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January/February 2006
Volume 2, Issue 1
In this Issue:
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Click on the icon to view the newsletter as a pdf. |
Vertebroplasty: Treatment of Spinal
Compression Fractures from Osteoporosis
An Original Contribution by Frank J. E. Falco, M.D.
Osteoporosis is a bone disease that leads to low bone mass affecting 10 million Americans. ("Osteoporosis: A Silent But Common Disease In Women and Men." The Pain Journal. November/December 2005.) There are approximately 700,000 spine fractures annually from osteoporosis ususally affecting the mid/upper lumbar and mid/lower thoracic spines. The spine fractures involve the vertebral body and cause significant localized pain.
Compression fractures are easily seen on x-ray but other imaging, such as MRI/CT and nuclear bone scan, provide important additional information such as fracture age, other possible causes and/or bone fragments.
Patients should initially be treated conservatively with pain medications, bracing and physical therapy.
Vertebroplasty (or kyphoplasty), which involves the injection of cement into the vertebral body, should be considered if they don't improve in six to eight weeks and their pain is incapacitating despite pain medications. Compression fractures secondary to osteoporosis usually respond very well to vertebroplasty with complete or near complete pain relief after the procedure. Even patients with compression fractures greater than a year old have been demonstrated in the literature to benefit from vertebroplasty.
Radiofrequency Surgery in Pain Management
An Original Contribution by Frank J. E. Falco, M.D.
The advantages of radiofrequency surgery include controlled lesion size, accurate temperature monitoring, limited need for anesthesia, precise probe placement under fluoroscopic imaging, low incidence of morbidity or mortality, and rapid post-procedure recovery. High frequency alternating current causes vibration of the electrons in the tissues in the vicinity of the radiofrequency (RF) probe, resulting in an increase in temperature. Radiofrequency surgery is performed at temperatures between 60 and 90°C depending on the structure that is causing the pain.
This pain management surgical procedure is used to treat a variety of painful conditions, such as chronic neck and back pain, headaches, trigeminal neuralgia, reflex sympathetic dystrophy (RSD), sciatica, facet syndrome, sacroiliac joint dysfunction, TMJ and cancer pain.
The procedure is performed under fluoroscopic guidance to ensure proper positioning of the RF probe. The surgery lasts approximately 30 to 60 minutes depending on the application. Some patients will experience a burning sensation at the surgery site after the procedure that is controlled with medication until it resolves in about three weeks. Nerves can regenerate over a period of one to two years that might require another RF surgery depending on whether or not the pain returns with nerve regeneration and to what degree.
Spinal Cord Stimulation for the
Treatment of Radiculopathy and Spine Pain
An Original Contribution by Frank J. E. Falco, M.D.
Spinal cord stimulation (SCS) has been used for controlling intractable back and leg pain for more than 30 years. The SCS system stimulates the dorsal column of the spinal cord by tiny electrical impulses from small electrical wires placed on the spinal cord.
Spinal cord stimulation typically consists of one or two wires with a number of electrodes and a pulse generator or battery. The wire carries the electrical stimulation from the pulse generator or battery to the posterior column of the spinal cord.
Some believe that the stimulation blocks pain transmission through the spinal cord, while others believe there is activation of supraspinal pain inhibition, and still others think there is activation of neurotransmitters or neuromodulators that provide pain relief.
Pain relief from SCS varies therefore all patients considered for SCS must undergo a trial. The trial involves percutaneous placement of the wires with an external power source for five to seven days. The trial is considered successful if the patient reports good pain coverage, stimulation tolerance, pain relief, increased function, and improved sleep. The trial will determine whether or not the patient is a candidate for surgical implantation of a SCS system.
The advent of newer techniques such as retrograde wire placement have improved the efficacy of SCS in the treatment of limb and axial pain. Other applications have been successful in treating pelvic pain, bladder dysfunction, chronic angina pain and headaches. |
