Had an accident recentley resulting in a compression break of L1 in my back. Alot of pain. This happened about 4 weeks ago, went to my family doctor a day later {waited because I had an appointment anyway-foolish to wait}. Doc did the normal stuff and sent me over for x-ray, radiology told me my results would be interpetated and at my Docs office within 24hrs. So I had prescription for muscle relaxer filled and tried to go on with life. Next day I call Doc's office about results and I'm informed that it would be a week before they would know anything. There were alot of distractions during this time period but I did not here back from my doctors office for 3 1/2 weeks after x-rays were taken- is this normal? Two days ago I get a phone call from one of the front office staff at Doc's office telling me that I need to get in to see an orthopedic surgeon right away, but they wouldn't tell me why over the phone and I told them I would not without knowing, so I had to make an appointment with them again lucky I was able to get in that day. Finally get to see a Doctors aid and then I'm told that I have a broken back. Some details are given to me and my information is faxed to an orthopedic surgeon whom they suggest. Cannot get in right away as aftermath of hurricane has changed a few things. So I am waiting {painfully} for my Tuesday morning appointment with orthopedic surgeon. Now I am wondering if there could be more damage from all this time that has gone by. Looking back I can see alot of mistakes made, but does this sound right? I have a disc from x-ray dept. and some documentation to take to bone doctor to speed things up but I'm waiting for Tuesday. Can anyone give me some sound advice? I figured Walter's own was the best place to vent about this, but seriously I need some help. Thanks anyone for reading, Rodney.

Damn, where do I begin....IMO your doctor office handled things about as poorly as the PCPs around here.

A) depending on where you went for images, a radiology report is usually dictated within 24 hours, and transcribed within another 48 hours. This could be considered the "standard" so when I hear that patients are still uninformed for weeks on end, that is bullshit and should never happen.

There is such a thing as a "wet read" and a "stat read." Your doctor should have asked for the wet read, meaning, a report will be over the phone by the radiologist in TWO HOURS. A stat read is ready in 6 hours and comes with a written report. This should be done when someone reports a spine injury.

B)

quote:

Finally get to see a Doctors aid and then I'm told that I have a broken back.

While this is true, it is hardly the way to tell patient they have a compression fracture, which mostly heal on their own without any intervention.

The most likely reason your orthopaedic doctor didn't get you in right away is b/c he/she is likely not going to do anything except for maybe brace you for a few weeks.

You will be given treatment options, like bracing for up to 12 or so weeks to immobilize the region and let it heal, or,

Balloon kyphoplasty where a balloon is delivered to the compressed bone, then filled with cement, or perhaps,

Percutaneous vertebroplasty which uses a catheter to deliver cement.

Then there's always fusion.

Ultimately, surgery is very rare for compression fractures. If you are told you NEED surgery, get a second opinion and do not tell the second doctor you are there for one. Go to a neurosurgeon that specializes in traumatic spine as well.

My thoughts: your case was not handled in a timely manner by any stretch. And, by the way, this is my 2nd visit to "Walter's" forum since 2004. If you want a lot of hits on a serious question, post it where a thread gets a lot of traffic, even though it may have nothing to do with your problem....American Big Game Hunting, Reloading, etc.

Thankyou Doc for responding. I put this here because this whole thing was handled about as ridiculas as some of the crazy subjects here at Walter's own- no offense Walter. And again I wanted some opinions in this. Here is what the radiology report reads: Findings- Compression of the superior endplate of L1 is noted. There is loss of 25% anterior vertebral body height. There may be disruption of the anterior cortex present. Prominent facet osteophytes present at the right L4-L5 level. Impressions- Suspected acute compression deformity of L1 is noted with no retropulsion seen. What does all this mean and could I have done any more harm to myself by trying to go on with normal activities. All I know is it hurts and is difficult to get rest at night. Can I still shoot my 505 Gibbs? Thanks, Rodney.

quote:

Compression of the superior endplate of L1 is noted. There is loss of 25% anterior vertebral body height. There may be disruption of the anterior cortex present.

