Neuro Interventional Radiology

Medical technology with its quantum growth has changed the very facet of healthcare. Interventional neurovascular radiology in keeping with this advancement, has altered the approach of cerebrovascular disease management. Our Interventional Neurovascular Radiology Department at The Kauvery Institute of Orthopaedics and Neurosciences is au courant in knowledge, expertise and equipment, to better serve our patients under our care.

Our specialist interventional neurovascular radiologists use a minimally invasive technique to diagnose and manage neurovascular diseases and spine disorders. Interventional neurovascular radiological procedures provide an alternative to traditional surgical procedures, for disorders such as strokes, cerebral aneurysms and back pain. Our radiologists also use the most advanced imaging systems to provide evaluations, diagnosis and treatment options for a gamut of neurological disorders.

Our specialized and expert interventional neurovascular radiologists focus solely on the specific conditions pertaining to the brain and the spinal cord. They are accomplished in the use of image-guidance procedures and our specialists are on call 24x7, 365 days of the year. Our interventional neurovascular radiologists work in tandem with our multidisciplinary team at The Kauvery Institute of Orthopaedics and Neurosciences to provide the best care and treatment to patients afflicted with neurovascular disorders.

Interventional Neurovascular Radiology is also known by these various terminologies:

  • Interventional Radiology (IR)
  • Vascular Interventional Radiology
  • Surgical Radiology

Interventional Neurovascular Radiology until recently was a sub-specialty. Now as an independent specialty, it involves minimally invasive, image-guided procedures to diagnose and treat neurovascular disorders. Our range of services include:

  • Stroke-Mechanical thrombectomy
  • Brain aneurysm coiling
  • Brain AVM embolization
  • Head and neck tumour preoperative embolization
  • Spinal vascular malformation embolization
  • Carotico-cavernous fistula embolization

Stroke-Mechanical Thrombectomy

Mechanical Thrombectomy is a contemporary, neurovascular, interventional radiological procedure developed for treatment of embolic stroke. The interventional mechanical treatment of stroke involves use of devices such as catheters and stent retrievers. This is a very safe and quick result oriented treatment, offered by only 6 renowned hospitals in Chennai, of which The Kauvery Institute of Orthopaedics and Neurosciences is one.

Our specially trained and skilled interventional neurovascular radiologists perform this procedure, using small wires and micro-catheters, measuring 0.0254 in diameter, to deliver thrombus dissolving medications, right into the blood clot. The immediate outcome of this procedure is that blood flow is immediately resumed. In comparison to pharmaceutical thrombolytic medications which take anywhere from 2 hours or more, to dissolve a blood clot, the mechanical thrombectomy effect is immediate. This procedure can be performed on a patient suffering from acute thromboembolic stroke, if brought into our hospital within 6 hours of the attack.

Our Interventional Neurovascular Radiology Department is equipped with some of the most avant-garde mechanical thrombectomy devices and our neurovascular radiologists have all been trained to use them expertly. Since the 1980s and 1990s, traditional surgery was not considered as the best optionas there were more risks involved and ever since then removing blood clots from the brain in patients suffering from ischemic strokes, through mechanical thrombectomy, has been by this new modality.

Catheter Directed Thrombolysis

Any interventional treatment involves minimally invasive procedures. Likewise the catheter directed thrombolysis, is a procedure where very small incisions are made, as opposed to the large incisions that are required in traditional surgery. This catheter directed thrombolysis treatment acts to dissolve aberrant blood clots in blood vessels (arteries and veins), in order to boost the flow of blood and prevent tissue and organ damage. An attack of stroke, if left untreated can culminate in dire consequences.

Before undergoing the minimally invasive operation, a blood test will be done to check whether your blood clots normally. The treating doctor should be informed of all medications, such as blood thinners and other medications taken by the patient, who is undergoing the treatment. This is an inpatient procedure and prior to the treatment the Interventional Neurovascular Radiologist (INR) will first perform an angiogram. After studying the angiogram, our specially trained neurovascular nurses or technologists will start an IV with moderate sedation. Using our state-of-the-art image guided systems (fluoroscopy or live x-ray), our Interventional Neurovascular Radiologist will insert a catheter into the femoral artery, after making a tiny incision, and will advance the catheter to the region where the embolus is present. A clot dissolving medication is then injected through another smaller catheter that is inserted into the first catheter. The medication is directly delivered to the embolus. This is a quick procedure (completed within an hour) and does not involve long hospital stays.

