Surgery, 'Sham' Equal in Treating Compression Fracture Pain

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It's great that they have a treatment like this. It gives the older person a chance to resume their activities without having to be wheelchair or bedbound because of pain and immobility. I am hoping that my mother walks out of the hospital within a few days minus the pain that she has been experiencing for the past 4 weeks.ga

Ali of NY 2:38PM June 19, 2012

I am a 45 year old patient with a rare genetic disease TRPS 1. As a result I have severe osteoporosis with multiple compression fractures in my back. After a year and a half of pain, which even morphine didn’t take away, I had kyphoplasty surgery performed.The surgeon came highly recommended, and at the time of my appointment my pain level was at about an 8. My physician assured me that I would see a significant decrease in pain after I had this surgery, he stated “I have done this surgery hundreds of times and everyone has seen significant decrease in pain”. Becoming increasingly desperate for relief of pain I went ahead with surgery at levels T4-T8.
After surgery the doctor came into the hospital room and asked me how I felt and if my pain level had decreased, but it didn’t but he told me “give it some time and we will see you in 6 weeks”. However, I did see a change in my pain it had gotten worse with my right hand turning purple because circulation was being cut off. When I told my doctor this and after he looked at my swollen, purple hand he actually got upset with me and said “I don’t know how this could be. I have never had a patient tell me this after having surgery. Maybe you should get a second opinion because clearly there is nothing more we can do for you”. I was speechless at his reaction.
I did end up going to the Mayo Clinic in Rochester MN, at which time they not only did an exam, but they also did a MRI and that’s when I discovered that the cement that they injected had leaked out. The cement had created a extra bulge that was putting additional pressure on my already problematic spine which explained my symptoms. I had an MRI done right after the surgery (at the cost of $3800.00), but the doctor that performed the surgery never mentioned the fact that the cement had leaked out.
Today I am still in a tremendous amount of pain and my spine continues to collapse, my right hand is still swollen and purple, have lost all sensation in my finger tips and have been told that I have permanent nerve damage. Because my disease has now progressed especially in the C2-C7 area, I have been told that there is little they can do for me. My advice to people considering this surgery is “carefully consider the risks, explore other options like acupuncture, understand that it may not work for relieving pain, get a second or even a third opinion, talk to other patients of that particular doctor to explore his success rate, if a doctor is too eager and praises the surgery too much, question if it is truly for the patient or for profit. Last but not least, understand that you may end-up worse off than when you started, be prepared to deal with that too.”

Angelia Baldwin of SD 5:10AM August 07, 2009

Also likely: neither the real shot or placebo shot work at all, but patients report improvement because they know that's what the doctor wants to hear.

andrew2 of MA 2:06PM August 06, 2009

My late father had a doctor who apparently foresaw the results of this study. His doctor prescribed opiates instead of surgery; even with the drugs my elderly father was in agony for TEN weeks before he had surgery. Afterward he was free of pain, but no amount of drugs could eliminate the memory of that nightmare.
Fast forward three years, my mother fell and suffered a compression fracture (she was now living near me, in another state). She was in so much pain she could not get out of bed and literally had trouble breathing. Warily, I asked the neurosurgeon what course of treatment he would recommend. "We'll do surgery, of course, to relieve pain and stabilize the fracture", he said, giving me an odd look. As in, why would we consider anything else? After the operation she was fine.
I have to wonder if the patients in this study had fractures of a different type, or different severity, than the ones my parents had. In light of my family's experience, this seems very, very odd.

Keith R. Pedersen of TX 9:07AM August 06, 2009

A 0.8 difference in a pain score is clinically undetectable. As such although technically from a statistical standpoint there is a numerical difference, from a clinical standpoint there is not appreciable difference in outcome from a pain reduction standpoint.... i.e. vertebroplasty is equivalent to placebo in reducing pain after compression fractures.

John of MI 8:59AM August 06, 2009

I'm a Respiratory Therapist. Patients used the receive a Swan Ganz catheter into their heart to measure blood pressures more precisely. It is not done much at all anymore? Why? Because the reimbursement is not there. before the change of reimbursement it was performed to everyone that came through ICU "weather they needed it or not". Today it not done even if the patient would benefit from it. USA Health care is the biggest scam on the planet. I work inn it and see it daily. Actually the whole USA is the biggest scam on the planet. Witness the RAPE OF AMERICA playing in the streets and suburbs near you.

