Kypho/Vertebroplasty for Endplate Fx without Compression

[crazywiththecheezwhiz]

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Patient w/ hx of prior L5-S1 fusion, now with worsening backpain. Found to have an acute L3 endplate fracture with no significant compression. Do any of you perform kypho/vertebroplasty on these if pain does not improve with conservative management?

 

[lobelsteve]

yes.
DO you have a bone density? Trauma?
Is it just a schmorl's node?
Post pic, give history.

 

[powermd]

Patient w/ hx of prior L5-S1 fusion, now with worsening backpain. Found to have an acute L3 endplate fracture with no significant compression. Do any of you perform kypho/vertebroplasty on these if pain does not improve with conservative management?

Like Steve said, more history is needed.

Assuming this is someone with poor bone density, unlikely to heal on their own, I will typically cement these patients. I have seen enough go from minimal compression to significant compression between the time of their MRI and the time of the kypho to know there is a risk to waiting or doing nothing. If it were me, I would want to preserve vertebral height before it's lost, not have to rely on the kypho balloon to do it for me.

 

[SSdoc33]

Like Steve said, more history is needed.

Assuming this is someone with poor bone density, unlikely to heal on their own, I will typically cement these patients. I have seen enough go from minimal compression to significant compression between the time of their MRI and the time of the kypho to know there is a risk to waiting or doing nothing. If it were me, I would want to preserve vertebral height before it's lost, not have to rely on the kypho balloon to do it for me.

till L4 goes.

or L2.

in the right setting i'd agree with kypho, but your doom and gloom scenario would convince anyone to get the cement

 

[NOSfan]

Patient w/ hx of prior L5-S1 fusion, now with worsening backpain. Found to have an acute L3 endplate fracture with no significant compression. Do any of you perform kypho/vertebroplasty on these if pain does not improve with conservative management?

MRI correlates with hyperintense STIR signal?

Clinically, this is likely the pain generator (nerve sprouting with high levels of substance P and CGRP can be found here in the degenerative disc).

Failed conservative therapy, then yes would offer vertebroplasty. EXPECT cement to leak out of the endplate and possibly into the disc (inform the patient in advance). You actually desire to see some spread through this region........Once you see it, stop instillation.

Cheers

 

[crazywiththecheezwhiz]

60 YO Male, No bone density scan done, positive STIR findings on MRI at L3 endplate.

Had some radicular L5/S1 sxs. as well. So I first tried a caudal ESI, but back pain has persisted. Leg pain is now “numb”... I’m thinking it is this acute L3 finding that came on after heavy lifting / twisting that is still causing axial pain

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[lobelsteve]

60 YO Male, No bone density scan done, positive STIR findings on MRI at L3 endplate.

Had some radicular L5/S1 sxs. as well. So I first tried a caudal ESI, but back pain has persisted. Leg pain is now “numb”... I’m thinking it is this acute L3 finding that came on after heavy lifting / twisting that is still causing axial pain

View attachment 233957


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No fracture there, That is MODIC change posterior inferior.
Nothing to kypho in that picture.
PT sounds reasonable.

 

[drrosenrosen]

Agree with Steve. No fracture

 

[freddydpt]

Neg