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.
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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.

Cervical Kyphoplasty

There are very few doctors who perform vertebroplasty or kyphoplasty in the upper thoracic or cervical spine. Luckily for our patients, we do.

This is a rotary kyphoplasty we performed today at the C7 vertebral body. This patient had suffered from the pain for over 7 years. It's another key example of a fracture that a radiologist called "old" or chronic, yet responds to treatment.

Due to potentially life-threatening complications, cervical fracture fixation is not to be taken lightly and should only be performed by experienced doctors. Although there are about 20 doctors in our area who have trained to fix fractures, only one or two of us perform them in the cervical spine. Who would you rather have fixing a fracture in your loved one?

Do Young People Get Osteoporosis?

Osteoporosis is typically thought of as a disease of aging or senescence. In my practice, the typical patients that I see are females over 65 years of age and men who are 72 and older. Unfortunately, however, this terrible disease is becoming more common among even younger patients. \

As an example, in the last 6 months, I have treated three young men, between the ages of 35 and 42 years old. Although that's not the type of person we usually associated with osteoporosis, all three of these men had fragility fractures.

Why would they get this at their age? The answer might surprise you. All three men had vitamin D deficiency. That's right--osteomalacia, the same disorder that is known as rickets in children. A recent study reported at the American Society of Bone Mineral Research showed that 90% Canadian children had rickets.

What's more, most every patient with a fragility fracture that I treat also has vitamin D deficiency. These findings suggest that this disease is being seen in epidemic proportions.

Diagnosing Back Pain

Thank you to those who came out to our seminar "New Advances in Back Pain Treatment" tonight in Tulsa. We appreciate your questions and willingness to take part in your own health care.

One of the questions that came up tonight was how do we know what causes back pain. While there are many different causes of back pain, most can be lumped into to groups--pain involving either the soft tissues or bone.

Pain from soft tissues can be due to muscle problems (spasm, strain, etc), intervertebral disc problems (disc tears, herniations, etc) and nerves (compression, nerve irritation, etc). Bone problems are usually due to arthritis (spondylosis, facet arthritis, etc) or fracture (vertebral compression fractures, etc).

Sometimes back pain is causes by both soft tissue and bone problems. It's important to remember that back pain can be caused by referred pain. When pain occurs because of disease in one area, but feels like it is in another, this is called referred pain. For example, back pain can be caused by arthritis in the hip or pain from the internal organs of the pelvis and abdomen.

Since there are so many different causes of chronic back pain, it's important to see a qualified physician who is skilled in the diagnosis and treatment of back pain. Only by reviewing your history and physical examination can a physician accurately determine the cause of your pain. Even then it usually takes imaging studies (such as x-rays and MRI) to confirm before effective treatment can begin.

Free Back Pain Seminar in Tulsa, 9/16/2008

We are pleased to announce that Dr. Webb will be presenting a free patient seminar on the latest advancements in back pain treatment including vertebroplasty and kyphoplasty. This insightful and stimulating presentation is free to the public, and outlines the various causes and treatments for back pain. Not only will this be presented in laymans terms, there will be a question and answer session immediately following.

Please join us for this informative event. Call (918) 260-9322 to register for this FREE seminar.

Time: Tuesday, September 16th at 6:00 p.m.
Location: Citiplex Towers at 81st & Lewis
Complimentary refreshments will be provided.

My Doctor Doesn't Think My Fracture Needs To Be Fixed

I am often asked by patients "My doctor told me I had a fracture, but that it will probably get better." Sometimes the doctor will tell them that "there is nothing we can do for it." While it's true that some fractures will get better with conservative therapy, many do not. In my opinion, it is important to take into account the amount of pain and suffering the patient has before decided if and when to fix the fracture.

As far as there being "nothing we can do about it", that's hogwash--as my patients know. In fact, if you have pain from a vertebral compression fracture, we can take that pain away in nearly 100% of the cases. There are two reasons doctors would say there is nothing can be done:
1. They don't know about the procedure.
2. They don't have experience with the procedure.

First of all, there is a huge amount of new information bombarding everyone, including doctors, everyday. Although vertebroplasty and kyphoplasty have been around for several years, most doctors haven't had direct experience with the procedure.

