#spinefractures #spinepain #lowerbackrelief
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Lumbar fracture management on your mind? Dr. Corenman introduces Dr. Gill who is a spine surgeon out of Spartanburg, SC. Dr. Gill speaks in detail about the thoracic, thoracolumbar, and lumbar fracture management of patients. If you look at the spine, we often think of it as cervical, thoracic lumbar and sacral. However, we really have these specialty segments which are cervical thoracic which is a junction, and thoracal lumber which is a junction. In and of themselves, they are very different; they react to the body differently.

Dr. Gill elaborates on the following topics: biomechanical anatomy of the thoracic spine, biomechanical anatomy of the lumbar spine, thoracolumbar junction and special considerations such as stress risers.

Here are some important questions to ask:
1. What was the mechanism of the injury?
2. What is the patient history?
3. What are the patient examination takeaways?
4. Are there any concordant spinal injuries?

Why do we even classify fractures? Answer: We need to learn about the fracture stability, the local deformity pain and the protection of the neurological elements. The classification system is discussed along with the following items: classification of injuries, transverse process fractures, traumatic isthmic spondylolysis, “Scottie dog with a collar” example, air fluid lines, simple compression fractures, flexion distraction fracture, flexion distraction MRI findings, posterior ligamentous disruption, chance fractures, flexion distraction fractures (don’t confuse the two), burst fractures, stable burst, stable burst fractures healing in a brace, unstable burst, unstable burst fracture pedicle splaying, spine fracture dislocation, spine pathological fractures, spine insufficiency fractures, osteopenic kyphosis from the loss of vertebral height in the body, and MRI findings in acute versus healed fractures.

How do you scan the xrays?
You are looking at the arc and the natural process if you have intact column height. You also want to see if you can look at the back of the body and can you actually see anything pushed back. On the AP, you are looking for the spinous process splaying.

Here are some other important items to look for: pedicle splaying, laminar split, measure kyphosis, and measure the anterior and middle column heights.

Dr. Gill explains how spine fractures heal and highlights the following important spine concerns: compression fracture treatment, simple compression fractures heal with minimal residuals, stable burs and lateral compression fractures and stable burst fractures heal with minimal residuals.

Dr. Gill speaks about the hotly debatable topic of kyphoplasty and vertebroplasty which are:
Useful for painful insufficiency (osteoporosis) fractures
Does not restore alignment or height
Not for significant comminution or displacement
Cement displacement into canal through basivertebral vein

As for the time to healing:
Most nonsurgical fractures heal within 1216
Jewett/TSLO on whenever upright
Cannot put on brace when sitting/standing
When healed – 48 weeks of PT for deconditioning
Residuals of barometric sensitive discomfort and occasionally problems with lifting
Up to 10% may need to go on late surgery from instability or degenerative pain

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With more than 30 years of experience, Donald Corenman, MD, DC, is a highlyregarded spine surgeon, considered an expert in the area of neck and back pain. His training as a Doctor of Chiropractic early in his career did not satisfy his desire for a deep understanding of the mechanics of the spine. This led him to medical school where he completed his Doctor of Medicine, Orthopedic Surgery Residency and Spine Surgery Fellowship. His study of spinal disorders and deformities brought him to Vail, Colorado where he joined The Steadman Clinic in 1994. With personalized clinical care a cornerstone of Dr. Corenman’s practice, he has been awarded the “Top 10 Doctor Award”, “Patient’s Choice Award”, “Compassionate Doctor Recognition” and is consistently recognized by Becker’s Spine Review in “Top Spine Surgeons to Know.”

He is passionate about educating patients on spine anatomy and disorders, so they have the ability to partner with their physicians in finding the most effective treatment for their back pain and disorders.