Pictures of the Week

[Taus]

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Another from a few months ago, elderly, frail, unable to independently ambulate or transfer. Sent by spine surgeon, not a candidate for fusion due to medical comorbid, osteoporosis. 90% relief. I see this outcome routinely. Do the procedure right, on patient with the right indications, and they do well with only very rare exception. Then get them on an anabolic agent.

I’ve got hundreds more cases on my phone if you still think this procedure can’t be done properly in a consistent basis….

 

[clubdeac]

Yep. Absolutele ****e. Weird how a procedure doesn’t work when someone does it poorly. Here’s mine from yesterday with 100% relief. A little bursty. Waited till cement was very thick, inject small volume slowly, take breaks to harden and seal off cracks.

Beautiful…it’s pics like this that make me sometimes wanna get back into it

 

[BobBarker]

With the cement in the superior and inferior disc, we have no idea how much he tried to reposition and it continued to just spill out the fracture line. We don’t have true control ever in these cases. Are there nuances that some doctors know and others don’t? Yes. But we shouldn’t be judgmental, especially here where it looks like his bone filler was well placed midline vb/pedicle. The doctor who did the case is disappointed in the outcome, too. When/if you redo it, it will probably have a better result as there is some cement plugging the fracture line and the bone is more sclerotic now.

 

[Taus]

With the cement in the superior and inferior disc, we have no idea how much he tried to reposition and it continued to just spill out the fracture line. We don’t have true control ever in these cases. Are there nuances that some doctors know and others don’t? Yes. But we shouldn’t be judgmental, especially here where it looks like his bone filler was well placed midline vb/pedicle. The doctor who did the case is disappointed in the outcome, too. When/if you redo it, it will probably have a better result as there is some cement plugging the fracture line and the bone is more sclerotic now.

You are right. I have had one really ugly looking leak that I could not get to stop despite adjustments and waiting in a highly compressed and comminuted fracture. I would be embarrassed if it was posted publicly.

Since then, if it is highly compressed with large voids in the endplate and not really room to adjust bone filler tip much ie high risk for leak, I have switched to a curved bone filler to allow for more adjustments in tip location, i.e. not just following the single straight path of entry. Even when it is not highly compressed, I have found just waiting to be unsuccessful at resolving the start of a leak. I don’t hesitate to re-stylet and adjust tip and bone filler location. If dense/sclerotic bone with minimal balloon expansion, I go to the curette to create some channels /voids to lower the pressure of cement injection. I have not found “egg-shelling” to be too helpful. I also do not think Osteopearl would help me in these highly compressed more complex fractures in the 2 cases I posted

 

[MitchLevi]

Heck of a caudal by an NP.

 

[clubdeac]

1

Heck of a caudal by an NP.


View attachment 416160

160mg depo and 12 seconds of fluoro. That person is an idiot

 

[BoardingDoc]

1

160mg depo and 12 seconds of fluoro. That person is an idiot

Also, why does it read like it was written in Chinese and then pasted into Google translate to convert to English?

 

[interjectionreflection]

#mskir #mri #kyphoflex | Glade Roper, MD — MSKIR
Basic question
Thoughts on the CLO view for the epidural contrast? Is it normal to have it in the middle like that?

 

[RoloTomassi]

#mskir #mri #kyphoflex | Glade Roper, MD — MSKIR
Basic question
Thoughts on the CLO view for the epidural contrast? Is it normal to have it in the middle like that?

Yes that's how it looks if contrast spreads across midline to contralateral side, which would make sense for a midline anesthesia epidural. Next time you do a paramedian ILESI shoot an ILO and see

 

[RoloTomassi]

Got sciatica watching this

Another successful Stearable cather foramenotomies at our great hospital ALMehwar Hospital | Prof.Dr.Mohammad Yosry | 21 comments

Another successful Stearable cather foramenotomies at our great hospital ALMehwar Hospital | 21 comments on LinkedIn

www.linkedin.com

 

[MitchLevi]

Got sciatica watching this

Another successful Stearable cather foramenotomies at our great hospital ALMehwar Hospital | Prof.Dr.Mohammad Yosry | 21 comments

Another successful Stearable cather foramenotomies at our great hospital ALMehwar Hospital | 21 comments on LinkedIn

www.linkedin.com

Dang dude!!!

