Kyphoplasty in young patients

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Vertebroplasty for traumatic non osteoporotic compression Fractures

pubmed.ncbi.nlm.nih.gov

A prospective multicenter randomized study comparing the SpineJack system and nonsurgical management with a brace in acute traumatic vertebral fractures: the SPICO study - PubMed

Overall, there was no statistical difference in the primary outcomes between the SpineJack treatment group and the NSM group. In terms of secondary outcomes, SpineJack treatment was associated with better radiological outcomes, shorter hospital stays, faster return to work, and fewer hours of...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
^^granted above did not show major difference in primary outcomes but the secondary did improve

Compared to NSM, the SpineJack treatment is associated with:
(+) Shorter median hospital stay duration (4 vs 5 days, p<0.001)
(+) Shorter median time to return to work (94 vs 122 days, p=0.013)
(+) Fewer medical visits (1000 vs 1306 visits) and fewer hours of nursing care (94 vs 145 hours)
Members don't see this ad.
 
Last edited:
Spine jack is FDA approved for traumatic VCF, non osteoporotic
Obviously conservative options should be tried first (as you mentioned in your prior post @masterPain) - Don’t think one needs to do it routinely but it’s not an insane idea to offer this as modality if refractory pain


That being said, I have not offered for traumatic VCF yet- I’ve been able to keep out of hospital with meds
 
Last edited:
Members don't see this ad :)
I’m not a KOL though I realize I’m starting to sound like one

The Sakos study showed no difference in adjacent level disease between BKP and Spine jack
 
SpineandWine said:
I’m not a KOL though I realize I’m starting to sound like one

The Sakos study showed no difference in adjacent level disease between BKP and Spine jack
Click to expand...
Does spinejack have to be done inside of a certain time frame?
 
Why would you do SpineJack on a fracture with minimal height loss as described by the OP?
 
Anyone have a link to the most recent guidelines for vertebral augmentation indications/timing. Or at least a cliff notes summary? In fellowship we typically only offered kyphoplasty in patients with osteoporotic compression fractures less than 8 weeks old. Literature is kind of all over the place. Some studies say less than 4 weeks, some less than 12.

By the time most patients get to me (private practice ortho group) their fractures are subacute/chronic. I have good success with bracing, activity modification and waiting things out. Have used intra nasal calcitonin. Occasionally will do mbb—>RFA for recalcitrant pain. Majority of the people that have acute fractures get sent to IR from ED.

I don’t do any vertebral augmentation, but im just curious if there is any newish literature I should be aware of so I can refer patients to IR if they do need something done. Thanks
 
Neurosurgeon friend at the university has done many, many spine jack cases for traumatic fractures. I imagine they admit the patient after the accident and if they are not better in a couple days do the spine jack.
 
I have done one kypho on 40yo traumatic fx. She was still miserable 4 months out and missing work. MRI STIR still lighting up I realize it is not in the guidelines. We had a long discussion and patient wanted to proceed. Patient did excellent and back to work full time the next week, never saw her again.

I don't understand the snide responses for someone asking a valid question and trying to learn from colleagues. Op you could try Docmatter.com
 
bubaghanush said:
I have done one kypho on 40yo traumatic fx. She was still miserable 4 months out and missing work. MRI STIR still lighting up I realize it is not in the guidelines. We had a long discussion and patient wanted to proceed. Patient did excellent and back to work full time the next week, never saw her again.

I don't understand the snide responses for someone asking a valid question and trying to learn from colleagues. Op you could try Docmatter.com
Click to expand...
It was more of the young doc posting the worry about adjacent segment disease in a 28 y/o. That reads to me that there is a fundamental misunderstanding of the literature when it comes to adjacent level fractures in osteoporosis. But it concerns me more that there is a lack of understanding on human bone physiology/pathophysiology as this patient had trauma and not osteoporosis.
 
lobelsteve said:
It was more of the young doc posting the worry about adjacent segment disease in a 28 y/o. That reads to me that there is a fundamental misunderstanding of the literature when it comes to adjacent level fractures in osteoporosis. But it concerns me more that there is a lack of understanding on human bone physiology/pathophysiology as this patient had trauma and not osteoporosis.
Click to expand...

A lot of experts in our field disagree with you, I’ve spoken to them personally. Opinions are like dinguses…
 
Members don't see this ad :)
N of 1 is still not something we should be basing routine clinical decision making on.


your blind trust in KOL opinions is consistent with the outward impression that you are giving, which is a lack of interest in true medicine.


to use your own words, opinions (from KOL) are like dinguses and are often tainted by $$$ and fame.


find the literature. read good high quality studies. base your medical decision making on data, not opinions.
 
Ducttape said:
N of 1 is still not something we should be basing routine clinical decision making on.


your blind trust in KOL opinions is consistent with the outward impression that you are giving, which is a lack of interest in true medicine.


to use your own words, opinions (from KOL) are like dinguses and are often tainted by $$$ and fame.


find the literature. read good high quality studies. base your medical decision making on data, not opinions.
Click to expand...

