A non-surgical procedure to eliminate or significantly reduce severe pain caused by spinal compression fractures.
In July of 2006, Carlette Absher, a 95-year-old resident of Richland Parish, suffered a fall in her home. Mrs. Absher experienced excruciating back pain from her fall. “The pain was so severe I could not get out of bed by the next day and was bed ridden for several days before I was taken to the hospital,” she says. Mrs. Absher was diagnosed with an L1 compression fracture. Dr. John Ledbetter of Louisiana Pain Care was consulted, and that day a minimally invasive outpatient procedure called vertebroplasty was performed at P & S Surgical Hospital. Within minutes of having the procedure, most of her pain was relieved, and she was discharged home two hours later. “My doctor said that I might have to use a walker to be able to get up and around, but I have not needed my walker at all,” says Mrs. Absher. “I have been feeling great and feel like I can do anything, even mow the lawn if my daughter would let me.”
“Spinal compression fractures usually occur because a vertebral body weakened by osteoporosis is no longer strong enough to support itself, so it collapses,” reports Dr. Ledbetter. “Many patients don’t know they have osteoporosis until their bones become so weak that a simple chore like bending over to make a bed or reaching to take clothes out of a dryer causes a sudden painful compression fracture.” Until recently, prolonged bed rest, external braces, and strong medications were the only treatment options available to relieve the pain and increase mobility. These alternatives can be slow or unsuccessful and can be very disruptive to a patient’s daily life. Vertebroplasty, a non-surgical outpatient procedure offered by Louisiana Pain Care, is an excellent option, as it can greatly reduce or eliminate the pain and get patients back to their active lifestyles quickly.
Strengthening and repairing weak bones
“Vertebroplasty is a minimally invasive procedure in which the pain management physician injects bone cement into the fractured vertebra to strengthen and repair the weakened bone,” explains Dr. Ledbetter. “The same material has been used for years by orthopedic surgeons for joint replacement procedures.” In most cases, the patient is given intravenous sedation so he or she will be comfortable during the procedure. The procedure is done under live x-ray to guide a needle through the skin and into the damaged vertebra and usually takes less than one hour, depending on the number of vertebrae treated; up to three vertebrae can be injected during the same visit. Patients arrive about one hour before the procedure and go home the same day. Most patients experience immediate pain relief and can walk around within minutes to hours.
Help for compression fracture sufferers
An ideal candidate for this procedure is an osteoporotic patient over the age of 60 who has moderate to severe back pain from one or more compressed vertebrae. Conservative treatment (bracing, analgesics, and bed rest) can be tried first in patients with mild to moderate pain, but if the pain persists or worsens over a few weeks, vertebroplasty may be indicated. For those with severe, incapacitating pain from the start, early intervention with vertebroplasty is appropriate.
John Ledbetter, M.D. and Vincent Forte, M.D., board certified pain management specialists of Louisiana Pain Care, offer Vertebroplasty. For more information call Louisiana Pain Care at 318-323-6405.
Dr. Mark Haynes of Claiborne Family Clinic in Homer, La.
LUMBAR FACET JOINTS AND LOW BACK PAIN
Low back pain is the second most common reason for a visit to the doctor’s office.
Dr. Mark Haynes, born and raised in Homer, Louisiana, started his practice at the Claiborne Family Clinic in Homer in 1987. He joined his father, Dr. Don Haynes, in his existing family practice clinic which has since grown to include his brother Dr. Scott Haynes and sister-in-law, Dr. Maria Haynes.
When Dr. Haynes was asked, “What is important to you when you refer a patient to another physician for pain management,” he states, “I make the patient diagnosis as close as I can and then I get them to a pain specialist after that. “It is important to me that my patients see a pain management specialist who is properly trained and one who routinely treats pain problems.”
Dr. Haynes has first hand experience at how persistent back pain can affect your every day quality of life. This past spring, Dr. Haynes had a severe flare-up of low back pain during turkey season. He says, “I had guests over to my camp and I was so miserable that I could not even hunt with them. I was stuck in the camp the whole time due to the pain.” Dr. Haynes saw Dr. Vince Forte, a board-certified, fellowship trained pain management specialist with Louisiana Pain Care, for his back problem and was treated with lumbar facet joint injections. “After about 24 hours, I was pain free for the first time in a long time and I have been doing really well since,” says Dr. Mark. “I am now back to working at the camp getting ready for deer season, playing golf, and back on the sidelines for the local football teams,” he says.
What are facet joints and why are facet joint injections helpful for low back pain?
Lumbar facet joints are small pairs of joints where vertebrae join on the back side of the lumbar spine. These joints provide stability to the spine, but also allow the spine to bend forward, bend backward, and twist. Pain in the lumbar facet joints is typically felt in the lower back, hip, buttock, and/or leg. The facet joints can become painful due to many different reasons such as back injury, arthritis of the spine, scoliosis, or damage to the joint linings or capsules.
Facet joint injections are commonly used in the treatment of low back pain and are considered quite safe, with few known complications. A facet joint injection can not only help diagnose the source of the pain, but can also provide pain relief. If a patient reports immediate pain relief from the injection of a small amount of numbing medicine (anesthetic) into the joint, this confirms that the pain is likely originating there. Corticosteroid is usually injected along with the anesthetic to decrease inflammation and provide long term pain relief.
In those patients who experience good but temporary benefit from lumbar facet injections, the joints can be numbed more permanently. The pain management specialist can precisely cauterize the small nerve endings which carry pain information from the facet joints using radiofrequency waves. This is also an outpatient procedure and can provide pain relief lasting months or years.
During facet joint injections, an IV is generally started for sedative medication to be administered. The patient lies face down on the table and the area to be treated is cleaned. The physician will numb a small area with a numbing medicine (anesthetic). Fluoroscopy (x-ray) is used by the physician to identify the facet joints and to guide a very small needle into the facet joint. Contrast dye is then injected to confirm needle placement. A small mixture of anesthetic (such as lidocaine) and anti-inflammatory medication (cortisone) is then slowly injected into the joint. The procedure takes about ten minutes. Patients are usually able to go home within an hour following the procedure, and can return to their regular daily activities by the next day.
Louisiana Pain Care physicians, Drs. John Ledbetter and Vince Forte, are the only board-certified, fellowship trained, pain management specialists in Northeast Louisiana. For more information regarding lumbar facet joint injections and other treatment options offered by Louisiana Pain Care, call 318-323-6405 or visit www.lapaincare.com.