 

[lobelsteve]

ZINeu Steerable Epidural Catheter with Balloon

www.medical.kln.com

Target Catheter in 2005.
Similar knockoffs at that time as well. Looks like these guys still trying.

 

[lobelsteve]

Acute neck pain on right. H/o C3-7 ACDF 3 years ago. Hodgkin's Lymphoma, Osteomyelitis T10-11 in 2016.
WBC 4
ESR/CRP mildly elevated.
MRI with STIR edema at this joint and in soft tissues.
Not toxic appearance, afebrile.

 

[lobelsteve]

Just here for the GTB shots, no I have not seen a Neurosurgeon. Already on Rinvoq. No mention on CT Chest regarding the canal.

 

[Orin]

View attachment 416569

Just here for the GTB shots, no I have not seen a Neurosurgeon. Already on Rinvoq. No mention on CT Chest regarding the canal.

Just a little tight.
What was the exam though?

 

[lobelsteve]

Just a little tight.
What was the exam though?

Ambulatory. A bit stiff.....
Was here for GTB and noticed difficulty getting up and off table due to whole spine fused. Went and looked at imaging. Seeing him back next week to discuss his spine.

 

[Orin]

Ambulatory. A bit stiff.....
Was here for GTB and noticed difficulty getting up and off table due to whole spine fused. Went and looked at imaging. Seeing him back next week to discuss his spine.

What? You didn't check for clonus before the GTB!!!

 

[cowboydoc]

View attachment 416568View attachment 416569

Just here for the GTB shots, no I have not seen a Neurosurgeon. Already on Rinvoq. No mention on CT Chest regarding the canal.

Needs some CLR. I would probably go interlam, as the risk of arterial CLR not well studied.

 

[BobBarker]

It is too high and too fused for them to safely get to the disc. They could do a single level lami. Wouldn’t ever get unstable do to the auto fusion.

 

[interjectionreflection]

It is too high and too fused for them to safely get to the disc. They could do a single level lami. Wouldn’t ever get unstable do to the auto fusion.

Would be worthwhile to get an MRI look for any myelomalacia or cord might push for sx if present

 

[lobelsteve]

No disc. Ankylosing spondylitis with a bit of OPLL. No surgery needed. Neuro intact. Fused C2-S1 from disease. C spine OPLL not fully appreciated but MRI C and T spine next week. Got Radiology on board to do addendum on CT above.

 

[clubdeac]

No disc. Ankylosing spondylitis with a bit of OPLL. No surgery needed. Neuro intact. Fused C2-S1 from disease. C spine OPLL not fully appreciated but MRI C and T spine next week. Got Radiology on board to do addendum on CT above.

Stuff like this is why I keep coming back to work. Not bc of all the shiny new toys…that typically don’t work well

 

[Orin]

Stuff like this is why I keep coming back to work. Not bc of all the shiny new toys…that typically don’t work well

I think an interspinous spacer could probably wedge it open?

 

[lobelsteve]

Figure - PMC

Prospective study. To characterize the normal pattern of kinetics of postoperative C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) after decompression, spinal instrumentation, and posterolateral fusion in 1, 2, and more than 2 ...

pmc.ncbi.nlm.nih.gov

 

[clubdeac]

Figure - PMC

Prospective study. To characterize the normal pattern of kinetics of postoperative C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) after decompression, spinal instrumentation, and posterolateral fusion in 1, 2, and more than 2 ...

pmc.ncbi.nlm.nih.gov

View attachment 417314

Didn’t know inflammatory markers peak after spine surgery and don’t return to baseline for 4 weeks. Good to know. Thanks

 

[lobelsteve]

AS.
Even facets fused.
Muscles not able to do much so they wither away.

