Compression Fractures
Can we start a conversation about spinal compression fractures: how they present, levels of pain, treatment, and recovery?
You can find some of this information by doing a search on the topic, but - selfishly - I'd like to aggregate the collective knowledge in one spot.
My experience is that I've had weird upper right quadrant pain for about a year now. I was convinced it was gallbladder pain. However, imaging sees nothing related to the gallbladder, and bloodwork confirms the imaging. An MRI from a year ago notes the beginning of a spinal fracture in the Thoracic region. But, I have gallbladder pain (dangit) , not spinal pain, and am so vehement about this that my medical team proceeds on that assumption.
As time progresses, I become more and more hunched. Side note: both my father and paternal grandmother were hunchbacks. Not Quasimodo style, more sincere dowager's hump. I was 5'6", but when recently measured I am 5"3". I can't stand or walk without pain in the right upper quadrant. In the last month, I start feeling the pain in my spine.
At last, MO breaks through my gallbladder fog and says that I should get a new MRI, as it picks up bone problems much better than a CAT/PT scan does. I had assumed that since I had been extensively scanned, of course they would see if there was any spinal deformity.
Fingers crossed that it is a compression fracture, because there is a solution to that problem. Right? Surgery to stabilize the spine with either bone glue or hardware, then radiation to wipe out any cancer cells that might be hanging around?
Will I be able to walk and stand without ferocious pain? Will I be able to bend at the waist? In the meantime, I am thinking of getting a walker. I figure a walker mimics the leaning forward posture I use with a grocery cart, which feels better than unsupported walking.
Does anyone have a walker recommendation? I like the all wheel version, as lifting a walker to move forward seems like it would be painful.
For all that have battled their way through this great wall of text, thank you. Please tell your experiences with compression fractures, and how you managed treatment and recovery.
Jennifer
Comments
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After my scans in July the MO said I had a compression fracture at T11. He also said, and I quote, "but no one will operate on you", so I knew I'd have to tough it out. It hurt at the spot and outward, not exactly rib pain but similar. It was sharp on movement and achy when still. I actually think it broke when they made me lie directly on the metal table for that bone scan, at least that is the first time I felt it and even cried out "oh, my back!" . I asked for a pillow, as I'd had before, and they said no. Anyway, I added bone broth capsules to my bucket o' pills and I've been very careful how I move, especially any twisting. I've had a few more xgeva shots in the interim so I'm hoping they've helped too. I started doing these exercises with one-pound weights to help strengthen the muscles around the area. https://www.prevention.com/fitness/a20503369/5-gen... I've increased the reps but not the weight; I want it to be gentle.
I haven't had a scan since then, but I perceive it to be better. I rarely feel the pain unless I forget and turn over in bed too abruptly or lift or lower something with a jerk. I'm supposed to have another bone scan (and CT's) Wednesday but the blanking idiots have messed up the scheduling and insurance approval AGAIN. Every dang time. Then they get snippy with me when I complain. This time they've had since mid-September to get it arranged competently.
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Did they give a reason why no one would operate on you? It seems a bit cavalier, doesn't it?
I'm glad you are able to handle recovery on your own, smart lady!
Jennifer
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I thought so too, blainejennifer. I think it's because stage iv, mets to bones, liver, and in some configuration to lung or pleura (they've never really explained it well) and so on. Usually my MO is very tactful and positive. I think he thinks it will happen again in another one or more. So, it hurt like crazy, and does bother me some now but not as much. Knock wood, all my "innumerable" bone mets hurt less now, although I still know they are there, especially when I'm tired. Good luck with your situation. You asked about bending and walking. I could do those. It was uncomfortable but not ferocious. I felt better if I moved more.
p.s. I haven't asked for a good explanation for the lung involvement. That was my initial crisis, and since I can breathe now after a lot of procedures, I'm trying to "ignore" it. Haven't read anything too alarming on my reports.