There are other doctors who know about vertebroplasty and kyphoplasty for compression fractures, but who have limited experience with it. They trained in an era when there literally was nothing that could be done for vertebral compression fractures (VCF). They have practiced for years when there was no effective therapy. Many are experienced spine surgeons who see how poorly these patients do at surgery, but haven’t had experience with vertebroplasty and kyphoplasty. Why is this? Until recently, the only treatment for vertebral compression fracture (VCF) was bed rest and oral pain medications, and those don't work for all patients. But as we will see in the next post, even these conservative therapies can be dangerous for the patient.

Thus, there are effective treatments for VCF, but most doctors haven't yet seen how effective the treatment is first hand. If you or a loved one are suffering from the pain of a VCF, give us a call. We would love help or refer you to a doctor in your area who can.

When Osteoporosis Affects Men

The Tulsa World published an article on 3/6/2008 about one of our patients. He was a typical male patient who suffered a vertebral compression fracture.


For ill or good, osteoporosis is often thought of as a disease of women. In fact, one of the major hospitals in Tulsa advertises osteoporosis as an area of focus at their women's health center. It's true that osteoporosis is more commonly seen in women, but why is that?


It comes down to math. Women get osteoporosis earlier and they live longer than men, in general. Let me explain.


Due to several factors, women present with osteoporosis at an earlier age--about ten years before men. For example, in my practice, women tend to present with osteoporosis and its related complications of VCF about age 65 and older. Men don't tend to present until they are in their seventies.


One reason for this discrepancy is overall bone density. Men tend to start out with high bone density than women. In the most simple terms, this is because men tend to be larger than women. While our bones are still growing, the body is actively laying down calcium and other bone minerals. This occurs until about age 25, after which the human body starts to lose bone density.

After that point, it's all downhill. The body slowly loses calcium rather than stores it. Although many factors can increase the rate at which we lose calcium, it is a part of aging. Some things that speed calcium loss are poor diet, lack of exercise, smoking, sodas and steroids.

So, although both men and women begin to lose calcium at this point, this reaches a critical level earlier in women. You can think of it like a savings account, where you have calcium instead of money--keep making the same small withdrawals and you run out over time. Since men generally have higher bone mass to start with, it takes them longer to run out.

Add to that, the fact that the life expectancy of women is typically several years longer than that of men, it's no surprise that we see more women with the disease.

Old Fractures--New Hope?

I am commonly asked the following question from referring practitioners: How old is too old when it comes to treating vertebral compression fractures (VCFs).

The answer is they are never too old if the patient is symptomatic from the fracture. Of course, many fractures heal on their own. Also, many old fractures do not cause clinical symptoms because they have healed on their own. For patients that have an older fracture that still causes pain, however, VCF fixation is highly effective.

One of my favorite examples is a patient I treated during my fellowship at the University of Oklahoma Health Sciences Center. This was an otherwise healthy lady in her thirties. She had suffered a single level VCF at from a car wreck about fifteen (15) years before. This was at T12 (one of the most common locations for these fractures).

To be sure, I was skeptical. At this point, I had experienced a lot of success from treating VCFs with vertebroplasty and kyphoplasty. Up until now, though, we had always used MRI as the gold standard for which fractures to treat. This patient's vertebral body had an abnormal shape, but no other signs of a unhealed fracture on MRI. So, her MRI was considered negative.

Her neurosurgeon, however, felt that the pain was due to the fracture. After examining her, we agreed. She had pain that was the classic 10 out of 10 and was worse with axial loading, such as standing and transferring from chairs.

We treated that patient with kyphoplasty and she was pain free afterwards--her postoperative pain level was zero. Since then, I've treated numerous patients with so-called old or healed fractures. I have found that the success rate for VCF fixation is similar to that seen in other patients--nearly 100% success.

So if you or someone you know has an old fracture and your doctor has told you there is nothing that can be done--rest assured that it can be treated. For more information, contact us at info@tulsamsk.com.

Expanded Vertebroplasty Locations

I am excited to announce that another neuroradiologist, Dr. Ning Huang has joined our staff. This will allow us to expand our on-site services and increase the depth of our subspecialty expertise. We now provide vertebral compression fracture fixation in the Tulsa metropolitan area as well as western Oklahoma.