Business Matters Fall 2018 - Page 18

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