Stent Retrievers in Mechanical Thrombectomy

Another device that our Interventional Neurovascular Radiology department at The Kauvery Institute of Orthopaedics and Neurosciences uses, is the stent retriever. These devices are now being increasingly used to restore and improve blood flow in acute embolic stroke patients. Stent retrievers have the capability of quickly restoring blood flow and also have the ability to retrieve large, intracranial blood clots, effectively.

A stent retriever is deployed to the distal site where the embolism is present, through a micro-catheter. The stent instantly creates a channel (a temporary bypass), to improve the blood flow, while compressing the thrombus.

Brain Aneurysm Coiling

The abnormal ballooning of an artery carrying blood to the brain is an intracranial or brain aneurysm. An intracranial aneurysm is also known as a brain aneurysm or cerebral aneurysm. The surge of blood through the arteries carrying blood to the brain is at high pressure and an aneurysm develops when the arterial walls weaken, creating a bulge (an abnormality) or a balloon like structure.

Behavioral patterns of an aneurysm include:

  • Aneurysms can either inflate or apply pressure on the structures in the brain
  • If an aneurysm ruptures, the blood will seep out of the blood vessel, under high pressure, either directly into the brain or into the fluid surrounding the brain
  • Sudden and severe headache commonly
  • Sometimes stiffness of the neck may also be there, together with vomiting
  • Sensitivity to normal daylight
  • Rarely an aneurysm, can disrupt vision, causing double vision

Our Interventional Neurovascular Radiology department at The Kauvery Institute of Orthopaedics and Neurosciences provides both magnetic resonance imaging (MRI) and computed tomography (CT scan) services to scan, diagnose and treat brain aneurysms.

Discovery of aneurysms that are yet to rupture are generally found when a patient undergoes a CT scan or MRI procedure for another reason. Such aneurysms which are yet to rupture, can be treated by the coil embolization process, provided the diagnosis is favorable that the aneurysm will not rupture or pose a risk for rupturing.

In an endovascular coiling procedure or endovascular embolization, as it is otherwise known as, blood flow to the aneurysm is blocked by the insertion of a long thin tube called a catheter, into the artery located in the groin, and is then advanced forward, with the help of a fluoroscopy apparatus (live x-ray), to the artery that is affected. After the catheter is in place, a smaller tube is then passed through the catheter, into the aneurysm and a length of platinum coils are wound into the aneurysm. With the help of the live x-ray imaging system, the radiologist will continue to pack the aneurysm until it is filled up and the blood flow to the aneurysm is brought down to a trickle. Slowly the blood starts to clot around the platinum coils and stops in due time. Blocking the blood flow from entering the aneurysm, will prevent it from leaking or rupturing. This procedure normally takes around 2 or 3 hours.

An endovascular embolization is a minimally invasive procedure and does not need to be a surgical procedure.

The advantage of undergoing an endovascular embolization procedure as against an endovascular aneurysm clipping, is that the skull need not be operated upon, consequently saving on hospitalization and recovery time, which is shorter than that involved in traditional surgery. Whether a patient is qualified to undergo this procedure, however, will depend on the patient’s medical history and other factors.

During an evaluation and diagnostic endovascular coiling procedure, our skilled Interventional Neurovascular Radiologists may also use some of our other state-of-the-art equipment (apart from the Fluoroscopy), such as, an electroencephalogram (EEG), cerebral arteriogram, magnetic resonance imaging (MRI), Doppler Ultrasound, Computed Tomography (CT scan), Positron Emission Tomography (PET scan) and X-rays of the skull and craniotomy.

Brain AVM Embolization

Brain AVM or Arteriovenous Malformations are the result of birth defects in the brain’s circulatory system, that are formed during the embryo or fetal stage.

