Thursday, February 26, 2009

What's Bone Cement-Part I


We get a lot of different questions from our patients about bone cement that is used to fix painful VCFs. While an exhaustive explanation is beyond the scope of this blog, I am going to answer some of the most common questions we get.

What is bone cement?
Also known as bone glue, the material we commonly call 'bone cement' is a polymer called polymethylmethacrylate, or PMMA for short. This is made from mixing a powder and a liquid together in the operating room. This forms a paste that quickly hardens up in about 15-25 minutes. It starts out thin like cream, then gets thicker, like toothpaste by the time it's used in the body. Then it gets as thick as modelling clay toward the end of the procedure. By the time the procedure is over, the PMMA is hardened to a consistency just harder than bone.

Can I melt the cement if I use a heating pad?
No, once the bone cement sets up it's that way forever.

Can I break the cement by certain activities?
No, I've never heard of anyone breaking their cement. Rarely, a patient may have another fracture at a treated level, but it's usually in severe osteoporosis and not usually related to a known cause.

Does the cement dissolve over time?
No, there is no evidence that the cement dissolves or dissipates over time.
Can the cement leak into the body?Once it sets up (by the end of the procedure) the answer is no. During the liquid state, it can leak lots of places. This is usually only an issue if a large amount leaks into the veins or by the spinal cord or nerves. Careful observation during injection is required to avoid this.


I've heard bone cement heats up; can it burn you?
When the PMMA hardens, it gives off heat. This is a common chemical phenomenon known as an exothermic reaction. If there is cement in contact with nerves, for example, it can cause irritation, however, this is very rare. Actually, the heating process has been theorized as one cause of pain relief.


That's it for now. As we get more questions we'll post them here, as well as on our FAQ at www.tulsamsk.com

Tuesday, February 24, 2009

Who Should Fix My Fracture? (Part 2 of 2)


Recap

In the last post, we talked about differences in training that different doctors receive. Many doctors go to a weekend course to learn the procedure--and they may have never actually treated a live patient before they operate on you or a loved one. So, it's important to check their credentials out.

In this post, we'll talk about how ongoing experience affects performance with doctors. We'll also include a list of questions that you may find useful to ask your physician.

Ongoing Experience

There are variable amounts of experience for fracture care. Some doctors read articles in medical journals about these procedures. Others write those articles. Some doctors try out new procedures to fix the fractures. Others are involved in the research and development stage before these procedures are available for most doctors to 'try out'.


For example, in the Tulsa metropolitan area, there are at least 15 doctors who are trained to perform these procedures. That may sound like a lot, but several only trained and rare perform the procedure. The majority may do 1 or 2 cases per month. Out of those doctors, there are probably only three or four of us who treat 10 or more cases a month consistently.


Summary

Although we would be delighted to help everyone with their fractures, we realize not everyone can travel to Oklahoma to have their VCF fixed.


As you can see, there are a lot of factors to consider when choosing a physician for VCF treatment. So, to help, here is a list of questions to ask your doctor to help you decide.


1. What kind of training did you receive to treat these fractures?

2. How many fractures have you treated?

3. How many fractures do you treat per month?

4. When was the last fracture you treated?

5. What is your success rate at treating fractures?

6. Have you ever had any serious complications with a patient?

7. Do you test for and treat underlying conditions (such as osteoporosis)?

Saturday, February 21, 2009

Who Should Fix My Fracture? (Part 1 of 2)

There are many doctors who perform vertebroplasty or kyphoplasty. They have different levels of experience in dealing with vertebral compression fractures (VCF). There are two areas where the degree of experience is important: training and ongoing experience.


Training

Most of the doctors who perform vertebroplasty or kyphoplasty learned how to do these procedures at a weekend course. That is, they went to a course, usually sponsored by a device company, where they attended some classes, then did the procedure on cadavers.


Others have had more extensive training, such as a fellowship. For me, I did a fellowship where treated over 100 live patients with these procedures.


In my next post, we'll talk about other factors in selecting a doctor for fixing fractures, including ongoing experience. I'll also include a list of questions to ask your doctor to help see if they are the right doctor for you.

Wednesday, February 18, 2009

Digg Question: Spinal Fracture

We received this question from a Digg user:

My mother got a compression fraction of a lumbar vertebrae last July. She has constant pain but was told there is no treatment. She is 92. She also has 2 old vertebral compression fractures. Would she be a candidate for spinoplasty?

If her doctor thinks her pain is due to the fractures, then yes, she is a candidate for fixation. We routinely perform vertebroplasty, kyphoplasty and even spinoplasty in patients over 100. This can be done even if the patient has severe medical disease, such as heart disease, stroke or diabetes. This is a significant advantage of these procedures because they do not require general anesthesia like major surgery does.

The interesting part of the question is spinoplasty. In experienced hands, spinoplasty is effective, however, it is not currently performed by many doctors. Personally, I performed the first spinoplasty in Tulsa. However, I have lately done more cement procedures because they cost the patient less and are essentially 100% effective at taking away pain.
read more digg story

Gift Basket Winner!

Thank you to everyone who stopped by our booth at the Tulsa Women's Living Expo. It was great to meet so many of you. Congratulations to Jean McDonald who was the lucky winner of the gift basket giveaway!

We are in the process of forming an Osteoporosis Support Group in cooperation with the National Osteoporosis Foundation so check back as we will be posting details here in the next few weeks.

Friday, February 13, 2009

video

Dr. Webb Speaking at the Tulsa Women's Expo


If you're planning on attending the Tulsa Women's Expo (see previous post) on Saturday, make sure you're there at 11am. Dr. Webb will be speaking about Osteoporosis on the Lifestyle Stage.

The Lifestyle Stage is located immediately to the right from the main entrance to the QuickTrip Center. Admission is $5 at the door with hundreds of vendors. Hope to see you there!

Tulsa Women's Expo


Come on out to the Women's Expo at the Tulsa Fairgrounds. We are located at booth 219, near the main stage in the QuickTrip Center. This is the building that has the golden driller in front of it.

While you're there, chat with our staff and be sure to sign up for our free gift basket drawing. There is plenty of free information about osteoporosis at our booth, as well as numerous freebies!

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All posts are copyright Musculoskeletal Imaging of Tulsa.