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Compression fracture pictures: Compression and Wedge Fractures

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Compression and Wedge Fractures

What is a Compression/Wedge Fracture?

A compression fracture, or vertebral compression fracture (VCF), is a common fracture of the spine. It implies that the vertebral body has suffered a crush or wedging injury. The vertebral body is the block of bone that makes up the spinal column.
X-ray from the side of the patient’s body shows a wedge shaped vertebral compression fracture in her thoracic spine. Photo Source: 123RF.com.Each vertebral body is separated from the other with a disc. When an external force is applied to the spine, such as from a fall or carrying of a sudden heavy weight, the forces may exceed the ability of the bone within the vertebral body to support the load. This may cause the front part of the vertebral body to crush forming a wedge shape. This is known as a vertebral compression fracture. If the entire vertebral body breaks, this is considered a burst fracture and is discussed elsewhere.

The compression fracture may range from mild to severe in terms of severity. A mild compression fracture causes minimal pain, minimal deformity and is often treated with time and activity modification.

Severe Pain

A severe compression fracture may be such that the spinal cord or nerve roots are involved, as they are draped over the sudden angulation of the spine. This may cause severe pain, a hunched forward deformity (kyphosis) and rarely neurologic deficit from spinal cord compression.

Risks – Osteoporosis – Trauma

The risk for spinal compression fracture increases with age. Osteoporosis is the most common risk factor for compression fractures. Osteoporosis is a condition in which there is thinning of the bones, weakening them. This may be due to certain medications, old age, inactivity, genetic factors, or a lack of calcium in the diet.

Learn the basics of osteoporosis and discover how it’s treated in our osteoporosis slideshow.

In general, some trauma occurs with each compression fracture. In cases of severe osteoporosis, the trauma may be minimal, such as, stepping out of a bathtub or lifting a heavy object. Moderate trauma is usually required to create a fracture in patients with mild to moderated osteoporosis. This may range from falling off a chair to an automobile accident. A normal spine may also suffer from a compression fracture when there is a severe forward bending injury. This most commonly occurs from a fall from a height or an automobile accident.

Nerve Injury

Neurologic injury is rare with compression fractures. The degree of neurologic injury is usually due to the amount of force present at the time of injury. If there is severe angulation of the spine secondary to a wedge fracture, this may stretch the spinal cord and create injury. This would then lead to loss of strength and sensation, as well as reflexes. In most patients with osteoporotic compression fractures, there is no neurologic injury but only pain from the fracture. However, if left untreated the fracture angulation may worsen and lead to late paralogic injury.

Diagnosis

A vertebral compression fracture is usually diagnosed by the medical history, physical exam and x-rays. In any patient over the age of 60 with the acute onset of sudden low back pain, a VCF should be suspected. Physical exam will usually note tenderness directly over the area of pain as well as mild kyphotic deformity (eg, a sudden angulation forward or hunched over appearance). Plain x-rays will demonstrate the wedge shape of the vertebral body on a lateral view. A CT scan is occasionally needed to help differentiate a compression fracture from a burst fracture.

Occasionally an MRI scan is obtained to rule out disc herniation along with a compression fracture. MRI scan may also help differentiate pathologic compression fractures, that is, those that involve a tumor, from a typical osteoporotic compression fracture. In any patient with a known history of cancer, a compression fracture should tip off the physician to look for evidence of a metastatic lesion and pathologic fracture.

If osteoporosis is suspected, a Bone Mineral Density (also called Bone Densitometry) test may be ordered. This test helps determine the severity of the bone thinning. In addition, laboratory tests to look at blood count and thyroid function may be indicated as well. A decision as to whether to treat osteoporosis should be made by the patients’ primary physician.

Commentary by Iain Kalfas, MD

This article provides an excellent overview of a complex injury: vertebral compression and wedge fractures that may occur in the thoracic and lumbar spine. These fractures can result in a variety of clinical presentations ranging from mild low back discomfort to complete paralysis.

The author correctly emphasizes the need for early recognition of these injuries in order to prevent serious neurological consequences. The article provides a concise description of the more common fracture types in this region and accurately reviews the accepted diagnostic steps for VCF and spinal wedge fracture.

6 Symptoms of a Compression Fracture

Are you experiencing back pain that won’t go away? While back pain is a common issue that will impact 80% of people at some point in their lives, it can also be a sign of something more serious. Vertebral compression fractures are an often-overlooked cause of back pain and when left untreated, can lead to further health issues.

What is a vertebral compression fracture?

Vertebral compression fractures are small fissures or breaks that appear in the bones in your spine (image below).

Image: The red arrow indicates a broken and compressed vertebral body (vertebral compression fracture). For comparison, look at the three vertebra above the compression fracture which are not fracture and of normal height.

Fractures can cause the vertebra to compress, which can eventually impact your height, your posture, and even lead to serious medical conditions such as blood clots and pneumonia. While the potential for experiencing a compression fracture increases with age, age is not the sole contributing factor. Vertebral compression fractures impact a startling 750,000 people annually. The most common indicator includes lower back pain in varying degrees of intensity. Back pain can occur suddenly, as the bone begins to compress, or it can build gradually over time.

What causes a vertebral compression fracture?

A vertebral compression fracture can happen to anyone; however, the leading cause of a compression fracture is Osteoporosis or other diseases that lead to low or poor bone density.

Image: The vertebra on the left of the screen has normal bone density. You can see how there are far fewer empty spaces within the bone when compared to the vertebra on the right of the screen. Low bone mineral density is one of the primary risk factors for a compression fracture.

In a healthy individual, trauma such as a car accident or sporting accident can cause a compression fracture and severe back pain. Individuals who already have low bone mineral density are at a much higher risk of compression fracture. As your bones become weakened or porous, even minor events such as stumbling, sneezing, or stepping out of the shower can cause a vertebral compression fracture.

What are common signs of a compression fracture?

Lower back pain is the primary indicator that you may be experiencing a compression fracture. But how do you determine if your back pain is caused by more than a general strain? These common signs may indicate you are dealing with a compression fracture.

    • The onset of pain happens suddenly and rapidly.
    • Pain decreases while lying down but increases while standing or sitting.
    • Your ability to turn or bend decreases significantly.
    • Pain increases when pressure is applied to the painful area.
    • Pain worsens with movement.
    • You experienced a recent trauma or injury, including minor events.

Why is early diagnosis and treatment important?

When left untreated, a vertebral compression fracture can lead to a multitude of back issues, as well as health risks and even death. While some health problems such as kyphosis—an unnatural curvature of the spine—result directly from a compression fracture, other health risks are a byproduct of pain and immobility.

Image: Compression fractures can cause a “hunchback” appearance which is due to a permanent bend in the spine called kyphosis. Kyphosis can lead to pain, poor inspiration, and loss of height.

Severe pain leads to inactivity, putting you at risk for blood clots, muscle wasting, and pulmonary issues. Long term use of painkillers can cause further loss of bone density and recurring compression fractures. Recent studies indicate that identifying and treating compression fractures early reduces the risk of fracture-related death and disease.

What are the treatment options for a compression fracture?

The first step to getting treatment for a compression fracture is determining the level of pain and damage in your spine. Conservative treatments include using a back brace, taking pain medication (both over the counter or prescription), and receiving physical therapy. When pain is severe, ongoing, or inhibiting, a common treatment is a vertebral augmentation. Two forms of minimally invasive augmentation are used today: kyphoplasty and vertebroplasty. While both treatments use bone cement to stabilize the damaged vertebra, kyphoplasty uses a unique method to first boost the compressed vertebra before inserting the cement. This practice helps re-establish the height and shape of the vertebra, decreasing both pain and spinal curvature.

Image: The image on the right shows how the height of the shattered vertebral body (on the left) has been restored with kyphoplasty. The white material in the vertebral body on the right is bone cement, which adds significant stability to the injured vertebral body as it heals. Most patients who undergo kyphoplasty for a compression fracture experience pain relief less than one hour after the procedure is finished.

Should I seek medical help for my back pain?

You should seek help if you have been experiencing back pain for more than four weeks or were recently in an accident or traumatic event that induced back pain. Even if you do not have Osteoporosis, low bone density, or remember experiencing trauma or an accident, ongoing back pain could be a sign of a bigger issue and it is important to get a proper diagnosis and care. If you have previously had a vertebral compression fracture, and your back pain has either returned or has been ongoing, consider seeking immediate medical attention.

A strong and healthy spine is an important ingredient to living an active, unhindered lifestyle. Pain and immobility are both a nuisance and a potential cause of unexpected health risks, all of which can be avoided with the right care and treatment. If your back pain is getting you down, and keeping you down, it may be time to seek medical care.

Spinal Compression Fractures – Los Angeles, CA

Compression fractures of the spine generally occur from too much pressure on the vertebral body. This usually results from a combination of bending forward and downward pressure on the spine.

A common cause of compression fractures is osteoporosis. This disease thins the bones, often to the point that they are too weak to bear normal pressure. The thinning bones can collapse during normal activity, leading to a spinal compression fracture.

Spinal compression fractures are the most common type of osteoporotic fractures. These vertebral fractures can permanently alter the shape and strength of the spine. The fractures usually heal on their own and the pain goes away. However, sometimes the pain can persist if the crushed bone fails to heal adequately.

