VCF's referred pain

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SIIMS

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I have seen a string of older patients who have lower thoracic and high lumbar VCF's, active on MRI (STIR) with pain that is seemingly distal to their affected vertebral level without much percussion pain over the involved segment.

For instance, an L1 50 % loss height with all his pain at the lumbosacral level.

Thoughts??

Also, if anyone can weigh in on V-plasty in this instance
 
SIIMS said:
I have seen a string of older patients who have lower thoracic and high lumbar VCF's, active on MRI (STIR) with pain that is seemingly distal to their affected vertebral level without much percussion pain over the involved segment.

For instance, an L1 50 % loss height with all his pain at the lumbosacral level.

Thoughts??

Also, if anyone can weigh in on V-plasty in this instance
Click to expand...

I've seen this a couple times. How about the experienced pros?????
 
I had a very nice lady with horrible left SIJ pain that has a few SIJ x-rays and some SIJ injections. I told her we needed to widen our scope and get lumbar spine films. She had an acute L1 compression fracture (osteoporosis).

Not a twinge of pain when I thumped on her spinous processes in the midline, or any lumbar midline pain with ext/flexion.
 
Jitter Bug said:
I had a very nice lady with horrible left SIJ pain that has a few SIJ x-rays and some SIJ injections. I told her we needed to widen our scope and get lumbar spine films. She had an acute L1 compression fracture (osteoporosis).

Not a twinge of pain when I thumped on her spinous processes in the midline, or any lumbar midline pain with ext/flexion.
Click to expand...


what did u do? Vertebral Aug L1? Did she get relief? I just thought you needed "point tenderness" AND edema on STIR imaging. I thought BOTH criteria needed to be filled....
 
PinchandBurn said:
what did u do? Vertebral Aug L1? Did she get relief? I just thought you needed "point tenderness" AND edema on STIR imaging. I thought BOTH criteria needed to be filled....
Click to expand...

Edema on STIR is all. Point tenderness on the SP is worthless. Dozens of patients get stone protocol, hip films, then get Dx. Usually a fall with mild pain that then worsens when the fracture starts collapsing.
 
Saw same thing this past week. Acute VCF @ L1 with edema on MR. Pt complains of pain around bottom of Lspine. Absolutely no pain to percussion over L1, only at bottom of spine. Problem though is that she has significant retropulsion with impingement upon thecum. Referred to neurosurgeon who says he won't touch her because she does not complain of pain over VCF.

Try ESI and/or mbnb just to resolve some pain for a short while? Don't really care about billing but more about just getting some relief.
 
Lizard1 said:
Saw same thing this past week. Acute VCF @ L1 with edema on MR. Pt complains of pain around bottom of Lspine. Absolutely no pain to percussion over L1, only at bottom of spine. Problem though is that she has significant retropulsion with impingement upon thecum. Referred to neurosurgeon who says he won't touch her because she does not complain of pain over VCF.

Try ESI and/or mbnb just to resolve some pain for a short while? Don't really care about billing but more about just getting some relief.
Click to expand...
???


she's got impingement and retropulsion and he wont touch her? Time to get a new neurosurgery consult....
 
I too have seen this scenario multiple times; upper lumbar VCF with either midline LS pain or sacral sulcus pain. For some I've targeted the area of pain, for others I've cemented. Variable results which I have yet to be to make any definitive conclusions about ... would love to hear any more experienced thoughts
 
1. He won't touch her because she does not complain of any radicular pain or have impingement symptoms. Also, she does not complain of pain over the VCF. The neurosurgeons out here in West TX are generally pretty conservative which I liked in the beginning but now is getting frustrating

2. Techie.....that's not my game unfortunately. I'll ask my office mgr on Monday about how to do this
 
For the lazy:

VCF-C.jpg


From the article:

Preoperative NRS was 7.7 in Type A, 7.8 in Type B1, 8 in Type B2, and 7.3 in Type C. PVP or PKP significantly reduced pain in all the patients with OVCFs in the same manner as in previously published studies. Type A showed the most improvement of pain following the procedures, followed by Type B1 and B2 (Fig. 4). However, Type C did not significantly affect the postoperative outcomes. Deformity index, kyphosis rate, and angle show a significant change following PVP or PKP (p<0.05), respectively (Fig. 5). As the height of vertebral body (deformity index) was increased following the procedure, postoperative outcome improved (Fig. 6). Consequently, postoperative difference of deformity index was reversely related with favorable outcome. Postoperative differences in the kyphosis rate and angle were, however, not correlated with postoperative outcome.



What it means: Remote pain from Fx does well with VCF augmentation.

Why am I not a consultant to Stryker? Beats me.
 
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