Louisiana Pain Care
Louisiana Pain Care


Vertebroplasty to Relieve Back Pain from Spinal Fractures Due to Osteoporosis

A non-surgical procedure to eliminate or significantly reduce severe pain caused by spinal compression fractures

Carlette Absher says that after vertebroplasty her back feels great

In July 2006, Carlette Absher, a 95-year-old resident of Richland Parish, suffered a fall in her home. Mrs. Absher experienced excruciating back pain from her fall. “The pain was so severe I could not get out of bed by the next day and was bedridden for several days before I was taken to the hospital,” she says. 

Mrs. Absher was diagnosed with an L1 compression fracture. Dr. John Ledbetter of Louisiana Pain Care was consulted, and that day a minimally invasive outpatient procedure called vertebroplasty was performed at P & S Surgical Hospital. Within minutes of having the procedure, most of her pain was relieved, and she was discharged home two hours later. 

“My doctor said that I might have to use a walker to be able to get up and around, but I have not needed my walker at all,” says Mrs. Absher. “I have been feeling great and feel like I can do anything, even mow the lawn if my daughter would let me.”

“Spinal compression fractures usually occur because a vertebral body weakened by osteoporosis is no longer strong enough to support itself, so it collapses,” reports Dr. Ledbetter. “Many patients don’t know they have osteoporosis until their bones become so weak that a simple chore like bending over to make a bed or reaching to take clothes out of a dryer causes a sudden painful compression fracture.” 

Until recently, prolonged bed rest, external braces, and strong medications were the only treatment options available to relieve the pain and increase mobility. These alternatives can be slow or unsuccessful and can be very disruptive to a patient’s daily life. 

Vertebroplasty, a non-surgical outpatient procedure offered by Louisiana Pain Care, is an excellent option, as it can greatly reduce or eliminate the pain and get patients back to their active lifestyles quickly.

Strengthening and repairing weak bones

“Vertebroplasty is a minimally invasive procedure in which the pain management physician injects bone cement into the fractured vertebra to strengthen and repair the weakened bone,” explains Dr. Ledbetter. “The same material has been used for years by orthopedic surgeons for joint replacement procedures.” 

In most cases, the patient is given intravenous sedation so he or she will be comfortable during the procedure. The procedure is done under live x-ray to guide a needle through the skin and into the damaged vertebra and usually takes less than one hour, depending on the number of vertebrae treated. Up to three vertebrae can be injected during the same visit. Patients arrive about one hour before the procedure and go home the same day. Most patients experience immediate pain relief and can walk around within minutes to hours.

Help for compression fracture sufferers

An ideal candidate for this procedure is an osteoporotic patient over the age of 60 who has moderate to severe back pain from one or more compressed vertebrae. Conservative treatment (bracing, analgesics, and bed rest) can be tried first in patients with mild to moderate pain, but if the pain persists or worsens over a few weeks, vertebroplasty may be indicated. For those with severe, incapacitating pain from the start, early intervention with vertebroplasty is appropriate.

John Ledbetter, MD and Vincent Forte, MD, board-certified pain management specialists of Louisiana Pain Care, offer vertebroplasty. For more information call Louisiana Pain Care at (318) 323-6405.

Spinal Cord Stimulator for the Treatment of Chronic Pain

“I am a believer in the spinal cord stimulator. It has given me a substantial portion of my life back,” states Mr. Dear.

The Brian Dear Family

One patient’s story about overcoming a life with chronic pain

“I am a believer in this stimulator,” states Brian Dear, a patient of Dr. John Ledbetter of Louisiana Pain Care in Monroe. Mr. Dear, born in Monroe and a current resident of Clinton, Mississippi, suffered an injury to his back while playing basketball in high school, years ago. 

Now 44 years old, Mr. Dear says, “When I was younger, the pain from that injury was not so much a problem, but over time the pain continued to advance, affecting my quality of life. My sister, who was a local physician at the time, recommended I see Dr. Ledbetter. We tried everything for over a year and a half for the pain, and I eventually had a fusion at L5 which gave me some relief.” 

A CPA by trade, former CFO for several multi-state companies, and now a self employed entrepreneur, Mr. Dear said, “I needed options other than pain medication to have the quality of life that I needed both professionally and personally, so I went back to Dr. Ledbetter, who recommended the spinal cord stimulator.”

In March 2007, Dr. Ledbetter inserted a trial spinal cord stimulator lead into Mr. Dear. He experienced immediate resolution of almost all of his low back and leg pain. Soon thereafter, Mr. Dear had a permanent spinal cord stimulator implanted. 

Married with young children, he states, “I have regained the ability to do the things I need to do for my business and that I love to do such as fishing and hunting. Most of all, I am able to go to my kids’ ballgames and enjoy time with my family on the beach without worrying about the pain interfering. I am much more active now, with only minor flare-ups that might require oral medication on occasion. I am able to walk a couple of miles a day and I do daily stretching exercises. The spinal cord stimulator has given me a substantial portion of my life back.”

How does spinal cord stimulation work to relieve pain?

