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7 years of back pain. Worse in last 3 months. Xray negative. Started getting weaker in thighs. No B/B.
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- Thread starter Epidural
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What did they read that as? Did it get better with steroids? It looks maybe like a vascular malformation or cancer with associated edema
So..they will get 2 weeks of relief with dex?
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Intradural/extramedullary. Schwannoma. Surgical pathology confirmed.
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Potentially, but worth trying before sending to surgeon imho. Already did interlam w depo.
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Damn. What’s their Neuro exam like ?
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WC-bound paraplegic.
L4/5 looks nice and well hydrated though. At least that’s something
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Probably the T12-L1 Modic changes. It’s vertebrogenic pain.
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Never seen a sacral fx quite like this one. Two weeks out.
43 F. CT negative for cancer, mets, etc. Starting osteoporosis work up. Multiple surgeons don't have any answers or don't want to touch her.
Does anyone have any suggestions for interventions that might help? Trying to get her to get that giant poop out is project #1 since she hasn't gone in 6-7 days.
43 F. CT negative for cancer, mets, etc. Starting osteoporosis work up. Multiple surgeons don't have any answers or don't want to touch her.
Does anyone have any suggestions for interventions that might help? Trying to get her to get that giant poop out is project #1 since she hasn't gone in 6-7 days.
i also wouldnt touch this.
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this might be a rare indication for long term opioids. sacral fractures can take a year to get better.
butrans patch for a year.
suggest Relistor or Movantik for the constipation if that is due to OIC. SQ if you feel the need to initiate faster...
butrans patch for a year.
suggest Relistor or Movantik for the constipation if that is due to OIC. SQ if you feel the need to initiate faster...
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That is a huge poop. Looks like she needs a manual.
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I would ask orthopedic trauma surgeons to take a look. S3 fracture looks like it could use a reduction and percutaneous screws from caudal to cranial one on each side.
Sacroplasty but reduction/fixation would be better with the displacement. Trauma surgeons are the ones that see this more than your usual ortho folks, so sending it to a level 1 trauma center may make sense.
Sacroplasty for Sacral Insufficiency Fractures: Narrative Literature Review on Patient Selection, Technical Approaches, and Outcomes
Sacral insufficiency fractures commonly affect elderly women with osteoporosis and can cause debilitating lower back pain. First line management is often with conservative measures such as early mobilization, multimodal pain management, and osteoporosis management. If non-operative management...
www.mdpi.com
She might be a candidate for something like approach D there but may be better for IR
