FAQ Category: Thoracic Spine

If your mother has vertebral fractures, she is likely in a good bit of pain. The treatment of injecting cement into the spinal area is meant to help relieve the pain. The cement the doctor uses is a special cement that has been used for many years in different types of treatments, including dental work. It’s designed to bond with bone and to set quickly so it doesn’t go outside of the area where it is supposed to be. The procedure is called a vertebroplasty.

The advantage to vertebroplasty is that it is not surgery, however, your mother may be given a general anesthetic – some doctors use only sedatives, given by intravenous, while others prefer to use general anesthetic. If your mother is not under a general anesthetic, a local anesthetic will be injected into the area where the needle will go.

The doctor will use an x-ray type of machine to know where exactly to inject the cement, which is injected through the back. After the cement hardens, usually about 20 minutes or so, the procedure is over.

The procedure is done on an outpatient basis.

Authors of a recent study reviewed available literature and found that subsequent vertebral fracture happens twelve to 52 percent of the time.

A significant kyphosis following spinal injury is called posttraumatic spinal deformity. Kyphosis is the most common of the deformities. Studies show that a kyphosis equal to or greater than 30 degrees is more likely associated with chronic pain and potential increase in neurological symptoms.

Reduction and fixation of spinal fractures in the thoracic spine can be a very complex procedure. Sometimes the facet (spinal) joints get disrupted overlap one another. They must be distracted, unlocked, and repositioned.

To do this, the surgeon can place screws through the pedicles of the vertebrae. The pedicle is the area of vertebral bone between the upper facet of one spinal segment and the lower facet joints of the adjacent spinal segment.

Usually a long rod that is curved to match the shape of the spine is attached to the screws. The surgeon uses the screws to hold and tighten the rod in place. X-rays taken in the operating room help the surgeon judge the correct facet position. Getting the upper and lower facet joint surfaces to match will ensure proper positioning and prevent deformity.

At the same time, bone chips are harvested from the patient’s iliac crest (top of the pelvic bone). The bone graft is placed across the top and bottom of the rod and screws. With the rod and bone graft in place, bracing may not be needed.

The pedicle screws go through 80 per cent of the depth of the vertebrae. The implants are designed to withstand fatigue failure even during the acute healing phase. The patient has some activity restrictions during the first four months until the fusion is strong enough to support more vigorous activities. There are usually some lifelong restrictions as well.

Persistent pain, deteriorating neurologic status, or residual deformity all point to the need for follow-up care. Surgery to stabilize the spinal segment may be needed, but it’s possible an orthosis (trunk and back brace) will be enough.

Immobilization is usually avoided early on because of the complications that can occur. But in some cases, immobilization is the treatment of choice and should not be avoided. Spinal injuries often lead to poor outcomes and low rates of return to work and function. This is true for young adults but even moreso for the older adult with osteoporosis or other health problems.

You may want to begin with a medical consult with an orthopedic surgeon. After taking a history and performing a clinical exam, he or she will present you with your options for treatment. Any neurologic involvement can become permanent. Treatment is aimed at preventing long-term complications and restoring full function.

If your mother is living with chronic back pain and has received other types of treatments that haven’t helped, it’s not unusual for her doctor to suggest this type of injections. For some people and for certain types of back pain, they can be very effective.

Like all medical procedures, epidural injections do have some risks. They include:

– infection at the site of the injection (rare)

– headache from a dural puncture (a puncture in the lining of the spinal canal)

– bleeding

– nerve damage (rare)

Your mother should discuss this with her doctor and weight the benefits and risks before undergoing treatment.

Researchers recently did a study of patients who had a disorder called spondylothoracic dysplasia. One of the problems that people with this disorder have is a smaller torso and a rib cage that can compromise the breathing.

While many with this disorder die as infants because of respiratory problems, the researchers found that there were patients who survived well into adulthood. These older patients had, except for one patient, adapted well to their condition and were living comfortably. One theory the researchers suggested was that the patients’ smaller size demanded less oxygen and their body simply adapted to what oxygen was available.

