Life or Death - Fixing Your Fracture

I continue to be amazed by the attitude taken by many spine surgeons regarding fixation of vertebral fractures. I can only assume that they are either uneducated or callous.

On a daily basis I hear local surgeons opine (either directly or indirectly through my patients) that vertebroplasty and kyphoplasty 'don't work', that fractures get better by themselves and that having a fracture 'won't kill you'. Although I would prefer that other doctors listen and modify their behavior, I continue to try to do the best thing for the patient. The truth is that people die of vertebral fractures--and they die for many reasons.

I can remember as an intern in internal medicine at the VA Medical Center in Oklahoma City being taught by our house officer that if a veteran came in with a vertebral fracture, that their likelihood of death was roughly equivalent to a patient being admitted for congestive heart failure or pneumonia. Yet, the next year in radiology residency, I was instructed by multiple board-certified radiologists to 'ignore those fractures' because 'they all have them.' I can't think of a more poignant contrast in knowledge and ignorance when it comes to training physicians to treat patients with osteoporotic vertebral compression fractures.

Today I would like to draw attention to yet another article showing the benefits of treating these fractures, rather than ignoring them--a recent article published in the Journal of Bone and Mineral Research (JBMR). The authors looked at death rates in 858,978 Medicare patients who were diagnosed with vertebral compression fractures. Those who underwent treatment with vertebroplasty or kyphoplasty were 37% less likely to die in the next 4 years.

There are many reasons why people die after a vertebral fracture. They often are immobilized, laid up in bed and unable to get around. They become weak and deconditioned. They develop blood clots in the legs that can travel to the heart and lungs (pulmonary embolus). They get bedsores. They get depressed and lose the will to live because of constant pain. Perhaps worst of all, fracture pain prevents them from living a normal life and stops them from doing the things that they love--the very things that make life worth living.

So, if you or a loved one suffers a vertebral fracture, this study suggests that if it is NOT treated, then you or they are 37% more likely to die in the next 4 years than if it was treated.

Yet again, more proof positive that interventional specialists who treat these fractures are on the right track. Everyday by fixing these vertebral fractures, they are not only taking away the pain, they are saving lives. Meanwhile, the doctors who continue to deny the efficacy of these procedures do so at the peril of their own patients.

Reference
Edidin A, et al. Mortality Risk for Operated and Non-Operated Vertbral Fracture Patients in the Medicare Population. JBMR, 2011: Feb 9. DOI: 10.1002/jbmr.353

On Car Crashes and Chronic Pain

A new study in the March 21st issue of the journal, Arthritis Care & Research found that people in car wrecks have an 84% increased risk of developing new onset chronic pain.

The study was done at the University of Aberdeen in Scotland, UK. The researchers reviewed over 2,000 patients who suffered from chronic pain. Out of these, 241 patients had new onset of chronic widespread pain after certain events such as trauma, hospitalization, surgery, etc.

What the study found was that those who said they had been in a car wreck had an 84 % increased chance of developing chronic pain--that is they didn't have chronic pain before the car wreck.

Unfortunately, the authors seem a little confounded. Many doctors will attribute this finding to a pre-existing physical or mental predisposition. Often, these poor patients will be dismissed as trying to game the system and trying to get a large insurance settlement from personal injury tort lawsuits.

However, I see these patients all the time. Most commonly, they have undiagnosed fractures. They have a fracture that is mistaken as a normal variant, just because it doesn't 'light up' on MRI. They have all of the other obvious clinical features, such as midline and/or radiating pain, pain worse with standing or lifting, and tenderness to palpation of the spinous process at the involved vertebrae.

What's more is these patients are often on narcotics. The doctors they have seen before have said that there is nothing that can be done. I hear that from patients so many times that it makes me angry. I just don't understand why other doctors insist on ignoring these clinically obvious fractures and choose to sentence their patients to a lifetime of narcotics which don't help. Often, this choice to do nothing leads to unnecessary loss of productivity and income, but also robs the patients of enjoying life.

Years ago, there was nothing that could be done for fractures. I understand why people have been suffering for years from a car wreck 20 years ago. However, now there are effective, non-operative, solutions for fractures that are effective in up to 95% of patients with back pain.

So, if your doctor has told you or a loved one that there is nothing that can be done, especially if you've been in a car wreck, please--get a second opinion. As an expert, board-certified radiologist, I am available to review films and do this for patients outside of Oklahoma.