John of OH 7:05AM August 06, 2009

This is not just about pain reduction -- it is about reducing loss of vertebral height. Having the cement injected, particularly in the kyphoplasty, where the vertebra is "re-inflated" before the injection of the cement -- can help the patient regain height that would otherwise be lost. This is very important, particularly to a younger patient with a compression fracture. m

Barbara Gardiner of NY 3:22AM August 06, 2009

If you read the article in the New England Journal of Medicine, you'll see that vertebroplasty reduced pain an average of 2.7 points on a pain scale going from 0 to 10. The placebo intervention reduced pain an average of 1.9 on the same scale. So the evidence indicates that vertebroplasty reduces pain more than a placebo, but we can't be very sure of this; such a difference could have occurred by chance if there were no differences in the treatments.
If the sample of patients had been larger, we could have been more sure that this difference was real, if indeed vertebroplasty is more effective. However, the best we can say is that this study partially supported the thesis that vertebroplasty is more effective than a placebo, but the difference is not statistically significant given the small sample size.
This article provides evidence of why journalists should contact statisticians when dealing with complex empirical evidence.

David R Dunaetz of CA 1:46AM August 06, 2009

My husband had the "cement" procedure on his back for fractured vertebrea. He did have subsequent fractures above and below the site of the surgery. Doctor cautioned that this was possible. Pain was so intense that surgery seemed to be the only possible way he could stand to live. Became addicted to Fentynl (??) and Vicodin prior to surgery. This is a man in his 80's with no substance abuse history of any kind. Tough circumstances.

Deborah Roe of NY 12:15AM August 06, 2009

The 'innovative' idea of a 'pay for value / outcome' pack came after the CBO had previously pointed out this health care reform wouldn't work without 'fundamental' change in the out of date system. It is said that as much as 30 percent of all health-care spending in the U.S. -some $700 billion a year- may be wasted on tests and treatments that do not improve the health of the recipients, and this 700 billion dollars a year can cover a lot of uninsured people.
The expected Benefits of this 'innovative idea' are as follows ;
1. Meet the objective of revenue-neutral.
Supporters of the agreement say it could save the Medicare System more than $100 billion a year and 'improve'
care, that means more than $1trillian over next decade, and virtually needs no other resources including tax on the
wealthiest. Supposedly even the 'conservative' number of such savings might be able to meet the objective of
revenue-neutral.
2. Quality and affordability.
If you are a physician, and your pay is dependant upon your patient's outcome, you will most likely strive to
prescribe the best medicine earlier in the process, let alone skipping the wasteful, unnecessary treatments.
3. No intervention in decision-making.
The innovative idea of 'a pay for outcome' will more likely prompt team approach and decision, as at Myo clinic.
Under the 'pay for outcome' pack, for good reason, best practices as 'recommendations' would simply help them
make a better decision, and the government won't still have to meddle in the final, actual decision-making
process as a non-expert.
4. Speed up the introduction of IT SYSTEM.
The pay for 'Outcome' pack is most likely to expedite the introduction of Health Care IT SYSTEM.
The synergy effect of the combined Health Care IT & a pay for 'outcome' system may allow the clinicians to
'correctly' diagnose and effectively treat a patient earlier in the process so that it can measurably scale back the
crushing lawsuits and deter the excuse for unnecessary cares to make fortunes.
5. Accelerate the progress in medical science, in return, it saves more cash.
6. Settle the regional disparity.
7. Reduce the emergency room visits & save immense costs.
Public health insurance plans such as Medicare and Medicaid paid for more than 40 percent of U.S. emergency
room visits in 2006, according to government figures released recently. Many experts say reducing these hospital
visits would be an important way to lower the enormous, and growing, expense of U.S. health care.
I share the opinion that unlike the insurer-friendly senate plan by 'some' members, only a strong public option will be capable of getting the premium inflation under control and saving the U.S in turbulence.
To my knowledge, a dual system tends to deliver better results than a pure single payer system. Supposedly, to be or not to be might be up to the innovations like a pay for value program, otherwise, the forthcoming start-ups may fill the void with competitive deals. The competition based on 'fair' market value would be a beauty of true capitalism, not monopoly, an objective for anti-trust.
Thank You !