Lumbar facet injection and Von Willebrand disease

[William Sparrow]

---

Members don't see this ad.

18 yo female with a history of congenital scoliosis s/p surgical repair ~7 years ago. Apparently almost bled to death on the operating table. Later workup found that she has Von Willebrand's disease. Fast forward to now:

Came in for axial back pain. Imaging shows some adjacent level disease in the facets. Was thinking about injecting. I think most would get a heme consult prior to proceeding with something like an epidural. Would you guys do the same for IA facet injection as well?

thanks

 

[SSdoc33]

yes. von willibrands can be nothing or a huge problem. variable penetrance. heme may give them a little sniff or shot of DDAVP

 

[lobelsteve]

Meh, young person- more aggressive PT and triple cream. But would not hesitate to inject if right demographic. (older).

 

[painfree23]

Meh, young person- more aggressive PT and triple cream. But would not hesitate to inject if right demographic. (older).

Triple cream? U mean a compound ointment?

 

[lobelsteve]

Triple cream? U mean a compound ointment?

Steven M. Lobel, MD LLC - Patients

New page

www.stevenlobel.com

No money exchanging hands through a compounding pharmacy. Not for human use.

 

[William Sparrow]

Meh, young person- more aggressive PT and triple cream. But would not hesitate to inject if right demographic. (older).

Crummy insurance :-\ Trying to find a good therapist to take her on. Ended up finding one and referring out to start.

 

[deleted875186]

I would take a good history regarding the VWD. If she knows the type or has an old consult note. If she knows it is a mild type, I would not investigate further. You could simply order the activity level and VWF activity level. If it’s abnormal than you’ll need the heme consult, if normal I would be fine doing an ILESI on them.

Facet or RFA I would be fine doing regardless.

 

[Sooshi]

Not unreasonable to get a heme consult to check factor levels and see if desmopressin-responsive. Anecdotally we've done a few RFs with oral amicar/TXA taken the day of, but it's good to have heme's blessing if you're going to do things like that. This, of course, being in an academic institution, so YMMV.

Also, Dr. Lobel, your kitchen chemistry brings me joy. We're out here mixing ketamine, diclofenac, clonidine, and all kinds of nonsense - meanwhile he's making 300IQ cream in Tupperware.