For the treatment of chronic spinal pain, spinal cord stimulation, or neurostimulation, involves the stimulation of the spinal cord or peripheral nerve by tiny electrical impulses. An implanted lead (flexible insulated wire), which is powered by an implanted battery or by a receiver, is inserted into the epidural space near the spinal cord. This lead, powered by an implanted neurostimulator battery, sends electrical impulses that block the pain messages on their way to the brain. The pain is replaced by a mild tingling sensation.

The stimulation can be adjusted in terms of strength and area of coverage via an external programming device. It may be felt as a small bulge under the skin, but does not normally show through clothing.

How do I know if I am a candidate for a spinal cord stimulator?

People with certain kinds of pain may be candidates for neurostimulation therapy. The following criteria are used to determine whether spinal cord stimulation is appropriate:

  • Spinal pain radiating into the leg(s) or arm(s)
  • More conservative therapies have failed to help the pain
  • An observable pathology exists that is associated with the pain
  • Surgical intervention has been tried and failed, and further surgical intervention is not indicated
  • No untreated drug habituation for the pain condition exists
  • Psychological evaluation and clearance for implantation have been received
  • No medical issues exist that would present problems with the surgery
  • The screening trial is successful (a short test stimulation procedure and an evaluation period of several days at home, which confirms how effective the modality will be before the commitment is made to implant a permanent stimulator)

Results may vary from patient to patient, and not every response is the same.

Louisiana Pain Care physicians Drs. John Ledbetter and Vince Forte are the only board-certified, fellowship-trained, pain management specialists in northeast Louisiana. For more information regarding spinal cord stimulation for back and neck pain and other treatment options offered by Louisiana Pain Care, call (318) 323-6405.

Facet Joint Injections for Low Back Pain

Low back pain is the second most common reason for a visit to the doctor’s office.

Dr. Mark Haynes of Claiborne Family Clinic in Homer, La

Dr. Mark Haynes, born and raised in Homer, Louisiana, started his practice at the Claiborne Family Clinic in Homer in 1987. He joined his father, Dr. Don Haynes, in his existing family practice clinic which has since grown to include his brother Dr. Scott Haynes and sister-in-law, Dr. Maria Haynes.

When Dr. Haynes was asked, “What is important to you when you refer a patient to another physician for pain management?” he states, “I make the patient diagnosis as close as I can and then I get them to a pain specialist after that.  It is important to me that my patients see a pain management specialist who is properly trained and one who routinely treats pain problems.”

Dr. Haynes has firsthand experience at how persistent back pain can affect your every day quality of life. This past spring, Dr. Haynes had a severe flare-up of low back pain during turkey season. He says, “I had guests over to my camp and I was so miserable that I could not even hunt with them. I was stuck in the camp the whole time due to the pain.” 

Dr. Haynes saw Dr. Vince Forte, a board-certified, fellowship-trained pain management specialist with Louisiana Pain Care, for his back problem and was treated with lumbar facet joint injections. “After about 24 hours, I was pain-free for the first time in a long time and I have been doing really well since,” says Dr. Mark. “I am now back to working at the camp getting ready for deer season, playing golf, and back on the sidelines for the local football teams,” he says.

What are facet joints and why are facet joint injections helpful for low back pain?

Lumbar facet joints are small pairs of joints where vertebrae join on the back side of the lumbar spine. These joints provide stability to the spine, but also allow the spine to bend forward, bend backward, and twist. Pain in the lumbar facet joints is typically felt in the lower back, hip, buttock, and/or leg. The facet joints can become painful due to many different reasons such as back injury, arthritis of the spine, scoliosis, or damage to the joint linings or capsules.

Facet joint injections are commonly used in the treatment of low back pain and are considered quite safe, with few known complications. A facet joint injection can not only help diagnose the source of the pain, but can also provide pain relief. If a patient reports immediate pain relief from the injection of a small amount of numbing medicine (anesthetic) into the joint, this confirms that the pain is likely originating there. Corticosteroid is usually injected along with the anesthetic to decrease inflammation and provide long-term pain relief.

In those patients who experience good but temporary benefit from lumbar facet injections, the joints can be numbed more permanently. The pain management specialist can precisely cauterize the small nerve endings which carry pain information from the facet joints using radiofrequency waves. This is also an outpatient procedure and can provide pain relief lasting months or years.

During facet joint injections, an IV is generally started for sedative medication to be administered. The patient lies face down on the table and the area to be treated is cleaned. The physician will numb a small area with a numbing medicine (anesthetic). Fluoroscopy (x-ray) is used by the physician to identify the facet joints and to guide a very small needle into the facet joint. 

Contrast dye is then injected to confirm needle placement. A small mixture of anesthetic (such as lidocaine) and anti-inflammatory medication (cortisone) is then slowly injected into the joint. The procedure takes about ten minutes. Patients are usually able to go home within an hour following the procedure, and can return to their regular daily activities by the next day.

Louisiana Pain Care physicians Drs. John Ledbetter and Vince Forte are the only board-certified, fellowship-trained, pain management specialists in northeast Louisiana. For more information regarding lumbar facet joint injections and other treatment options offered by Louisiana Pain Care, call (318) 323-6405.