Dr. Sagun Tuli: A Primer on Spinal Stenosis

Spinal stenosis is a relatively common problem that occurs in many individuals as they age. In general terms, spinal stenosis is a narrowing of the spinal canal, which is an opening in each vertebra through which your spinal cord travels down from the brain to the sacrum. When this opening is narrower, it places pressure on the spinal cord and associated nerves. While stenosis can occur anywhere along the spinal canal, it is frequently seen in the lower back, or lumbar spine, and is usually caused by general aging of the body.

Many people with stenosis have no ill effects. Others may experience symptoms ranging from numbness, cramping, and tingling of the legs to bladder and bowel control problems. The symptoms of stenosis may resemble other back problems, and the condition can be detected through a variety of imaging methods, such as magnetic resonance imaging (MRI) or computerized topography (CT).

In some cases, stenosis can be alleviated with medications or physical therapy. However, in severe or persistent cases where these treatments have not helped, surgery may be the most appropriate option. As always, it is important for patients to discuss all treatment options with physicians before deciding on surgery.

About Dr. Sagun Tuli: A spinal surgeon who obtained her education at the University of Toronto and Harvard University, Dr. Sagun Tuli is a Fellow of the Royal College of Surgeons (Canada).

On the Use of Steroids for Those with Spinal Injuries

For four years, Dr. Sagun Tuli worked on a Canadian task force that conducted research on the effectiveness and safety of steroid treatment for those with spinal injuries. Many individuals with back pain have received cortisone steroid injections to help with their pain, as this kind of steroid is mainly used to decrease inflammation. Recently, however, the New York Times reported that a trial showed that even cortisone treatments used to help those with a specific condition, known as lumbosacral radiculopathy, which causes back pain, had little to no effect.

The practice of steroid use for those with back pain and spinal cord injuries has been under scrutiny for a number of years, and an orthopedic surgeon from the Mayo Clinic released a statement saying that IV steroids don’t help patients any more than placebo injections. Instead of focusing on this method, which hasn’t been found to be successful across the wide range of research projects that have been conducted in the field, the Mayo Clinic chose to focus its efforts on the study of spinal cord regeneration through tissue engineering methods.

Dr. Sagun Tuli has completed research projects in the spinal surgery sector, and she has been granted several honors and accolades for her significant achievements in this field.

About Advanced Cardiac Life Support

Many medical professionals, like Dr. Sagun Tuli, choose to continue their educational endeavors after completing medical school. Some of Dr. Sagun Tuli’s postgraduate licenses include her certification in controlled substance registration and advanced cardiac and trauma life support. There are professional several agencies that issue licensure for advanced cardiac life support, and it is defined as the medical schema doctors use to intervene when a patient is undergoing cardiac arrest and other medical emergencies that threaten the cardiovascular system.

When a doctor starts treating a patient who has undergone or is currently experiencing cardiac arrest, he or she must decide what tools to implement. Cardiopulmonary resuscitation (CPR) is vital in the early stages of cardiac arrest, and the use of a defibrillator can also increase the person’s chance of survival with minimal damage. Other issues the doctor must possess knowledge of and decide what best methods can be used to help the patient include the management of the individual’s airway, when to insert an IV into the bloodstream, and how to interpret the reading of an ECG. Emergency responders must maintain ACLS certification, which can help doctors save lives in and outside the clinic.x

Sagun Tuli on the Symptoms of Degenerative Disc Disease

Though called degenerative disc disease, the condition is, in fact, neither degenerative nor a disease. Instead, it is a result of the normal aging of the spine and can be treated. It is also one of the leading causes of lower-back pain in relatively healthy 30 to 40 year olds.

 

The symptoms generally involve pain in the lower back that worsens when sitting, lifting, bending, and twisting. Changing positions frequently, walking, or running may alleviate the pain. Lying down often offers the most relief. For some, severe lower-back pain comes in intermittent episodes. Tingling, numbness, or leg pain may also accompany the lower-back pain.

Degenerative disc disease is treatable, but it is important to visit a doctor at the onset of the condition to avoid further damage.

About the Author:
Sagun Tuli, a surgeon at the Center for Advanced Brain and Spine Surgery at Metro West Medical Center in Massachusetts, has over a decade of professional experience in the medical field. She has been published in numerous medical journals, including the Journal of Spinal Cord Medicine and The Spine Journal.

Dr. Sagun Tuli and the American Medical Association’s Women Physicians Congress

A highly accomplished surgeon with nearly 20 years of clinical experience, Sagun Tuli treats patients at the Center for Advanced Brain and Spine Surgery, a leading health care center located in Natick, Massachusetts. Prior to joining the center’s staff, Dr. Tuli spent nearly a decade at Brigham and Women’s Hospital in Boston where she maintained a full patient load and served as a mentor to medical students and residents. For her work with this group of aspiring surgeons, the American Medical Association’s Women Physicians Congress (AMA-WPC) selected Dr. Tuli as the recipient of its Physician Mentor Recognition Award in 2007.

Comprised of nearly 70,000 female AMA members, the WPC channels its resources to advocate for women in the medical profession. Providing a solid foundation of networking, the consortium leverages its influence to encourage young female physicians in their professional endeavors through mentorship programs in hospitals across the country. Further promoting its mission of raising awareness about women’s health care issues, WPC also serves as a policymaking organization due to the efforts of its Governing Council. Taking a close look at emerging issues of particular interest to female physicians, the WPC Governing Council represents a wide variety of viewpoints in the public sphere by collaborating with a network of WPC Liaisons, women who have distinguished themselves as especially active and engaged in the practice of their medical specialty.