Blood vessels called the arteries supply oxygenated blood to the different parts of the body and the brain. The blood flow through the arteries is pumped at high pressure. The de-oxygenated blood is taken away by the venous system (part of the circulatory system) back to the heart to be re-oxygenated. The blood that flows back into the veins is at a much reduced pressure in comparison to the pressure in the arteries. The walls of the arteries are thick to withstand the high pressure of the blood being pumped through it and the walls of the veins are thin, as they do not have to withstand the same pressure as the arteries. The arteries further branch out into smaller tubes called the capillaries, which carry the blood to the cells. As the blood flows through the capillaries, the pressure of flow slows down and by the time it reaches the veins the pressure is adequately adjusted for the veins to bear.

In an arteriovenous malformation, the capillaries that connect the arteries and veins in the brain are absent and much larger vessels connect the arteries and the veins, consequently there is no bridge to slow down or block the high flow of pressure of blood into the veins. These larger vessels that are in place of the capillaries are called shunts and the network of shunts is called the nidus. Though the nidus replaces the capillary network, it does not function in the same way as the capillary network and therefore the veins experience the same high pressure of blood flow as the arteries do. Since the walls of the veins are thin, the flow of blood at a higher pressure ruptures the walls of the vein and causes a leak or bleeding in the brain. This bleeding is referred to as hemorrhagic stroke.

There are no known reasons for the formation of arteriovenous malformations. They do occur during the fetal and embryonic stage, but do not cause any bleeding in a newborn generally, though there have been some rare cases. It occurs equally in both men and women and is considered to be hereditary.

If left untreated, a hemorrhagic stroke can cause death or lead to other visible disabilities such as, neurological disorders like vision or speech problems, numbness or weakness of parts of the body and seizures. Excessive bleeding can even lead to death.

The onset of a sudden and severe headache generally is the precursor to an AVM, accompanied by nausea and vomiting. A Computed Tomography or CT scan will be performed to evaluate and diagnose the presence of an AVM. Once the presence of an AVM is confirmed, then an angiography and an MRI is performed to further localize the exact region the AVM is present in.

An AVM can be treated in three ways, by surgery, radiation or by neuro-endovascular embolization. The neuro-endovascular embolization is performed by our experienced interventional neurovascular radiologists, by blocking the malformed nidus. Our radiologists will perform an angiogram, which is not a surgical procedure, but a minimally invasive procedure. It is performed by inserting a small plastic tube or catheter into the femoral artery or through the groin, and navigated through into the shunts of the AVM. An injection is administrated through the catheter to block the shunts. Since the shunts are merely connections between the arteries and the veins they do not serve any real purpose, consequently blocking them will not adversely affect the patient.

Head and Neck Tumour Preoperative Embolization

Tumours or carcinoma growth in the brain and neck are supplied with a large amount of blood. Before performing any surgical procedures on a patient diagnosed with brain or neck tumour, draining the blood out from the tumours will prevent bleeding and any risks that could possibly arise, during surgery. A planned blockage or embolization of the blood vessels helps the neurosurgeon to expeditiously execute the surgical procedure and also the embolization procedure averts the necessity for blood transfusion, during the surgical procedure.

The head and neck tumourwherepreoperative embolization procedure is performed:

  • Meningiomas (tumours that occur on the covering or meninges of the brain)
  • Glomus tumours or paragangliomas (tumours that occur on the nerves of the head and neck)
  • Juvenile nasopharyngeal angiofibromas (tumours of the nose)
  • Tumours of the spinal column (vertebral column)

Head and neck malignancies

Preoperative embolization procedures are also performed on other types of tumors such as:

  • Hypervascular Metastases
  • Schwannomas
  • Esthesioneuroblastomas
  • Plasmacytomas
  • Hemangiopericytomas
  • Chordomas
  • Rhabdomyosarcomas

Our experienced and comprehensive team of interventional endovascular radiologists, neurologists, neurosurgeons, physicians, specialists and other care givers coordinate to provide the best preoperative evaluations and treatment plans for patients diagnosed with head or neck tumours.

Our multidisciplinary approach is the key to our multiple success in providing analytical and treatment strategies. We ensure that we carry out a detailed clinical examination and pre-surgical diagnosis.