In severe cases of osteoporosis, actions as simple as bending forward can be enough to cause a “crush fracture,” or spinal compression fracture. This type of vertebral fracture causes loss of height and a humped back, especially in elderly women.

This disorder (called kyphosis or a “dowager’s hump”) is an exaggeration of your spine that causes the shoulders to slump forward and the top of your back to look enlarged and humped.

Trauma to the spinal vertebrae can also lead to minor or severe fractures. Such trauma could come from a fall, a forceful jump, a car accident, or any event that stresses the spine past its breaking point.

Another cause of vertebral fractures is a metastatic disease. Metastasis is a term that refers to the spread of cancer cells into other areas of the body. The bones of the spine are a common place for many types of cancers to spread.

A compression fracture of the spine that appears for little or no reason may be the first indication that an unrecognized cancer has spread to the spine. The cancer causes destruction of part of the vertebra, weakening the bone until it collapses. This is a sign that something going on internally is harming the bones.

Lumbar Compression Fracture – Physiopedia

Original Editors – Sam Verhelpen

Top Contributors –  Remko De Smedt, Ivakhnov Sergei, Andreas De Feyter, Lucinda hampton, Kim Jackson, Lien Hennebel, Lauren Lopez, WikiSysop, Rachael Lowe, Sam Verhelpen, Joshua Samuel and Alexander Ghyssels  

Fractures of lumbar vertebrae occur in the setting of either severe trauma or pathologic weakening of the bone, see image R L4 compression fracture.

  • Osteoporosis is the underlying cause of many lumbar fractures, especially in postmenopausal women.
  • Osteoporotic spinal fractures are unique in that they may occur without apparent trauma. 
  • Any injury that changes the shape of a lumbar vertebra will alter the lumbar posture, increasing or decreasing the lumbar curve.
  • Most of the fractures occur at the thoracolumbar junction. [1][2]

Osteoporotic spine fractures can be graded based on vertebral height loss as:

  • Mild: 20-25%
  • Moderate: 25-40%
  • Severe: >40%[3]

    [4]

Clinically Relevant Anatomy[edit | edit source]

The figure on the right gives an illustration of the anatomy of the lumbar spine:

The lumbar vertebrae are the 5 largest and strongest of all vertebrae in the spine and the strongest stabilizing muscles of the spine attach to the lumbar vertebrae. This anatomical structure offers them the opportunity to bear the whole upper body.

The lumbar vertebrae:

  • Start at the thoracolumbar junction and extend to the promontorium of the sacrum.
  • Are “stacked” together and can provide a movable support structure while also protecting the spinal cord from injury.
  • Have a greater mobility in flexion and extension.
  • Involved in lateroflexion and rotation of the spine, but to a lesser extent.[5]
  • Because of the increased mobility, the lumbar spine is more susceptible to injury. The lumbar disk works as a cushion for the mechanical loads.[6]

Epidemiology / Risk factors[edit | edit source]

Compression fractures are caused by trauma, osteoporosis, infection and neoplasm.[2][7][8]

  • Most of the fractures occur at the thoracolumbar junction. This is a transition zone (T12-L2): the thoracic vertebrae are more rigid in compare to the mobile lumbar region which means that the transition zone receives the biggest load during impacts.
  • > than 80 years (40% of the women at this age have received at least one compression fracture).[2][8]
  • Female sex: Postmenopausal middle-aged (55-65) women go through hormonal changes which give them a higher change of developing osteoporosis.[7][9] One-fourth of the postmenopausal women will be affected with vertebral compression fractures.[10][11] The difference in incidence according to sex is nearly double for women, particularly as they age. In general, 10.7 per 1000 women have a vertebral compression fracture annually in the United States, compared with 5.7 fractures per 1000 men.[1]Bone loss is more common in women, especially post-menopausal women. This is due to the steep drop in estrogen, which goes on to makes bones lose density and become prone to fractures.
  • Certain medications: eg oral steroids, anti-depressants, diabetes drugs.
  • A pre-existing spinal fracture: Having one spinal fracture greatly increases your chances of having another.
  • Unhealthy lifestyle habits: Smoking, excessive alcohol consumption, and/or living a sedentary lifestyle affects bone density. Smoking and heavy alcohol consumption affects your body’s ability to absorb calcium.
  • Decreased pulmonary function         
  • Decreased mobility and balance impairmen                   
  • Multiple compression fractures. An existing compression fracture increases the risk to five-times to obtain an other compression fracture in the future. Having 2 or more compression fractures increases the risk by 12 times to get another fracture. [7]There are several patient population studies who suggests an increased mortality rate in patients with osteoporosis vertebral compression fractures that correlates with the number of involved vertebrae.[10][11]
  • loss of height
  • Tumour cells in the vertebra in 80% of the situations are invaded by tumor cells from the breast or prostate cancer.[2] This cancer metastasis on the vertebrae, is the most common skeletal complication in vertebral compression fractures.[10]

Characteristics/Clinical Presentation[edit | edit source]

Vertebral compression fractures (VCF)

  1. Most common with osteoporosis
  2. Possibly they are caused by high load impact trauma with a flexion compression mechanism.[12][2]

A lumbar compression fracture is a serious injury, both when caused by osteoporosis or by trauma. There is a risk of neurological damage, when this is the case, surgery is recommended,[10] Neurologic deficits are quite uncommon. [2]

  • Midline back pain is the hallmark symptom of lumbar compression fractures.
  • The pain is axial, non-radiating, aching, or stabbing in quality and may be severe and disabling.
  • The location of the pain corresponds to the fracture site, as seen on radiographs.
  • In elderly patients with severe osteoporosis, however, there may be no pain at all as the fracture occurs spontaneously.[13]
  • A fracture has an influence on the quality of life and the disability can last at least 5 years and the pain for 2-4 years.               
  • VCFs can lead to chronic pain, disfigurement, height loss, impaired activities of daily living, increased risk of pressure sores and psychological distress.               
  • Patients with an acute VCF may report an abrupt onset of back pain with position changes, coughing, sneezing, or lifting.[14]               

Classification of Fractures[edit | edit source]

There are several classification systems for VCF

  1. Wedge fracture [1][5] Burst/crush fracture [1][5] Biconcave fracture (meaning the walls of the vertebrae stays intact but the center portion is compressed).[6]
  2. Applied Forces of impact: [7]
    • Flexion compression with damage in posterior ligamentous structures.
    • Lateral compressions that can be the cause of scoliotic deformation.
    • Axial compression causing burst fractures.
  3. Damage in the included endplate. There are four subtypes for compression fractures. [8]
Type A: Both endplates are involved. = Axial load → 16%
Type B: The superior endplate is damaged. = Axial load + flexion → 62%
Type C: Inferior endplate is damaged = Axial load + flexion → 6%
Type D: Both endplates are intact. = Axial load + rotation → 15%
  • Coccyx pain: Coccygodynia (Coccydynia, Coccalgia, Tailbone Pain)
  • Lumbar facet arthropathy: Lumbar Facet Syndrome
  • Mechanical low back pain (Clinical pain presentations)
  • Lumbar degenerative disc disease
  • Lumbar Spondylolysis and Spondylolisthesis
  • Primary OsteoporosisSecondary osteoporosis

Compression fractures are typically diagnosed by lateral radiography of the vertebral column, with or without anteroposterior views. Radiographic criteria for VCFs include a decrease in vertebral body height of at least 20% or a 4-mm reduction from baseline height. The classic radiographic finding is an anterior wedge fracture.[14]

  • Comparisons to pre-existing spine X-rays allows the clinician to diagnose and judge the age of the vertebral fracture.
  • A plain radiograph may be all that is necessary for a majority of compression fractures, especially if one proceeds with conservative, medical management[1].
  • CT  scans allows for the best imaging of bony anatomy and improved assessment of loss of height, fragment retropulsion, and canal compromise. [1]
  • Magnetic resonance imaging (MRI) – best study for judging fracture age. [1]
  • DEXA scan: Roughly half of patients with vertebral fractures have osteoporosis (T score , −2.5) and another 40% have osteopenia (T score −1 to −2.5). 

There are several medical management methods to treat a lumbar compression fracture.
Before anything else you need to control the pain:

Acute pain control may include: [1]

NSAIDs are often first-line drugs for back pain as they do not have sedating effects. However, they do have gastric toxicity and an increased risk of cardiac events for patients with hypertension and coronary artery disease  [12]
Opioids and muscle relaxants may provide strong relief when NSAIDs are inadequate but have significant sedative effects as well as the risk of dependency. As such their use needs to be carefully balanced in the geriatric patient. ‘ [5]

Preventative Medicine

[edit | edit source]

Other than acute pain control, medical therapy should be aimed at improving bone quality and thus reducing the risk of future fracture. Agents for treating osteoporosis include:

  • Bisphosphonates
  • Selective estrogen receptor modulators
  • Recombinant parathyroid hormone
  • Calcitonin
  • Vitamin D

These agents act through either antiresorptive or osteogenic mechanisms.[1]

Surgical Management[edit | edit source]

Percutaneous vertebral augmentation, including vertebroplasty or kyphoplasty, can be considered in patients with inadequate pain relief from nonsurgical care, or when persistent pain substantially affects quality of life.

Recent studies have questioned their effectiveness.

  • Vertebroplasty entails injecting liquid cement into a collapsed vertebral body through a needle inserted transpedicularly.
  • Kyphoplasty involves percutaneously injecting a balloon into the vertebral body, inflating it to restore vertebral height, and injecting cement to reduce pain.

