Vertebral Fractures

Fightingirl

I have a fracture on one vertebrae. I've met with a neurosurgeon who doesn't feel that surgery is the best option for me. (of course, he was giving me the sad eyes and asking me if anyone has talked to me about prognosis) In the end, he stated that he didn't think I should be put through that. I wouldn't go to Mr Sad Eyes anyways! Dude, I've got years and years so save it!

I am now scheduled to meet with a radiation oncologist next Tuesday and go over my options there. Back in January, I met with a doc at CTCA and they suggested filling the fracture with a cement type substance as well as heating up or freezing the cancer cells in the area while he was in there. I was quite sick at the time and I met with many doctors there in a short time so can't remember if it was heating them up or freezing the area but CTCA was not for me. I personally didn't like the vibe there.

I'm looking for anyone who has had anything done to treat a vertebrae fracture. What did you do and how are your side effects?

I'm concerned as I've had radiation to both femurs and I wish I'd been told how my legs would feel after.

Grateful for any advice...thanks in advance!

JFL

Is your fracture symptomatic or unstable? If so, you should consider treatment. I have read a lot of favorable experiences on these boards with the cement procedure (kyphoplasty, I believe?). If the fracture is stable and not causing you problems, you may not need to do anything. I have had at least 4 vertebrae fractures/partial collapses but haven’t had any of them treated. No one informed me about them. I learned about them myself reading my PET-CT reports over the last few years. Occasionally, one or two are mentioned in my report as being “unchanged” from previous reports. Never has any of them been listed as new. I have read about all of them for the first time as if they have been around forever, which is odd. I have likely had them since diagnosis 4.5 years ago, although they didn’t start showing up in the PET-CT write-ups until the last few years, described as “stable wedge fracture” and/or “stable deformity on ___ vertebra”. When I mentioned them to my MO, he didn’t seem too concerned. They do not restrict my physical activity. I could barely walk when I was diagnosed as my bone mets were very advanced, in nearly all of my bones and causing uncontrollable hypercalcemia but am able to run, do yoga, etc. now that they are healed. It took about a year for all the bone damage to heal.

On a separate note, nothing bothers me more than the “sad eyes”!

Mermaid007

Hi,

I had that exact procedure 4 years ago to my collapsed L5 vertebrae. It is called Vertebroplasty. The procedure didn’t hurt, I was sedated. I was a little stiff for a couple of weeks but recovery time was quick. The L5 vertebrae was collapsed due to the tumour inside it which I believe was removed at the same time. I also had Radiotherapy to that area after the operation. I wouldn’t hesitate to have it done.

Good luck

Fightingirl

Thank you both for chiming in! It doesn't seem to cause me too much pain but it's bad enough they think I need at least radiation...I guess to keep it from collapsing? My sister has a friend that had multiple fractures that have healed themselves but when I asked the neurosurgeon if he thought that was possible, he said it was highly unlikely. I guess I'll see what the radiologist thinks. I'm so happy to hear you are running and doing yoga again JFL...what I wouldn't give to get on my yoga mat! I've been told I'm not allowed to lift or do anything other than walk. I was also the same as you when first diagnosed...I could barely walk. My back is what kept me going to the doc time and time again trying to figure out what was wrong and eventually they discovered the mets.

pajim

Back when I had a severely collapsed L5 the orthopedic surgeon offered two options. One was vertebroplasty and the other a fusion. Radiation either way -- it's to kill the cancer cells so they don't eat more bone.

If you're having back symptoms you should do something. If you're having shooting pains down your leg(s) you should really do something.

My MO encouraged me to think long-term. So should you. I'm sorry your neurosurgeon doesn't want to think long-term. Time for a second opinion. . .

Fightingirl

pajim, I was thinking of a another opinion to break the tie. I had one at CTCA that said yes and now this new guy says no. First I'll see what the radiologist has to say and go from there. Thank you!

How are you all doing from surgery/radiation? Do you notice any side effects? As I stated, I had my femurs radiated and I was not aware of how much my legs would change from that. I have sever tightness and it is hard to do things like step into a bath tub...when I have to bring my leg bent up over something like that. I do stretches every night but it doesn't seem to help much. I'm so scared that my back will end up all tight like that...I know I also have to do something.

Pamela48

yes I had surgery on my t10 vertebrae. It had gotten so bad I ended up in the hospital in an emergency situation.

They did surgery right away by filling the vertebrae with a cement like substance. For me the pain relief was not immediate but I cannot image waiting longer and ending up with nerve problems. I am pain free and doing well. I have a normal movement in my back. I am a ceramic artist and am back at work! I take fasoldex and xgevia for my cancer therapy

Wishing you the best!😊

Moomala

Interesting - I just visited a new orthopedic spinal person last week who said he'd like to put rods and pins in my spine to brace up T11 which has a compression fracture and cancer but also osteoporosis. He said he'd rather not do any surgery on me at all and sent me to PT instead. I've had radiation already but I wonder why both orthopedics are not talking with me about repair for T11. I'll ask when I see him again later this summer. I was assuming that they weren't doing surgery becuase I'm Stage 4 but I prefer to think long-term and for certain my mobility is really affected by this.