 

[BobBarker]

Reactivate or Nalu over the medial branches?? 😝

 

[cowboydoc]

View attachment 417752

AS.
Even facets fused.
Muscles not able to do much so they wither away.

Wagyu-licious!

 

[lobelsteve]

L5L and L5R (Rads called it L5 on right and L6 on left)
L3-4 facet failure of segmentation.
Also h/o clubfoot deformity.
Cord ends at top of L4.
Otherwise looking good.

 

[interjectionreflection]

View attachment 417803View attachment 417801


L5L and L5R (Rads called it L5 on right and L6 on left)
L3-4 facet failure of segmentation.
Also h/o clubfoot deformity.
Cord ends at top of L4.
Otherwise looking good.

Heads up, there is still patient name and info on the axial images

 

[mdo1738]

Heads up, there is still patient name and info on the axial images

I think that’s the imaging facility name

 

[lobelsteve]

Heads up, there is still patient name and info on the axial images

On first post. Edited her name off.

 

[lobelsteve]

 

[SSdoc33]

View attachment 417851View attachment 417852

looks like Johnny 5

 

[lobelsteve]

looks like Johnny 5

Wait til you see my artwork. 😜

 

[lobelsteve]

The nurses getting better with AI. Sent me this as I was driving in to work.

 

[Taus]

I love a good cleft fill. Had two today.The t7 collapsed a lot between MRI three weeks ago and today. Lots of air in the bone with the balloon lifting as much as I could safely.

 

[Orin]

I love a good cleft fill. Had two today.The t7 collapsed a lot between MRI three weeks ago and today. Lots of air in the bone with the balloon lifting as much as I could safely.

Which balloon is that?

 

[Taus]

Which balloon is that?

Medtronic Kyphoflex system (which is merit Arcadia balloon)

 

[lobelsteve]

Revisiting this image. MVA 30 years ago. Patient reports Fx and experimental treatment. Markers in body, facet, and spinous process. WTH is this?

 

[DODOCSS]

View attachment 418111

Revisiting this image. MVA 30 years ago. Patient reports Fx and experimental treatment. Markers in body, facet, and spinous process. WTH is this?

20 gauge shotgun

 

[MitchLevi]

‘rona vaccine

 

[SSdoc33]

View attachment 418111

Revisiting this image. MVA 30 years ago. Patient reports Fx and experimental treatment. Markers in body, facet, and spinous process. WTH is this?

Not sure, but there are 2 pairs and 2 singles. They look symmetrical

 

[PMROralBoards]

View attachment 418111

Revisiting this image. MVA 30 years ago. Patient reports Fx and experimental treatment. Markers in body, facet, and spinous process. WTH is this?

Gold thread acupuncture?

 

[JFS]

View attachment 418111

Revisiting this image. MVA 30 years ago. Patient reports Fx and experimental treatment. Markers in body, facet, and spinous process. WTH is this?

Per Claude

Those are almost certainly tantalum bead markers from Roentgen Stereophotogrammetric Analysis (RSA), a research imaging technique developed by Selvik at Lund University in the 1970s and used heavily in spine trials from the mid-1990s through mid-2000s to measure sub-millimeter intervertebral motion. The 0.5–1.0 mm beads were impacted into cancellous bone with a spring-loaded injector through small pilot holes — no plates, screws, or hardware tracts — which is why they remain as isolated radiodense dots in body, facet, and spinous process decades later. Given a ~1996 MVA and “experimental treatment,” this patient was most likely enrolled in a lumbar fusion cage or early dynamic stabilization trial of that era.

 

[nvrsumr]

Prp. 27g. Trochlear arthritis.

 

[Taus]

Rare one. Baastrups. Prior neg mbb.

 

[SSdoc33]

Rare one. Baastrups. Prior neg mbb.

how did you code it?

 

[Taus]

how did you code it?

Wasn’t sure, Made it up… 20600x3, 77003
M47.816, M48.26

 

[SSdoc33]

Wasn’t sure, Made it up… 20600x3, 77003
M47.816, M48.26

actually think that is a good idea. more likely to get a joint covered than the NOS code