Meningitis and Spinal Meningitis in Children By Dr. Sagun Tuli

Because meningitis in children left untreated can result in death or permanent disability, parents should educate themselves about its causes, symptoms, and treatments.

Meningitis, an inflammation of the tissues that surround the spinal cord and brain, occurs in two forms: viral and bacterial. The two cause similar symptoms and only a doctor can determine which one is affecting your child. Viral meningitis is the less severe form. Bacterial meningitis can be deadly, and it must be treated via antibiotics in the hospital. Patients with bacterial meningitis may also be prescribed doses of the steroid dexamethasone. Both viral and bacterial meningitis are highly contagious. In rare cases, a child may develop an ear infection or other illness that spreads to the spine and causes spinal meningitis.

The symptoms of both bacterial and viral meningitis in children and the elderly include difficulty breathing, seizures, lethargy, flu-like manifestations such as coughing, and crankiness, rash, and irritability in babies. In teens and adults, symptoms can involve headache, intermittent loss of consciousness, a stiff neck, vomiting, fever, or seizures.

Your doctor will consider several kinds of tests to diagnose meningitis, among them x-rays, blood assays, a CT or MRI scan, or a spinal tap in which a needle punctures the lumbar area to withdraw fluid for examination.

Seek medical assistance immediately if you believe that a child or adult is displaying symptoms of meningitis.

About the Author: Dr. Sagun Tuli was the first woman physician to be board-certified in spinal surgery within Harvard’s medical system. A graduate of the University of Toronto and the Harvard School of Public Health and a Fellow of the Royal College of Surgeons of Canada, she has taught at several major North American universities. She currently practices spinal and neurosurgery in the Greater Boston area.

Dr. Sagun Tuli’s Comments on Studies on Neurological Outcomes Following CSF Diversion

An experienced neurosurgeon, Dr. Sagun Tuli is the only female board-certified spine surgeon within the Harvard medical system. Dr. Sagun Tuli has published numerous peer-reviewed research papers over her career, as well as several non-peer-reviewed articles including “Normal-Pressure Hydrocephalus Outcomes after CSF Diversion” (Journal Watch Neurology, 2009).

Dr. Tuli’s article examines two independent analytic studies that were undertaken on patients with normal-pressure hydrocephalus. The condition is characterized by an increase in cerebrospinal fluid (CSF) in the brain, affecting cerebral function. Dr. Tuli noted that both studies provided evidence of motor function improvement following CSF diversion. One short-term study involved the use of a functional MRI (fMRI) to identify enhanced activation three days after fluid drainage. The other study involved a long-term clinical follow-up of patients. While both studies’ clinical evaluation components revealed cognitive functions improvement, Dr. Sagun Tuli noted that the fMRI evaluation alone did not make this improvement apparent.

Q & A With Dr. Sagun Tuli: Methylprednisolone

When dealing with the immediate aftermath of acute injuries, it may be possible for neurosurgeons to make assumptions about care that, in fact, have limited support. In the case of acute spinal injury, steroids such as methylprednisolone are used in high doses for patient care within a short timeframe after the injury occurs. Dr. Sagun Tuli, one of a team of neurosurgery experts who conducted a study on the use of this drug, gave his perspective on the team’s findings.

Q: What are some of the errors made by doctors in the prescription of methylprednisolone for these types of injuries and why?

Dr. Sagun Tuli: Doctors often infuse methylprednisolone as an anti-inflammatory and a neuroprotective substance but for motor and sensory functions, it is only effective if administered within eight hours of the injury. However, since these high-dose, 24-hour infusions were applied in this way, such a dose became a post-hoc standard of care for acute spinal injuries.

Q: Are there any dangers to this assumption about the use of such medication?
Dr. Tuli: The last of three significant studies on its use found that patients administered a 48-hour dose of methylprednisolone had a higher chance of developing sepsis or pneumonia. It seems that the use of such medication should be carefully considered, as it can present a danger to health.

Q: What was the final conclusion of the study?
Dr. Tuli: Our committee decided to stand behind the recommendation that infusing methylprednisolone for acute spinal injuries should not be considered as a standard treatment, but only as an option.

The Pros and Cons of Third Ventriculostomy by Dr. Sagun Tuli

While working for the Division of Neurosurgery at the Hospital for Sick Children in Toronto, Canada, I researched two procedures intended to relieve cerebrospinal fluid blockage in children with hydrocephalus. One of these procedures is the insertion of a cerebral shunt, a tube and valve system that conducts and drains fluid trapped in the cerebral ventricles. The second is an alternative procedure called endoscopic third ventriculostomy, where a hole is created in the brain’s third ventricle, re-establishing the flow of fluid.

With a cerebral shunt, the patient must undergo extensive surgery with multiple incisions, and there is a risk of post-operative infection due to the addition of a foreign body. With a third ventriculostomy, surgery is relatively quick, with a dime-sized hole created in the skull to access the cerebrum, and the risk of infection is lower.

However, third ventriculostomy is not without disadvantages. Patients who choose this procedure may have a lower chance of improvement than patients with a shunt. But in a study I and others conducted, we found no significant difference in long-term failure rates of patients who received a third ventriculostomy versus a fluid shunt, based on survival method analysis.

A third ventriculostomy may be the optimum procedure for select individuals. Patients should carefully consider the advice of their doctors before choosing a treatment plan.

About the Author:
Dr. Sagun Tuli is a surgeon at the Center for Advanced Brain and Spine Surgery in Massachusetts and an Assistant Professor at Harvard Medical School. She holds membership in the American Association of Neurological Surgeons and the Congress of Neurological Surgeons.