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Old 11-17-2007, 07:02 PM   #1
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Kyphoplasty & Ongoing Pain

Hi All,

This is my first post although I have become a faithful reader over the last 4 months. I'm 60 year old female with T11 compression fracture and I had a kyphoplasty 3 weeks ago. The pain has returned - big time - and now the doctor has ordered an MRI to see if there is another fracture. I can't believe I have another one - I haven't even gone through PT yet and done anything other than walk a little bit each day!
Have any of you experienced a return of pain after a kyphoplasty? The dr isn't saying much other than this is unusual and life should be grand. My feeling is they give you unrealistic expectations, like you'll jump off the table after the procedure,and your life will return to normal. Nothing could be further from the truth for me.
Spinal dexa is 2.9, hip is 3.5 and I'm now into 3rd year with Fosamax which obviously isn't doing a whole lot. Docs wanted me on Forteo about 4 months ago (when fracture first occurred) but I've been delaying a decision on this.
I welcome any of your thoughts and experiences about any of this.
Your insights and knowledge have kept my spirits up these last several months. It's great to have a community like this to turn to. Thank you!
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Old 11-18-2007, 11:24 AM   #2
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Re: Kyphoplasty & Ongoing Pain

BoomerBones-Hi and Welcome to the board.I am sorry to hear about what you are going through following the kyphoplasty.I hope that your pain is subsiding .When will you go for the mri? Does it feel like it did when you first had a compression fracture?If you feel comfortable , perhaps it would help for you to share your story with us. When were you diagnosed? How did your compression fracture occur? Did you have prior fractures anywhere? How did you find the doctor who did the kyphoplasty and what did he say about the risks?

I do not have experience with kyphoplasty, perhaps someone with that experience will respond in time. I do have experience with osteo- I am 55 and my numbers are basically the reverse of yours, your hip number is my spine number and vice versa. None of our situations are exactly the same but it does seem to help to share what we are going through. There are alot of helpful , knowledgeable and caring people on this board . Recently the board has been a little slower than usual but give it a little time and I am certain you will have many who respond.I hope that we can help !!

Last edited by osteoblast; 11-18-2007 at 11:27 AM.

 
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Old 11-18-2007, 12:15 PM   #3
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Re: Kyphoplasty & Ongoing Pain

BoomerBones-After writing my last message to you , I did some research on kyphoplasty. I searched with the following 3 words-"kyphoplasty" "risk" "mayo". The reason that I added mayo was that I recall reading an article about research mayo had done on kyphoplasty risks about a year ago. Your search should get you to mayo's patient information about the procedures done at mayo. If you then hit on the text links you will get to a listing of various scientific journal articles about research done on risks of kyphoplasty and there are short summaries available for most of the articles. The chief risk appears to be a stiffening of the spine due to the cement fill which may in some cases lead to adjacent fractures. Also there can be a leakage of the cement apparently as the needle is inserted and that cement tract can press on the disc causing pain. If I understood that article correctly. So, it appears that your pain could have at least two possible causes and I would expect that there may be many other possible causes as well . Do you think that worry over the procedure may have resulted in muscular tension that could be painful to you? Are you on a muscle relaxant ?I am sure this all must be quite stressful- Soon though you will have more information from the mri. Do you have close family members or friends you can rely on at this time? Does your general doctor provide support to you? Let us know how you are doing.You are in my prayers.Take care.

Last edited by osteoblast; 11-18-2007 at 12:23 PM.

 
Old 11-18-2007, 01:31 PM   #4
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Re: Kyphoplasty & Ongoing Pain

Hi Boomerbones: Welcome to the board!!! I haven't ever had kyphoplasty, but I have had many lumbar fusions, disectomies etc. and I don't think that recurring pain 3 weeks post op is all that unusual. I know with this procedure most people get immediate relief, but I have talked to quite a few that took several weeks before they got any relief. If your pain went away post-op and then returned, there could be many explanations that only an mri will explain. Did the dr mention anything like residual nerve pain? With most back procedures there are many secondary problems that can occur that would cause pain, but they usually go away when the tissue, spine, vertebra calms down.

All the things that osteo mentioned are possible problems, but I wouldn't worry about these until I had the results of the mri. Hopefully you can find out soon what the cause is and have it treated. Since you haven't started PT, maybe that will help with some of the pain, when you are able to go.

I'm taking forteo, and I know that they are using this now to speed fracture healing plus it could help to prevent further fx's. Obviously taking a med like this is a "personal" choice so if you aren't comfortable with it I understand. Personally I have had great results with it and no side effects.

Since your surgery have you strained your thoracic spine in anyway? Sometimes the simplist movements can cause excruciating pain post op. Do you think the pain is worse than before the procedure?

