just another kypho question

[Espn123]

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Stand-Alone Balloon Kyphoplasty for Treatment of Traumatic Burst Fracture in Pediatric Patient

Kyphoplasty is commonly employed in the treatment of compression fractures in the elderly and is increasingly used in the treatment of adult trauma al…

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As young as 13.
I declined a 16 y/o after fall from trampoline. Needed it done to play football that year.
Brace and wait.

Yikes

 

[sdnuser001]

The downside is they will have an increased fracture risk above and below the augmented segment the rest of their lives. May not be a big deal when they’re young but once their bone starts to weaken they’ll have an increased risk

But if you don't do it and leave saggital balance of spine unrestored couldn't the stooped posture set up levels below for more rapid facet arthropathy? I thought that was the main point of ballooning and regaining height versus just vertebroplasty

 

[clubdeac]

But if you don't do it and leave saggital balance of spine unrestored couldn't the stooped posture set up levels below for more rapid facet arthropathy? I thought that was the main point of ballooning and regaining height versus just vertebroplasty

Not sure how much “sagittal balance” or true height restoration you get with kypho. Others on here probably know the exact stats. Regardless he achieved absolutely no height restoration in his post kypho pic

 

[nvrsumr]

32 year old, high income, weight lifter with ankylosing spondylitis. 2 month history. MRI one month old. Schmorls node nothing else.
Remembers date of injury. Not improving.

Advised relative rest and follow up in 3 months. Patient of course deferred bracing.

Anyone who would kypho this if no improvement in 3-6months?

Other options? He specifically asked for “stem cell” injection. so thankfully found me before the “stem cells are us” shop 15 miles away

 

[Ferrismonk]

32 year old high income weight lifter with ankylosing spondylitis. 2 month history. MRI one month old. Schmorls node nothing else.
Remembers date of injury. Not improving.

Advised relative rest and follow up in 3 months. Patient of course deferred bracing.

Anyone who would kypho this if no improvement in 3-6months?

Other options? He specifically asked for “stem cell” injection. so thankfully found me before the “stem cells are us” shop 15 miles away

Nothing about AS or schmorl's nodes say anything remotely close to kypho to me. Lay off the weight lifting for a while and if pain continues consider MBB.

 

[MitchLevi]

32 year old high income weight lifter with ankylosing spondylitis. 2 month history. MRI one month old. Schmorls node nothing else.
Remembers date of injury. Not improving.

Advised relative rest and follow up in 3 months. Patient of course deferred bracing.

Anyone who would kypho this if no improvement in 3-6months?

Other options? He specifically asked for “stem cell” injection. so thankfully found me before the “stem cells are us” shop 15 miles away

Not sure what "high income weight lifter" means, but I wouldn't do much about this
If you mean he lifts weights and separately happens to make a lot of money, definitely don't kypho him.

TPI and PT.

 

[RoloTomassi]

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pubmed.ncbi.nlm.nih.gov

 

[lobelsteve]

Sounds like a perfect candidate to send to Doug Beall in Oklahoma.

 

[Orin]

32 year old, high income, weight lifter with ankylosing spondylitis. 2 month history. MRI one month old. Schmorls node nothing else.
Remembers date of injury. Not improving.

Advised relative rest and follow up in 3 months. Patient of course deferred bracing.

Anyone who would kypho this if no improvement in 3-6months?

Other options? He specifically asked for “stem cell” injection. so thankfully found me before the “stem cells are us” shop 15 miles away

Cash pay him for a BVN ablation at that level

or just SpineJack him up

 

[TIVAndy]

1 month old T12 compression/burst fracture. kypho - yay or nay? concerned about leakage posteriorly with this fracture?

 

[oneforfighting]

View attachment 368798
1 month old T12 compression/burst fracture. kypho - yay or nay? concerned about leakage posteriorly with this fracture?

Yeah that looks too messy for me. I’d personally refer out to surgeon based off of this one image.

 

[TweeterB]

These spine surgeons love to pile on at once when they see pain docs post something. Most of the time what’s posted is foolish and they do deserve to be criticized.

Let’s assume this young otherwise healthy patient with a traumatic VCF did try conservative measures for a few months including bracing, meds, etc and she still had significant pain.

What’s the harm in kypho? Isn’t it a risk benefit discussion at the end of the day?

I’ve had this very thing happen with a 26 yo. MVA failed conservative tx for 4-5 months better after 2 level kypho

 

[TIVAndy]

Yeah that looks too messy for me. I’d personally refer out to surgeon based off of this one image.

u mean a kypho to be done by a surgeon?

 

[oneforfighting]

u mean a kypho to be done by a surgeon?

Yes. Look, I’m sure this can be done in competent hands but I’m in a small hospital without spine backup. Not comfortable with this myself but you could maybe do it if you go slow and take lots of images. T12 should be treated as it can cause lots of pain and sagittal balance thrown off significantly if left alone.

 

[TIVAndy]

Whats ur thought @lobelsteve

 

[lobelsteve]

Whats ur thought @lobelsteve

Need to see mire images. Nothing posted here yet to dissuade me.