Pre-procedure, a contrast is enhanced through CT or MRI, to gather information on the bone, soft tissue and lesion locale. Prior to any intervention, a detailed angiography is done and the catheter selected.These steps ensure that the location of the tumour and the surrounding cells and blood vessels is compartmentalized. This helps to potentially identify dangerous anastomosis between the blood vessels supplying the tumour and the lesion itself.

Priorto surgery, our interventional radiologists will insert a catheter into the femoral artery (artery in the upper leg/ thigh region) and another catheter, smaller in dimension than the first catheter, is inserted into the larger catheter and is threaded up through the artery or arteries that are feeding the tumour with blood. An appropriate embolic material is injected, under continuous fluoroscopic guidance to clog the blood supply to the tumour. This procedure of blocking or clogging the blood supply is called embolization.

There are many different types of embolic material available and depending on the type of tumour, the size of the tumor’s blood vessel, and where the tumor is located, an embolic material will be used. A preoperative embolization is generally performed a few days (24-72 hours) prior to the planned surgery, so that a paramount thrombosis of the blocked blood vessels develops and therefore cannot re-canalize or form collateral arterial canals.

In cases where the blood supply needs to be blocked off from tumours on the bones of the spine, a needle is inserted directly into bone where the tumour is located and embolic material is injected to arrest the blood supply or even to annihilate the tumour.

Embolic materials generally used in a preoperative embolization procedure are:

  • Embospheres (BioSphere Medical, Rockland, Mass)
  • Polyvinyl alcohol (PVA)
  • Liquid embolic agents (glue, ethylvinyl alcohol copolymer or EVOH)
  • Irvine
  • Onyx or ev3
  • Gel foam, Uppsala,Phadia, Sweden – gelatin sponge

Spinal Vascular Malformation Embolization

The spinal cord in the central nervous system is the extension of the brain, connecting the nerves from the brain to the different parts of the body. Malformations in the human body’s network of blood vessels is caused when the arteries and veins are directly connected instead of through a network of capillaries that temper the flow of blood between the arteries and veins. Vascular malformations in the spine either encompass the spinal cord, the vertebrae or bones of the spine, the tissues surrounding the spinal cord within the spine, the soft tissue around the spinal column or sometimes it could be a combination of any one of these. Vascular malformations in the spine or around the spine can cause severe medical disorders such as weakness of the spine or in serious cases paralysis of the limbs partially or fully. Bleeding or hemorrhaging internally in the spine, or a stroke in the spinal cord, because of the presence of AVMs or DAVFs, can lead to abrupt or progressive loss of movement of the limbs which could be either temporary or permanent paralysis. Sometimes abnormal tingling sensations or total loss of any sensation in the limbs can also be experienced. In some cases loss of bladder and bowel control can be experienced, due to the presence of an AVM or DAVF.

If such abnormalities are left untreated, in the advanced stages it could lead to permanent disability or in rare cases, death.

Whether it is an AVM (Arteriovenous Malformation) or a DAVF (Dural Arteriovenous Fistula, the malformed connections between the arteries and veins in the spinal column), both these conditions are abnormal.

It is yet to be discovered as to why these abnormalities occur in the human system. However, it is supposed that these arteriovenous malformations or dural arteriovenous fistula are congenital or inherited in certain people which at some stage manifests itself. Arteriovenous malformations are known to occur in older children and adults who are less than 50 years of age.

AVMs and DAVFs are either treated by embolization or by a combination of embolization and open or traditional surgery. The embolization procedure is a minimally invasive procedure or keyhole procedure. It is performed through a very small incision, the size of a keyhole and with the visual aid of a fluoroscopy (live x-ray). Special tiny coils, or sand like particles, or medical grade glue is directly injected into the nidus (abnormal canals) to occlude it.

The procedure itself involves the placement of a catheter (a plastic tube of tiny dimensions) inside the femoral artery, guided by an image guidance system (fluoroscopy or live x-ray), to ensure that the catheter is in the spot where the AVM or DAVF is, before treating the AVM or DAVF, with coils or glue particles.