Complications include extravasation of cement (more common with vertebroplasty), embolism, neurologic injury, bleeding, hematoma, infection, and an increased risk of VCFs at other levels[14].

Non-operative treatment consists of[7] 

  • Pain relief (NSAIDs,muscle relaxants,narcotic pain medication →see medical management)
  • Orthesis
  • Rehabilitation program

Non-operative treatment goals[8]

  • Pain control
  • Early mobilisation
  • Prevention of deformity
  • Functional Restoration

Physical Therapy Management[edit | edit source]

Subjective Examination[edit | edit source]

Any notable event the patient experienced in the history, causing the symptoms and complaints.
High-Risk Mechanism of injury [2]

  • Accident with a vehicle with a higher speed than 70 kph
  • Fall from 3m or higher
  • Ejection from a vehicle seat
  • Check for Red Flags in Spinal Conditions                           

Objective Examination[edit | edit source]

It is important to know that there are no fully validated screenings for diagnosing lumbar compression fractures. Therefore radiologists have an important role in diagnosing spinal fractures.
Input from radiologists is needed because there is a lack in knowledge for diagnosing those fractures without images and the symptoms might be absent or it is difficult to determine the cause of the complaints.[2]

Inspection – Look at: [edit | edit source]
  1. Sagittal convexity [11] -Thoracic kyphosis, Lumbar Lordosis, Dowager’s hump (indication for osteoporosis)
  2. Swelling or hypertonic muscles
  3. Posture
  4. Antalgic stand

Acute phase: Localised tenderness over the involved level is a known characteristic for acute fracture. However, this does not distinguish whether the anterior or posterior column is involved. [11]

Changes in the size of the thoracic kyphosis/lumbar lordosis: [11][10]

  • Can lead to a reduction of the abdominal space and/or a decreased ventilator capacity.[10]
  • Can lead to multiple anterior wedge fractures: increased thoracic convexity[11]
  • Can lead to an increased thoracic kyphosis with missing prevalent fracture of the vertebrae in older adults.[11]
Testing        

 [edit | edit source]

  • Active ROM- will be restricted with most acute fractures (flexion/extension/retroflexion/rotation)[10]
  • Gait          
  • Provoking movements – flexion, extension, rotation, sneezing/coughing [11]                  

Specific clinical signs in physical examination:

  1. Patient is standing in the front of a mirror with the examiner behind him. That way the therapist can gauge their reaction. Using firm, closed-fist percussion the spine will be examined over the entire length. [11] Positive test: Patient is complaining about sharp, sudden, fracture pain.[11]Sensitivity: 87,5, Specificity: 90 %
  2. Patient is gently asked to take place on the examination couch and lie supine, using only one pillow.[11] Positive test: Patient is unable to lie supine, because the severe pain is the limitation factor. [11] Sensitivity: 81,25 Specificity: 93,33 %
  3. Physical examination reveals- tenderness when palpating or directly percussion over the area of the fracture, spasm in paraspinal muscles.[1]mostly in acute phase [11]
  4. Osteoporotic patients might have a loss of height. We look at the fingertips;Positive test: When the patient’s fingertips hit the knee or lower thigh during standing [11]

Note: Signs 1 and 2 are useful adjuncts in evaluation symptomatic osteoporotic vertebral compression fractures and are reliable indicators of the presence of a fracture. When the test is positive there is reason to rationalise and refer the patient for a MR scan. [11]

Education in activities of daily living and mobility in ways to avoid pain is essential for this impaired patient population that is often elderly. [8] It is important that the patient overcomes his fear of movement (kinesiophobia) and continues with his/her activities. Rest is not recommended, it’s important that the patient remains active.[9]

Supervised Physical Therapy:[edit | edit source]

  1.  Postural taping: from anterior aspect of each shoulder, posteriorly and obliquely down to opposite rib cag[11]
  2. Soft tissue massage: performed in prone to erector spinae, rhomboids, upper trapezius -stroking, circular frictions and petrissage  [11]
  3. Strengthening-exercises: It is important to improve the lumbar stabilization by strengthening the muscles of the lower back, strengthening the patient’s supportive axial musculature (in particular the spinal extensors) but also the muscles of the trunk. Exercises should focus on strengthening back extension and may include weighted or unweighted prone position extension exercises, isometric contraction of the paraspinal muscles, and careful loading of the upper extremities.  [1],[1]
  4. Physiotherapy program with manual techniques, clinician-led exercises, and home exercises designed to reduce pain, increase back extensor and lower limb muscle strength, and improve posture, trunk stability and trunk mobility.  [11]
  5. The Spinal Proprioception Extension Exercise Dynamic (SPEED) program designed by Sinaki9 is an example of a regimen that focuses on strengthening the spinal extensors using a weighted kypho-orthosis and postural and proprioceptive training, through twice-daily, 20-minute exercise sessions.  [2]
  6. Strengthening of abdominal, gluteal and hip muscles is important to support spinal structures with noncompressive forces and can be done for integrating the exercises into a more functional rehabilitation programme. Functional exercises that use all planes of motion and stimulate activities of daily living may be more beneficial for the patiënt. [8]

Example of Exercise Program:

[11][edit | edit source]

Exercise Dosage Weeks
Elbows back in sitting
Hands behind head with elbows pointing out to side. Pressing elbows back by performing
scapular retraction
5 sec hold × 5 reps 1-10 daily
Trunk mobility in sitting
Hands on shoulders, gentle rotation in both directions and lateral flexion to each side
5 reps in each direction 1-10 daily
Four point kneeling with transversus abdominus
Push into floor with hands, knees and feet then draw navel up and in. Hold 5sec
8-10 reps × 2

3×/week

Four point kneeling with one arm and leg lift
As above, then lift one arm off ground. Progress to also lifting extended leg off ground at same time
8-10 reps × 2 3-10
3×/week
Bridging in supine
Knee bent and feet flat on ground. Pushing through feet to lift back and pelvis off ground
5-10 sec hold × 5 1-2
3×/week
Hip extension in prone
8-10 reps × 2 3-10 Raising one leg off the ground and then the other
8-10 reps × 2 3-10
3×/week
Seated row with dumbbells
Upright sitting and pull hands up towards chest by bending elbows and then lowering
8-10 reps × 2 1-10
3×/week

Patients who followed a back extensor-strengthening program have a smaller chance to relapse into a new lumbar fracture in the future.[1]

Note- if the patient continues to have a lot of pain, or there is no progression at all, it is advised to send the patient to a doctor or preferably an orthopedic surgeon for a review and possible surgery. [10]

Figure 8: Thoracolumbar orthesis

The rehabilitation starts with a thoracic-lumbar-sacral orthosis. The physiotherapist learns the patient how to use that orthosis. It is recommended to wear the brace/orthosis for 6 to 12 weeks, followed by supervised physical therapy.[5]

It is important to highlight that there isn’t really any true evidence on the effectiveness of a brace in the healing of the vertebrae itself, but we can be sure a brace improves the body posture. It increases the trunk muscle strength in patients with osteoporotic fractures in the vertebrae.  [2] The use of a spinal orthosis maintains neutral spinal alignment and limits flexion, thus reducing axial loading on the fractured vertebra. In addition, the brace allows for less fatigue of the paraspinal musculature and muscle spasm relief. [1]

Fractures in the thoracic spine may be treated with thoracolumbar orthesis. Examples include the Jewitt, cruciform anterior spinal hyperextension, and Taylor brace. Braces which extend to the sacrum are termed thoracolumbar sacral orthoses. Finally, lumbosacral orthoses are also available for lumbar fractures but are only effective in restricting sagittal plane motion in the upper lumbar spine (L1–3). [1] Intervertebral motion has been shown to actually increase from L4–S1 with a lumbosacral orthoses brace. [5]

