severe pain, spinal deformity and loss of stability, and neurological deficits. (biomedcentral.com)
  • Surgery for treatment of spinal tuberculosis is divided into anterior, posterior and combined anterior and posterior approaches, such as: anterior debridement and bone grafting, anterior debridement and bone graft internal fixation, anterior debridement and bone graft combined with posterior internal fixation, and simple posterior Road lesion removal, bone grafting and internal fixation. (medicaltrend.org)
  • 6. Does spinal tuberculosis need bone grafting and internal fixation? (medicaltrend.org)
  • At this time, bone grafting and internal fixation are required to restore spinal stability. (medicaltrend.org)
  • Bone graft fusion and internal fixation is an important method for spinal tuberculosis surgery. (medicaltrend.org)
  • From January 2015 to June 2020, a total of 62 patients presenting with lumbar Brucella spondylitis underwent either one-stage posterior pedicle fixation, debridement, and interbody fusion (Group A, n = 33) or anterior debridement, bone grafting, and posterior instrumentation (Group B, n = 29). (bvsalud.org)
  • Secure spinal fixation using an innovative dual-trajectory technique in patients with osteoporosis: Surgical technique and case series. (cgmh.org.tw)
  • Surgery consisted of percutaneous fixation with pedicle screws without debridement, fusion arthrodesis, or anterior reconstruction. (surgicalneurologyint.com)
  • [2] Conversely, coagulase-negative staphylococci and Propionibacterium acnes are the most common pathogens in cases of exogenous osteomyelitis after spinal surgery, particularly with the use of spinal fixation devices. (nih.gov)
  • The surgical procedure was thorough debridement of infected tissue and material, including PMMA following anterior column reconstruction via the anterior approach and percutaneous pedicle screw fixation. (biomedcentral.com)
  • It can be caused due to spinal tuberculosis and spread along spinal ligament to involve the adjacent anterior vertebral bodies, causing angulation of the vertebrae with subsequent kyphosis. (wikipedia.org)
  • Even with anti-tuberculosis treatment, progressively worsening kyphosis may still occur over time, and the patient slowly develops symptoms of paralysis. (medicaltrend.org)
  • This invaluable experience equipped him with specialized skills in pediatric spinal surgeries, e.g. like scoliosis and kyphosis, expanding the breadth of his expertise. (mumbaispineclinic.com)
  • 1 - 8 Anterior approaches may lead to shorter segment fusions, reduced operative blood loss, and reduced cost, and improved kyphosis restoration. (vermaspine.com)
  • Occasionally, when kyphosis is more severe, a spinal brace or rest with recumbency on a rigid bed is indicated. (msdmanuals.com)
  • [4] Circumferential reconstruction alongside adequate debridement and decompression, exclusively via the posterior approach, is one of the surgical treatment modalities in the management of spinal tuberculosis. (archintsurg.org)
  • In addition to the complicated anatomy of the neck, such as dense blood vessels, nerves, thyroid gland, trachea, esophagus, etc., this type of cervical tuberculosis debridement operation is of high difficulty also due to the fragility of the cervical spine and the destruction of tuberculosis. (liweinlp.com)
  • The most common primary spinal infection is pyogenic vertebral osteomyelitis. (wheelessonline.com)
  • Differential diagnosis of the clinical syndrome and spinal lesion seen in our patient includes other forms of bacterial osteomyelitis and metastatic cancer. (uab.edu)
  • Vertebral osteomyelitis (additionally referred to as spinal osteomyelitis or spondylodiskitis) accounts for approximately 3% to 5% of all cases of osteomyelitis annually. (nih.gov)
  • This retrospective study aimed to compare the clinical efficacy of the posterior procedure with the combined anterior and posterior procedure in the surgical management of lumbar Brucella spondylitis. (bvsalud.org)
  • tuberculosis: Clinical and biologic study. (edu.pk)
