Patient Referred for Kypho: What's your Next Move?

[drusso]

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Merry Christmas from the Pain Clinic...

 

[ScawtyDawg]

spinejack that up brah 🔝

 

[SpineandWine]

But are they tender over location of the cluneal nerves?

 

[BobBarker]

What is in there already? Bullet?

 

[mdo1738]

Incredibly lucky patient. Bullet less than an inch away from complete cord transection. Was he just standing on the corner minding his own business?

 

[Taus]

Incredibly lucky patient. Bullet less than an inch away from complete cord transection. Was he just standing on the corner minding his own business?

Training at a level one trauma center in North Philly… I learned that’s actually the most common reason by far for getting shot, stabbed, hit repeatedly with crowbar, thrown off a building or combination thereof. It is known to get you handcuffed in bed, despite being tetraplegic, so your friends can’t come escort you home.

 

[clubdeac]

Merry Christmas from the Pain Clinic...

View attachment 396610

Come in on the left and fill baby fill

 

[drusso]

But are they tender over location of the cluneal nerves?

Extremely tender.

 

[drusso]

What is in there already? Bullet?

86 year old female shot in the back by her father at age 12. Raised 5 children, owned and operated her own business. Husband died in Vietnam. Fell three weeks ago and now with worsening low back pain.

Percussion tenderness over spine processes, tender over iliac crests. History of Fibromyalgia.

 

[BobBarker]

mri has to show edema or no kypho but you can’t get a mri so you have to order a bone scan.

 

[lobelsteve]

Open bullet removal then spinejack.

 

[BoardingDoc]

Open bullet removal then spinejack.

Why spinejack over straight Kypho? I'm curious both in this case and in general. I've heard the pitch from Stryker but I'm hesitant to take a rep's word about this sort of thing for obvious reasons.

 

[clubdeac]

mri has to show edema or no kypho but you can’t get a mri so you have to order a bone scan.

Why can’t you get MRI? If bullet imbedded in bone it ain’t moving right. No different than imaging prior fusion patients?

 

[BobBarker]

They will not ever allow her to get an mri due to the unknown metallurgy of the bullet.

 

[RoloTomassi]

Def won't allow. Might vibrate, create heat, unlike titanium. Beautiful transpedicular technique without violation medial wall. I'm assuming there's prior imaging to tell if that fx is new

 

[SpineandWine]

It’s not worth extracting bullet (no one would do it).

 

[Taus]

Bone scan to confirm acute/sub and then maybe vertebroplasty, no balloon, entering from left?

 

[Clean7795]

Why can’t you get MRI? If bullet imbedded in bone it ain’t moving right. No different than imaging prior fusion patients?

The bullet would obscure the surrounding bone on MRI with artifact. It would not be diagnostic for assessing the surrounding bone.

Also even though it is unlikely to move while embedded in bone, I doubt you'd find a radiology department willing to take on that risk for an elective procedure.

 

[lobelsteve]

Why spinejack over straight Kypho? I'm curious both in this case and in general. I've heard the pitch from Stryker but I'm hesitant to take a rep's word about this sort of thing for obvious reasons.

So I don’t have to see her. It looks vertebra plana and I would not offer to put cement in her bone and disc. Happy to treat OP with anabolics after NS fixes them open.

 

[hyperalgesia]

3 weeks? Needs time to heal. Tramadol.

I would send to surgery if she's unable to function and refusing to get out of bed and deteriorating and it's all due to this pain, ie not fibro, etc.

It's too complicated for my taste for kypho around hardware (bullet). No idea what effect gluing a bullet in bone will have.

 

[pmrmd]

Interesting case. I had no idea what in the world that was.