sacral insufficiency fracture interventional tx

[schmee90]

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Have a nice 84 Yo lady with osteoperosis surgeon sent to me with sacral insuf fx, asking for an RFA as she do esnt want any surgical tx. I dont see any evidence for this, or really much to offer her other then rest, tx osteoperosis, and surgical tx options is she wants them or sacroplasty?

 

[clubdeac]

Only interventional treatment with any evidence I’m aware of is sacroplasty.
Anecdotally I’ve had success with caudal epidurals but you will likely want to wait at least three months for adequate healing. even then someone could argue that you’re still negatively affecting the healing process with your steroid

 

[lobelsteve]

Sacroplasty. Miacalcin NS for bone pain. No RFA. No caudal. Treat the OP. Tymlos>Evenity>Prolia.

 

[DODOCSS]

Have a nice 84 Yo lady with osteoperosis surgeon sent to me with sacral insuf fx, asking for an RFA as she do esnt want any surgical tx. I dont see any evidence for this, or really much to offer her other then rest, tx osteoperosis, and surgical tx options is she wants them or sacroplasty?

Caudal 100%, wait 6M

 

[PinchandBurn]

Sacroplasty. Miacalcin NS for bone pain. No RFA. No caudal. Treat the OP. Tymlos>Evenity>Prolia.

Doesnt get paid...sacroplsdty

 

[PinchandBurn]

Sacroplasty. Miacalcin NS for bone pain. No RFA. No caudal. Treat the OP. Tymlos>Evenity>Prolia.

Whats dose of these meds?

Amy contraindications? Labs tht need to be followed?

 

[lobelsteve]

Whats dose of these meds?

Amy contraindications? Labs tht need to be followed?

Miacalcin is 1 puff alternate nostrils (BID).
Others far too complex for a post. Lots of labs and A DEXA. Ca levels followed if low GFR.
Miacalcin short term only. Others- renal failure or unexplained parathyroid disease gets Endo consult.

 

[PinchandBurn]

Miacalcin is 1 puff alternate nostrils (BID).
Others far too complex for a post. Lots of labs and A DEXA. Ca levels followed if low GFR.
Miacalcin short term only. Others- renal failure or unexplained parathyroid disease gets Endo consult.

Any contraindications to Miacalcin? Seems easy.


I am a pain doc like you.


Going beyond something relatively easy to do with all the other stuff private practice entails would be challenging. I hear the "own the bone" mantra. But logistically stabilizing the fracture and doing something relatively simple is all most of us can do.

 

[lobelsteve]

Any contraindications to Miacalcin? Seems easy.


I am a pain doc like you.


Going beyond something relatively easy to do with all the other stuff private practice entails would be challenging. I hear the "own the bone" mantra. But logistically stabilizing the fracture and doing something relatively simple is all most of us can do.

Then you need to be able to talk to PCP or whomever will be treating the underlying disease. If she has another fracture, it is your fault.
Miacalcin more than 6 mo associated with potential malignancy.

 

[SpineandWine]

Bringing this thread back. Want to learn sacroplasty- where do I start?
Any review articles?
Any tips?

 

[BobBarker]

No. Don’t learn it. Doesn’t get paid. Crappy spread of cement 90% of the time.

 

[SpineandWine]

No. Don’t learn it. Doesn’t get paid. Crappy spread of cement 90% of the time.

Does it help?
I don’t mind doint it at place I’m wRVU

 

[BobBarker]

You want to cost the facility $5000 after kit and staffing for 7 units?

 

[SpineandWine]

You want to cost the facility $5000 after kit and staffing for 7 units?

Can you bill as lumbo-sacral vertebroplasty?

 

[BobBarker]

That is what some say but that does not appear covered by the ncd either.