Online Query


Dr. Pithwa is a Consulting Spine Surgeon, practicing in Bangalore, India. You can reach him regarding any queries related to spine surgery by filling up the following questionnaire.

  • Personal Information
  • Name
  • Age
  • Sex
  • MaleFemale
  • Address
  • Telephone
  • E-mail

Complaints

Issue Status If yes, Duration in months Other Comments
Backpain Yes No
Does the backpain wake you up in the night? Yes No
Do you have pain going down from the back to the legs? Yes No
Do you have pain going down from the neck to the hands? Yes No
Do you have tingling sensations/ numbness in the hands/ legs? Yes No
Do you have any weakness in the hands/ legs? Yes No
Do you have any difficulty in writing/ buttoning up your shirt? Yes No
Do you have any unsteadiness while walking? Yes No
Do you smoke? Yes No
Do you have diabetes? Yes No
Do you ride 2-wheelers? Yes No
Have you taken any particular treatment for this problem? Yes No
On a scale of 0 to 10, if 0 is no pain and 10 is maximum tolerable pain, how much pain do you have, looking back at the past one week?
How severe is your pain in terms of activity restriction?
Restricts recreational activities Yes No
Restricts occupational activities Yes No
Restricts basic activities such as taking bath, wearing clothes, brushing teeth, etc. Yes No
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