Let us know what you find out... Good Luck

 
Old 11-18-2007, 07:12 PM   #5
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Re: Kyphoplasty & Ongoing Pain

DesertBloom and Osteoblast - thank you both for your helpful and thoughtful responses. This is the reason I have become an avid fan of this message board. The level of insight and knowledge of members such as the two of you gives hope to people like me who have gotten far too much conflicting information from specialists who are supposedly the "experts" in osteoporosis, therapy, and treatment modalities.
I fell on a cement train platform and suffered a T11 compression fracture plus a fractured cocyx bone. The cocyx healed but the T11 did not. I then found myself in a tug of war between one orthopod/physiatrist who recommended not to do the kyphoplasty and the surgeon who of course wanted it done immediately. I finally said yes to the kyphoplasty after 3 months of intense pain and not working.
My biggest issue with the docs is their inability to manage expectations. They lead you to believe that you do the procedure and you jump off the table and are "cured." But you are not. Your risk of fracture on the surrounding vertebrae increases dramatically which is scary when you consider that once you have any compression fracture you're automatically at highest risk for another one.
DesertBloom, I appreciate your guidance on the Forteo. I don't tolerate most drugs too easily but I don't think I can risk not taking Forteo at this point.
Thanks again for your support and rapid responses.
Best to all.
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Old 11-19-2007, 11:04 AM   #6
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Re: Kyphoplasty & Ongoing Pain

BoomerBones-I just wanted to check in and see how you were doing today. How is it going?
Sorry to hear about the fall on the train platform. Were the surfaces uneven or slippery?Or did you just lose your footing for some unknown reason? Was this the first time you had ever fractured anything? After the fracture did they advise bed rest for a period of time? Did you have to take any meds then? I have heard such conflicting information about compression fractures- apparently some people don't know it has happened and just continue with their lives. Others feel something, others seem to feel more .

That must have been very difficult to get conflicting messages from the orthopod/physiatrist and the surgeon. I feel for you having to make that decision. It does seem however in the world of medicine that there are few clear decisions. So much is a trade off, a risk analysis and then ultimately taking that chance on our decision. It is not easy, not easy at all. It gives me anxiety to have to face these decisions. I know some people do alot better at it than I do. I have had some bad incidents with doctors-when I dislocated my thumb ,the doctor set it wrong and put it in a cast. I just had an inkling things were not right. I saw another doc who did an x-ray and said that cast needs to come off now, the thumb is not set in proper alignment. Well that led to finding a surgeon and one surgeon said you must fuse the bones together and have limited mobility. No way around fusion. Another doctor more experienced said I won't know till I get in, whether you need a fusion. I went with the more experienced doctor.Well, I didn't have the fusion and so far so good. Maybe sometime I will have to have a fusion. But , it sure didn't help to have the immobility for weeks in the cast when it was set wrong. Plus I had more immobility after the surgery. All that immobility took alot of bone density from my hands. When doctors see my hand x-ray , there is comment about how much bone I have lost- it is scary to me.So - I know some of the agony that you must have gone through with your decision. A thumb,or hand is not of course as major as the spine.

I hope your mri shows no problem of significance. One thing I have been thinking about is whether you are aware of the importance of vitamin d. Some think it is even more important than calcium for bones. Also vitamin d deficiency has been implicated in various diseases and it is even thought among vitamin d experts that adequate d levels can significantly reduce the chance of certain cancers. Also what has previously been thought an adequate level is not now deemed adequate among the major vitamin d researchers both mds and phds. You can look at the Vitamin D Council for information -it is an eye opener. With the healing that you need to do now, I would think that you should be certain to get your vitamin d levels checked now and supplement adequately. As you are in the north, as I am, our vitamin d levels fall in winter and large percentages of the population fall into a deficiency status. So I really would suggest that you get tested , even if you were tested a few months ago, and see if your level is at what is now thought optimal not just adequate by what is put on the standard lab report as a range. Also, I do not think alot of doctors are up on the latest research about adequate levels.So, you might have to be the person who pushes for this if your doctor is not up on it.

 
Old 11-20-2007, 06:02 AM   #7
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Re: Kyphoplasty & Ongoing Pain

Hi there, I am also a new member of these boards, and just by chance happened on these posts. I had kyphoplasty on 9-28, and while not all pain has ceased, I felt an immediate relief of the acute pain. My fracture was L-1, but my pain is actually lower down my back, though as I said it is not acute.

Just to give you some background...the fracture was not the result of a fall or any other specific action that I noticed...it was just there. Very scary for someone who has been taking Fosomax for nine years and is only 64!

I just started back very slowly with Pilates...hoping to loosen up my spine. I am not sure if my stiffness is due to the surgery, or just to the fact that I have been traveling the last month, and had to sit more than usual.

What I am very interested in, is using Forteo. I Just started and am having all sorts of problems...perhaps there is another thread going about Forteo?
My problems are with the actual injection and then there is the issue of keeping it at Temp. when I take a month long trip to Australia at the end of Febuary. This is all starting to keep me up at night.
Any ideas?
I think this will be a great resource for me.

