Is there a fracture on these images?

[interjectionreflection]

#vertebralaugmentation | James Robert Webb, MD | 30 comments

Spinous process percussion confirmed under fluoroscopy is the only specific way to be sure you’re treating the right level in #vertebralaugmentation. This is a septuagenarian veteran who had got the run around by his surgeon a VAMC. Unipedicular approach and 13cc at L2. On second image note...

www.linkedin.com

I can't see a fracture but asking from those more experienced they author said there was a 29% loss of height at L2 and the pedicle screw was loose but I don't see anything was hoping those with a keener eye can help me find subtle imaging findings

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[SpineandWine]

are these two different patients?
He seems below the screws on top image and then above in bottom

 

[Ducttape]

i love the question from the non interventional radiologist "what is the pathology we are treating here?"

and Bealls answer is a logical fallacy. if you are making an argument, then you cannot defend that position by requesting those objecting to provide data. the onus is on you for your position.

 

[MD87]

i love the question from the non interventional radiologist "what is the pathology we are treating here?"

and Bealls answer is a logical fallacy. if you are making an argument, then you cannot defend that position by requesting those objecting to provide data. the onus is on you for your position.

You beat me to it.
His saying: "Adjacent level cementation can prevent additional extension of fusion. if you ask for data stating this, I would ask you for data stating that it does not" is INSANE! So... I guess I can start doing C6 TFESI for carpal tunnel syndrome now since you can't provide data saying it doesn't work? It's bad when the most vocal people are cowboys.

 

[RoloTomassi]

He lost me at spinous process percussion

 

[interjectionreflection]

are these two different patients?
He seems below the screws on top image and then above in bottom

I just took a second look. You're correct AP the cannula is below screws while lateral it is above. Also I just realised that he said 13cc cement

 

[Agast]

#vertebralaugmentation | James Robert Webb, MD | 30 comments

Spinous process percussion confirmed under fluoroscopy is the only specific way to be sure you’re treating the right level in #vertebralaugmentation. This is a septuagenarian veteran who had got the run around by his surgeon a VAMC. Unipedicular approach and 13cc at L2. On second image note...

www.linkedin.com

I can't see a fracture but asking from those more experienced they author said there was a 29% loss of height at L2 and the pedicle screw was loose but I don't see anything was hoping those with a keener eye can help me find subtle imaging findings

Actually, the author specifically states the screw is not loose. This is after Beall congratulates him on treating a screw that is “obviously” loose to him. Lol.

 

[callmeanesthesia]

The most valuable lesson the fellows reading this can learn is “just because you can doesn’t mean you should.”

 

[Tboned]

are these two different patients?
He seems below the screws on top image and then above in bottom

I just took a second look. You're correct AP the cannula is below screws while lateral it is above. Also I just realised that he said 13cc cement

The first image is just a radiographic marker over the spinous process it’s not a kypho cannula

 

[Tramadeezy]

He lost me at spinous process percussion

And tuning fork… I don’t see much of a fracture. How can you tell if a screw is loose on those images??

 

[clubdeac]

Just read this guys post, WTH? Spinous process percussion more sensitive than STIR? What is he talking about. And he said that vertebrae is 29% compressed? Huh, i think he’s crazy. Am I missing something

 

[SpineandWine]

Question- can someone explain the test for pedicle screw loosening around the hardware test he’s referencing
Tuning fork and palpation of a screw that’s in the vertebral body?

 

[lobelsteve]

Question- can someone explain the test for pedicle screw loosening around the hardware test he’s referencing
Tuning fork and palpation of a screw that’s in the vertebral body?

When he talks his lips don’t move because he’s talking out of his ash hole

 

[SpineandWine]

Okay as an aside and general question. I see this quite a bit.
Lose S1 or L5 screw with lucency around hardware vs. SI joint dysfunction

How does one treat screws with lucency around hardware

 

[clubdeac]

Okay as an aside and general question. I see this quite a bit.
Lose S1 or L5 screw with lucency around hardware vs. SI joint dysfunction

How does one treat screws with lucency around hardware

Did you not read the post? Vertebral augmentation obviously 😉

Or have the surgeon take care of it. You my friend can not treat screws with lucency

 

[SpineandWine]

Did you not read the post? Vertebral augmentation obviously 😉

Or have the surgeon take care of it. You my friend can not treat screws with lucency

It appears either revision surgery is what surgeon may do, bone stimulator and time with meds, stop smoking, work on bone health
OR
Anything else?


Here's a Pub med article on it (https://www.ncbi.nlm.nih.gov/books/NBK554385/)- following is closest I can find for non-surgical management.
When the bone has a decrease in blood supply, it can not heal. This can occur with poor nutrition (pre-albumin levels pre-op to measure) and smoking from poor living habits. Biologic causes of poor blood flow and poor bone healing include diabetes, peripheral vascular disease, vitamin D deficiency, renal insufficiency, and medications (steroids, NSAIDs, opiates). Treatment may contribute to inadequate fracture fixation or stabilization.
- Not sure if NSAIDs are proven in this setting
- Opiates, definetely avoid - may be hard after surgery depending on outcome
- Can optimize bone health certainly with medications
- Steroid is a risk vs. benefit
- Stop Smoking

"The usual course of nonoperative treatment with ultrasound is the placement of ultrasound therapy within three months after the last surgical procedure."
- What the F does this mean?

 

[MD87]

Just read this guys post, WTH? Spinous process percussion more sensitive than STIR? What is he talking about. And he said that vertebrae is 29% compressed? Huh, i think he’s crazy. Am I missing something

He sees things with his radiology eyes that we can’t $ee.

 

[maxxor]

#vertebralaugmentation | James Robert Webb, MD | 30 comments

Spinous process percussion confirmed under fluoroscopy is the only specific way to be sure you’re treating the right level in #vertebralaugmentation. This is a septuagenarian veteran who had got the run around by his surgeon a VAMC. Unipedicular approach and 13cc at L2. On second image note...

www.linkedin.com

I can't see a fracture but asking from those more experienced they author said there was a 29% loss of height at L2 and the pedicle screw was loose but I don't see anything was hoping those with a keener eye can help me find subtle imaging findings

I don’t see a fracture but the screw on image right has lucency at the metal-bone interface. It’s easier to see after he injects cement in the last image.

Not sure how this helps a putatively loose screw.

Maybe he’s just thermally ablating the end plate nerves by way of cement…