Doctors can often tell if someone is going to have difficulty with breathing by examining the upper body. If the rib cage is small or fixed in such a way that it can’t expand on breathing, this can compromise respirations and the amount of oxygen that is taken in. This evaluation can be done with x-rays and with imaging such as computed tomography imaging, or CT scans.

Tests called pulmonary function tests evaluate how much air a person can hold in their lungs when they take a deep breath. Finally, if doctors are concerned about the amount of oxygen actually in the blood, an arterial blood gas, can measure this. This is a sample of blood that is taken from the artery, the blood vessels leaving the heart and lungs, carrying oxygenated blood, as opposed to the blood from the veins, where samples are usually taken. The blood in the veins is “used” and is returning to the heart and lungs for oxygen.

Scheuermann’s kyphosis is an abnormal forward curvature of the thoracic spine. Patients with this condition have a very rounded mid-back. They appear to be very stooped forward. Kyphosis is a term that refers to this position of the spine and resulting posture.

When the kyphosis is more than 70 degrees and getting worse, then surgery is considered. Back pain and cosmetic appearance are two other reasons to manage the problem operatively.

Special hardware implants are used to help hold the spine in an upright position. Bone graft is placed between multiple levels of vertebrae to fuse the spine. As with any operation and especially one this extensive, problems can occur after surgery.

These complications can range from persistent pain to deep wound infection requiring further surgery. Other problems can include blood clots to the lungs, fractured rods or other implants, and acute kidney failure.

One common problem that has been reported is junctional kyphosis. This means the patient develops another kyphosis above the level of the fusion. Junctional kyphosis occurs in up to one-third of all patients after fusion. Loss of correction is another potential result after surgery.

Patients who have a combined anteroposterior procedure are at the greatest risk for complications. Anteroposterior means the fusion is done from both the front of the spine and the back of the spine.

Talk to your son’s surgeon about your concerns before the operation. Find out what problems are possible and/or likely. There’s nothing wrong with knowing what to expect. However,it may be best to avoid catastrophizing the situation — in other words, don’t discuss the operation as if the worst IS going to happen. This can be very unsettling for the child and other family members.

Scheuermann’s kyphosis is an excessive forward curvature of the thoracic spine. The thoracic spine is located midway between the neck and the lumbar spine (low back).

Scheuermann’s kyphosis is an uncommon condition that begins in childhood. It affects less than one percent of the population. Boys and girls are affected equally. When it occurs, it is usually diagnosed by the time the child is 11 years old.

Proper treatment during childhood is needed to relieve back pain and prevent both pain and spinal deformity. If casting or bracing don’t work, then surgery to fuse the spine may be required to halt the progression of this disease.

Surgery for this condition has improved over the years. Better surgical technique, improved tools, and up-to-date implants are part of the current picture. But even with advances in operative procedures, problems can occur.

One of those problems is called junctional kyphosis. This is the development of another kyphotic curve above or below the top or bottom of the fusion site. Surgeons aren’t entirely sure what causes this to happen.

It’s possible that the spine is trying to balance uneven forces or imbalances that are present next to the fusion. As the kyphosis is straightened, the unfused spine responds with its own changes. It appears that this compensation is influenced by the angle of the pelvis. Loss of ligamentous integrity on either side of the fused site may also be part of the problem.

Patients with large curves before surgery tend to develop junctional kyphosis at the top of the fused area. Although the new kyphosis may cause problems with cosmetic appearance, further surgery is rarely required.

Scheuermann’s kyphosis is the name given to a condition of increased rounding of the thoracic spine. Structural deformity of the vertebral bones is involved. As the spine curves forward, the front part of the vertebrae become wedge-shaped.

Other changes may also occur. The cartilage around the discs can get pushed up into the end-plate of the vertebral body. There is a distinctive change seen on X-rays to suggest when this has happened.

The protrusion of the cartilage may contact the marrow of the vertebra. If this happens, inflammation and even destruction of the vertebral bone may occur. Surgery may be advised to avoid this complication.

An anterior release and fusion (a two-step operation) is the usual procedure performed. The timing of the surgery is decided on a case-by-case basis. Anyone with pain and a rigid spine that is curved forward 70 degrees or more is usually a good candidate.

