T4 Compression Fracture CHRONIC PAIN

[T4 Injury]

     In August 2004, my T-4 vertebra was compressed.  My MRI showed the following:
1) Greater than 50% compression fracture deformity of the anterior and middle one third of T-4 vertebral body associated with horizontally oriented fracture line and marrow edma is consistent with acute compression fracture of T-4.  Mild kyphosis has resulted at this level.  The posterior column is flattened by between 20 – 30%.  
2)T-7 to T-8 Right paracentral small disc herniation compressing the ventral dural sac.
     I also had a DEXA Scan, which showed that I have Osteopenia.
     In December 2004, I had Kyphoplasty surgery.  The surgery did not restore any height to the vertebra or fix the wedge shape.  
     Since 2004, I have tried the following to relieve my chronic pain but nothing has helped.
1) Three different physical therapy programs
2) Various pain medicine and anti-inflammatory medicine (Minimal Relief)
3) TENS Unit (Minimal Relief)
4) Five thoracic injections ((Minimal Short Term Relief )
     When I wake up, my of level of pain was between a 4 and 6.  My pain is still dull and aching.  Some of my thoracic pain is relieved by lying on my side.  When I laid flat on my back, the pain is increased in my thoracic region within minutes and it felt like my organs were lying on my spine.  It also felt still like my ribs in my back at and below my T-4 vertebrae were pushing into my spine.  I still had to slowly roll to my side to attempt to get up.  The pain was also still worsened by motion, for example, standing, lifting, walking, or sitting.  When I moved my upper body or lifted a weight bearing item, the area between my shoulder blades was still aggravated, pain increased, and the area was tender.  When I attempted to sit at the computer with proper posture, my level of thoracic pain increased with 30 to 60 minutes.  My level of pain increased to an 8 or 10 immediately from certain activities or through out the day from daily activities.  Throughout the day, my pain is still was persistent.  I still felt sharp stabbing pains on both the left and right thoracic area at and below the T-4 vertebrae.  The pain also radiates down to approximately my T-8 vertebra and to the left and right of the spine.  But the pain is usually stronger on the right side of the back.  Sometimes the pain feels nauseating or like my bones were rubbing together.  Sometimes a burning pain is felt between my shoulder blades and it wraps around my back to my chest.  The pain caused more sleepless nights which caused me to feel more rundown and more depressed about my situation.  I also take pain medication throughout the day and night to relieve the pain.  

What is causing my chronic pain and how can I relive or stop it?

[mike1105]

1. I had these facet blocks and then the radiofrequency becasue I felt the facet blocks worked. The radiofrequency procedure did not help me at all. I think I felt better after the facet blocks becasue I had a bit of anesthetic and becasue I was relaxed on the table-- so I felt better--my muscles relaxed.. From all I've read the risk level is pretty low-- but of course you are having needles stuck into your sipne.. Alot depends on the practitioner.

2. I totally agree with this.. it is a fancy way of saying what I said before -- your muscles go into spasm becasue the spine itself needs the extra support becasue the biomechanics are "off" kilter.

3. I think quite possibly yes for the fracture (bomechanics are altered so muscles go into spasm=myofascial pain) and probably no for the discs unless the nerve roots are compressed. Central protrusions into the cord usually casue loss of function/weakness not pain/spasm.

4. There is no guarantee with this stuff- especially since, as you say, your skeleton has been permanently altered (and hence so have your biomechanics). But the body is amazing in the way it heals/adapts . Giving it a better chance to do so cant hurt. MUSCLES SUPPORT THE SPINE. THE MORE MUSCLE< THE MORE SUPPORT.

5. this is a question for an orthopedist........


Keep in mind I am a dentist, not an MD-- I studied muscular pain syndromes and the spine on my own for 2 years in an effort to "fix" myself, which I did. This is my opinion only, not medical advice. I would certainly review what I had to say with your MD.

[T4 Injury]

One more time, thank you very much for your time!  Just a few more questions:
I found the following information in a book called "Vertebral Osteoporotic COmpression Fractures"

Question 1:
Per the book, "Both the facet and costovertebral joints are well innervated and are agreed to be a source of pain in many spinal conditions.  Any sighificant abnormal angulation of the spine caused by collapse causes alteration to the neutral position and stresses the joint capsule and the articular cartilage.  This alters the local biomechanics, causing pain.  It is also likely to provoke spinal reflexes in the affected segment, causing paraspinal muscle spasm."  
I am going to have a diagnostic facet block at T3, T4, T5.  If the injection reduces the pain in the area,  the radio frequency can be performed on the nerves and may reduce the pain in the facet joints for 6 months.
Do you agree with the facet blocks and is there serious risks with radio frequency of the nerves?

Question 2:
Per the book, "Any significant abnormal angulation of the spine causes an alteration in the neutral posture with a consequent change in the muscle balance required to maintain a normal upright stance.  Adverse or sustained muscle contracture is apotent source of pain in mayny conditions, includig spinal disorders."
Would I have this problem or this the cause of the thoracic muscle spasm?

Question 3:
Would my T4 wedge shaped compression fracture and T7, T8 disc protusions be also causing Myofascial pain, Segmental Instability, and Spinal Ligaments pain in the thoracic region.

Question 4:
I am a 35 year old male.  I am off work due to may throacic pain.  My job requires exerting 20 to 50 pounds of force occasionally or 10 to 25 pounds of force frequently, and up to 10 pounds constantly to move objects.  It also reques occasionally climbing, stooping, kneeling, crouching, crawling, and reaching.
If I complete trigger point work and stretching along with strength training in physical therapy, will I be able to return to work with minimal pain?  

Question 5:
Will my compressed T4 vertebra and osteopenia cause more strain on my muscles and vertebra to cause another fracture or severe strain from working at the above job?  Or would the T4 vertebra be stronger since it is a healed bone but still compressed?

Thank you!

[mike1105]

actually- be careful about stretching the thoracic back muscles too much. with mid back pain, thee muscles are usually weak and loose, and need to be strengthened

[mike1105]

trigger point work, stretching--- get a trigger point manual by clair davies.

[T4 Injury]

Thank you for the response.  Since the vertebra is permanently compressed,  will the muscles always spasm to protect the spinal cord?  Or is there anything that can be done to stop the chronic pain if it is coming from the muscles spasms?

[mike1105]

the pain is probably coming from muscles in that area going into spasm to protect your spinal cord, since the spine itself has become compromised. the pain may also be from compressed or irritated nerves that are leaving the spinal cord. but i would suspect it is mostly from the muscles.

[T4 Injury]

How does the compressed and wedged shape vertebra cause the chronic thoracic back pain.

[mike1105]

there are surgical ways to address compression fractures. i suggest you contact a teaching hospital with a cutting edge orthopedic pogram