DISH

[Dr. Ice]

You guys have any success treating axial mid back pain in obese males with DISH? Any good interventional options? Pain is midline, axial with some sensation of anterior chest wall radiation. The remainder of thoracic MRI does not reveal any disc herniations or stenosis.

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[MitchLevi]

One of the worst Dx in our field IMO.

I am sure you struggle with that Dx just like we all struggle with it too.

No good options for the miserable pt.

Can't fix everything, and it's not your fault that pt is suffering.

 

[Agast]

I was under the impression that lots of PT so you don’t get functionally worse was the only treatment.

 

[Dr. Ice]

I mean the guy is obese, so obviously a conversation about weight loss, but let’s face it, he knows he’s fat. It’s not like the weight loss will undo the calcifications

 

[callmeanesthesia]

I’ve had surprising (purely anecdotal) success with thoracic RFA for patients with Scheuerman’s kyphosis. I’d probably at least try it for DISH. They’re not exactly fused.

 

[PinchandBurn]

Why not rfa the painful lumbar facets? Could help if mbbs are diagnostic...

 

[SSdoc33]

can try thoracic mbbs/rf, but they wont work very well, if at all. a mid-thoracic ESI may give some short term benefit

 

[Dr. Ice]

can try thoracic mbbs/rf, but they wont work very well, if at all. a mid-thoracic ESI may give some short term benefit

Yeah was thinking that, although might not be able to get it approved with his mri the way it looks

 

[RoloTomassi]

RFA sometimes works for me. Like anywhere else, discs and osteophytes can look ugly but pain can be plain old facetogenic.