  • Vertebral compression fractures (VCFs) are the most common complication of osteoporosis, affecting more than 700,000 Americans annually (typical candidate R)
  • Fracture risk increases with age, with four in 10 white women older than 50 years experiencing a hip, spine, or vertebral fracture in their lifetime.
  • VCFs can lead to chronic pain, disfigurement, height loss, impaired activities of daily living, increased risk of pressure sores and psychological distress.
  • Physical examination findings are often normal, but can demonstrate kyphosis and midline spine tenderness.
  • More than two-thirds of patients are asymptomatic and diagnosed incidentally on plain radiography.
  • Acute VCFs may be treated with analgesics such as acetaminophen, nonsteroidal anti-inflammatory drugs, narcotics, and calcitonin (be mindful of medication adverse effects in older patients).
  • Other conservative therapeutic options include limited bed rest, bracing, physical therapy, nerve root blocks, and epidural injections.
  • Percutaneous vertebral augmentation, including vertebroplasty and kyphoplasty, is controversial, but can be considered in patients with inadequate pain relief with nonsurgical care or when persistent pain substantially affects quality of life.
  • Family physicians can help prevent vertebral fractures through management of risk factors and the treatment of osteoporosis.[14]
  1. 1.001.011.021.031.041.051.061.071.081.091.101.111.121.131.14 Zdeblick TA. Compression and wedge fractures: treatment and recovery. Spine Univers 2009
  2. 2.02.12.22.32.42.52.62.72.82.9 Alexandru, Daniela, and William So. “Evaluation and management of vertebral compression fractures.” Permanente Journal 16.4 (2012). (Level of evidence: 2A)
  3. ↑ Radiopedia. Osteoporotic spinal compression fracture Available from: https://radiopaedia.org/articles/osteoporotic-spinal-compression-fracture (last accessed 17.5.2019)
  4. ↑ Spinelive Spinal compression fractures. Available from: https://www.youtube.com/watch?v=LILgFAEMAbg (last accessed 17.5.2019)
  5. 5.05.15.25.35.45.5 Kinematics of the Spine. In White AA, Panjabi MM, eds: Clinical Biomechanics of the Spine, 1990
  6. 6.06.1 Bogduk N. Clinical anatomy of the lumbar spine and sacrum. Elsevier, 2005
  7. 7.07.17.27.37.4 Gertzbein SD, Khoury D, Bullington A, St John TA, Larson AI. Thoracic and lumbar fractures associated with skiing and snowboarding injuries according to the AO comprehensive classi cation. Am J Sports Med 2012 Aug;40(8):1750-4. DOI: http://dx.doi. org/10.1177/0363546512449814 (Level of evidence: 2A)
  8. 8.08.18.28.38.48.5 Goldstein, Christina L., et al. “Management of the elderly with vertebral compression fractures.” Neurosurgery 77 (2015): S33-S45. (Level of evidence: 2A)
  9. 9.09.1 Meunier PJ. Osteoporosis: diagnosis and management. Martin Dunitz, 1998
  10. 10.010.110.210.310.410.510.610.7 Sujoy M, Yu-Po, L. Current concepts in the management of vertebral compression fractures. Oper Tech Orthop 2011; 21:251-260 (Level of Evidence 2A)
  11. 11.0011.0111.0211.0311.0411.0511.0611.0711.0811.0911.1011.1111.1211.1311.1411.1511.1611.1711.18 Kim DH, Vaccaro AR. Osteoporotic compression fractures of the spine; current options and considerations for treatment. The spine Journal 2006; 6:479-487 (Level of Evidence 1A)
  12. 12.012.1 Chieh-Tasai W, et al. Classification of symptomatic osteoporotic compression fractures of the thoracic and lumbar spine. Journal of Clinical Neuroscience 2006; 12: 31-38 (Level of Evidence 1B)
  13. ↑ Medscape. Lumbar compression fracture clinical presentation. Available from: https://emedicine.medscape.com/article/309615-clinical (last accessed 18.5.2019)
  14. 14.014.114.214.3 McCARTHY JA, Davis A. Diagnosis and management of vertebral compression fractures. American family physician. 2016 Jul 1;94(1):44-50. Available from:https://www.aafp.org/afp/2016/0701/p44.html (last accessed 7.6.2020)

Spinal Compression Fractures Causes, Pain, Risks and More

It’s easy to think back pain is just part of getting older. But be careful. If you’re nearing age 60, it may be a sign that you have tiny cracks in the bones called vertebrae that form your spine. When these small hairline fractures add up, they can eventually cause a vertebra to collapse, which is called spinal compression fracture.

How Fractures Happen

Soft, weakened bones are at the heart of the problem. Compression fractures are usually caused by the bone-thinning condition osteoporosis, especially if you are a woman over age 50 who has been through menopause.

When bones are brittle, your vertebrae aren’t strong enough to support your spine in everyday activities. When you bend to lift an object, miss a step, or slip on a carpet, you can put your spinal bones at risk of fracture. Even coughing or sneezing can cause compression fractures if you have severe osteoporosis.

After a number of small compression fractures, your body begins to show the effects. The strength and shape of the spine can change. You lose height because your spine is shorter.

Most compression fractures happen in the front of the vertebra. When you get enough of them, the front part of the bone can collapse. The back of the vertebra is made of harder bone, so it stays intact. That creates a wedge-shaped vertebra, which can lead to the stooped posture you might know as a dowager’s hump. Doctors call it kyphosis.

Who’s at Risk?

Two groups of people are at highest risk for spinal compression fractures:

  • People with osteoporosis
  • People with cancer that has spread to their bones

If you have been diagnosed with certain kinds of cancer — including multiple myeloma and lymphoma — your doctor may monitor you for compression fractures. On the other hand, sometimes a spinal fracture may be the first sign that a person has cancer.

But most spinal compression fractures happen because of osteoporosis. Some people have a higher chance of getting the disease because of:

  • Race: White and Asian women have the greatest risk.
  • Age: The chances are higher for women over 50 and go up with age.
  • Weight: Thin women are at higher risk.
  • Early menopause: Women who went through it before age 50 have higher chances of getting osteoporosis.
  • Smokers: People who smoke lose bone thickness faster than nonsmokers.

You can have osteoporosis and not even know it. In fact, about two-thirds of spinal compression fractures are never diagnosed because many people think the back pain is just a part of aging and arthritis.

But if osteoporosis isn’t treated, it can lead to more fractures. It’s important to see your doctor if you’re in pain. Osteoporosis treatment won’t guarantee that you’ll never get another compression fracture, but it will significantly lower your odds.

What Can You Do to Prevent It?

Natural ways to prevent compression fractures include taking calcium supplements, getting more vitamin D, quitting smoking, preventing falls, and doing weight-bearing and strength-building exercises. You can also take medications to halt or slow osteoporosis, including:

  • Bisphosphonate drugs. Alendronate (Binosto, Fosamax), ibandronate (Boniva), and risedronate (Actonel, Atelvia) can slow bone loss, improve bone density, and help prevent fractures.
  • Teriparatide (Forteo), an injectable synthetic hormone that stimulates bone growth and reduces spinal fractures for women with severe osteoporosis
  • Raloxifene (Evista), an estrogen-like drug that slows bone loss and helps increase bone thickness
  • Zoledronic acid (Reclast), which is given as a once-yearly, 15-minute infusion in a vein. Reclast is said to increase bone strength and reduce fractures in the hip, spine and wrist, arm, leg, or rib.
  • Denosumab (Prolia, Xgeva), a monoclonal antibody that can be used to decrease the risk of fractures in people at high risk

The drugs are effective in strengthening bones. If you’re at high risk for compression fractures, it’s critical to take action. See a doctor and get the right medication to prevent future fractures.

Guide | Physical Therapy Guide to Spinal Compression Fractures

The American Physical Therapy Association believes that consumers should have access to information that could help them make health care decisions, and also prepare them for a visit with their health care provider.

The following articles provide some of the best scientific evidence related to physical therapy treatment of spinal compression fractures. Wendy Katzman, PT, DPTSc, is a world-renowned researcher on the topic of exercise for the stability and reduction of thoracic kyphosis. You will find several references below regarding her work. The other articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

Katzman WB, Parimi N, Gladin A, et al. Sex differences in response to targeted kyphosis specific exercise and posture training in community-dwelling older adults: a randomized controlled trial. BMC Musculoskelet Disord. 2017;18(1):509. Article Summary in PubMed.

US National Library of Medicine, Medline Plus. Compression fractures of the back. https://medlineplus.gov/ency/article/000443.htm. Updated July 9, 2018. Accessed January 21, 2020.

Katzman WB, Vittinghoff E, Lin F, et al. Targeted spine strengthening exercise and posture training program to reduce hyperkyphosis in older adults: results from the study of hyperkyphosis, exercise, and function (SHEAF) randomized controlled trial. Osteoporos Int. 2017;28(10):2831-2841. Article Summary in PubMed.

Katzman WB, Vittinghoff E, Kado DM, et al. Study of hyperkyphosis, exercise and function (SHEAF) protocol of a randomized controlled trial of multimodal spine-strengthening exercise in older adults with hyperkyphosis. Phys Ther. 2016;96(3):371-381. Article Summary in PubMed.

Bansal S, Katzman WB, Giangregorio LM. Exercise for improving age-related hyperkyphotic posture: a systematic review. Arch Phys Med Rehabil. 2014;95(1):129-140. Article Summary in PubMed.

Sinaki M. Exercise for patients with osteoporosis: management of vertebral compression fractures and trunk strengthening for fall prevention. PM R. 2012;4(11):882-888. Article Summary in PubMed.

Shipp KM, Gold DT, Pieper CF, Lyles KW. Improving trunk strength and endurance in older women with vertebral fractures. J Bone Miner Res. 2010;22:S463.

Pawlowsky SB, Hamel KA, Katzman WB. Stability of kyphosis, strength, and physical performance gains 1 year after a group exercise program in community-dwelling hyperkyphotic older women. Arch Phys Med Rehabil. 2009;90(2):358-361. Article Summary in PubMed.

Katzman WB, Sellmeyer DE, Stewart AL, Wanek L, Hamel KA. Changes in flexed posture, musculoskeletal impairments, and physical performance after group exercise in community-dwelling older women. Arch Phys Med Rehabil. 2007;88(2)192-199. Article Summary in PubMed.

Huang MH, Barrett-Connor E, Greendale GA, Kado DM. Hyperkyphotic posture and risk of future osteoporotic fractures: the Rancho Bernardo Study. J Bone Miner Res. 2006;21:419-423. Article Summary in PubMed.

Kim DH, Vaccaro AR. Osteoporotic compression fractures of the spine: current options and considerations for treatment. Spine J. 2006;6(5):479-487. Article Summary in PubMed.

