Concluded Case

Vertebroplasty.. a grey zone

another controversial area.. 68/f, severe Mid and low back pain, 14 months, no neurological complaints, multiple admissions, two MRI, traction, physiotherapy, pain killers, etc, no relief, vertebroplasty with bone cement 2 months ago, no relief.. invite views of forum

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Concluded answer
vertebroplasty is of dubious therapeutic value... many a times it harms by extravaseted cement producing neuronal compression which was not there.. huge amount of fees are taken for this procedure..all vertebral fractures will heal with complete bedrest. if no deficits, nothing further is needed. x-ray correction is never the goal of any treatment. inadequate and improperly rested patients only continue to experience backache whereby these procedures are advised. so the indication is generated by such inadequate prior advices
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D12 and L1 wedging Reduced height multiple thoracic vertebrae Degenerative disc disease lumbar spine Symptoms correlate with MRI findings Short Taylor's brace for ambulation Calcium vitD Gabapentin will help Further evaluation needed in view of multiple vertebral involvement CBC esr Urine bence Jones protein Serum protein electrophoresis Usg abdomen Chest xray Skull lateral view Calcium Phosphorus Alkaline phosphatase vitD levels Nothing much can be done about the existing pathology Full evaluation will reassure the patient
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Only One level addressed initially. Or development of new wedge compression # following vertebroplasty (many studies show such correlation) (cement leak anteriorly seen) Also need to see other MRI cuts.. Canal stenosis and disc bulge to be ruled out More than 40 yrs low back ache rule out metastasis and multiple myeloma is the rule Rule out infective inflammatory degenerative traumatic history To do esr crp alkaline phosphate t. Protein alb s. Ca p usg abd with pelvis, neck and breast, Rft, s. Electrophoresis
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Wedging and destruction at D12L1 Probably 1st surgery failed as seen from picture orthodesis with bone cement seen could not takeup rather bulgeing and narrowing of canal noted Yes beside neuropathy i will also r/o Potts spine This case will require second surgery with decompression and internal still bracket fixation followed by physiotherapy
Thanx dr Sanjoy Sarkar
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Noncompressive myelopathy Vitamin B 12 assay
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Myelopathy go for vit B12, n vit D level
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vertebroplasty is of dubious therapeutic value... many a times it harms by extravaseted cement producing neuronal compression which was not there.. huge amount of fees are taken for this procedure..all vertebral fractures will heal with complete bedrest. if no deficits, nothing further is needed. x-ray correction is never the goal of any treatment. inadequate and improperly rested patients only continue to experience backache whereby these procedures are advised. so the indication is generated by such inadequate prior advices
Rigid Taylor's brace . Complete treatment of osteoporosis.back muscle strengthening and posture correction exercises . Considering osteoporosis age multiple level involvement degenerative disc disease it will long time.
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Low back pain For niramavastha - Shunthi churna 2gm before meal Rasna Saptak kwath40ml+2tsf castor oil bd Maha yograj guggulu 2bd Ajmodadi churna 1tsf bd kati basti -mahavishgarbh tail
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!
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Alignment disturbing due to d12&L5vertebral compression # osteoporosis and degeneration r seen physiotherapy back isometric Rx vit d ca++B12 Gabalamin Nsaid
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