It's a compression fracture and, as far as compression fractures go, about an average one.

quote:

Prominent facet osteophytes present at the right L4-L5 level.

This means you have old degenerative changes which I frequently call wear and tear arthritis. It's a common finding in the middle to later years in life.

quote:

Impressions- Suspected acute compression deformity of L1 is noted with no retropulsion seen.

No retropulsion is good. That means it's less likely that bony or disc material is pressing on the spinal cord.

quote:

What does all this mean and could I have done any more harm to myself by trying to go on with normal activities.

It's quite unlikely that you did any harm to yourself by being active. Little old ladies frequently get fractures like this. They hurt but aren't told to stay in bed.

If I were you, I would wait to shoot the 505 Gibbs until your pain pretty much goes away. Actually, I guess I lied. I would probably shoot the 505 Gibbs; not that it's necessarily a good good idea but I'm the one that went jogging on a broken foot.

You are not a surgical candidate for any reason listed on the rad report you supply. You hurt b/c you indeed have a mild compression fx and it will elicit pain for several weeks as it heals. However, you MAY need an MRI in my opinion b/c if your spine suffered enough force to cause that kind of compression, you may have a noncompressive disc protrusion or extrusion (herniation) that may also be contributing to your pain even though it is not causing any radiculopathy as far as I can tell. Radiculopathy is pain radiating down to your butt, legs, etc. It sounds like you need a simple soft back support to the tune of about $45 to help with comfort right now. Call any physical therapist and ask if you can buy one.

Now, the orthopaedic doctor will likely ask you some questions about the mechanism of injury. He will likely ask you if your pain is sharp, stabbing, or dull and ache(y). He'll want to know if you've had any difficulty with ADLs (activities of daily living), does your pain travel?...like I mentioned, down your butt or legs.

He'll watch you ambulate to see if your gait is altered from norm. He will likely have you sit and/or lie down supine (face up) and lift your legs to straighten them out to see if this elicits any back pain. If it does, he may also dorsiflex your foot to see if it worsens.

He may ask you to move at the trunk while standing...side to side, front and back to see if any of these motions elicit pain.

Depending on how the visit and exam goes, he will likely order either a spiral CT scan or an MRI without contrast if you've never had a spine surgery before. If he does, ask him to order it with 3D reconstruction if they have that technology there. I would think so.

The compression fx may be the only cause of pain and it will subside over time and eventually you'll feel like you never had one if you fall into that stat. However, there may be something else going on and it is worth looking into.

The disc may not indeed be bulging or herniated but you may have an annular tear. This is a rupture in the outer third of the disc which is fibrous. When this happens the acidic jelly goo in the center of the disc (called the nucleus), hence, "herniated nucleus pulposis" or "HNP," this seeps through the tear/rupture and causes "chemical pain." The nucleus undergoes anaerobic metabolism so it is very acidic. When it reaches the torn part of your disc, it is like pouring salt on a wound times 50. Chemical pain is not really a theory anymore with most physicians. Some still don't buy it though.

By the way, sorry....do you know what the disc is? It is the cushion between the spine bones. It's there for support and to absorb vibration and shock.

My guess is, if you have an MRI done, and you have a disc lesion of some sort, he'll likely tell you to try some epidural injections, and/or PT.

If you had enough force to cause a compression fracture, then you should also have standing flex/ex films taken to see of there is any overtravel when moving fwd and backward while standing.

Finally, health insurance is different everywhere, so just from experience, my advice is this...if you are indeed sent for an MRI and you are sent to a hospital, they are paid at a tier 1 level, meaning they charge the most usually and get paid the most. If you have a deductible or co-insurance for imaging, then your portion to pay will be higher.

Call your health insurance and find out if there are any IN-network independent facilities that charge less and get paid less. If so, your out of pocket will be less.

If your insurace covers imaging at 100%, go wherever you want. But call and ask this:

"how is diagnostic imaging such as CT scans and MRI covered under my plan?"