Pfeifer M, Sinaki M, Geusens P, et al. Musculoskeletal rehabilitation in osteoporosis: a review. J Bone Miner Res. 2004;19(8):1208-1214. Article Summary in PubMed.

Old JL. Calvert M. Vertebral compression fractures in the elderly. Am Fam Physician. 2004;69(1):111-116. Article Summary in PubMed.

National Osteoporosis Foundation. Health Professional’s Guide to Rehabilitation of the Patient With Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2003.

* PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

Compression Fracture | Michigan Medicine

Introduction

A compression fracture is a type of fracture in which the vertebral body collapses more in the front producing a wedge shaped vertebrae. This can be caused by osteoporosis or cancer involving the vertebral body.

Risk factors

Osteoporosis

Osteoporosis is a disease that thins and weakens the bones to the point that they become fragile and break easily. Women and men with osteoporosis most often break bones in the hip, spine, and wrist. There are several causes and types of osteoporosis. The first is primary osteoporosis, which has two types – (I) and (II).

Type I is an excessive loss of the spongy tissue of the bone (cancellous bone), with some sparing of outer bone. This type of osteoporosis is six times more common in women than men, and the onset usually occurs in the 15-20 years following menopause. The loss of bone is thought to be linked to an estrogen deficiency in women and a testosterone deficiency in men — both of which are due to aging. In this type of osteoporosis, vertebral spine fractures are the most common result.

Type II refers to a simultaneous loss of both the outer bone and the spongy tissue inside the bone. This type is only two times more common in women than men. It typically occurs once people reach their 70s and 80s. It is also thought to be the result of a deficiency in dietary calcium, age-related Vitamin D decline, or increased activity of the parathyroid glands (secondary hyperparathyroidism). Hip fractures are the most common result of this type of osteoporosis.

Secondary osteoporosis, also known as “high-turnover osteoporosis,” is a condition of an increased rate of bone remodeling — or an increase in the amount of bone being remodeled. This condition causes an overall increase in the rate of bone loss. Bone turnover is caused by two functions: (1) the production of new bone, and (2) the loss (resorption) of old bone. The amount of bone mass you have depends on the balance between these functions, which is your bone turnover rate. If you have a high turnover rate, you are at greater risk for developing osteoporosis. Secondary osteoporosis can also have four hormonal causes:

  • Hyperparathyroidism – increased activity of the parathyroid glands
  • Hyperthyroidism – an excessive secretion of the thyroid glands
  • Diabetes – a disease where the body does not produce or use insulin correctly (This leads to: hyperglycemia — an increase in blood sugar, increasing susceptibility to infection, and glycosuria — glucose in the urine)
  • Hypercortisolism – a result of systemic illness or long-term use of oral corticosteroid

Osteoporosis can also be the result of disorders where the bone marrow cavity expands at the expense of the trabecular bone. The trabecular bones have a honeycomb appearance and large marrow spaces. They are called cancellous or spongious bone, and are found along lines of stress created by weight-bearing forces. If a trabecular bone is affected by increased bone marrow cavities, it loses some of its strength.

Other links to secondary osteoporosis are:

  • Thalassemia – a hereditary form of anemia
  • Multiple myeloma – multiple tumors within the bone and bone marrow
  • Leukemia – a serious disease that is characterized by unrestrained growth of white blood cells in the tissues
  • Metastatic bone diseases – when malignant tumor cells spread from one part of the body to another; the disease travels through the blood and settles in the bones

Cancer involving the vertebral body is common in patients diagnosed late in the course of their disease. The resulting change in height and spinal alignment can lead to serious health problems, including:

  • chronic or severe pain
  • limited function and reduced mobility
  • loss of independence in daily activities
  • decreased lung capacity
  • difficulty sleeping

The first osteoporotic fracture makes it five times more likely further fractures will occur.

Treatment

Acute compression fractures are usually managed with 3 months of spinal bracing with a thoracolumbosacral orthosis (TLSO), also called an underarm or low-profile brace, and narcotics to stabilize the fracture and reduce pain. Vertebroplasty and kyphoplasty are both minimally-invasive surgical procedures for treating osteoporotic fractures where an orthopedic cement is injected directly into the fractured bone. This stabilizes the fracture. Patients are also prescribed oral medications for osteoporosis to prevent further bone loss.

Vertebroplasty

A hollow needle (trocar) is passed into the vertebral bone and a cement mixture including polymethylmethacrylate (PMMA), barium powder and a solvent is injected. The cement mixture resembles toothpaste or epoxy. The physician will monitor the entire procedure on a fluoroscopy imaging screen and make sure that the cement mixture does not back up into the spinal canal. Sedation medication will be administered through an intravenous catheter. A Foley catheter may be placed in your bladder. You will be attached to equipment that monitors your heart beat and blood pressure throughout the procedure.

Kyphoplasty

Kyphoplasty is similar to vertebroplasty except it includes an additional step. Prior to injecting the cement mixture, a special balloon is inserted and gently inflated inside the fracture vertebrae. The goal of this step is to restore height to the bone thus reducing the deformity of the spine. Most patients return to their normal daily activities one to two days after either procedure.

Limitations of Vertebroplasty/Kyphoplasty (V/K)
  • V/K is not used for herniated disks or arthritic back pain.
  • V/K is not generally recommended for otherwise healthy younger patients, mostly because there is limited experience with cement in the vertebral body for longer time periods.
  • V/K cannot serve as a preventative treatment to help patients with osteoporosis avoid future fractures. It is used only to repair a known, non-healing fracture.
  • V/K will not completely correct an osteoporosis-induced curvature of the spine, but it may keep the curve from getting worse.
  • Patients with healed vertebral fractures are not candidates.
  • It may be difficult for someone with severe emphysema or other lung diseases to lie flat for the one to two hours required to perform the procedure.

Compression fracture of the spine – Clinic “Noosphere”

Compression fracture refers to a very serious injury to the spine. Compression of one or several vertebrae occurs at once, which leads to rupture of bone tissue. Typically, this injury can be experienced after falling from a significant height or during a collision with a car. But sometimes a compression fracture can occur due to excessive load when a person works with large weights, as well as in violation of the density of the bones themselves.

These fractures are more likely to involve the thoracic or lumbar spine. And it is impossible to hesitate with treatment, otherwise, then there will be a need for surgical intervention. Recently, this type of injury has become younger and can occur during sports activities against the background of working with large weights.

Symptoms

This injury can be recognized by certain signs, the main of which is pain of an intense nature, affecting the entire back area. Compression fracture is also indicated by the following symptoms:

  • severe pain syndrome at the time of injury;
  • numbness, weakness of the upper and lower extremities;
  • the mobility of the spine becomes limited;
  • pain is of a girdle character, radiating to the legs or arms;
  • back discomfort occurs when exhaling or inhaling;
  • the general weakness of the body increases;
  • increases human fatigue.

Such symptoms clearly indicate that a compression fracture has occurred. The diagnosis is confirmed if unpleasant pain occurs when pressing on the spinal axis.

Consequences

In some cases, when it comes to a minor injury, such a fracture may occur without specific symptoms. And a person may not even be aware that he is walking with a spinal fracture. Considering that no medical measures are being taken, the damaged area begins to heal incorrectly.

This subsequently leads to instability of the vertebrae and stenosis of the spinal canal, as well as to serious neurological disorders. If at the same time the injured area puts pressure on the nerve endings, sciatica or osteochondrosis may develop. Other possible consequences include:

  • curvature of the spine;
  • kyphotic deformity;
  • displacement of the intervertebral disc;
  • compression of the spinal cord.

And if the situation goes too far, then paralysis of the limbs can occur.

Diagnostics

Back pain does not necessarily mean a vertebral compression fracture. To correctly determine the cause of the ailment, you need a comprehensive examination. The doctor of the Noosphere clinic will carefully examine, interview the patient and determine how dangerous the fracture is, if any. The doctor will make an accurate diagnosis using the following diagnostic methods:

  1. MRI.Magnetic resonance imaging
  2. Ultrasound examination (ultrasound)
  3. Laboratory research

Treatment

A compression fracture of the spine is treated conservatively, and only in case of complication, surgery can be used. Clinic “Noosphere” uses effective methods and the latest technologies to avoid surgical treatment.

During conservative therapy, the injured area is securely fixed.This facilitates the subsequent rehabilitation phase. Our specialists try to completely restore the damaged structure of the spine, in order to thereby restore the impaired mobility.

Therapy is selected only on an individual basis. Since the patient’s age, the characteristics of his body and the complexity of the fracture itself are taken into account. A complete therapeutic course consists of the following procedures:

  • Resonant wave UHF therapy

Resonant wave therapy is a method of therapeutic action on the aquatic environment of the body with low-intensity high-frequency electromagnetic waves.

  • Fermatron pricks

Fermatron intra-articular injections are an effective method of treating various diseases of the musculoskeletal system by injecting a drug (chondroprotector) into the affected joint.

  • Rehabilitation on the Thera-Band
  • simulator

Treatment of the spine and joints with the Thera-Band will restore limb mobility in a short period of time without expensive treatment in specialized sanatoriums.

  • Blockade of joints and spine

Joint blockade is a type of medical treatment of the spine and joints, aimed at relieving acute pain, relieving inflammation and muscle spasms.

  • Drug treatment

Medical treatment of joints and spine in the Noosphere clinic is used in a wide range and in combination with physiotherapy. Intra-articular injections, blockades and droppers.