Before scheduling a vascular malformation embolization procedure, an angiogram will be performed by our interventional neurovascular radiologists, in order to pictograph a roadmap of the exact location of the vascular abnormality, the surrounding soft tissues, the location of the adjacent blood vessels and nerves.

To perform an angiogram, a catheter is threaded through the femoral artery. A contrast or substance containing iodine, called iodinated contrast, is injected through the catheter to highlight the blood vessels on the x-ray images. Once the radiologist has studied the angiogram, , the embolization procedure is planned.

Carotico- Cavernous Fistula Embolization

Carotico or Carotid Cavernous Fistula (CCF), are similar to vascular abnormalities that occur in the brain and spinal cord. Carotid Cavernous Fistula occurs when the internal or external arteries supplying blood to the carotid artery, the cavernous sinus and the veins, are directly connected. This is a sight robbing affliction, though not of life endangering proportions.

In a carotid cavernous fistula, the absence of the fine network of capillaries to temper down the rush of blood from the arteries (due to the high pressure of blood flow in the arteries), directly into the veins puts the veins under great strain, as the veins drain out the blood at a lower pressure than the arteries.

Diagnosis of CCF is often tricky as CCF can often present symptoms akin to conjunctivitis or any of the other ophthalmic disorders; this poses a problem as it considerably reduces the possibility of speedy diagnosis and treatment outcomes. Despite the masquerade by CCFs, at The Kauvery Institute of Orthopaedics and Neurosciences, the expertise of our interventional neurovascular radiologists have been able to achieve 100 percent results in cases where early diagnosis and repairs were made. Further in our carotico-cavernous fistula embolization procedure we make use of such advanced technology as the endoscope, which has made treatment of the CCF considerably less risky.

Carotico-cavernous fistula are of two types – direct carotico-cavernous fistula and dural arteriovenous shunts.

Direct carotico-cavernous fistula occur when there is a tear or hole in the branch of the carotid artery, internally within the cavernous sinus. This tear or hole could occur due to any one of the following reasons:

  • Trauma such as a car accident or force applied to the head with a bat or club
  • Consequences of medical treatment, iatrogenic consequence of a neurosurgical or interventional neuro-radiological procedure

A spontaneous rupture, a carotid artery aneurysm rupturing in the cavernous sinus, the abnormal connection of the cavernous sinus and one or more meningeal branches of the internal carotid artery, or the external carotid artery, or even both, cause dural arteriovenous shunts. Carotico-cavernous fistula in both the arteries is quite common. The direct origin of dural CCF as on date is not known, but is believed to originate from the tinier arteriovenous shunts present in the dura that are normal modifications. It is presumed that for some abnormal reason, the formation of new blood vessels and their proliferation, produces these shunts, which generally act as barricades in the adjacent venous dural sinuses, otherwise known as cavernous sinus.

Dural arteriovenous shunts have formed as a consequence of:

  • Systemic hypertension
  • Pregnancy
  • Atherosclerotic vascular disease
  • Any trauma on a minor scale
  • Ehlers–Danlos syndromes

Carotico-cavernous Fistula is treated with the embolization procedure at our Kauvery Institute of Orthopaedics and Neurosciences, by our specialist interventional neurovascular radiologists, in conjunction with our comprehensive team of Ophthalmologist, Neurologist, Neurosurgeons, Physicians and other specialists. The procedure involves depositing platinum coils in the abnormal shunt, thereby preventing any direct blood flow from the carotid artery to the vein.

The procedure is executed by inserting a catheter through the femoral artery and progressed to the location where the CCF is; the platinum coils are then injected through a second catheter, inserted into the first catheter. This treatment often reverses the symptoms of disability that led to the investigation in the first instance.


