Dear Dr. Roach: An almost 90-year-old friend has osteoporosis. In January, she collapsed while walking home.
Now, five months after having a compression fracture of her vertebra, she says she is most comfortable while lying in bed. She has been taking OxyContin and oxycodone. She is afraid of becoming addicted.
She has been advised that kyphoplasty is the recommended surgery. She is scared and wants more opinions.
She saw an advertisement on TV about minimally invasive back surgery, so I called about it for her, but it was symptom-relief surgery and they do not provide kyphoplasty, which, when successful, relieves the pressure (almost immediately) that causes the pain without cutting the nerves. Re-establishing the original height and shape of her bone with balloon kyphoplasty seems like an amazing surgical approach and has been available for about 25 years.
My friend believes in offering up her pains (she is deeply spiritual), and I am doing my best to help her make her decision.
The neurosurgeon advised her that all surgery has risks, that he has performed the surgery many times, that the vertebra will heal to this new shape and that her pain threshold should be a significant part of her decision.
It comes down to the fact that she is scared and between the proverbial rock and hard place. Please help her make her decision.
B.C.
A compression fracture happens when a vertebral bone, usually weakened through osteoporosis, is crushed. (Imagine a cardboard box with too much weight on top partially collapsing.) This often causes the nerve roots, which exit between the vertebrae, to be compressed by the bone, causing pain and sometimes weakness. For a compression fracture that continues to be so painful that it requires opiates, surgical intervention is clearly worth considering.
Both balloon kyphoplasty (where the compressed vertebra is returned to nearly its original height with a balloon and filled with cement to keep it from crushing again) and minimally invasive lumbar fusion (where metal rods keep the nerve from being compressed) are reasonable surgical options.
I can鈥檛 give an opinion on which of those two would be better, but it sounds like her surgeon has recommended the balloon kyphoplasty, which sounds entirely reasonable to me.
Long-term opiate use is safe and effective for some people, but there are many risks, including dependence on the medication. It is clear that lying in bed is a bad long-term solution.
I also can鈥檛 comment on the religious nature of her pain. However, I asked a friend of mine, Clare Rothschild, a professor of Scripture Studies at Lewis University, and she recommended that your friend consult with a trusted leader in the community before making her decision.
Dear Dr. Roach: I have (inherited) essential tremor, which is controlled by propranolol. Over the years, my dosage has increased from 10 mg to 60 mg. My tremor (in my dominant hand only) is getting worse. I have heard that there is brain surgery available to address the issue. Is this a better option than the pills? I am 75 and otherwise in good health.
C.C.
There are several medications for essential tremor, such as primidone, but in people for whom medications don鈥檛 work, both deep-brain stimulation and focused ultrasound are now options in many major medical centres across the U.S. and Canada. You can read more about it and find centres that use these treatments at https://tinyurl.com/ETsono.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
