spineimageBeat the pain– have a healthy spine and brain!
The fast paced modern lifestyle has taken its toll on human body, with neck and back pains becoming an ever-increasing problem. It’s estimated that while back pain affects nearly 80 percent of the entire adult population, almost 50 percent people experience neck pain. And this in turn results in disability, high healthcare costs and loss of work days. Dr Prem Pillay – the Senior Consultant Neurosurgeon at Singapore Brain, Spine, Nerves Center located in Mt. Elizabeth Medical Center – talks on various lifestyles issues and how to keep the spine, nerves and brain perfectly healthy

QIs Singapore facing a ‘spine epidemic’?
Pillay: Whether to call it an epidemic or not but certainly the cases of spine related pain have
doubled over the last few years. Blame it on general aging of population, improper ergonomics
in the work environment or a sedentary lifestyle; I have noticed an increasing number of individuals who are desk bound executives, frequent business travelers and computer operators to be suffering from back and neck pain. What is worrisome is that more and more young people are facing such problems. This is
mainly due to excessive computer games and television, along with near absence of physical activities
for children these days.
Q What is the main reason for such spine pains?
Pillay: An important reason for such pains is the pinching of a nerve root by a disc bulge known as a ‘slipped disc’ or a ‘bony spur’. Although these may be caused by some genetic causes as well;
the external factors normally precipitate and accelerate these degenerative changes, culminating
in pain and actual weakness of arms or the feet in some cases.
Q Can this be treated effectively?
Pillay: When the problem is not severe, a course of pain killers and muscle relaxants, along with advanced physiotherapy will suffice. Modern diagnostic tests like MRI and ultrasound give a clear
picture of the possible causes of nerve pressure. In some cases, neck traction and nerve blocks are also
useful. Sometimes we recommend a neck collar or a lumber corset as a preventive measure to limit the
excessive movements and provide support. The usage of modern spine mattress is also very beneficial.
For the more severe cases – of disc rupture or narrowing of the spinal canal – involving nerve malfunctioning, surgery may be required.
Q Tell us something about these surgical procedures. Are they painful or risky?
Pillay: Fortunately, not. Nowadays, with the advancement of neurosurgery, several minimally
invasive surgical procedures are available. Various disc interventions like discoplasty and nucleoplasty are carried out, under local anaesthesia, as needle procedures with imageguidance including biplanar fluoro and 3D CT guidance. Other less invasive options include endoscopic microsurgery and microsurgical spinal decompression; which can relieve and release spinal cord, nerve root, cauda equine pressure. Another technique is dynamic implants that allow a return to more normal spinal dynamics.
Intraoperative image guidance and neuro-monitoring together with advances in microsurgery (including robotics) are also making contributions to better results and increased safety in the spinal surgery.
Q What the ‘wafers on the brain’ surgical procedure for treating brain tumors?
I believe, you were the first doctor to perform it in Asia?

Pillay: ‘Wafers on the brain’ has been the major breakthrough in treating brain tumors in over two decades. See, brain tumors are one of the most frightening forms of cancer and most people are dead within six months of diagnosis. The traditional treatment only slowed down the spread of tumor. But
now, with this new treatment, survival rate has shown marked improvement.
Firstly, six to eight biodegradable disc-shaped wafers, soaked with the anti-tumor drug carmustine,
are placed in the affected area of the brain. This is done during the surgery, after the accessible part
of the tumor has been removed. The drug is slowly released from the discs — each just 14mm
in diameter and 1mm thick – – over several weeks. It is called interstitial chemotherapy.
The wafers were developed at the Massachusetts Institute of Technology and went into use
in 1996. I was the first one to perform this procedure in Asia and the results have been very encouraging. Additionally, the new procedure also minimizes the side-effects associated with conventional chemotherapy like nausea, hair loss and drop in white blood cell count.
Q You have been a regular visitor to lesser developed countries – in terms of healthcare – to Singapore. What has been your experience so far?
Pillay: Yes, I have been fortunate enough to have visited various neighbouring countries including Indonesia, Malaysia, Philippines, Pakistan and India. And my experience says that modern lifestyle has taken its toll everywhere in terms of patient profile. But luckily in Singapore, we find growing health awareness among the general population. This along with better trained and qualified doctors may help
in countering what you called a ‘spine epidemic’.

Q What your advise to our readers for a healthy body?
Pillay: It’s very simple. Just remember that absence of disease doesn’t necessary mean that you are healthy. Incorporate some physical labour in your daily life. Encourage your children to go out
in the open and play. Take some time out to indulge in physical activities like trekking, swimming
with them. Even little things like drinking ample amount of water, which is essential for proper
hydration of muscles, will help. And most important, if you have a desk bound job, always stand
up after every 25-30 minutes, and walk around for at least 1-2 minutes, to rejuvenate yourself.

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