Neuro Critical Care

Neuro Intensive Care Units are the fastest growing critical care units in medicine today. The Neuro ICU at The Kauvery Institute of Orthopaedics and Neurosciences is a tertiary and multidisciplinary intensive care unit, outfitted to treat patients with life threatening neurological disorders and diseases of the peripheral and central nervous system. Our multidisciplinary team of specialists, work together toprovide comprehensive care to patients with frequent updates to family members. The Neuro Intensive Care is equipped to treat a spectrum of neurologic disorders and diseases, such as:

  • Acute Ischemic Strokes
  • Traumatic brain injury
  • Intracerebral Hemorrhage
  • Tumors of the brain and Spine
  • Arteriovenous Malformations
  • Encephalitis
  • Coma
  • Encephalopathy
  • Hydrocephalus
  • Meningitis
  • Neuromuscular disorders such as Myasthenia Gravis, Guillain-Barre Syndrome
  • Seizures / Epilepsy
  • Severe neurological manifestations of medical illness
  • Subarachnoid hemorrhage / brain aneurysms
  • Post-operative management of neurosurgical patients

Our team comprises of intensivists,pulmonologists,neurosurgeons, neurologists, anaesthesiologists, critical care nurses specially trained to treat neurological problems, physical therapists, occupational therapists, clinical pharmacologists and speech-language pathologist. This collective expertise allows us to impart the best treatment and healing to every single patient under our care.

The Neuro Intensive Care Unit, functions 24x7 and each of the closed units are designed to provide complete intensive care management of patients placed in emergency care for disorders such as neurology, neurosurgery, orthopaedics, spine, interventional neuroradiology and otolaryngology.

The prime advantage of care in the NICU is the 24 x 7 monitoring by the trained neuro nurses and also the immediate availability of on-call physicians, specialized interventions and neuroimaging. Thesecritical care techniques enable the experienced staff to correct or reverse any medical condition that is progressively worsening, so as to prevent any permanent brain damage.

At the Kauvery Institute of Orthopaedics and Neurosciences Neuro Intensive Care Unit, we use sophisticated techniques that are unique to neurological intensive care to monitor our patients such as:

  • Transcranial Doppler Ultrasonography
  • Intracranial Pressure Monitoring
  • Single Photon Emission Computed Tomography
  • Invasive Hemodynamic Monitoring
  • Continuous Electroencephalographic Monitoring
  • Jugular Venous Oxygen Saturation Monitoring
  • Near Infrared Spectroscopy

In a serious illness, our advanced techniques are capable of improving the patient’s prognosis, but many of these treatments to be optimally effective, must be administrated in the initial stages of the illness. Listed below are therapeutic techniques employed by our neuro intensive care unit, in the treatment of neurologic ill patients.

  • Ventricular Drainage
  • Cerebral Angioplasty
  • Endovascular GDC Coils
  • Thrombolysis
  • Hypertensive Hypervolemia Hemodilution
  • Hypothermia
  • Specialized Pharmacotherapies
  • Plasmapheresis
  • Phrenic Nerve Pacing

To surmise, the paramount goal of The Kauvery Institute of Orthopaedics and Neurosciences, Neuro Intensive Care Unit is to focus on delivering exceptional and personalised neurological care.


Pain Intervention services

Image guided injections to relieve pain, are administrated by a doctor, who injects medication using a small needle to perform a minimally invasive procedure on soft tissue, guided by direct visualization. To target the precise spot, our interventional orthopaedicradiologists use digital fluoroscopic x-ray guidance technology or ultrasound guidance techniques. Consequent to these procedures, the patient will experience relief from pain immediately, and these procedures are also of a very low risk.

24 hours Accident and Trauma care

Patients affected with the following disorders will generally benefit from undergoing our image-guidance injections:

  • Soft tissue or ligament injuries
  • Local chronic pain
  • Arthritis
  • Pain before undergoing joint replacement procedures

The areas on the body that are commonly treated are:

  • The joints such as the knees, shoulders, elbows, wrists, thumbs and ankles
  • Hips and lumbar spine

At The Kauvery Institute of Orthopaedics and Neurosciences, our interventional orthopaedicradiologists use an array of pain therapies to identify, diagnose and to treat the pain. Our treatments include:

  • Steroid (Cortisone) injections
  • Platelet-rich plasma (PRP) injections
  • Viscosupplementation injections (Hyaluronic acid - a fluid that is similar to the type of fluid found in the human musculoskeletal joints)
  • Tendon fenestration and therapy for calcific tendinopathy

The nature of our treatments explained further:

Cortisone Injection is an anti-inflammatory medication that is injected into soft tissues and joints to decrease the inflammation and to reduce the pain. The steroid is injected with the aid of a fluoroscopic x-ray or ultrasound guidance system. The conditions treated by this method include, inflammation of bursa, arthritis, and tenosynovitis (around a tendon).

