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 jrw@tulsamsk.com or call our office at (918) 260-9322.

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 jrw@tulsamsk.com or call our office at (918) 260-9322.