  • Currently, more than 2 billion people (ie, one third of the world's population) are infected with tuberculosis (TB), 10% of whom develop clinical disease, and 1.4 million of whom die of the disease annually. (medscape.com)
  • Although both anterior and posterior spinal approaches have been indicated for the surgical correction of AIS and have comparable clinical and radiographic outcomes, each approach has advantages. (vermaspine.com)
  • Although posterior approaches have the advantage of being familiar and minimally disrupt the chest cage, anterior and video assisted thoracoscopic surgical release (VATS) procedures offer clinical benefi ts for patients with AIS. (vermaspine.com)
  • In atypical cases, generalized skeletal dysplasia must be excluded by x-ray skeletal survey, and, if suspected on clinical grounds, spinal tuberculosis must be excluded by CT or MRI. (msdmanuals.com)
  • All prospective tissue and organ donors should be routinely assessed for tuberculosis risk factors and clinical findings. (cdc.gov)
  • Certain atypical clinical and radiological presentations of spinal tuberculosis are described infrequently. (perujournalneurosurgery.org)
  • In this setting, clinical practice is guided by an understanding of the principles of spinal biomechanics and knowledge of the generally accepted indications, contraindications, and controversies regarding fusion surgery. (medscape.com)
  • Due to the insensitivity of the body's reaction ability in the elderly, the early clinical symptoms are not typical, and the imaging findings are easily confused with spinal tuberculosis. (scirp.org)
  • Brown-Séquard syndrome is an incomplete spinal cord lesion characterized by a clinical picture reflecting hemisection injury of the spinal cord, often in the cervical cord region. (medscape.com)
  • As an incomplete spinal cord syndrome, the clinical presentation of Brown-Séquard syndrome may range from mild to severe neurologic deficit. (medscape.com)
  • Spinal cord anatomy accounts for the clinical presentation of Brown-Séquard syndrome. (medscape.com)
  • The comparison between anterior and posterior approaches for removal of infected lumbar interbody cages and a proposal regarding the use of endoscope-assisted technique. (cgmh.org.tw)
  • Lateral spinal x-rays confirm the diagnosis of Scheuermann disease by showing anterior wedging of ≥ 5° of 3 or more consecutive vertebral bodies, usually in the lower thoracic and upper lumbar regions. (msdmanuals.com)
  • Retroperitoneal fibrosis (RPF) is a form of chronic periaortitis characterized by the development of extensive fibrosis throughout the retroperitoneum, typically centered over the anterior surface of the fourth and fifth lumbar vertebrae and resulting in entrapment and obstruction of retroperitoneal structures, notably the ureters. (medscape.com)
  • Evaluating for a sensory level using a pin to detect pain sensation is more sensitive to detect a spinal level originating from a lesion in the spinothalamic tract. (emcrit.org)
  • Motor weakness may be used to evaluate the level of a spinal lesion that involves the corticospinal tract. (emcrit.org)
  • Thus, a central spinal cord lesion may cause neurologic deficits in a descending order. (emcrit.org)
  • Some patients with spinal tuberculosis cause bone destruction of the vertebral body, loss of spinal stability, or large bone defects after surgical removal of the lesion. (medicaltrend.org)
  • In view of the patient's condition, because the lesion is located in the upper thoracic spine, the front of the spinal cord is compressed significantly, and only indirect decompression through the rear, the surgical effect is extremely limited. (medicaltrend.org)
  • Although other minimally invasive procedures such as nucleoplasty, nucleolysis, or percutaneous rhizotomies had already been used since the 2000s, it was not until 2011 that endoscopy was used for the first time in a standardized manner in spinal surgery with the endoscope as the only element of vision, successfully resecting a vertebral lesion. (perujournalneurosurgery.org)
  • Spinal infection may be defined as an infectious disease that affects the vertebral body, the intervertebral disk, or adjacent paraspinal tissue. (medscape.com)
