Extrapedicular Vertebral Augmentation

[Taus]

Just add to the fusion. Already ruined his spine.
Nevro when it doesn't work. Fusion after Nevro.
Abbott after fusion.
Dead.

So you’re saying I shouldn’t have chosen the option with the lowest pro fee?

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[lobelsteve]

So you’re saying I shouldn’t have chosen the option with the lowest pro fee?

Choose the annuity plan.

 

[MitchLevi]

Just add to the fusion. Already ruined his spine.
Nevro when it doesn't work. Fusion after Nevro.
Abbott after fusion.
Dead.

Say that again?

The Abbott and Nevro part...Not sure what you're saying.

 

[lobelsteve]

Say that again?

The Abbott and Nevro part...Not sure what you're saying.

One system pre-surgery.
Different systems so something new after surgery.

 

[Taus]

One system pre-surgery.
Different systems so something new after surgery.

This one already has an SCS with paddle that is not helping. Mechanical axial back pain….

Perhaps its cluneal nerves…..

 

[lobelsteve]

This one already has an SCS with paddle that is not helping. Mechanical axial back pain….

Perhaps its cluneal nerves…..

Through perc leads under the paddle as high as they go. If IPG still good....

 

[MitchLevi]

Through perc leads under the paddle as high as they go. If IPG still good....

Why?

 

[lobelsteve]

Why?

I thought we were talking about how to profit off this guys a pain. Didn't realize someone thought he could be made better.
It's ok to put down the needle sometimes.

 

[manowar rules]

Update! No intervention was performed. Patient’s pain progressed significantly until new imaging was obtained:



And those are 2 weeks after original imaging below with original report:


Glad I didn’t do that transdiscal kypho! In retrospect I should have been more suspicious of that disc signal

 

[lobelsteve]

Update! No intervention was performed. Patient’s pain progressed significantly until new imaging was obtained:
View attachment 366865View attachment 366866
View attachment 366867

And those are 2 weeks after original imaging below with original report:
View attachment 366868
View attachment 366870
Glad I didn’t do that transdiscal kypho! In retrospect I should have been more suspicious of that disc signal

Radiology could have tipped you off on disc signal. Chronic immunosuppression. Guess ESR/CRP could have been done. Glad somebody repeated the imaging. The initial set of films was an impressive in the second set clearly showed the answer. I’d like to know how the guy looked clinically.

 

[manowar rules]

His presentation is part of what threw me off. I thought that clinically, he looked like many other patients do with an acute compression fracture. He was obviously uncomfortable and tender to lumbar palpation. He did not appear ill, have neurologic signs, or any weird radiation of his pain. No fever/chills/etc. He could name the instant that his pain started, when he got up out of a chair and twisted a couple weeks before.

 

[callmeanesthesia]

Update! No intervention was performed. Patient’s pain progressed significantly until new imaging was obtained:
View attachment 366865View attachment 366866
View attachment 366867

And those are 2 weeks after original imaging below with original report:
View attachment 366868
View attachment 366870
Glad I didn’t do that transdiscal kypho! In retrospect I should have been more suspicious of that disc signal

I saw a similar thing a couple years ago. I think I posted it in the images thread too. Complicated by a pacemaker. Referred from a partner for possible kypho after CT and Bone scan read as concerning for acute fracture, but on CT the endplate looked very ratty to me - eroded, not compressed. Denied fevers/chills. CRP came back in the 30s.