JFL

I suspect some orthos are scared when they hear metastatic "cancer" in bones. They shy away in fear or for CYA purposes. Beyond orthos, I think other surgeons question the value of what is termed "elective" surgery on stage 4 patients - not elective in that it is cosmetic but elective in that it is not an emergency matter that needs to be handled immediately such as via an ER visit and is a scheduled surgery and not necessarily required. Sad. We are all living so much longer. It would be ideal to have an ortho that does a lot of cancer-related surgeries on metastatic breast cancer patients. Given that breast cancer has a more favorable life expectancy than some of the other cancers, the analysis for us is different. Especially for someone who has bone mets only. Not sure if that ortho exists.

MargaritaMS

Hi All, I just found this thread and it has begun to answer some of my questions, so thank you all for sharing your experiences already. I'm hopeful that someone can help me to make sense of my current situation. The background is this: I have had bone mets since dx in 2015 but it's limited to my L2-L3 vertebrae. I've already had SBRT to the L2 which seems to have been successful in that the lesion currently shows no uptake on a PET scan. However, I do now have a compression fracture. My recent MRI report says:

Redemonstration of metastatic lesion completely involving the L2 vertebra. This is characterized by T1 hypointensity with heterogeneous T2 hyperintensity and heterogeneous enhancement following contrast administration. There is a fracture line that extends obliquely within the vertebral body. There is interval development of asymmetric height loss involving the left aspect of the vertebra with approximately 50% vertebral height loss. There is no evidence of retropulsion component.

Huh? I don't understand a word of this! I had a meeting with my RO and asked him to explain. He's not very good at making things comprehensible to me but he did say that we might consider kyphoplasty. I saw the MRI picture of my spine and it looks like I'm missing an entire vertebrae - the image was just dark where the L2 should be visible. Yikes. In the end, we agreed that we not do anything right now since I'm not having pain and there are "risks" involved in kyphoplasty (of course I failed to ask what risks?). I did ask if it might heal on its own - to which he said "no, not likely". I also asked if it might entirely collapse someday and leave me writhing in pain on the ground - to which he said "possibly"! Double yikes!!

So, now that I've had time to think things over, I'm wondering if the kyphoplasty is something that really can and/or should wait or is it something that would best be pursued now before I have significant pain or mobility problems?? What are the risks of doing it now vs doing it later once I have pain or reduced mobility etc?

I really appreciate any thoughts, comments or experiences anyone can share. Thanks much!

Moomala

There is a bit of disagreement about this from what I can tell. My ortho does not believe in doing the kyphoplasty if you aren't having pain and I tend to agree. I have fractures at C7, T11 and L4. T11 is the worst and I've lost about three inches of my height. I'd say I have a good amount of back issue but nothing I'd even take an advil for so I'm not going to add a surgery. Compression fractures don't ever heal, however my ortho says that with time and PT your body can adjust. I got two opinions on that. My MO thinks I should have a kyphoplasty but both orthopedics I consulted said no.

If you are having significant pain that is an entirely different situation. I know someone who had all of her thoracic vertebrae fracture and she had a kyphoplasty for pain that didn't really work. Surgery is risky.

For me, (and I have a pretty gross looking MRI) I have done really well with PT alone. I had limited mobility at first but it came back. I have gone from not being able to walk to walking three miles a day. I hope you can get an answer that feels right to you.

vlnrph

Actually, I think that sometimes compression fractures do heal on their own depending on the cause. For instance, elderly ladies with osteoporosis may experience this. However, those of us with tumor eaten bone would probably expect the cancer to keep on a path of destruction unless treatment halts it.

My L1 was completely gone to the point where I could not stand or walk just over a year ago. An extensive operation replaced it with a flexible cage, altogether a 5 level fusion. A couple months later, I had a sharp pain in the middle of my back which bought me a set of interventional radiology procedures as an outpatient involving thoracic vertebrae: ablation to T9, cement only in a higher spot and both to another location.

It sounds to me as though Margarita might benefit from another opinion or two. My doctors were from a dedicated spine oncology program, trained in neurosurgery although an orthopedic specialist helped make the diagnosis by getting an x-ray via his sports medicine walk in service (I arrived there in a wheelchair after other primary care people told me I had muscle strain. They did not employ sufficient suspicion regarding metastases despite my history). Let us know how it goes.

Moomala

Yes I'd like to stay updated on this too. I'm seeing a spinal oncologist as well but I've often thought I'd like to go to a bigger hospital like MSK or Roswell to get another opinion. vlnrph your post gave me a lot to think about. My diagnostic experience was similar to yours. the PCP kept goin after muse strain in spite of my history. This is somewhat reasonable becuase I was so far out from original diagnosis and had additional history of Paget's Disease in my spine.

MargaritaMS

Thank you for your replies, vlnrph and moomala. You've both given me some things to think about. I am fortunate that at the moment I don't have significant pain. More like stiffness and aches when I get up in the morning and if I sit or stand in one position too long during the day but it's totally manageable. I'll admit, your stories about such limited mobility scare me a little - but that's exactly why I want to explore whether something should be done now. Though like moomala, I don't really relish the idea of surgery. However, so far, the SBRT seems to have halted the cancer in the L2 but we all know it may flare up again at anytime and I worry that if the damage were to continue that I might have pain and mobility issues in the future while having missed the window to treat - assuming there is a "window to treat" as I call it. Seems like these would be good questions for another opinion from a spinal specialist: what can be done and when is the best time to do it? Thanks so much!