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i used to be a nurse in interventional radiology. Vertebroplasty is the outpatient procedure that fills in vertebra with "cement" . it smells like stuff they use in nail salons. Kyphoplasty is same, but they use a ballon to open area up first. A interventional radiologist does them. A MRI is needed before to dx. I think we used to do up to 3 levels or vertebra. the patient is on stomach in xray room. I used to sedate little old ladies for this. There bones can be like butter. Anesthesia can do the rest of us. Its a quick and fairly easy solution. Some IR docs have there own outpatient clinics. sometimes you can find them by seeing a orthopedic or a pain specialist
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Jennifer, in the last year or so, there was a sudden mention in my PET/CT of a "stable wedge fracture" (think rectangle suddenly turning into triangle with one side collapsed) still visible at L4 and then 3 months later, a mention that there were still two visible stable wedge fractures at L4 and L1. In both cases, it was described as if they had been there for a long time although these were the first mentions I have had of any spinal fractures. My MO has never mentioned any and I read my PET/CTs word for word and had never seen a mention before. I suspect it happened 4 years ago and that they were probably there at the time of my initial mets diagnosis. When I was diagnosed, I had very advanced, widespread bone mets everywhere with uncontrollable hypercalcemia and was in excruciating pain. However, since my first PET/CT 3 months into treatment, my bone mets have remained inactive for nearly 4 years now, so I don't think it happened later on. It took a good year, maybe longer, but everything healed up over time. I was not at all surprised to hear the fractures were at L4 and L1 as those were the two vertebrae that hurt more than the others in a scary way, like something was not right. Leaning forward to do my makeup over the bathroom sink for work or to do the dishes over the kitchen sink became impossible as it was too painful. However, I never knew they were fractured and they healed on their own and apparently a "stable wedge fracture" does not require surgery in most if not all cases. I do wonder whether it is turning me into a hunchback. Not sure which side of the vertebrae collapsed with these two, whether it is the inside of vertebrae or outside - is it turning me into a hunchback or arching my back out in an odd way? To this day, I do have trouble sitting in many chairs as I feel like they don't line up with my back and are positioned too far forward as if I am leaning forward when I should be sitting upright. I don't know if that issue is from these fractures or from my extensive liver mets which may be pushing out my rib cage in my back and misaligning the contour of my back. I have some numbness along the right side of my middle spine, behind my liver, that I thought for years was from the bone mets but it turns out it is my liver mets pressing on a nerve. Ahh, the mysteries and surprises of Stage 4 . . . . .
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Hi Jennifer,
My cancer recurrence presented as a spinal fracture. I had tumors on my spine, with a large one on T4 causing a fracture and also pressure on my spinal column resulting in numbness below the chest. I felt pain in my ribcage, actually, rather than my spine.
I had radiation treatments to the T4 area, which seemed to kill the tumor and release the pressure on the cord, and the numbness went away. I was lucky, as it doesn't always. I recovered all of my movement and mobility with the radiation and Faslodex/Xgeva meds.
There was still concern about my fracture so I my oncologist insisted that I see spine surgeons for their opinion. He set up three for me- and they all had a different opinion! One wanted to do surgery with rods and prop up the area, another said he could operate but that there was no guarantee it would help, and another said I could watch it and wait to see if it continues to heal. So I went with the one that said "wait and watch," and I'm glad I did. That was in 2011, and I've had no surgery, and no further problems with the fracture. It seems to have healed, although I do still have some cancer throughout my skeleton, including my spine.
Fo me, it was the radiation followed by systemic therapy that helped. It was interesting that the radiation oncologist that did my treatments told me surgery would not be advised from the outset. He said that if I put in rods or in some way artificially stabilized that area, that it could cause trouble by putting more strain on the other parts of my spine that also had cancer.
Bones have been fairly stable since 2011. The liver is my problem area now.
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Sandilee,
Thank you for that advice. It's good to know that there are non-surgical approaches that work.
Jennifer
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