Let’s say I do have a gap in knowledge here, why this response? This isn’t as black and white as you guys are making it. I am merely looking out for patient safety.
 
masterPain said:
Let’s say I do have a gap in knowledge here, why this response? This isn’t as black and white as you guys are making it. I am merely looking out for patient safety.
Click to expand...
The Efficacy of Balloon Kyphoplasty Compared to Conservative Treatment for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis.

Sebastian Encalada, M.D.1, Christine Hunt, D.O.1, Belinda Duszynski, B.S.2, Vafi Salmasi, M.D. M.S. 3 , Paul Scholten, M.D. 4, Zirong Zhao, M.D., Ph.D.5, George Rappard, M.D.6, William Evan Rivers, D.O.7,8, To-Nhu Vu, M.D.9 Steven Lobel, M.D.10, Adrian Popescu, M.D.11, D. Scott Kreiner, M.D.12


These are my experts. Pending publication.
 
1. because you clearly did not look at primary source data such as found on pubmed.
2. you perseverated with questions that were dubious in nature and were answered succinctly by lobelsteve, who i consider a KOL with no financial stake, and continued to disagree with him.
3. i personally find it strenuous that so many on this forum see pain management only through the tip of a needle.


if you are going to disagree with someone, bring data.
 
Will ensure I do an extensive literature search prior to posting a question next time your excellence.
 
Ducttape said:
N of 1 is still not something we should be basing routine clinical decision making on.


your blind trust in KOL opinions is consistent with the outward impression that you are giving, which is a lack of interest in true medicine.


to use your own words, opinions (from KOL) are like dinguses and are often tainted by $$$ and fame.


find the literature. read good high quality studies. base your medical decision making on data, not opinions.
Click to expand...
Expert opinion (us hashing it out here) is a tier of evidence. Tons of the pain literature is garbage and we all know it. Most of it is case studies (N of 1) or case series (“in my experience”), and most of the large RCTs are biased due to industry funding. We are all just doing the best we can for our patients. Unlike the perpetual motion machine of the political debate thread, this type of discussion benefits us all in refining our practice. I’ve learned and changed a lot as a result of these types of discussions. So please, keep it civil. Save the ad hominem attacks for the political thread.
 
callmeanesthesia said:
Expert opinion (us hashing it out here) is a tier of evidence. Tons of the pain literature is garbage and we all know it. Most of it is case studies (N of 1) or case series (“in my experience”), and most of the large RCTs are biased due to industry funding. We are all just doing the best we can for our patients. Unlike the perpetual motion machine of the political debate thread, this type of discussion benefits us all in refining our practice. I’ve learned and changed a lot as a result of these types of discussions. So please, keep it civil. Save the ad hominem attacks for the political thread.
Click to expand...
sure.

but i fail to see any ad hominem attack. if there is a disparaging comment about his personality or his character, i do apologize for it.
 
Ducttape said:
sure.

but i fail to see any ad hominem attack. if there is a disparaging comment about his personality or his character, i do apologize for it.
Click to expand...
Ducttape said:
your blind trust in KOL opinions is consistent with the outward impression that you are giving, which is a lack of interest in true medicine.
Click to expand...
 
Medicine is not cut and dry. Literature can help support our decisions but there are outliers and exceptions. Most pain docs prescribe chronic pain meds despite lack of evidence.
 
RoloTomassi said:
Medicine is not cut and dry. Literature can help support our decisions but there are outliers and exceptions. Most pain docs prescribe chronic pain meds despite lack of evidence.
Click to expand...
Because of the inherent difficulties of studying pain and the large number of patients already receiving opioids, new research designs and analytic methods will be needed to adequately answer the important clinical and research questions. Until the needed research is conducted, health care delivery systems and clinicians must rely on the existing evidence as well as guidelines issued by professional societies, which need to be continually updated and harmonized to reflect recent research evidence and changes in expert opinion. Systems of care must facilitate the implementation of these guidelines rather than relying solely on individual clinicians, who are often overburdened and have insufficient resources. Clearly, there are some patients for whom opioids are the best treatment for their chronic pain. However, for many more, there are likely to be more effective approaches. The challenge is to identify the conditions in patients for which opioid use is most appropriate, the regimens that are optimal, the alternatives for those who are unlikely to benefit from opioids, and the best approach to ensuring that every patient’s individual needs are met by a patient-centered healthcare system. For the more than 100 million Americans living with chronic pain, meeting this challenge cannot wait.