 
Old 11-20-2007, 01:47 PM   #8
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Re: Kyphoplasty & Ongoing Pain

Quiz, Glad to hear you've gotten relief from the Kyphoplasty. How long did the dr. keep you low-key before resuming normal activities including travel? Did you also find your dr(s) overpromising the effects of the procedure, only to come down to "reality" afterwards?
Also, have you found Pilates trainers who are really knowledgeable about osteo-safe movements? That's a whole other scary conversation - the lack of knowledge from PT and trainers about what moves are/aren't safe for osteo.
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Old 11-21-2007, 06:11 AM   #9
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Re: Kyphoplasty & Ongoing Pain

Quote:
Originally Posted by BoomerBones View Post
Quiz, Glad to hear you've gotten relief from the Kyphoplasty. How long did the dr. keep you low-key before resuming normal activities including travel? Did you also find your dr(s) overpromising the effects of the procedure, only to come down to "reality" afterwards?
Also, have you found Pilates trainers who are really knowledgeable about osteo-safe movements? That's a whole other scary conversation - the lack of knowledge from PT and trainers about what moves are/aren't safe for osteo.
OH, Pilates, that is a whole 'nuther story isn't it? My trainer seems very knowledgeable and I am going very slowly, but I am uncertain about roll downs and roll ups as well as any thing near my neck. Do you know of any sites that address osteo and pilates?
As to the kyphoplasty, my doctor didn't oversell it, and when I go back to the surgeon next week, I will be curious. There were really no restrictions placed on me after the surgery, just to walk a lot and use my common sense...I started my trip less than a month after the surgery, and while I still had some pain, it was manageable.

 
Old 11-21-2007, 07:09 AM   #10
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Re: Kyphoplasty & Ongoing Pain

Quiz,
Did the Dr. say that your compression fracture happened because of your osteoporosis? My Dad had 3 compression fractures, he had osteoporosis because of so much prednisone that he had to take for his pulmonary fibrosis.
The way that my back has been aching since Sunday, I am a little worried if I have a fracture.
I'm going to try and wait it out, I guess!
Do you or anyone know if the Forteo is covered by insurance?
I do take prescription Vit D once a week, plus calcium with D twice a day.

 
Old 11-21-2007, 08:02 AM   #11
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Re: Kyphoplasty & Ongoing Pain

Yes the dr. said that osteoporosis was the cause of the compression fracture. And as of now, my insurance is covering the forteo...well at least the needles. I don't think there will be a problem when I get my first pen...I am using the one the dr. gave me now.

 
Old 11-21-2007, 09:03 AM   #12
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Re: Kyphoplasty & Ongoing Pain

Hi Elphers: What type of insurance do you have? Most insurances cover Forteo, but then there are some that don't. You can always call your insurance and ask them if they do and what the copay is. If they don't cover it you can start a "drug exemption" where the dr fills out the forms for the insurance to cover it through an appeal. My insurance isn't covering forteo right now so I get it free from the dr.

Good Luck...

 
Old 11-21-2007, 09:38 AM   #13
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Re: Kyphoplasty & Ongoing Pain

Quote:
Originally Posted by DesertBloom View Post
Hi Elphers: What type of insurance do you have? Most insurances cover Forteo, but then there are some that don't. You can always call your insurance and ask them if they do and what the copay is. If they don't cover it you can start a "drug exemption" where the dr fills out the forms for the insurance to cover it through an appeal. My insurance isn't covering forteo right now so I get it free from the dr.

Good Luck...
I have PPO Blue insurance right now. I am changing to my school insurance Jan. 1. I'm thinking that might be what I have to try, the forteo, since I can't tolerate the other drugs that I tried. Does the forteo cause bone pain too? Like the actonel and boniva?
Those that had a compression fracture from the osteoporosis, is it just a bad ache? I mean worse than normal, but tolerable, but bothersome? That's the way my back is right now and my gyne on Monday isn't going to do anything about that. I might have to go to the osteo dr. that performed my Dad's kyphoplasty's if this pain keeps up!
Thanks!

 
Old 11-21-2007, 01:31 PM   #14
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Re: Kyphoplasty & Ongoing Pain

Hi Elphers: I would think that your insurance would cover the forteo if it's a ppo. Also I don't understand why your dr wouldn't order a x-ray or mri, since you don't need a referral for it-correct. I've had fractures in the lumbar area and they were very painful, making it hard to sit, stand and walk. Some compression fx's don't hurt as much and some are very painful. If the problem is the type of dr you have (gyn) then can't you see an ortho, neuro, or pc for the order of an x-ray or mri? Is your posture stooped forward?

"Symptoms of compression fractures are pain in the middle to lower back that is worsened by sitting or standing, loss of height, and a rounded back. X-rays are usually taken. If osteoporosis is suspected, bone density is measured, and blood tests may be done." Merck Manual Section 3 Chapter 23, 2007

I've never had bone pain from forteo, and some people say that it helps with certain types of back pain, but it hasn't done that for me. I have constant lower back/neck pain and the forteo hasn't helped that, but it hasn't made it worse either. I haven't had any side effects from it and haven't had any problems with the injection either.

Good Luck... Let us know what you find out.

 
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