Compression fracture of the T-spine

A compression fracture is when one bone is broken and pressing up against another bone. A great example of this is the vertebral column of the thoracic spine. Compression fractures can be caused from various reasons. One of the most common is osteoporosis, which is bone thinning and usually happens in post menopausal women. Other reasons are METS (metastatic cancer), falling, lifting injuries, and even coughing or sneezing.

There are several different ways of treating this condition. Giving the patient NSAIDS (non-steriod anti-inflammatory drugs) will help with the inflammation and some pain. I found it very supprising that WebMD said, "anti-depressants can also help relieve nerve related pain." Simply wearing a brace can also help or patients could go a completely different route and have surgery done. Kyphoplasty is probably on of the most common types of surgery. It is where the physician injects a substance of bone acrylic in the vertebral body to help stabilize it. The patient must have a new fracture to have this type of procedure done. Vertebroplasty is very similar to kyphoplasty, but it does not use an inflated balloon to help position the vertebral height. Spinal fusions and bone grafts are other methods of treating this condition.

References:

Images: www.iofbonehealth.org

WebMD.com

Cervical disc herniation

My father was involved in a motorcycle accident about 15 years ago, but since his accident he has had terrible back trouble. He had had seven back surgeries since his accident. In 2007, he was complaining numbness, tingling, and decreases sensation in his left arm, thumb, index, and middle fingers and a lot of pain in his neck that wouldn't go away. His MRI showed foraminal narrowing in C4-T1 area and he was also diagnosed with radiculopathy, which is where the nerves become inflamed by disc herniation. A disc herniation is where the nucleus pulposus (the center of the disc) is squeezed out of a torn annulus (the coating around the nucleus pulposus) and pushes out into the spinal canal. His doctor suggested an epidural steroid injection, but my dad refused because steroid injections have never worked for him in the past. After reviewing over possible alternatives, my dad decided to have a cervical spine fusion of C5-C6 and C6-C7. My father, thankfully, did not have any major risks from the surgery besides decreased range of motion and pain. According to my fathers' surgeon blindness, paralysis, difficulty swallowing, voice changes or damage to vocal cords, infection, esophageal injury, decreased blood, and dural tears are all possible outcomes from having a spinal fusion.

Only about 1 in 10 people have to have surgery, according to the mayo clinic. Other alternatives for disc herniation are medication, exercise, stretching, wearing a brace, etc.

I have uploaded an image of a disc herniation example from www.health-res.com.

Aneurysms

A patient arrives in the ER with major headaches and is very confused. She had just given birth to twins three weeks prior and a history of high blood pressure. After being evaluated by the ER doctor, it was noticed that her blood pressure was extremely high. A CXR and CT head was completed and showed a ruptured aneurysm and a subarachnoid hemorrhage. The patient was immediately transferred to the ICU where they could make her stay more comfortable, because at this point she was pretty well brain dead. What is an aneurysm? It is a bulging in a blood vessel, which can occur anywhere, but happens more often in the aorta and the brain. The patient that I helped to treat had a brain aneurysm, which means that the blood pooled between the brain and the brain covering. Some symptoms include a sudden headache, confusion, blurred vision, loss of consciousness, nausea, vomiting, etc. According to the Mayo clinic, "50% of ruptured aneurysm are fatal". Aneursms are caused from a thinning in the vessel wall. Common risk factors are age, genetics, HBP, smoking, increased alcohol consumption, AVM's (as recently discussed in a previous blog), and low estrogen levels. Patients who chose not to breastfeed, estrogen and prolactin levels decrease after pregnancy. Imaging modalities that are used are CT, MRI, and angiography to visualize blood vessels. Aneurysms can sometimes be fixed by using an aneurysm clip to clip off the bulge or an endovascular coil can be placed within the vessel. Certain medications for HBP, calcium channel blockers, or vassopressors may be used to decrease the chances of having an aneurysm. Risks can be decreased by not smoking, exercising, eating a healthy diet, and decreasing caffeine and aspirin intake.

References:
mayoclinic.com
babyboomercaretaker.com
ideasforsurgery.com

Hodgkin's lymphoma

I once had a 22 year old male patient came in to the urgent care that complained of swollen lymph glands in his neck and right shoulder area for approximately one week. His main concern was that the lymph glands got very large in a short period of time. The doctor I was working with ordered a mono test, CBC (complete blood count), a CMP (complete metabolic panel), an influenza test, and x-rays of the chest and soft tissue neck. All of the in house labs came back normal, but his white blood cell count was extremely high, and his x-rays showed swelling of the lymph glands all the way down to almost the hilar area. After the doctor reviewed his test, he sent the patient to have a STAT CT scan of the chest. The patient was allergic to contrast, so a non-contrast exam was done. The impression of the scan was, "Anterior mediastinal and right peritracheal lympadenopathy as well as supraclavicular adenopathy and the radiologist suggested the patient see an oncologist to do further testing to rule out cancer. After visiting the oncologist, a biopsy was performed and was confirmed as Hodgkin's Lymphoma. The patient went through numerous radiation therapy and chemotherapy treatments and is now cancer free!

Lymphoma's are cancers involving the lymph system. There are two major types of lymphomas, one being non-Hodgkin's lymphoma and the other being Hodgkin's lymphoma. Non-Hodgkin's lymphomas are more aggressive so the treatment for those patients are stronger. Patients with Hodgkin's lymphoma have a high survival rate especially when caught early. CT, MRI, and PET scans are usually the imaging choices and the first step in determining the problem. After the initial scans, a biopsy is taken out of the area of interest and a "stage" is given to the type of cancer, if any. There are 4 stages of cancer. Stage 1 is when the cancer is found early and stage 4 is later and more complex. Some risk factors include: being male, an infection with the Epstein Barr Virus (mono), and a weakened immune system. Treatments for Hodgkin's lymphoma is chemotherapy, radiation therapy, or mixture of both, which depends on age, gender, severity of cancer, etc. I have uploaded an image of Hodgkin's lymphoma on CT soft tissue neck.

References:

http://www.mikety.net/X-rays/HL-neck-a.jpeg

http://www.lymphomainfo.net/hodgkins/description.html