[cindy2836]

#35273

I have chronic T4 and T8 VCF’s. My fusions are S1-T4 and C3-C7. I’m a 68 yr old active woman. I take Prolia for my osteoporosis. Neurosurgeon suggests RF nerve ablation for my pain to avoid adding on to my fusion

[Donald Corenman, MD, DC]

#35274

You are fused from T4 through S1 (I assume solidly) so the T8 compression fracture should not be an issue. The T4 fracture is not uncommon as T4 Is a stress riser right at the end of your fusion with a long lever arm and osteoporosis makes the vertebra more susceptible to fracture. I assume that the old chronic fracture is painful as many old compression fractures can become non-painful over time.

Radiofrequency ablation (RFA) can be helpful if the facets at T3-4 are painful. There is an easy way to test that hypothesis and that is facet blocks of the nerves that supply these particular facets. See the attached hyperlinks. If you gain good temporary relief, you could be a candidate for RFA. If this facet block does not work, consideration can be given to vertebroplasty, a technique where cement is placed into the fractured vertebra. Finally, an add on fusion could be considered if nothing else works and this level is proved to be the pain generator..

https://neckandback.com/treatments/facet-blocks-and-rhizotomies/
https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections/

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[cindy2836]

#35279

Thank you for the info doctor. At my one year post op March 2022 my Ohio State neurosurgeon said he could not see a solid fusion. I’m asking for a CT now for our 18 momth post op. I’ve been treating my osteoporosis since diagnosed with it in 2019 with Prolia injections twice a year. Dr. Grossbach has told me he would probably have to take my next fusion up from T4 to meet my C7 fusion that is C3-C7 from 2020. I waa told I’m not a candidate for the bone cement procedure at T4 due to having fusion hardwsre.

[Donald Corenman, MD, DC]

#35280

If you already have a fusion from C3 to C7 and another fusion from T4 to the sacrum with a failure of the T4 vertebra, the the proper procedure is to fuse C7 to T4, especially if you have osteoporosis. You could still try the facet blocks and RFA prior to committing to the fusion.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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