Friday, January 21, 2011

Radicular pain from fractures

A phenomenon associated with vertebral compression fractures (VCFs) that is documented in the medical literature is the fact that 10% of these fractures have radicular symptoms that mimic a slipped disc and that goes away with fixing the fracture.

Think about it. We all know patients with thoracic fractures that presented like rib or anterior chest pain or angina (radicular pain). Often a thoracic fracture is mistaken for pneumonia or a heart attack.

However, when a patient has radicular symptoms due to a lower back (lumbar) fracture and it goes into the legs, most spine surgeons think slipped disc and patients frequently get what I consider unnecessary fusions. Many of these surgeons will argue with this, but one of the most common causes of failed back surgery syndrome (aka post-laminectomy syndrome) is an untreated fracture. I see this on a monthly and, unfortunately often weekly, basis. One of the saddest things that I see in clinic when a patient has had a $50,000-$100,000 fusion and is worse off than before surgery--then we fix them with a procedure that costs about $2,000.

This bias against and ignorance of the fractures as a common and grossly under-diagnosed cause of back pain is best exemplified by a patient story here. This patient was diagnosed with a thoracic compression fracture, but all of her 'doctors' agreed that it couldn't possibly be causing her pain. They did test after unnecessary test and eventually performed a splenectomy because they refused to believe that her diagnosed fracture could cause her pain. As soon as we fixed her fracture, her pain was gone.

I would love to discuss more. Feel free to contact me at or call our office at (918) 260-9322.

Wednesday, January 19, 2011

Chronic Vertebral Fractures--do they respond to therapy?

The Question--Chronic Fractures

I had a question today from a chiropractor regarding so-called chronic vertebral compression fractures (VCFs). In particular, this regarded a patient with a 3 year old fracture.

The Answer Is Easy

Let me be clear--in my experience, as long a vertebral fracture is clinically symptomatic, it has a near 100% success rate with vertebroplasty or kyphoplasty. By symptomatic, I mean that the patient has a fracture, has back pain and has tenderness to palpation or percussion at the spinous process.

Belt Line Pain Syndrome

Often, folks will present with remote fractures at the thoracolumbar junction, commonly T11-L1 sustained in a car crash perhaps 20 years or so ago. However, their main complaint of back pain is lower, often described as "belt line pain". My theory is that this is due to chronic paraspinal muscle spasm due to the fracture. Why? Because this, too, goes away immediately after fixing the fracture. In fact I've had 2 patients this month with that exact phenomenon.

I have personally fixed fractures up to 35 years old with complete pain relief afterward.

Medical Literature

Some notes from the medical literature regarding chronic fractures. These are often overlooked our flat out ignored by most doctors--
1. 94% success rate for vertebroplasty on fractures <1 year old
2. 80% success rate for vertebroplasty on fractures >1 year old.

I would love to discuss more. Feel free to contact me at or call our office at (918) 260-9322.

Thursday, January 13, 2011

Insurance won't cover Sacroplasty? We have a solution.

I recently had a patient ask if I performed many sacroplasties. The answer is absolutely. I counted 22 patients that we performed sacroplasty on in 2010. I have two patients scheduled for sacroplasty in the next two weeks.

Sacroplasty was part of my fellowship training and I often get referred sacral fractures from other doctors around the state as well as in Tulsa. For example, we often have patients come from out of state or patients may be referred by other pain specialists in town because they don't perform this procedure. We even get patients transferred from local hospitals. Of the two specialty hospitals I operate at in Tulsa, I am the only one I'm aware of who performs sacroplasty at either location.

Sacroplasty is typically done as an outpatient and takes me about 15 minutes to perform in most cases. Patients can go home after a brief monitoring period and resume their normal activities generally on the next day.

We often see patients for osteoporotic fractures who are confined to nursing homes because of decreased mobility. It's very gratifying to be able to help these patients, because if that's the only reason they are in a nursing home, they can usually go back to their homes afterward. In fact, I have been able to get more patients out of a nursing home and back home with sacroplasty than with any other procedure that I do. I think the reason is that sacral fractures affect the entire pelvic ring and more often progress to unstable lesions than vertebral fractures.

Unfortunately, although sacroplasty is a proven, effective treatment for sacral insufficiency fractures, many insurances won't cover it. In that case, we have a cash pay arrangement in clinic with a 30% discount for upfront payment. If you or someone you love has a painful sacral insufficiency fracture, call (918) 260-9322 for more details.

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