If the deformity is getting worse even with casting and/or bracing, then surgery is the next step. An unacceptable cosmetic appearance is also considered in the decision-making process.

Your surgeon will be able to give you the best timeline to consider. X-rays and MRIs are often used along with the history of the case to determine the optimal timing for surgical intervention.

Vertebroplasty is the injection of a liquid cement that hardens quickly and holds the bone together. The procedure is fairly simple but requires a skilled surgeon. Complications can occur if the cement leaks out of the bone and into the surrounding spaces.

The biggest problem occurs if the cement leaks into the area where the spinal cord or spinal nerves are located. In such cases, mild to severe neurologic damage can occur.

The risk of leakage varies from three to 74 per cent. Surgeons and researchers are working together to find ways to reduce this problem. New techniques and tools for cement delivery are underway. Injecting the cement slowly under low pressure helps.

Studies show that the vertebroplasty method uses less cement and only requires injection from one side. These two factors may help reduce cement leakage and fractures of adjacent bones.

Careful surgical technique by a qualified surgeon should minimize this problem. The experienced surgeon uses fluoroscopy (special X-ray imaging) to see the extent and direction the cement is flowing. Any time cement leakage is seen, the procedure should be stopped immediately.

Vertebral compression fractures (VCFs)can be completely asymptomatic. Asymptomatic means there are no symptoms. The person doesn’t even know they have the problem until it shows up on an X-ray. In such cases, there is no pain but deformity of the spine is possible. Over time, the shape of the spine changes because of the bone that is collapsed.

Other patients experience severe back pain that motivates them to try anything for treatment. In many cases, the pain and deformity result in loss of sleep, weight loss, and decreased quality of life. Activites are curtailed by the pain and discomfort. Breathing and respiratory function are also limited by the pain and deformity.

For these reasons, most doctors are treating VCFs more aggressively than in the past. Conservative care may be tried at first. But if pain persists and/or deformity occurs, then surgery is recommended.

All surgical procedures come with their own potential complications. Most of the time, nothing happens and the patient has an uneventful and successful recovery. But in a few people, there can be problems.

Vertebroplasty is an operation in which a special glue is injected into the spinal bone. The goal is to hold the fractured bone together and keep it from breaking apart and compressing even more. Once the glue hardens, the bone is stabilized.

The most common problem reported with this operation is increased back and leg pain from nerve root irritation. The glue oozes out the back of the bone and comes in contact with the spinal nerve. This is called cement extravasation. If it hardens around the nerve, it can cause chronic pain, weakness, and disability.

Other complications of vertebroplasty include rib fractures, blood clots, bleeding, and infection. It’s also possible that the bone above or below the vertebral compression fracture can develop a compression fracture.

Problems can occur immediately after surgery up to three months later. Any new symptoms should be reported to the surgeon as soon as possible. Early treatment for some of these problems can make a difference in the final results.

Kyphoplasty is the injection of a liquid cement into the broken vertebral bone. The cement seeps into the fracture lines and hardens. With a kyphoplasty, the surgeon inserts a deflated balloon inside the vertebral body first before injecting the cement.

After inflating the balloon, then the cement is injected inside the balloon. The effect is to restore the vertebral heighth and shape. This operation is being used more and more because of its success rate. Many patients get pain relief without any problems.

But in a small number of patients, complications can occur. The most common early problem is irritation of the nerve tissue from the cement. If it oozes back out of the vertebral body and comes in contact with the spinal cord or spinal nerve, acute (immediate) symptoms can occur. The patient reports symptoms similar to what your father is experiencing.

There are other possible causes for these type of symptoms. Once your father’s physician has a chance to examine him and review the records, you may have a better idea of what’s going on.

Further treatment may be needed. It may be necessary to go in and remove any remaining cement. In some cases, the cement just isn’t enough and a spinal fusion is needed.

Myelopathy of the thoracic spine is rare but can be disabling. This condition is more likely to affect the lumbar spine (low back). Sometimes the neck is affected.

Myelopathy is any condition that can damage or affect the spinal cord. The most likely causes of myelopathy are usually a protruding or herniated disc, bone spurs, or ossification of the spinal ligaments. Ossification refers to hardening of the ligaments as tiny bits of bone form within it. All of these causes are related to the aging process.