In the platelet-rich plasma procedure, the patient’s own blood is used and is injected using an image guidance equipment. This is also a very effective and safe treatment used in the healing of new injuries and repairing chronic injuries. This procedure has been found to be very effective in the treatment of chronic ligament and tendon injuries. It further quickens the healing of fresh muscle or tendon injuries.

Viscosupplementation injection or hyaluronic acid is a fluid akin to the fluid present in a healthy cartilage. When injected the hyaluronic acid helps reduce the pain, improves mobility and stimulates the joints to produce more hyaluronic acid. This injection is always delivered under an image-guidance x-ray, to ensure that the medication is delivered to the exact spot, under treatment. Viscosupplementation injections are used mostly to treat osteoarthritis and the areas under treatment generally include, the shoulder, elbow, wrists, knee, hip and ankle.

Our intervention orthopaedicradiology department also offers two types of tendon fenestration and therapy for calcific tendinopathy. The process of tendon fenestration is similar to acupuncture, whereby the radiologist will make tiny jabs, using an image-guidance system, in the inflamed tendon. If needed,the radiologist will also inject steroids in the adjacent tissues to control the inflammation, subsequent to the procedure. In the therapy for calcific tendinopathy, the radiologist with the aid of an ultrasound guidance system, uses a needle to remove the excess deposit of calcium on the tendons or muscles around the joints. This extra calcium deposit impairs the movement of the joints and causes pain.


Neuro Rehabilitation

Neuro Rehabilitation (NR) is an in-depth medical program aimed at helping people suffering from diseases, injuries or disorders of the nervous system. NR is a doctor-supervised program that helps accelerate recovery, restore normal functioning, improve well-being, minimize emotional trauma and compensate for any lifestyle alterations arising from the patient’s condition.

NR covers a large number of conditions that can be classified as

  • Vascular disorders such as strokes caused by blood clots or bleeding
  • Trauma from brain or spinal cord injuries
  • Structural or neuromuscular disorders such as cervical spondylosis, Bell’s palsy, brain or spinal cord tumors, carpal tunnel syndrome, etc.
  • Infections such as polio, encephalitis and meningitis
  • Functional disorders such as dizziness, headache, seizures and neuralgia
  • Degenerative disorders such as Parkinson’s, Alzheimer’s and Huntington’s diseases

The need for NR arises from the fact that a person suffering from any these conditions, as well as his/her family members undergo a lot of disruption in their lives, and even the career in case of working individuals is affected. A NR program is holistic and aims at coping with the changes and overcoming the challenges, in order to lead a better quality of life.

Accordingly, NR programs involve various players such as the patient, his/her family members, orthopaedician/orthopedic-surgeon, neurologist/neurosurgeon, specialty doctors, psychiatrist,internist,physical therapist, rehabilitation specialists, occupational therapist, registered dietitian, social worker, speech/language therapist, psychologist/psychiatrist, recreational therapist, chaplain, audiologist, case manager, vocational counselor etc. While some sessions are conducted on an inpatient basis, most of them are on an outpatient basis.


Spine Rehabilitation

The human back and lower back is made up of various kinds of tissues such as the inter-vertebral discs, spinal muscles, ligaments, tendons and spinal nerves. Unexpected force or physical stress that comes from a fall, lifting heavy weight, or even ordinary wear and tear that comes with age can affect the health of these tissues. In the process, the person begins to experience repeated pain of the back and lower back.

In recent years, there has been a spurt in incidences of back pain and lower back pain across all age-groups. The first reaction from friends, family members and general physicians is to suggest exercise for overcoming the pain. However, the patient is not educated on the techniques and exercises that are effective in overcoming the pain. As a result, patients avoid exercising and trigger a vicious cycle of weight-gain, deterioration in condition of the affected tissues and leading to more pain.