  • Before the development of antibiotics and bacteriology, little knowledge was added to the basic understandings of the Hippocratic school until Servino and Potts characterized and described the pathology of tuberculosis infection of the spine. (medscape.com)
  • Although successful treatment of spinal abscess with surgical drainage was reported early on, the high complication rate from secondary infection caused this surgery to remain in poor favor. (medscape.com)
  • Three major routes of spread are: (1) hematogenous spread from a distant infection, (2) direct inoculation from trauma, (3) direct inoculation following invasive spinal diagnostic procedures and from spinal surgery. (wheelessonline.com)
  • Infection of spine occurs due to tuberculosis, atypical tuberculosis, pyogenic, fungal and parasitic infestation (e.g.hydatid cyst). (ijsonline.co.in)
  • Skeletal tuberculosis is thought to result from hematogenous dissemination from a primary site and occurs 6 months to 3 years after primary infection. (uab.edu)
  • One-stage posterior approaches for treatment of thoracic spinal infection: Transforaminal and costotransversectomy, compared with anterior approach with posterior instrumentation. (cgmh.org.tw)
  • the paralysis is caused by localized infection of the anterior horn cells of the spinal cord, resulting in signs and symptoms similar to poliomyelitis. (cdc.gov)
  • When the recipients are persons without previous natural contact with M. tuberculosis, the infectious process is denominated primary infection. (tuberculosistextbook.com)
  • Treatment is usually bracing and anti-tuberculosis antibiotics in the absence of neurological defects or mechanical instability. (orthobullets.com)
  • The bone is damaged and the supporting force is reduced, causing the instability and collapse of the anterior column. (medicaltrend.org)
  • Radiologic evaluation is used to confirm the diagnosis and estimate the degree of spinal instability. (boneandspine.com)
  • Spinal fusion and instrumentation were developed and applied as independent techniques for treatment of spinal instability in the first half of the 20th century, before the biomechanical principles surrounding spinal instability were understood. (medscape.com)
  • However, it soon became apparent that the application of spinal instrumentation (without fusion) for treatment of spinal instability often ended in breakage or loosening of the hardware (hardware failure). (medscape.com)
  • Strictly defined, spinal fusion is an operation designed to treat spinal instability. (medscape.com)
  • The first step towards diagnosis and therapy is recognizing that the patient has some sort of spinal cord pathology. (emcrit.org)
  • tuberculosis in developed countries: Difficulties in diagnosis. (edu.pk)
  • Early diagnosis of spinal tuberculosis by MRI. (edu.pk)
  • Diagnosis of tuberculosis using colorimetric gold nanoparticles on a paper-based analytical device. (cgmh.org.tw)
  • Fluorescent double-stranded DNA-templated copper nanoprobes for rapid diagnosis of tuberculosis. (cgmh.org.tw)
  • Smartphone-assisted fluorescent analysis of polyT-Cu-nanoprobes using nucleic acid amplification test for the diagnosis of tuberculosis. (cgmh.org.tw)
  • Diagnosis is with spinal x-rays. (msdmanuals.com)
  • Using data from the National Tuberculosis Surveillance System, we identified all cases of tuberculosis during 2011 to 2019 that were reported as occurring among individuals incarcerated in a state prison at the time of diagnosis. (cdc.gov)
  • He continued anti-tuberculosis treatment for half a year and recovered well. (liweinlp.com)
  • [ 2 ] It can develop from direct open spinal trauma , from infections in adjacent structures, from hematogenous spread of bacteria to a vertebra, or postoperatively. (medscape.com)
  • Following the introduction of antisepsis, surgical intervention for spinal infections became feasible. (medscape.com)
  • The initial procedure introduced for the surgical treatment of spinal infections was a laminectomy. (medscape.com)