"do I have a deductible or copay? Co-insurance?"

"is it covered at 100% if I go to an in-network facility?"

good luck and keep us posted.

OH, as far as shooting goes, well, you can, but you'll likely regret it. Anytime you do damage to your spine like this you'll have a degree of inflammation. Recoil will only irritate it.

For now, at home, put an ice pack on your back for about 20-25 mintues. Take it off for 45-60 minutes. Repeat this about 4-5x/day. It may help some.

Do NOT use heat for acute traumatic pain.

I greatly appreciate the information and I'm feeling alot more comfortable {mentally} about the situation. But I have known some pretty tough old ladys. My 1st thoughts when this happened was that I ruptured a disc, bruised my hip and jarred some things around inside. I was even afraid to go to the restroom out of fear due to all the pain inside. This all happened from a motocycle and I was moving along fairly well when I came off and landed on my butt more to my right side with a thick wallet in that pocket. I have never experienced any back problems before this. The pain is with me and is only amplified the more active I become. Tried riding the bike {different motorcycle} but every little bump is felt straight up my back and besides its too painful to swing my leg over it to get on. Of course that was before I was back at the docs office to learn about all this. The pains due extend from between my shoulder blades down into my hips/butt and and is stabbing in my right hip. Back pain itself varies according to what activity is attempted. I will go Tuesday and hopfully learn what is going on. Again thanks a million, Rodney. I'll keep this updated.

Rodney,
I'll call when i pass though CnS later today... i want to look at your well before you spend a bunch...

And i'll tell you, again, about my back injury... i did rupture two discs to go with it. I went the fusion route and i do okay for all.

Rodney. sorry to here about your "broken back"/
I had deard you were having problems when I went to Sportsmans, but didnot know it was rhis bad.

Now. about your 505......

Keith

Keith the 505 is fine just was'nt through workin some loads for hog-killin this fall. As for me I will not know much more other than what has been mentioned above until I get to see the bone doc on Tuesday morning. Thanks Keith, Rodney.

A prescription for Vicodin.
Lyle Been there done that.

I got hydrocodone-ibuprof 7.5/200mg and tizanidine 4mg. Had mri and ct scan today, but was not told any results yet. They said I would be a good candidate for something called kyphoplasty as mention in Doc's post above. From here all my information was sent to the next stage, a pain management doctor and that starts Thursday morning. Rodney.

Kyoplasty (Khoplasty) help my mother and my mother-in-law. Pain relief was almost immediate!

My mother-in-law suffered several stress fractures on her back. The proceedure kept her up and going instead of on pain killers and living in a bed. After the fractures were repaired we put her on "Forteo" and her bone density increased dramatically!

I hope you are a candidate for the Kyoplasty. Just an overnight stay.

Thanks Rusty, The only thing that really kept me moving around is the anger Ive had with myself over the situation concerning my accident and the doctors office for not telling me for 3 1/2 weeks. Going in tommorrow morning to see another doc, I think thier going to want to start epidural steroid injections. Will this do anything for the healing process? Or is this just to mask the pain. I will talk to this doctor about the possibilities of Khoplasty and see what he thinks. Rodney.

Rodney,
If you don't get anywhere with your doctor please contact Dr. Hani Haykal, MD. Call Methodist Hospital at 713-790-3300 and as to be transfered to Dr. Haykal's PA. His last name is pronounced Hi-kal.

A wonderful doctor with a kind and gentle manner!

Appreciate the help Rusty, I put the number for Methodist Hospital in my cell along with Dr Haykal's name. I'm in a bind here trying to get through this as it difficult to impossible to do my job as a pipe and instrument fitter. Just too many responsibilities right now for something like this to shut me down. We'll see how this goes in the morning with the results from the mri, ct scan and the next doctor. I just need someone to tell me about the healing part. Rodney.

