Post-kypho care

[RoloTomassi]

I've admittedly been focused more on the interventional side of managing fractures, and referring to PCP or Endo for medical management of fractures and bone health.

Been wanting to take more ownership of these issues. What do you all do, in terms of DEXA, labs, meds, supplements, etc? Any good guidelines to get me up to speed?

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[ateria radicularis magna]

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[Orin]

What about the rebound fractures with Prolia or is that just a money making venture?

 

[lobelsteve]

What about the rebound fractures with Prolia or is that just a money making venture?

Rebound occurs when they miss their 6 mo dose.

And both tymlos and evenity should be done before prolia.

I don’t do kypho unless i have dexa and appropriate labs. Cmp, uric acid, pth. I ask all patients to take 5000 u of VitD daily.

 

[RoloTomassi]

Rebound occurs when they miss their 6 mo dose.

And both tymlos and evenity should be done before prolia.

I don’t do kypho unless i have dexa and appropriate labs. Cmp, uric acid, pth. I ask all patients to take 5000 u of VitD daily.

No bisphosphonates? Forteo?

 

[drrosenrosen]

Rebound occurs when they miss their 6 mo dose.

And both tymlos and evenity should be done before prolia.

I don’t do kypho unless i have dexa and appropriate labs. Cmp, uric acid, pth. I ask all patients to take 5000 u of VitD daily.

So pts with acute fx and previously undiagnosed, you send for Dexa before doing kypho?

 

[lobelsteve]

So pts with acute fx and previously undiagnosed, you send for Dexa before doing kypho?

Ordered, logistics determines timing.
DEXA useless for these patients except getting all meds paid for.
DEXA screening tool to determine risk of Fx.
Current Fx means 50+% chance of another Fx in next 12 mo.

 

[lobelsteve]

No bisphosphonates? Forteo?

Bisphosphonates are too late after Fx.
Tymlos/Forteo/Evenity/Prolia.

 

[pmrmd]

I’ll kypho and then manage meds after. Nice to have DEXA ahead of time but sometimes it’s shortly after. At least in the Noridian LCD we need to be managing the condition if doing procedure. I can’t get my patients to commit to Tymlos/Forteo and then if I do insurance won’t pay. Prolia is my mainstay/calcium/D3.

 

[GoBeers]

sorry for hijacking thread again, but does anyone do the en-face approach for kyphos? wondering if people find it easier and maybe "safer" compared to traditional approach.

 

[RoloTomassi]

sorry for hijacking thread again, but does anyone do the en-face approach for kyphos? wondering if people find it easier and maybe "safer" compared to traditional approach.

I dock that way, then go between AP/L

 

[lobelsteve]

sorry for hijacking thread again, but does anyone do the en-face approach for kyphos? wondering if people find it easier and maybe "safer" compared to traditional approach.

I go left transpedicular approach down the barrel 99% of the time. Stop right anterior vertebral body. Balloon centered in bone. Cement fill from middle to outer portions.

 

[GoBeers]

I go left transpedicular approach down the barrel 99% of the time. Stop right anterior vertebral body. Balloon centered in bone. Cement fill from middle to outer portions.

How much obliquity do you do? How would I know is too much or little? Appreciate any guidance on what to look for

 

[lobelsteve]

Obliquity determined on MRI by measuring from final position back to skin with care not to breach medial pedicle border. Then measure from midline on skin to this line. Once under fluoroscopy I know how many mm I should be from midline to starting position.

 

[oneforfighting]

Obliquity determined on MRI by measuring from final position back to skin with care not to breach medial pedicle border. Then measure from midline on skin to this line. Once under fluoroscopy I know how many mm I should be from midline to starting position.

I did a case recently where the MRI cut off before imaging her skin level. Tried my best to get an angle but ultimately it was off. Salvaged the unipedicular approach with the kyphon kurve. Cement fill adequate but wasn’t ideal. Is there a workaround for these situations?

 

[lobelsteve]

I did a case recently where the MRI cut off before imaging her skin level. Tried my best to get an angle but ultimately it was off. Salvaged the unipedicular approach with the kyphon kurve. Cement fill adequate but wasn’t ideal. Is there a workaround for these situations?

Experience.

 

[RoloTomassi]

I did a case recently where the MRI cut off before imaging her skin level. Tried my best to get an angle but ultimately it was off. Salvaged the unipedicular approach with the kyphon kurve. Cement fill adequate but wasn’t ideal. Is there a workaround for these situations?

With the Stryker curved stylet/balloon you can back up and re-advance to redirect your flow. If this doesn't work you can always quickly put a trocar into the other side and inject like a vertebroplasty since you shouldn't put a balloon in there.

 

[oneforfighting]

With the Stryker curved stylet/balloon you can back up and re-advance to redirect your flow. If this doesn't work you can always quickly put a trocar into the other side and inject like a vertebroplasty since you shouldn't put a balloon in there.

Is the Stryker stylet much easier to use than the Medtronic? Used the kurve for the first time and really didn’t like how much grip pressure it required to change the tip direction or to disengage from bone.

 

[RoloTomassi]

Is the Stryker stylet much easier to use than the Medtronic? Used the kurve for the first time and really didn’t like how much grip pressure it required to change the tip direction or to disengage from bone.

Can't comment, only ever used Stryker

 

[lobelsteve]

Stryker bevel stylet can change course of needle cm, not mm.