  • Spinal infections can also develop postoperatively and most often develop secondary to direct inoculation of the wound. (wheelessonline.com)
  • This chapter describes both primary and post-operative spinal infections. (wheelessonline.com)
  • Primary spinal infections are described as infections of the vertebrae that are not secondary to an operation. (wheelessonline.com)
  • Spine infections are rare infections that can involve the intervertebral disc space (discitis), the vertebral bones, the spinal canal or adjacent soft tissues. (wheelessonline.com)
  • Comparison of the Efficacy of Hyperbaric Oxygen Therapy in Patients with Postoperative Spinal and Extremity Wound Infections. (cgmh.org.tw)
  • All patients with postoperative spinal infections between January 2010 and July 2020, who primarily underwent VA, were examined after obtaining approval from the institutional review board of the hospital. (biomedcentral.com)
  • Gross anterior angulation of the vertebral column at the L2-L4 level [see images at right, A & B] with overlying skin ulcer. (uab.edu)
  • The spinal or vertebral column. (lookformedical.com)
  • In addition, tuberculosis lesions cause damage to the vertebral body. (medicaltrend.org)
  • Spinal column affection by neoplastic lesions include primary (benign or malignant ) or secondary metastasis. (ijsonline.co.in)
  • Chest X-ray (see Image at right) shows apical lesions consistent with pulmonary tuberculosis. (uab.edu)
  • The spinal lesions of advanced brucellosis include bridging osteophytes, simultaneous with the presence of both osteoblastic lesions and loss of bony mass in the same vertebrae [see Gorgas Case 2001-02 ]. (uab.edu)
  • Discitis occurs post-surgically in approximately 1-2 percent of patients after spinal surgery. (wikipedia.org)
  • When does spinal tuberculosis need surgery? (medicaltrend.org)
  • The purpose of spinal tuberculosis surgery is to remove tuberculosis foci, relieve nerve compression, rebuild spinal stability, save nerve function and rebuild spinal stability as much as possible. (medicaltrend.org)
  • Surgery requires direct removal of ventral compression of the spinal cord. (medicaltrend.org)
  • The Textbook of Spinal Surgery. (edu.pk)
  • Effects of Strontium Ranelate on Spinal Interbody Fusion Surgery in an Osteoporotic Rat Model. (cgmh.org.tw)
  • Dr. Sharma practices at best hospitals for spine surgery in Mumbai, equipped with state-of-the-art facilities and the latest advancements in spinal treatment techniques. (mumbaispineclinic.com)
  • Patients with prior spinal surgery or asthma were excluded from the study. (vermaspine.com)
  • Eagle M, Bourke J, Bullock, R, Gibson MJ, Mehta JS, Giddings D, Straub V, Bushby K. Managing Duchenne muscular dystrophy - The additive effect of spinal surgery and home nocturnl ventilation in improving survival. (mehtaspine.co.uk)
  • Mehta JS, Gaines RW Jr. Anterior surgery in spinal pathology. (mehtaspine.co.uk)
  • they cannot bear the trauma caused by one-stage anterior and posterior surgery. (biomedcentral.com)
  • Most spinal diseases can be treated via a single surgical approach with the familiarity of spinal anatomy and the highly developed surgical instruments related to spinal surgery. (biomedcentral.com)
  • In the past 3 decades, increased understanding of spinal biomechanics, proliferation of sophisticated spinal instrumentation devices, advances in bone fusion techniques, refinement of anterior approaches to the spine, and development of microsurgical and minimally invasive methods have made it possible to stabilize every segment of the spine successfully, regardless of the offending pathology. (medscape.com)
  • Accordingly, use of spinal fusion and instrumentation has increased. (medscape.com)
  • Around this time, spinal instrumentation, which mostly consisted of wiring of posterior elements, was employed sporadically for treatment of spine fractures. (medscape.com)
  • Harrington later expressed the idea that there is a "race between instrumentation failure and acquisition of spinal fusion. (medscape.com)