Spine rehabilitation overcomes all these challenges. Spine rehabilitation is a holistic, doctor-supervised program that includes various activities such as manual therapy, functional training, postural correction exercises, therapeutic exercises, muscle energy techniques, mobilization techniques, lower extremity strengthening exercises, lumbar stabilization, core strengthening, stretching and flexibility exercises, etc. All these are aimed at reducing pain and restoring function. It also educates the patient on correct body posture and motion, to prevent injuries.

The contents of the program vary from patient to patient. To begin with, a physiotherapistwill thoroughly evaluate the patientand then work closely with an orthopedic physical therapist to design a customized program for the patient.


Ortho Rehabilitation

Ultrasonic Therapy

  • It speeds up the healing process by increasing blood flow in the treated area.
  • Also helps to decrease pain by reducing edema or swelling.
  • It can be used to treat injured ligaments, tendons, fascia, joint capsule and scar tissue.

Interferential Therapy (IFT)

  • Used for pain management and reduction of muscle spasm.

Mechanical Spinal Traction

  • It is indicated in the management of spinal pain when decompression of nervous, vascular or articular structures is sought.
  • Reduces the intervertebral disc herniation (cervical/ lumbar)
  • Relaxes the spinal muscles.

Electrical Stimulation

  • Intervention through the application of electricity – electrical stimulation of individual muscles is a means of providing exercise to muscles that the patient is unable to contract voluntarily.
  • It is used to activate muscle by stimulating an intact or partially intact peripheral nerve.
  • Can be used for Bell's palsy, facial nerve palsy or any other peripheral nerve injuries and to regain the muscle action.

Continous Passive Motion (CPM)

  • It is a device which continuously moves the affected joint without any assistance.
  • It is used following surgery focusing on passive range of motion and to restore mobility.
  • It improves recovery and prevents adhesions, joint stiffness or contractures.

Wax Bath

  • Moist heat is applied to ease the pain and stiffness of osteoarthritis
  • Helps loosen up the joint before exercises or joint mobilization.

Manual Therapy

Manipulation/ mobilization is used to diagnose and treat soft tissues and joint structures for the purpose of modulating pain; increasing range of motion, reducing or eliminating soft tissue inflammation, inducing relaxation, improving contractile and non- contractile tissue repair, extensibility, and or stability, facilitating movement and improving function.

Therapeutic Exercise

A broad range of activities intended to improve strength, range of motion, flexibility, cardiovascular fitness and to increase a person's functional capacity.

Home Exercise Programs

Individual home programs are written, taught and monitored closely by the therapist through the duration of one's therapy with progressive modifications that are based on the individual needs, progress and established goals.


Podiatric Clinic

Podiatry is one of the more recent specialties focused on the diagnosis, treatment and management of diseases, injuries, deformities and ailments of the feet, ankles and lower extremity or lower limb. The specialist is accordingly called a Podiatrist and at KION, our panel of podiatrists comes with a DPM or Doctor of Podiatric Medicine degree, combined with other sub-specialties in the area of Podiatric Medicine.

There are various ailments and conditions that can affect the feet, toes, ankles and soles. This includes but is not limited to:

  • Ingrown toenails
  • Corns and calluses
  • Fungal nail infections
  • Athlete's foot
  • Thickened toenails
  • Verrucas
  • Flat feet
  • Smelly feet
  • Bunions
  • Blisters
  • Heel pain
  • Ageing feet
  • Sports injuries
  • Gout
  • Dry and cracked heels
  • Warts
  • Scaling or peeling of soles
  • Painful feet

At KION, our podiatric specialists can diagnose and treat any conditions that affects thefeet or lower limbs. They will treat infections, cure the deformity, relieve any pain and help patients move about like normal people. They will also give advice on how to care for thefeet and what kind of footwear to use. They can also clip toenails, and remove any hard skin from thefeet. For athletes and sportspersons, a complete consultation is offered on how to prevent and manage recurring injuries.

KION also supplies ‘orthotics’ to help relieve heel pain or arch pain. Basically, these are custom-made insoles, arches and padding.

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