Tuesday, January 27, 2009

What's the time limit on fixing fractures?

I am amazed at the number of times this question comes up. I hear it from patients, I hear it from family doctors. I even hear it from experienced spine surgeons.

The answer is simple enough. There is no time limit on fixing vertebral compression fractures. Even if the fracture is 20 years old or older, as long as a patient has back pain and your physician thinks that pain is from the fracture, it will almost always respond to therapy.

In the medical literature, older fractures have documented success. In one study that looked at patients with chronic fractures, 70% of them got essentially complete pain relief from vertebroplasty. In my experience, the success rate is even higher.

The more significant question to ask is this. If a patient has back pain and has a fracture, why wouldn't the doctor treat it using proven therapy such as vertebroplasty? It certainly costs a lot less than having surgery. Unfixed vertebral compression fractures are a known cause of so-called failed back surgery syndrome (post-laminectomy syndrome). Unfortunately, this is a fact lost on a lot of spine surgeons, as I continue to see patients get fusions for these fractures when vertebroplasty is more effective.

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