  • Imaging: MRI of D/L spine with screening of whole spine shows T1 hypo & T2 hyperintense signal change with heterogenous contrast enhancement at D4 & D5 vertebral bodies and intervening intervertebral disc with almost complete collapse of D5 vertebral body with similar signal intensity pre and para vertebral soft tissue swelling at the same level with epidural extension causing spinal canal stenosis with cord compression and bilateral nerve root compression. (jmedcasereportsimages.org)
  • No cases of tuberculosis, congestive heart failure, lupus-like symptoms, or demyelinating disease were reported. (bmj.com)
  • Some spinal tuberculosis abscesses will penetrate the skin to form a fistula, puncture organs or blood vessels, and form corresponding complications, which will cause great damage to the patient and a high rate of disability and teratogenesis. (medicaltrend.org)
  • In the early stage, patients without severe bone destruction, giant abscesses and nerve tissue compression can be cured with anti-tuberculosis drugs. (medicaltrend.org)
  • Spinal tuberculosis accounts for almost 50% of all skeletal involvements. (archintsurg.org)
  • The spine is the most common site of skeletal tuberculosis as it accounts for almost 50% of all musculoskeletal involvements amongst the rather less common extra pulmonary manifestations of the disease. (archintsurg.org)
  • Tuberculosis of skeletal system, 2nd ed. (edu.pk)
  • Spinal TB accounts for more than 50% of all skeletal cases. (uab.edu)
  • Note that the spinal cord level doesn't line up precisely with the corresponding vertebrae, especially caudal to the thoracic spine. (emcrit.org)
  • However, the front decompression of the thoracic spine via the posterior approach makes the operation extremely difficult and the risk of spinal cord injury during the operation is extremely high. (medicaltrend.org)
  • Tuberculosis of the thoracic spine: A classification based on the selection of surgical strategies. (mehtaspine.co.uk)
  • If not treated in time, the entire vertebral body and its appendages will be destroyed, leading to spinal deformities, even compressing the spinal cord and causing paralysis. (medicaltrend.org)
  • OBJECTIVE: Mid-thoracic spinal tuberculosis is prone to kyphotic deformities and neurologic impairment. (bvsalud.org)
  • There, he immersed himself in the intricacies of degenerative spine problems and became proficient in surgically correcting spinal deformities, including complex conditions. (mumbaispineclinic.com)
  • Spinal misalignment is predominantly kyphotic but is sometimes partly scoliotic. (msdmanuals.com)
  • We aimed to compare the therapeutic efficacy of three bone graft struts, for anterior and middle column reconstruction through a posterior approach in cases of mid-thoracic spinal tuberculosis. (bvsalud.org)
  • Tuberculosis destroys the vertebral body and leads to pathological fractures. (medicaltrend.org)
  • The first seven VERTEBRAE of the SPINAL COLUMN, which correspond to the VERTEBRAE of the NECK. (lookformedical.com)
  • The bacilli may then seed to the central nervous system (CNS) and result in three forms of CNS TB: tuberculous meningitis, intracranial tuberculoma, and spinal tuberculous arachnoiditis. (medscape.com)
  • For patients requiring a fusion procedure, the use of growth factors for the induction of spinal fusions is a theoretically attractive approach. (medscape.com)
  • The study involved 1975 cataract patients and showed that the mean corneal curvature was negatively correlated with axial length (AL), while anterior chamber depth and white-to-white were positively correlated with AL. (uwi.edu)
  • METHODS: Hundred and thirty seven patients with thoracic spinal tuberculosis who had undergone a posterior approach from June 2010 to December 2018 were enrolled. (bvsalud.org)
  • Methods: During the period from 2005 to 2012, 336 patients of spinal tuberculosis wereadmitted in Department of neurosurgery, Liaquat University Hospital, Jamshoro. (edu.pk)
  • All 44 patients underwent decompression through anterior cervicalapproach followed by fusion with iliac bone graft and then stabilization with titanium locking plate.Results: There were 20 males and 24 females. (edu.pk)
