vertebroplasty

[lattimer13]

so, i got to watch my little old lady on my internal medicine service w/ a vertebral compression fracture undergo vertebroplasty today. awesome procedure done by the neuroradiologist.

went back to check on her prior to leaving the hospital...less than 6 hours after the procedure and no pain w/ movement anymore. she's sitting upright eating and talking like she never needed her MS contin and dilaudid prn to control her 10/10 low back pain.

amazing stuff you guys are doing.

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[Docxter]

so, i got to watch my little old lady on my internal medicine service w/ a vertebral compression fracture undergo vertebroplasty today. awesome procedure done by the neuroradiologist.

went back to check on her prior to leaving the hospital...less than 6 hours after the procedure and no pain w/ movement anymore. she's sitting upright eating and talking like she never needed her MS contin and dilaudid prn to control her 10/10 low back pain.

amazing stuff you guys are doing.

I've done quite a few vertebroplasties, but I'm still constantly amazed how fast it kills the pain. Of course some benefit from it more than others, and there are potentially serious complications, but overall it is still a very satisfying procedure, seeing these little old ladies almost run around the hospital whereas a few hours earlier they could barely sit up because of the pain.

 

[fedor]

Are NS and Ortho doing these or is this still mostly IR ?

 

[Docxter]

Are NS and Ortho doing these or is this still mostly IR ?

Initially it was mostly neuroradiology, but now interventional radiologists, general radiologists, neurosurgeoes, orthopods, and pain medicine people are doing it.

 

[Cowboy DO]

Why is it seemingly impossible for IR to keep it's procedures?

 

[bugmenot]

Why is it seemingly impossible for IR to keep it's procedures?

not enough IR guys

 

[banner]

Why can't IR "keep" these procedures?


1. The most important prerequisite to me doing any procedure on a patient is my ability to convince the patient that I can do the procedure. Most patients don't know jack about medicine, and if a Doc is nice to them, they're convinced the doc is competent. The other prerequisite is to have a supply of patients.

2. IR procedures reimburse very well. Anything that reimburses well, everyone tries to do.

IR is now slowly realizing than it must develop realtionships with primary care MDs to supply the patients.

 

[Cowboy DO]

I mean if thats the case that any specialty can do whatever it wants as long as its lucrative, whats stopping us from doing shoulder and knee arthroscopies. Those look easy enough.

 

[Tenesma]

i think one of the reasons that pain is relieved so quickly is related to the temperature of the cement. the nociceptive fibers can't survive that heat - same thoughtprocess for IDET.

 

[banner]

I mean if thats the case that any specialty can do whatever it wants as long as its lucrative, whats stopping us from doing shoulder and knee arthroscopies. Those look easy enough.

In reality, nothing. Legally, you can. The procedures themselves are easy. You just need to get priveledges at a hospital or surgery center and the only thing you need to show those guys is that you won't kill people (meaning be able to deal with the complications) and you'll have a lot of cases and make a lot of $$$ for them.

The hard part of surgical fields are not really the procedures themselves, but managing the complications and knowing when you need to operate and who you need to operate on for a good outcome.

Historically, IRs would not deal with the complications of their procedures and would ship them off to other services to deal with that for them. Additionally, these same services, like Vascular surgery, were the ones sending the IRs the patients in the first place. Kind of stupid on the vascular guys part initially (and the IRs for that matter). But now they have wisened up. So IR has to respond by getting referrals from primary care guys and learning how to manage their own cases.

 

[Imhotep]

Initially it was mostly neuroradiology, but now interventional radiologists, general radiologists, neurosurgeoes, orthopods, and pain medicine people are doing it.

Add Interventional Neurologists to the list.

 

[droliver]

So IR has to respond by getting referrals from primary care guys and learning how to manage their own cases.

For the most part, it won't be primary care people directing the management on these problems, but rather the cardiologist or one of the surgery disciplines. IR just isn't in a favorable position for these overlap areas when other providers are interested in delivering those services

 

[Molly Maquire]

Would'nt primary care doctors be the ones making referrals to specialists? It seems PCPs are the ones who control patients, not surgeons or cards. In reality, an interventional radiologist isn't that much worse off than any other physician who depends on referrals for a living, which is everyone except family practice, IM and Peds.

Interventional neurology? What the hell is that? Isn't that an oxymoron? Who teaches them this stuff?

Is there anything legally preventing an IR from advertising himself as an "interventional pain specialist" and performing vertebraplasty all day? Especially considering the technique was invented by an interventional neuroradiologist?

 

[Imhotep]

Would'nt primary care doctors be the ones making referrals to specialists? It seems PCPs are the ones who control patients, not surgeons or cards. In reality, an interventional radiologist isn't that much worse off than any other physician who depends on referrals for a living, which is everyone except family practice, IM and Peds.

Interventional neurology? What the hell is that? Isn't that an oxymoron? Who teaches them this stuff?


Molly: There has recently been the creaion of a new ACGME specialty titled "endovascular surgical neuroradiology"

This is open to radiologists, neurosurgeons, and neurologists. There are additional requirements including one additional year of neuroICU training for neurologists, completion of diagnostic neuroradiology fellowship for radiologists etc. I personally know of at least 3 neurologists who are doing NeuroInterventional radiology fellowships.

 

[droliver]

Would'nt primary care doctors be the ones making referrals to specialists? It seems PCPs are the ones who control patients, not surgeons or cards. In reality, an interventional radiologist isn't that much worse off than any other physician who depends on referrals for a living, which is everyone except family practice, IM and Peds.

Absolutely correct, however on a practical level and in the real world, I don't think patients or referring PCP's are going to feel comfortable sending patients to radiologists for unilateral mangement of this without an intermediate surgical specialist evaluating them. That's why I feel like IR is going to lose this business if/when it becomes more of a mainstream tool used by the Neurosurgical or Orthpedic Spine Surgeons.

 

[trouta]

.

 

[f_w]

Absolutely correct, however on a practical level and in the real world, I don't think patients or referring PCP's are going to feel comfortable sending patients to radiologists for unilateral mangement of this without an intermediate surgical specialist evaluating them.

Already happens every day. There are successful IR practices which have split off from the 'normal' radiology practice model and see patients by direct consults. It takes marketing, investment and quality work, but it can be done (most of the vertebroplasties I was involved in so far came from rheumatology docs internists, without the involvement of a NS or Ortho).

 

[Docxter]

Already happens every day. There are successful IR practices which have split off from the 'normal' radiology practice model and see patients by direct consults. It takes marketing, investment and quality work, but it can be done (most of the vertebroplasties I was involved in so far came from rheumatology docs internists, without the involvement of a NS or Ortho).

Same with us. At our place we do A LOT of vertebroplasties. They are referred by all types of physicians, including a large number from primary care docs, without any referral from neurosurgeons or orthopods (though they send us cases too). I have even sometimes put in my MRI reports that the fractures appears to be a candidate for vertebroplasty and you can contact our clinic at this number. A lot of primary care docs like that, because just putting in compression fractures at whatever levels doesn't solve the problem much for them in terms of further management, but once they know we offer the service, they love it and send us the patients.