In addition to a compression fracture, our Noosphere clinic treats its consequences.As a result, it is possible to cope with such problems as:

  • relieve a person from severe back pain;
  • to restore strength to weakened muscles;
  • restore impaired mobility of the spine;
  • to normalize blood circulation in bone tissue;
  • Strengthen the muscle corset in the back.

All this can be achieved with the help of specially selected procedures. It is important that even after the completion of the treatment, our doctors remain in touch with the patients.

Rehabilitation

If, nevertheless, with a compression fracture, it was necessary to use surgical intervention, rehabilitation becomes an important stage. You can also help to recover from surgery in our clinic.

The patient will be selected a set of medical procedures that can restore all damaged areas of the vertebrae. As a result, after a while, a person returns to his usual active life.

Prevention

In order not to face such a fracture in the future, you should take care of the skeletal system and try to strengthen it.After 40 years of age, have an annual diagnosis to determine the condition of the bones. To do this, you need to exercise regularly. The best activity is considered:

  • moderate running;
  • 90,012 fitness classes;

  • swimming;
  • dances.

Walk in the fresh air under the sun as often as possible so that the body receives the required dosage of vitamin D. In order to strengthen the skeletal system, nutrition should be normalized. The daily menu should be enriched with foods high in calcium.These are cheese and sour cream, natural cottage cheese, almonds, herbs and fish. Walnuts, bananas, and grains can help restore bone density. It is good to eat legumes, celery and seafood.

Avoid cigarettes, strong tea, coffee, cocoa, chocolate, alcoholic and carbonated drinks. Use margarine, butter, mayonnaise less often.

Symptoms and Treatment of Compression Fracture of the Spine

Compression Fracture is damage to bones resulting from simultaneous compression and compression.This type of injury often occurs in the thoracic or lumbar spine, less often in the pelvic bones, sometimes in the heel bones. At a young age, it usually develops when exposed to a traumatic agent of high strength. In older people, bone integrity is compromised as a result of osteoporosis. Symptoms of a spinal compression fracture depend on the cause of the injury. The prognosis is good, except in cases with severe spinal cord injury. You can undergo restorative treatment (rehabilitation) after a compression fracture at the Spine Clinic of Dr. Razumovsky in St. Petersburg.

What you need to know about the diagnosis for back pain

Most often, the pathology is localized in the thoracic region below TH4 (4th vertebra) and the lumbar region, usually at the junction of TH12 and L1 (1st lumbar vertebra). The cervical spine is affected much less frequently. The reasons can be traumatic and pathological. In the first case, the violation of the integrity of the bone occurs as a result of a strong blow: a car accident, a gunshot wound, a fall from a height.

Such fractures are not complicated and complicated.If only the integrity of the bone structures is violated, then they speak of uncomplicated damage. In complicated cases, damage to the spinal cord and spinal roots occurs, which leads to the development of paralysis (impaired motor function of the limbs).

Pathological compression fractures are more common in people over 50, especially in menopausal women. Old age is accompanied by a decrease in the density of bone structures due to the natural aging of the body. In menopausal women, the production of sex hormones – estrogen decreases, which leads to bone loss.This disease is called osteoporosis.

With a compression fracture, the vertebrae acquire a characteristic wedge-shaped shape, which is clearly visible on radiography. The height of the spine decreases. In osteoporosis, in addition to changes in the shape of the vertebrae, a decrease in X-ray density and a violation of the structure of the cancellous bone tissue are observed.

Types of compression fractures

The classification helps to determine the tactics of treatment and the prognosis of the disease for recovery or life.

Due to fractures there are:

  • traumatic;
  • pathological.

According to the degree of damage, injuries are distinguished:

  • lungs – loss of bone volume up to 10%;
  • medium – bone tissue is reduced by up to 50%;
  • heavy – more than 50%.

By the mechanism of damage:

  • wedge-shaped injury – characteristic of the spinal column, the vertebrae take the form of a wedge;
  • fragmentation – the formation of several bone fragments under the impact of an impact;
  • detachable – separation and displacement of a part of the bone with uneven edges.

Compression-type spine fractures are often combined with damage to the heel bones when falling from a height on straightened legs.

Symptoms and treatment of a compression fracture in St. Petersburg

Clinical manifestations of the disease depend on the cause of the violation of the integrity of the bones and the localization of the pathological process. In case of injury, vivid symptoms appear immediately after the impact. This is intense pain at the site of injury, here hematomas and swelling of soft tissues form, inability to move.In case of damage to the structures of the spinal cord, paresis or paralysis develops, depending on the level of the lesion. The pathological form is accompanied by scant clinical symptoms and can be detected during the diagnosis of other diseases. Kyphosis (hump) develops more often, the pain is aching and unstable.

Symptoms of damage to the cervical spine:

  • headache, dizziness;
  • neck pain;
  • blurred vision, tinnitus;
  • Difficulty breathing and swallowing;
  • Violation of movements in the upper and lower extremities.

Clinical manifestations of lesions of the thoracic region:

  • respiratory failure;
  • pain in the thoracic spine;
  • obstruction of cardiac activity;
  • curvature of the spinal column (kyphosis).

Symptoms of a lumbar spine injury:

  • movement disorder in the lower extremities;
  • Pain in the lumbar spine;
  • deterioration in the function of the pelvic organs;
  • fecal and urinary incontinence.

Signs of violation of the integrity of the pelvis:

  • acute pain syndrome;
  • Swelling and bruising in the lumbar region and perineum;
  • violation of the act of defecation and urination;
  • Impossibility of movement in the lower body.

Clinic of trauma to the heel bones:

  • edema and hematoma of the foot;
  • Intense pain due to displacement of fragments;
  • violation of the support and motor function of the leg.

Bone damage is diagnosed using radiography and CT (computed tomography).If a spinal cord injury is suspected, MRI (magnetic resonance imaging) and myelography are indicated.

Treatment depends on the cause and severity of the bone damage. In case of injury, the victim is taken to the hospital after transport immobilization of the spine, pelvis or leg. In the hospital, anesthesia is carried out with the help of non-narcotic or narcotic analgesics, depending on the intensity of the pain syndrome. Then, medical immobilization is applied for up to 6 months.

Pathological forms of the disease involve the treatment of osteoporosis with calcium preparations, bisphosphonates, calcitonin, vitamin therapy, and a balanced diet.During the healing of the vertebrae, it is recommended to wear a corset. In some cases, vertebroplasty is recommended. At the stage of rehabilitation, for all forms of fractures, physiotherapy, physiotherapy exercises, massage, osteopathy are prescribed.

In order to prevent pathological forms of the disease, it is recommended to undergo annual preventive examinations after 50 years, which include densitometry. This is an instrumental type of diagnosis aimed at examining bone density and determining the severity of osteoporosis.

Kyphoplasty – restoration of damaged vertebrae

Key facts: Kyphoplasty / elastoplasty – treatment of compression fractures of the vertebrae

  • Symptoms: Painful osteoporotic compression fracture of the spinal column can lead to a permanent change in its height and contribute to the deterioration of the functions of the nervous system.
  • Treatment strategy: Using the percutaneous (percutaneous) technique without sutures and scars, a special cement made of polymethyl acrylate is injected into the cavity of the fractured vertebra.Thus, the natural elasticity and structure of the vertebral bodies is achieved. After the operation, the pain caused by a compression fracture of the vertebrae disappears immediately.
  • Inpatient stay: 5 days
  • Rehabilitation treatment: 14 days outpatient rehabilitation
  • Earliest flight home: 7 days after surgery
  • Recommended time to fly home: 14 days after surgery
  • Showering: 1 day after surgery
  • Duration of incapacity for work: 2 weeks after surgery
  • Driving is possible: 1 week after surgery
  • References

The value of the “Kyphoplasty” method for the treatment of osteoporotic vertebral fractures

Osteoporotic fracture of the vertebral column: Kyphoplasty helps to repair the fracture of the vertebral bodies.© Bruce Blaus via Wikimedia Commons

Kyphoplasty is a minimally invasive method for treating an injured spine. In addition, kyphoplasty was developed to treat spinal problems such as separation and weakening of the bone material of the vertebral bodies.

Osteoporosis is a common cause of these fractures. In recent years, the methods of Kyphoplasty and Vertebroplasty have acquired a completely different meaning in medicine. Previously, surgeons used standard open surgery to correct vertebral compression fractures resulting from osteoporosis.

Open surgery, which aimed to increase the volume of the injured spine and reduce pain, required wide incisions to provide adequate access.

Since 1984, kyphoplasty has been a minimally invasive operation.

Terminology

Vertebroplasty is a minimally invasive operation aimed at fixing a vertebral fracture and relieving pain. The surgeon inserts a special needle into the body of the broken vertebra, through which bone cement is injected into the vertebra, filling the space between the fragments and hardening within a few minutes.
Kyphoplasty is a similar procedure in which a special balloon is first inserted into the body of the broken vertebrae, which is inflated under pressure. This contributes to the correction of deformity and the formation of a cavity in the vertebral body.

