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16 EXECUTIVE BRIEFING symptomatic, while others may be experiencing pain due to a different issue," Dr. Jackson said. The Milliman Care Guidelines recommend a positive MRI to show edema and confirm a VCF, but Dr. Jackson questions whether that testing is necessary. "My concern with that request is that it's wasteful to spend $1,000 to confirm what clinical acumen and a basic radiologic image can give you," he said. After vertebral augmentation, follow-up care is critically important If patients aren't treated after vertebral augmentation, they may suffer additional fractures. As a result, the Michigan Neurosurgical Institute has created a care pathway that conforms to criteria set by the Bone Health and Osteoporosis Foundation. "We are a BHOF-certified Fracture Liaison Service, and we are recertified annually to maintain an aggressive approach for preventing and treating vertebral compression fractures," Dr. Jackson said. After treatment with vertebral augmentation, patients participate in early follow-up with standard films and an examination. The patients are then placed immediately into MNI's Fracture Liaison Service. "Our Fracture Intervention Clinic is run by two outstanding physician assistants who engage patients in an extensive interview followed by a six- prong approach to aggressively prevent future fractures," Dr. Jackson said. The prevention protocol includes gathering the patient's medical history, providing appropriate Vitamin D and calcium supplementation, encouraging lifestyle changes like minimizing alcohol and caffeine which can contribute to osteoporosis, discussing the role of diet, prescribing physical therapy to strengthen the vertebrae and handling the medicinal aspect of osteoporosis treatment and prevention. Vertebral augmentation and Fracture Liaison Services are a win for both communities and healthcare organizations To improve VCF care in their communities, providers must persuade key decision-makers. "My advice is for clinicians to work simultaneously with the administrators at their institutions and the leaders in the C-suite regarding the importance of preventative clinics. Present the argument that osteoporosis prevention and a Fracture Liaison Service will help all primary care offices and providers," Dr. Jackson explained. Working alongside primary care offices is important. All too often, primary care physicians simply don't have time to sit down and discuss osteoporosis and its prevention with patients and their families. In addition, Dr. Jackson advises providers to focus on financial considerations. "Make the argument that the financial benefit will outweigh the risk of recurrent complications after surgeries," he said. "The financial reward, in addition to the clinical reward, is that vertebral augmentation interventions will support the salary of a Fracture Liaison Service coordinator. Ultimately, it's a win-win for the community." Partnering with a medical technology leader to help implement the VCF care pathway is also recommended. "Medtronic has acquired a great amount of experience and expertise in the treatment of VCFs," said Anu Codaty, vice president and general manager, Medtronic Interventional Pain. "This allows us to work with our accounts to identify barriers, and suggest potential solutions. The care pathway provides a standard that accounts can build into their workflow, helping streamline follow-up and treatment. By educating our accounts with supportive data and expert consensus, we can drive buy-in at every level, from administration to the emergency department and the clinic. Our goal is to ensure that patients have consistent access to the best care, wherever they live." To learn more about the VCF care pathway, visit Medtronic. com/VCFcarepath. The preceding testimonial contains the opinions of Anu Codaty and the opinions and personal surgical techniques practiced by Dr. Avery Jackson III. The opinions and techniques presented herein are for information purposes only, and the decision of which technique to use in a particular surgical application should be made by the surgeon based on the individual facts and circumstances of the patient and previous surgical experience. n References 1. Hirsch JA, Beall DP, Chambers MR, et al. Management of vertebral fragility fractures: a clinical care pathway developed by a multispecialty panel using the RAND/UCLA Appropriateness Method. Spine J. 2018. doi: 10.1016/j.spinee.2018.07.025. 2. Medtronic Data on File - Business Insights & Analytics Sept 2019 3. Yang, Wencheng MD; Yang, Jianyi MD; Liang, Ming MD Percutaneous Vertebroplasty Does Not Increase the Incidence of New Fractures in Adjacent and Nonadjacent Vertebral Bodies, Clinical Spine Surgery: March 2019 - Volume 32 - Issue 2 - p E99-E106 doi: 10.1097/BSD.0000000000000734 4. Teuber, H., Tiziani, S., Halvachizadeh, S. et al. Single-level vertebral kyphoplasty is not associated with an increased risk of symptomatic secondary adjacent osteoporotic vertebral compression fractures: a matched case–control analysis. Arch Osteoporos 13, 82 (2018). https://doi.org/10.1007/s11657-018-0489-6 ©2022 Medtronic. Medtronic, Medtronic logo, and Engineering the extraordinary are trademarks of Medtronic. All other brands are trademarks of a Medtronic company. UC202212206EN VCF Becker's Article - Insights from MNI Great Lakes ECHO Bold thinking. Bolder actions. We are Medtronic. 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