It's why no one is starting patients on opiates these days. But we have 20-30 years before our current patients expire.
 
lobelsteve said:
Because of the inherent difficulties of studying pain and the large number of patients already receiving opioids, new research designs and analytic methods will be needed to adequately answer the important clinical and research questions. Until the needed research is conducted, health care delivery systems and clinicians must rely on the existing evidence as well as guidelines issued by professional societies, which need to be continually updated and harmonized to reflect recent research evidence and changes in expert opinion. Systems of care must facilitate the implementation of these guidelines rather than relying solely on individual clinicians, who are often overburdened and have insufficient resources. Clearly, there are some patients for whom opioids are the best treatment for their chronic pain. However, for many more, there are likely to be more effective approaches. The challenge is to identify the conditions in patients for which opioid use is most appropriate, the regimens that are optimal, the alternatives for those who are unlikely to benefit from opioids, and the best approach to ensuring that every patient’s individual needs are met by a patient-centered healthcare system. For the more than 100 million Americans living with chronic pain, meeting this challenge cannot wait.


It's why no one is starting patients on opiates these days. But we have 20-30 years before our current patients expire.
Click to expand...

What are your thoughts on intrathecal pumps for chronic non-cancer pain?
 
masterPain said:
What are your thoughts on intrathecal pumps for chronic non-cancer pain?
Click to expand...
I dread every one I put in. Currently 4 of them. All happy with current setup. 2 are palliative, 2 are younger and I explanted their SCS.
Had 7 in my career, 3 died as expected, in less pain.
 
lobelsteve said:
I dread every one I put in. Currently 4 of them. All happy with current setup. 2 are palliative, 2 are younger and I explanted their SCS.
Had 7 in my career, 3 died as expected, in less pain.
Click to expand...

How do you handle patients who don’t respond optimally to procedures? (Non surgical)

(Probably just a handful per year I’m sure 😉
 
masterPain said:
How do you handle patients who don’t respond optimally to procedures? (Non surgical)

(Probably just a handful per year I’m sure 😉
Click to expand...
I avoid procedures until meds and exercises fail. Most procedures are only done to get the patient able to do exercises. If procedures fail, then surgical consult if warranted, meds, PT, reevaluate with new imaging.
 
lobelsteve said:
I avoid procedures until meds and exercises fail. Most procedures are only done to get the patient able to do exercises. If procedures fail, then surgical consult if warranted, meds, PT, reevaluate with new imaging.
Click to expand...
What kind of med management? Not being facetious
 
masterPain said:
A lot of experts in our field disagree with you, I’ve spoken to them personally. Opinions are like dinguses…
Click to expand...
I’m confused. When you guys are talking about adjacent segment disease after kypho I assume you’re talking about increased risk of adjacent level fracture, right? And then the debate is whether there is still a concern in a young healthy nonosteoporotic patient. Is that what we’re debating?

If so, I think there still is a risk albeit much lower. No data just my 2cents 😉
 
clubdeac said:
I’m confused. When you guys are talking about adjacent segment disease after kypho I assume you’re talking about increased risk of adjacent level fracture, right? And then the debate is whether there is still a concern in a young healthy nonosteoporotic patient. Is that what we’re debating?

If so, I think there still is a risk albeit much lower. No data just my 2cents 😉
Click to expand...

Not in the immediate future for the young patient, but as they age decades later it “could” put them at higher risk for fractures. That’s the way I understand it and likely associated with ostoeporosis/decreased bone density later in life. The stiff vertebra changes normal biomechanics of spine at adjacent levels. Not claiming to be an expert on the matter just what I’ve been told which is why most avoid doing kyphos in younger population. (Not to mention like others have said traumatic vs non-osteoporotic)

Voodoo probably but the reason I asked
 
A quick question: If we see posterior extravasation during early phase of cementing, what should we do? Thanks.
 
Stop and figure out how to get the bone filler to a different bone island in the vertebral body. So probably using the bevel tip to drive the jamshidi more inferior and anterior in the vertebral body. If you have time, could reballoon. Or you could reballoon in the same spot you injected with cement (egg shell technique). Could deploy a curved needle also to try to fill the opposite side better. Sometimes you just have a crappy case and can’t fix it.
 
BobBarker said:
Stop and figure out how to get the bone filler to a different bone island in the vertebral body. So probably using the bevel tip to drive the jamshidi more inferior and anterior in the vertebral body. If you have time, could reballoon. Or you could reballoon in the same spot you injected with cement (egg shell technique). Could deploy a curved needle also to try to fill the opposite side better. Sometimes you just have a crappy case and can’t fix it.
Click to expand...
Can you describe this egg shell technique again.
So you inject cement, go back in with balloon and redeploy in the same area?
 
You must log in or register to reply here.

Similar threads

G
Kyphoplasty vs epidural
Replies
16
Views
1K
PMROralBoards
P
C
Perc SCS in patients with FBSS?
2
Replies
53
Views
3K
Orin
O
lobelsteve
Running the patients
Replies
35
Views
2K
hyperalgesia
hyperalgesia
bronchospasm
Kyphoplasty with 2 C arms
Replies
46
Views
4K
SC Tian
SC Tian
P
Intra-Articular Hip Injections in Obese Patients
2
Replies
95
Views
5K
cowboydoc
cowboydoc
Top