Update from this morning's visit to doctor's office. MRI and CT scan both confirmed compression break/fracters of L1 and also was enlightened with the knowledge of three bulging discs. Going in for verteplasty in the morning to glue back together L1 and get that out of the way. They said we would work with the discs after the verteplasty procedure. Kind of glad this is happening fast so as I don't have time to think about it or am I wrong? Wish the doc and me luck, Rodney.

If the discs are only bulging, tx conservatively. Go do a lot of traction, buy a home inversion table, like a "Teeters."

PT would be next, then epidurals if still in pain.

The only time you should be offered a spine surgery for discs is if the pain is uncontrolled by conservative measures, you have such neurological deficit, that you have incontinence, foot drop, etc.

Verteplasty is done and staying at brother-in-laws home for some help through this. The doctor said to take it real easy for two weeks which during this time there will also be visits to his office. Think the verteplasty was the way to go, I couldn't picture myself wearing a back brace for 8 or possibly more weeks. Thanks Doc and Grumulkin for your responses. This is all new and happened very fast to me. Just hope I can be out huntin' and shootin' soon. Rodney.

Rodney,
Glad to hear you are improving!
If you get down to Houston I'll buy ya lunch!

Thanks Rusty, doing better but got a little ways to go. Just hope I can get some hunting in this fall- think there is a .243 win in the safe that should take care of those pesky deer. Rodney.

Just wait around until Obamateur is elected, then he'll wave his mighty hand on Election Night and everything will be OK-- even your back injury...

If Obama does get into office at least I won't have to worry about work anymore as he'll eliminate poverty and I can sit out on my front porch with my hand out... Rodney.

Had another visit with the back doc today, the verteplasty to L1 has really helped but will be getting epidural injections next to S1-L5 and then maybe L5-L4. There will be about a two week delay for the epidurals as I've just had another surgery {unrelated} last Monday and doc wants that to heal before proceeding with the injections. Trying quickly as possible to get back in shape for our whitetail deer season. Rodney.

back in 1985 i ruptured 4 disks all lumbar and now carry 6 screws and about 18 in. of wire.things have come a long way, wished it would have waited 10 or 15 years to happen.as far as shots i get 2 or 3 a year depending on how stupid i get and do something i shouldn't do.my pais mgmt. doc is a godsend and helps. good luck

I go back on the 31st for the epidurals. My doctor is talking about more than one injection to spread out the effects. They said it would be the same amount of medicine as in one normal shot but broken up over multiple doses. Like I mentioned before, this is all new to me. Rodney.

Keep us up to date on your progress. Those epidurals should help.

Went to the range day before yesterday to shoot in my low recoiling .243win at 200 yards and the walk back and forth from the targets was a bit much for me. I'm looking forward to the injections as I need some relief before deer season and beyond. Rodney.

Had four injections yesterday with little relief yet. My Doc said that the steroid used can take up to three days before relief can be felt and will keep working for about two weeks. These injections are to reduce inflamation and enhance circulation to the area, also reducing pain. My last week and a half has been absolutely miserable with the pain being more intense throughout my lower back and in to my groin area. I'm just hoping to get some relief soon as I'm already sitting out our opening weekend of deer season. All I can say is take care of your back because this $#@&'s. Rodney.

Hope your better soom, Rodney.

Rodney
i know this is tough.. do not do ANYTHING... meditate and heal.. really

The hardest thing is trying not to do anything. I'm very busy in nature and it's just not me laying around the house which is why I've had more problems in the last couple weeks. Now I have to take it easy and still no work. I appreciate everyone here and venting this problem here has really helped me. Rodney.

Rodney,
Hey, I just realize that what you need is some "Bubba Occupational Theropy"!

Jeff and a couple of "Bubbas" and me could come up your way and really show you how to sit on your ass around the house. We would be glad to school you in the fine are of "tweaking" the horizontal hold on your couch!
We'd be glad to eat up your snacks and drink your beer while we showed you how to have fun all day nap'n and scratch'n!

Just let us know when it would fit your schedule, and we'll load up the pick'emup trucks and coolers!