Studies show that surgery is needed to treat this problem. The surgeon removes bone from around the involved spinal cord or spinal nerves. The goal is to take the pressure off the nerve tissue and alleviate the symptoms.

Patients who have milder symptoms for less time seem to have a better result after surgery. This suggests that surgery should be done earlier than later. Many times the diagnosis is delayed allowing the condition to progress before the operation can be done.

A wait-and-see approach is not advised for this problem but you should ask your surgeon this question. There may be other reasons why you should have this operation right away.

You may want to see your physician first before starting an exercise program for this problem. Without knowing your age, past medical history, or the state of your general health, it’s impossible to recommend specific exercises without a diagnosis.

Several different things could cause your symptoms. Women with undiagnosed heart disease sometimes report similar symptoms to what you’ve described. With their arms overhead, the heart is unable to pump enough blood uphill to supply the arms with needed oxygen.

This problem occurs most often in postmenopausal women with a personal or family history of high blood pressure or heart disease. A medical exam is needed to know for sure.

A second, more common cause of your symptoms could be a condition called thoracic outlet syndrome (TOS). This refers to pressure on the nerves and blood vessels as they travel down from the neck to the arms. For a variety of reasons, they can get pinched or compressed. Patients with TOS report neck and/or arm pain and fatigue, numbness and tingling, and muscle weakness.

The doctor can perform special tests in his or her office to look for TOS. A physical therapist can then help you with the right exercises. Sometimes stretching tight bands of tissue is all that’s needed.

In other cases, strengthening and stretching the muscles is helpful. The therapist will show you how to improve your posture, if that is contributing to the problem. In very rare cases, surgery may be needed.

A cervical rib is an extra rib. It is attached to the last vertebra in the cervical spine (neck). Normally, the ribs start in the thoracic spine at T1. A cervical rib is considered a congenital anomaly meaning it’s an abnormality present at birth.

Cervical ribs attach to the first thoracic rib with a dense band of fibrous tissue. Usually there is only one cervical rib and it’s only on one side. Less often, there is a cervical rib on both sides.

The nerves and blood vessels that come down from the neck to the arm are called the neurovascular bundle. This bundle may rest on top of the cervical rib. In other people, the nerves pass through the ribs.

Pressure on the neurovascular bundle can cause a wide range of symptoms. Neck and/or arm pain are typical. Numbness and tingling in the arms and hands are also reported. Muscle fatigue and weakness is reported by some patients. Lifting the arms overhead causes increased pressure on the neurovascular bundle. In this position, the symptoms that are present at rest will be even more pronounced.

Maybe not. An orthopedic surgeon would need to see him and evaluate his situation. A clinical exam along with X-rays will help identify the problem and possible solutions.

Kyphosis or forward curvature of the spine can occur after injury to the spine, especially if there’s been a fracture that wasn’t treated properly. This type of post-traumatic deformity can be improved with surgery to fuse the spine.

The surgeon may have to remove any badly broken, compressed, or deformed vertebral bones. Bone graft is used to fill in the empty hole. Titanium plates and screws or a dual rod system is used to hold the spine in place until fusion is complete.

Correction of the curve is easier with better results if done early after the injury. But even when delayed, patients report good results. They have less pain, better function, and fewer neurologic symptoms.

Vertebroplasty is the injection of liquid cement into a fractured vertebra. Once it has been injected it hardens and holds the bone together. The procedure works well to relieve pain and stabilize the weakened bone.

As your doctor told you, there are some potential problems with this operation. Cement leakage into the spinal canal or around the spinal nerves can cause nerve pain, numbness, and muscle weakness.

Studies have been done with cadavers (human body preserved for study after death) and computer simulations. Researchers have been able to calculate an average amount of cement needed. Factors to consider include size and condition of the bone.

Complication rates with vertebroplasty are fairly low (around one to two per cent). These rates go up in cancer patients treated for fracture from spinal metastases. The procedure requires destruction of as much of the tumor as possible first. Calculating the amount of cement needed is a little more complicated in those cases.