Consequences of osteoporotic fracture of the spine

Pain after vertebral fracture

  • Deformation of the spine, expressed when the trunk is tilted forward.
  • Reducing the diameter of the vertebral bodies – reducing the height of the vertebral bodies.
  • Constant changes in the spine impair mobility.
  • Reduced height of the vertebral bodies negatively affects the volume of the lungs, breathing worsens and leads to a deterioration in the general metabolism.
  • Increased pressure of internal organs due to spinal deformity.
  • Possibility of neurological disorders (paralysis, numbness, loss of strength, impaired reflexes) due to increased pressure on the spinal column and nerve roots.

In healthy patients, a vertebral fracture may result from a serious accident.

In patients with osteoporosis, a vertebral fracture can occur during everyday life: situations can be different, even trivial. For example, when a person stumbles on the stairs, carrying a bag, coughs, or just sneezes – all this can be the cause of a vertebral fracture.

Pain after vertebral fracture

Pain resulting from a compression fracture of the spine is very painful and irritating.

In addition, every bone fracture can lead to edema (fluid formation, causing painful internal swelling).

Pain is often felt near the fracture site – usually near the waist in the lumbar spine. It is in this area of ​​the spine that the muscles and ligaments are subjected to strong stretching, and the bones and articular surfaces are subjected to strong pressure.

The pain worsens when the person is sitting. In addition, painful sensations appear in the supine position. Due to a compression fracture of the spine, a person’s mobility, duration and quality of life are reduced.

If the spinal column is unstable for a long time, it can lead to a rapid fracture of the vertebral bones. Pain caused by a compression fracture of the spine will continue until the bone fracture is stabilized.

In order for the pain to subside, it is also necessary to wear a special fixation corset that holds the spine in one position. In some cases, kyphoplasty or vertebroplasty is necessary.

Neurological consequences of osteoporotic compression fracture of the spine

The spinal column protects the central nervous system (spinal cord), from which nerves extend to muscles and internal organs.That is why the decrease in the height of the vertebral body, which occurred as a result of its damage, is the cause of painful pressure on certain areas of the spinal cord. These problems can lead to damage to the spinal cord and nerve roots.

Paralysis, numbness, loss of strength, impaired reflexes and loss of muscle strength after a compression fracture require complex treatment in a specialized clinic. After determining the neurological symptoms of the disease, the exact location and nature of the neurological injury resulting from a compression fracture of the spine are determined using an extensive magnetic resonance imaging (MRI) scan.

Vertebral fracture changes the shape of the human skeleton and impairs its function

Osteoporotic fractures of the vertebral bodies cause the “widow’s hump” (kyphosis), as during this disease the spine shortens and leans forward. The following problems also arise: a decrease in the tidal volume, dysfunction of the nervous system, an increase in pressure on internal organs, a decrease in mobility. Figure 1 (right) shows a case of decreased bone density and stability due to osteoporosis.In fig. 2 – healthy bone. © Bruce Blaus via Wikimedia Commons

The spine, as the central axis of the nervous system (spinal cord) and the human skeleton, protects internal organs, is a support for the body and an axis for all levers and joints during movement, and also maintains an upright position and balance.

The spine loses its natural shape, the volume of the lungs decreases. Moreover, respiratory and respiratory disorders are observed, which ultimately leads to a sharp deterioration in the patient’s metabolism and health.

Depending on the location of the fracture, nerve function may be impaired and pain may occur.

In addition, due to the loss of the height of the spine, the pressure on the organs of the human digestive system also increases.
Vertebral fractures result in loss of height, chronic pain, and difficulty in performing normal daily tasks.

The ability of the spine to withstand a certain load is reduced. Likewise, its elasticity also deteriorates: the patient will constantly try to direct his gaze downward, since due to the deformation of the spine due to a fracture, the patient will have difficulty raising his head.

Conservative treatment of vertebral compression fractures

Vibration (biomechanical stimulation) activates metabolism in skeletal muscle. Increase bone density by exercising on a special vibration machine. © Gelenkreha.de

In most cases, vertebral compression fractures are treated naturally (8-12 weeks after the fracture appears).

The patient is helped to overcome the painful period by a state of rest, as well as pain relievers.

In order for the fracture to overgrow as quickly as possible, it is necessary to ensure the immobility of the injured spine with the help of special bandages and corsets.

However, it is worth paying attention to the fact that in addition to the positive effect, fixation of the spine and constant adherence to bed rest sometimes lead to a significant weakening of the muscles and a deterioration in the general condition of the patient.

Conservative treatment is recommended by doctors with extreme caution, especially for people of mature age, whose general condition may already be weakened.

Bed rest and an orthopedic brace may prevent pain from worsening after a vertebral compression fracture of the spine, but attention should also be paid to the fact that immobility can accelerate bone loss and weaken surrounding muscles.

Building bone mass with medication is the most commonly recommended treatment.

Sports activities can also help in the treatment of osteoporosis: Various exercises help to stop the development of osteoporosis.Biomechanical stimulation, which exerts a mechanical effect on human muscles, repeated at a high frequency, is part of the range of physiotherapy services offered at our clinic.

Conservative treatment of vertebral compression fractures

  • Pain medications
  • Drugs to increase bone density
  • Physiotherapy to activate calcium metabolism
  • Biomechanical stimulation or matrix therapy to stimulate calcium metabolism in muscles and minerals
  • Elimination of deficiencies
  • Nutritional counseling
  • Regulation of acid-base balance in the body
  • Regular measurement of bone density

This diagram shows the level of development of a compression fracture during a person’s life.Loss of bone mineralization and density goes unnoticed. During hormonal changes after menopause, women experience a decrease in bone density, which can serve as the formation of an osteoporotic compression fracture. Continuous monitoring of bone density and lifestyle can prevent the onset of osteopenia (decreased bone density and demineralization) © OpenStax College via wikimedia commons

Expert diagnosis of vertebral compression fracture of the spine

Diagnosis of osteoporosis is often misdiagnosed

Very often, the diagnosis of vertebral compression fracture is incorrect: only in 30% of cases, doctors determine that the cause of this pathology is osteoporosis.In other cases, sudden attacks of pain are associated with nerve compression and muscle strain.

Spinal fractures due to osteoporosis are more common than osteoporotic fractures of the wrist and hip joints.

Osteoporosis (asymptomatic disease) is the first sign of weakening of the bone structures of the body.

Clinical Investigation of Compression Fracture of the Spine

During a clinical trial, a spine specialist will conduct a comprehensive examination and visual examination of the patient for spinal pathologies.

Using manual pressure on various parts of the upper body, the specialist will determine the cause of the pain (pinched nerve, muscle strain, bone degeneration). This will be followed by a neurological examination to determine or refute additional nerve damage.

X-ray, MRI, bone density measurement

The diagnosis of vertebral compression fracture of the spine is confirmed by X-ray. The presence and localization of narrowed vertebrae is determined under visual control.Problems such as degeneration of the intervertebral disc, scoliosis and spondylolisthesis are also identified using x-rays.

Magnetic resonance imaging (MRI) of a compression fracture will give an idea of ​​the duration of the disease. The amount of fluid (edema) at the fracture site allows you to determine how long ago the fracture occurred and to what extent it was delayed in the new position.

Bone density measurement (dual energy X-ray absorptiometry) will help assess the general condition of the bone structure and the degree of development of osteoporosis.With the help of dual-energy X-ray absorptiometry, it is possible to determine the presence of osteopenia (decrease in bone volume), as well as to measure the mineral composition of bone tissue. Thus, the risk of an additional vertebral compression fracture is established.

How is the treatment of osteoporotic vertebral fractures with kypolasticism?

Kyphoplasty: Step 1: Insertion of the tube. Step 2: Insertion and infiltration of the balloon. Step 3: Insertion of bone cement or silicone material into the fissure © via4spine

For many patients, changes in the shape and height of the body resulting from a compression fracture are unacceptable.In some cases, patients with moderate symptoms are treated with conservative treatment, which includes bed rest, warmth, and the use of anti-inflammatory drugs.

Patients who do not want to experience pain associated with compression fractures of the spine decide on an operation that helps to stop or reduce pain in the back, prevent the “subsidence” of the injured vertebra, and thus stop the progression of spinal deformity, as well as maintain natural posture and restore the physiological curves of the spine.As a rule, the patient is discharged home 2 days after the operation. Mobility and painlessness return immediately after the procedure.

According to Dr. Frank Haberstro, a specialist in spinal orthopedics with many years of experience, kyphoplasty is one of the most effective procedures for the treatment of the spine. Kyphoplasty is characterized by the absence of pain after surgery, and also helps to restore the natural shape of the spine. Also, kyphoplasty eliminates all possible risks arising from radical spinal surgery.

Stages of kyphoplasty

Insertion of the trocar under fluoroscopy control, filling the cavity with bone cement. The operation is performed under local anesthesia and is a typical minimally invasive procedure, without scars or stitches. © via4spine

  • During kyphoplasty or vertebroplasty, the patient lies facedown on his stomach.
  • General or local anesthesia.
  • Minimum skin incision (1cm).
  • Treatment of the skin with a trocar, which is advanced to the fracture site under fluoroscopy control.
  • A special balloon is inserted through the trocar and filled with a radiopaque contrast solution.
  • The balloon is inflated until the natural height of the damaged vertebral bodies is restored.
  • Removing the cylinder.
  • Filling the cavity with bone cement through the trocar.
  • Bone cement is set within 10 minutes.

In what cases, after the treatment of a compression fracture of the spine, do specialists offer alternative procedures?

When are alternative therapies recommended?

