CHAMBERTHINK COLUMN
"
Dr. Masciale with daughter, Angela Masciale.
Like every
surgical
procedure,
its successful
completion
is a matter
of art and
science."
Many patients will then return to their primary care
physician or healthcare provider with continued reports of
ongoing persistent pain, and again a red flag should be raised
with regards to the potential for an underlying vertebral body
fracture. Unfortunately, the opportunity to make this diagnosis is
still frequently missed, and the patient is sent out for "conservative
treatment" with physical therapy, or sent to a chiropractor
for a little manipulatory treatment. These types of treatments
may actually contribute to additional failure and collapse of an
unhealed vertebral compression fracture.
Finally, the patient or family may voice greater complaints
of pain and incapacitation in the manner which will then result in
an order for a simple x-ray examination. Because of the nature
of osteoporosis, the weaker the bone, the more "washed out"
the appearance of such bone on x-ray examination and at times,
a subtle fracture can be missed, especially if it is mixed in the
midst of a multitude of vertebral segments which have chronic
deformations of shape and whose fracture does not stand out as
the acute cause of severe discomfort and pain.
The solution of course is to proceed with an MRI
examination of the thoracic or lumbar spine, as these studies
accurately depict the location of new fractures with the STIR
sagittal images. Unfortunately, some individuals, especially
those with pacemakers cannot undergo MRI examinations.
Thus, it is not uncommon for us to see in our clinic patients
who've had many weeks or even months of symptoms before
being referred for an orthopedic spine evaluation and treatment.
Oftentimes we are the ones that order the MRI examinations, and
at other times they have been performed, and, x-rays then taken
in our office show the shape of the bone to have substantially
collapsed relative to the shape of the bone on its MRI appearance,
indicative of instability and the need for surgical intervention. In
general terms, fractures that have collapsed by 50% probably
should be treated by surgical intervention, however, lesser
fractures present for weeks compromising function in the face
of pre-existing osteoporosis probably are also best treated by
surgical means.
The surgical treatment for such fractures is by kyphoplasty.
This is a minimally invasive treatment done under fluoroscopic
imaging, under general anaesthesia, requiring only small
incisions to access the fractured vertebral segment. By means
of fluoroscopic placement of hollow working cannulas, tracks