Would you vplasty

[clubdeac]

so got my first vplasty at my new gig and patient has retropulsion with moderate stenosis. Would you guys do it or punt?

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[lonelobo]

punt

 

[NOSfan]

IMHO too much retropulsion.....punt.

 

[Orin]

That looks very likely to be unstable and require a fusion. If they won't fuse it though, I would only do it with surgery readily available to help out. You'll want to carefully watch for more retropulsion during the procedure, especially if you're inflating balloons. It look as if it'll be very challenging though based on the pedicle size and the plana nature so I would make sure they've failed conservative management.

 

[lobelsteve]

MRI does not look bad. Plenty of canal space. Would want more views of vb but parapedicular approach at L1 looks pretty easy.

I would brace, Tymlos/Proloa, then fix it if intractable.

 

[thecentral09]

no

 

[clubdeac]

Thanks for the responses...I’m not too eager considering it’ll be my first at the new location.

 

[Orin]

Would want more views of vb but parapedicular approach at L1 looks pretty easy.

Do you do parapedicular often for the flatter retropulsed VCFs?

 

[unchockey21]

Thanks for the responses...I’m not too eager considering it’ll be my first at the new location.

I’d do the same. First impressions matter and you don’t want to be known as the cowboy.

 

[BobBarker]

It looks pretty bad to me. You could send it for a spine jack. Look in the picture thread above for one Doug Beall did.

 

[lobelsteve]

Do you do parapedicular often for the flatter retropulsed VCFs?

I measure depths, angles, and pedicle size on mri and plot a course. Retropulsion does not alter my course. But if i see too much canal compromise it is a no go.

 

[emd123]

so got my first vplasty at my new gig and patient has retropulsion with moderate stenosis. Would you guys do it or punt?

Way too much retropulsion. I wouldn't do that one personally. It's not so much that the bone will move further back, although it could, it's that cement could leak through the crack in that fragment that looks like a " > "

It wouldn't take much to squeeze through then harden and all of a sudden you've got some cord compression. I've done enough kyphos to be fairly confident in doing them, but I, personally would punt that one to neurosurg or ortho spine.

 

[clubdeac]

Way too much retropulsion. I wouldn't do that one personally. It's not so much that the bone will move further back, although it could, it's that cement could leak through the crack in that fragment that looks like a " > "

It wouldn't take much to squeeze through then harden and all of a sudden you've got some cord compression. I've done enough kyphos to be fairly confident in doing them, but I, personally would punt that one to neurosurg or ortho spine.

Thanks emd...that’s what I decided to do. Gonna get an easy one for my first partly bc I’m not even comfortable with the support staff yet