The support here has really been enlightening to me and I appreciate it very much. The pain was just about unbearable the week and a half before the injections even to where just my heart beat made the pain surge. The steroid injections did take that edge of the pain off but now most of the pain has returned and I'm afraid fusion will be in my future. Will be checking in with the doctor this afternoon for the standard one week follow-up from last fridays procedure and try to find out what are the next steps. Have'nt been to work now in just about two months but the job is waiting and I'm not starving because the disability insurance I have from work has kicked in. Things are tough but I'm making it- just wish I could go hunting. I'm not bed ridden by any means, I can walk short distances without too much pain but things like staircases and ladders are definiatly out for the moment. Rodney.

Had another CT scan last Friday of lower abdomine and got a positive report back but did find this interesting: There is a treated fracture with contrast density seen within the L1 vertebral body and also extending into the T12-L1 disc space, what does also extending into the T12-L1 mean? Will be having some discussions with the "Doc" on Monday. Going in tomorrow morning for bone scan. Hopefully we can resume epidurals because I've only recieved them to L5-L4. Pain is still so great just below last series of shots that I'm unable to determine just how much the epidurals really helped. Guess I'll be radioactive tomorrow afternoon, maybe I should walk around the airport and see what happens. Rodney.

i hope they get you fixed up where you can do without too much pain Good Luck.

Thanks plainsman456, well things went down hill for me in the last week. Pain had increased over time to where I finally fell at my house last Sunday. Could'nt get up but had cell phone on my body so was able to make a call for help. Had some family and a good friend collect me from the floor and take me to the ER. After 10 hrs waiting finally get room and some pain relief. Next morning {Monday} have another MRI to reveal that L3 was broken also but was surprised bone scan did not show this. So Wednesday evening rolls around and a bone doc finally visits me and confirms the matter and turns me back over to pain management doc as surgury is not required. So now it will be more epidurals and physical therapy. This whole experience has just been unbelievable for me. Still in hospital and hope to be released in a day or two. Meanwhile I've been introduced to a walker. Still tough for me being reduced to this but then there are alot of people in here more worse off than me. If I can make it back to the house I will at least start loading and dreaming of using the .505 again. Geez when will it stop? Rodney.

sorry to hear about your fall it has happened to me ,finally figured out if it was going to happen then i better get used to hitting the ground softly by not trying to put out my arms to catch me.learned the hard way my right arm is screwed up because ot that.i still hope that they get you up and running soon.Good Luck and get better.

Rodney
Remember, I am a spinal fusion survivor...
took 22 months to heal.. son, go slow!

Spent a total of 5 1/2 days in the hospital from the fall with additional tests including X-rays, MRI {2nd MRI} and more blood work. Was in my pain management Docs office the next business day after release from hospital only to find him puzzled with my situation. He orders more blood testing for any signs of infection potentially brought on from any procedures that I've recently recieved. Find out today there is concern. Backing up to pain Docs visit he referred me back to orthopedic surgeon for further analysis. Had appointment with bone Doc last Thursday the 4th only to have him also order more blood work, another CT scan {the 3rd} and sent me out to be fitted for back brace. Should pick up brace tomorrow. Also in phone conversation with Pain Doc this afternoon he instructed me to call bone Doc in the morning to make arrangements to go in to the hospital for a test that tags white blood cells to try to find where any problem area might be. So here we go again! Geez! Rodney.

Rodney, hope all is going well for you. Playing the same game with my wife.

My wifes whole lumbar region is junk. L3/4 and L4/5 are totally herniated and pressing against the nerves. the rest of the disks are bad but not to bad. Her so called specialist wouldnt do anything for the past week. all he said was take some Ibuprofrin and call me in 2 weeks?????

Found a pain management doctor (epiderals rule, according to my wife) and a neurosurgeon to talk to today.

Hopefully something can be done without surgery, but we will see. she's been dealing with this for about 5 years now.

I feel for anybody who has back pain.