  • The goal of this study is to present the outcomes of endovascular treatment performed on a group of patients diagnosed with ruptured aneurysms in the anterior communicating artery . (perujournalneurosurgery.org)
  • Less than 1/3rd of patients present with posterior uveitis without anterior involvement. (aao.org)
  • Posterior approach can effectively restore the spinal stability by reconstructing the anterior and middle spinal columns. (bvsalud.org)
  • Anterior cruciate ligament deficiency causes brain plasticity: a functional MRI study. (orthopatras.gr)
  • Interruption of the lateral corticospinal tracts, the lateral spinal thalamic tract, and at times the posterior columns produces a picture of a spastic, weak leg with brisk reflexes and a strong leg with loss of pain and temperature sensation. (medscape.com)
  • Nationwide tuberculosis outbreak in the USA linked to a bone graft product: an outbreak report. (cdc.gov)
  • We investigated a tuberculosis outbreak in the USA linked to a bone graft product containing live cells derived from a single deceased donor. (cdc.gov)
  • INTERPRETATION: Donor-derived transmission of M tuberculosis via bone allograft resulted in substantial morbidity and mortality. (cdc.gov)
  • The operation continued, exposing the focus of cervical vertebra 5 by anterior approach, I removed the dead bone, scraped off the granulation of tuberculosis, flushed the pus cavity, inserted streptomycin and isoniazid, put the drainage piece in, with suture. (liweinlp.com)
  • presumed pulmonary tuberculosis. (uab.edu)
  • The use of anterior approaches for spinal fusion for the treatment of adolescent idiopathic scoliosis (AIS) has been debated because of the concern that pulmonary function is compromised with procedures that violate the chest wall. (vermaspine.com)
  • Later, Hodgson et al extensively reported this procedure in the treatment of tuberculosis of the spine. (medscape.com)
  • Whereas Hodgson et al performed fusions from the anterior approach, Hibbs et al independently presented techniques for posterior spinal fusion in the treatment of spinal tuberculosis. (medscape.com)
  • The treatment of spinal tuberculosis. (edu.pk)
  • 7 ] We found 25 reports of spinal TB related to intravesical administration of BCG vaccine for the treatment bladder cancer. (surgicalneurologyint.com)
  • All 105 living recipients started treatment for tuberculosis disease at a median of 69 days (IQR 56-81) after product implantation. (cdc.gov)
  • Endovascular treatment with coils of aneurysm of the anterior communicating artery, angiographic control, and evolution according to packing density: case series. (perujournalneurosurgery.org)
  • Undiagnosed progression to severe disease leads to spinal cord compression and neurologic deficit. (uab.edu)
  • The operation may be one of the effective treatments if the patient suffers from intolerable severe pain, neurological deficits, and damage to spinal stability. (biomedcentral.com)
  • The dens articulates anteriorly with the anterior arch of the atlas, and posteriorly with the transverse ligament of the atlas. (boneandspine.com)
  • Therefore, a sensory level to light touch may be absent unless both of these are involved (e.g., a complete injury that involves all spinal cord tracts). (emcrit.org)
  • Tuberculosis, syphilis, leprosy may produce granulomas with scanty bleeding. (tandurust.com)
  • In sheehan syndrome, which may be misinterpreted as anterior wall of the heart rate is within hour of receiving a long-term goal, but problems of being important causes of torticollis include spinal cord compression. (elastizell.com)
  • Brown-Séquard syndrome results from damage to or loss of ascending and descending spinal cord tracts on 1 side of the spinal cord. (medscape.com)
  • Brown-Séquard syndrome can be caused by any mechanism resulting in damage to 1 side of the spinal cord. (medscape.com)
  • Recognizing the significance of comprehensive spinal care, Dr. Sharma dedicated an entire year to exclusive pediatric orthopaedic work at Children's Hospital in New Orleans, USA . (mumbaispineclinic.com)