  • Progressive spinal stenosis
  • Spondylolisthesis
  • Urinary tract dysfunction, sexual dysfunction, severe neurological deficits

For more information, please contact us by phone or email.

In some cases, there is increased mobility (hypermobility) of the vertebrae.

This condition – spondylolisthesis – is a pathology of the spinal column, in which there is a clear displacement of the body of the overlying vertebra relative to the underlying, directed in the horizontal plane.

Often, the treatment of vertebral hypermobility is carried out using fusion surgery (fusion).

Efficiency and results of kyphoplasty

  1. Treatment with balloon kyphoplasty helps to restore the height of the vertebra, which reduces its deformation.After such a procedure, most patients recover the normal activity of the vertebrae
  2. Even a year after surgery, patients who underwent surgery to treat a vertebral fracture lead a more active lifestyle.
  3. Reliability: pain relief, spine stabilization and vertebral height restoration after osteoporotic fracture.
  4. Using a special instrument, the doctor injects the formed cavity with a special cementing material polymethyl methacrylate (PMMA), which quickly hardens, which helps to stabilize the vertebral bone

bibliography

Rehabilitation after kyphoplasty

1 day after surgery.For several weeks after the operation, the patient is advised to wear a lightweight corset design. Already a few weeks after the operation, it is allowed and even recommended to perform a special set of physical exercises to strengthen the back muscles.

90,000 Compression fracture of the spine – treatment, surgery and rehabilitation

3 February 2020 121386

Spinal fractures account for about 2–2.5% of injuries. Among them, the most common are compression fractures, which are a serious test for the human body and psyche.They can arise in connection with a wide variety of reasons, but always require immediate treatment, conservative, and in severe cases, surgery.

What is a Compression Fracture?

The spine is formed by 33 vertebrae, each of which has a body and 2 arches with processes of different sizes. The processes of the arcs of the adjacent vertebrae are interconnected, forming intervertebral joints, and intervertebral discs are located between the surfaces of the vertebral bodies to prevent their friction, soften shocks when walking and other loads.

The spine of a healthy person can withstand a load of up to 400 kg.

With strong compression, compression of one or a whole group of vertebrae is observed, as a result of which their shape changes, and cracks or even separation of bone fragments may occur. Therefore, a compression fracture is called a back injury, in which flattening occurs, that is, a decrease in the height of one or more vertebrae under the action of a perpendicularly directed load on the spine.In most cases, they are observed in the thoracic and lumbar regions. Compression fractures of the cervical vertebrae practically do not occur.

Causes of compression fractures

Most often, compression fractures are the lot of the elderly. This is due to the fact that they often suffer from osteoporosis, that is, a disease of bone tissue that provokes a decrease in bone density and thinning. As a result, bones, and vertebrae in particular, become fragile and easily break even under the influence of minor traumatic factors.Sometimes it is enough for a patient with advanced osteoporosis to make a careless movement, bend or even cough to cause a compression fracture of the spine.

But even young people and even children without bone pathologies are diagnosed with compression fractures of the spine. In most cases, they are the result of a powerful external mechanical effect on the back, the force of which exceeds the physiological potential of the strength of the bone tissue.

Among the main reasons leading to the violation of the integrity of the vertebrae are:

  • falls from a height onto the back, buttocks and especially legs;
  • Lifting weights in a jerk with a load on the back, not on the legs;
  • sports injuries;
  • car accidents;
  • diving with head hitting the bottom or any object;
  • strong backstabs;
  • Barbell Squats
  • Formation of metastases of malignant tumors in the spine or bone tuberculosis.

Among the elderly, women are significantly more likely to develop osteoporosis than men. Therefore, compression fractures are observed much more often. At the same time, among young people, men are more likely to experience spinal fractures.

Compression fracture can occur in any of the 33 vertebrae forming the spine. But more often injuries of the lumbar and thoracic regions are observed. Therefore, in the overwhelming majority of cases, fractures of the 11th and 12th thoracic vertebrae, as well as 1 lumbar vertebra are diagnosed.

Types

Compression fractures differ in the degree of compression of the vertebrae, their modification and the presence of complications.

According to the degree of compression of the vertebral bodies, there are 3 types of compression fractures of the spine:

  • 1 degree – the height of the vertebral body has decreased by less than 20-30% of its original value;
  • 2 degree – compression of the vertebra reaches 50%;
  • Grade 3 – the height of the vertebra is reduced by more than 50%.

Depending on the severity and direction of the load applied to the spine, as well as its initial strength, the vertebrae can be deformed in different ways.Therefore, there are:

  • wedge-shaped fractures, in which the vertebral body is compressed only on one side, as a result of which it acquires the shape of a wedge, with its sharp end turned into the body;
  • compression-detachable, accompanied by the separation and movement of the anterior-upper part of the vertebra forward and downward, which is accompanied by the formation of uneven edge surfaces and injury to the ligaments;
  • fragmentation – the most severe type of fracture, in which the vertebra is split into several fragments that can damage the spinal cord and provoke severe neurological symptoms.

Thus, a distinction is made between uncomplicated and complicated fractures. In the first case, patients are concerned only with pain in the area of ​​the affected vertebra, sometimes radiating to the limbs or chest. In the second case, damage to the nerve roots occurs, which leads to the appearance of neurological symptoms and their gradual increase.

The main danger of compression fractures is that in the first day after injury, sometimes a person can move independently without giving seriousness to pain in the back.But after a few hours or even days, partial or complete paralysis may occur.

Compression fractures of the spine occurring against the background of osteoporosis are often asymptomatic or with minimal disruption.

In the absence of timely medical care, an uncomplicated compression fracture can turn into a complicated one. This will require more complex and lengthy treatment.

Symptoms

Compression fractures are characterized by:

  • acute pain at the site of the lesion, which can be given to the hands (in case of damage to the thoracic region) and legs (in case of injury to the lumbar region), as well as intensify when pressed;
  • increased skin temperature and swelling of soft tissues in the projection of the affected vertebra;
  • limitation of mobility, muscle weakness;
  • general weakness, blurred consciousness;
  • nausea and vomiting;
  • asymmetry of the spine;
  • Bulge formation.

If a compression fracture is triggered by hitting something, abrasions, bruises, or at least redness of the skin may be present on the back skin at the site of the affected vertebra’s projection.

Complicated fractures involve nerve roots that run in the immediate vicinity of the spinal column. In such cases, the following may occur:

  • decreased sensitivity of the hands or feet;
  • paresis and paralysis of the limbs;
  • Disruption of the pelvic organs, which is manifested by the involuntary diversion of urine and feces, in men, the sensitivity of the genitals may decrease and erectile dysfunction may occur.

A characteristic sign of a spinal fracture is a sharp increase in pain at the site of injury with gentle pressure on the head.

The nature of the symptoms also strongly depends on the location of the fracture. So, in case of damage to the vertebrae of the thoracic region, it is possible:

  • difficulty in breathing;
  • pain in the chest and heart;
  • numbness of the skin of the legs;
  • disruption of the digestive tract;
  • violation of urination and defecation.

At the same time, injuries of the lumbar spine are often accompanied by:

  • girdle pains or radiating to the buttocks and legs;
  • disorders of the genitourinary system;
  • Difficulty rolling over and lifting legs;
  • loss of consciousness;
  • passing lameness;
  • leg paralysis.

Injuries of the cervical spine provoke:

  • pain in the neck, spreading to the back of the head, shoulder girdle, arms and aggravated by turning the head and pressing on the affected area;
  • dizziness;
  • discomfort when swallowing;
  • tinnitus;
  • reflex hypertonicity of the neck muscles;
  • Inhalation discomfort.

Diagnosis

Patients with back pain should be examined by a traumatologist or vertebrologist. Based on the examination, history, and test results, the doctor may suspect a fracture. To confirm the diagnosis, as well as to clarify the type and degree of the fracture, patients are prescribed:

  • X-rays of the spine in frontal and lateral projections – the main method for diagnosing fractures, which allows you to determine which vertebra is damaged and the degree of its destruction;
  • CT – provides more complete data on the state of the spine and allows you to assess the stability of the damaged segment;
  • MRI is a highly informative research method that provides comprehensive information about the state of the intervertebral discs, ligaments and the state of the spinal canal.

To assess the degree of spinal cord preservation in compression fractures, myelography may be prescribed. For older people, densitometry is done to assess bone density. Thanks to this, it is possible to diagnose osteochondrosis or discard this factor as the cause of the onset of a compression fracture of the spine.

Treatment of compression fractures of the spine

Patients with such injuries become patients of traumatologists, vertebrologists or even neurosurgeons.It is these specialists who, from the very first day, should supervise the treatment of a compression fracture and select the optimal treatment tactics. For each patient, it is selected strictly individually.

Selection of treatment is carried out taking into account many factors, including:

  • location of the fracture;
  • number of affected vertebrae;
  • their compression ratio;
  • presence of neurological or other complications;
  • presence of concomitant diseases, etc.

As a result, the doctor develops the most effective treatment strategy. It can consist in the use of conservative methods or immediate surgical intervention, but it is always aimed at eliminating the pain syndrome, stimulating regeneration processes, eliminating compression of the nerve roots and restoring the tone of the back muscles.

Conservative

For mild uncomplicated 1st degree compression fractures, treatment is possible without surgery.In such cases, skeletal traction is performed to restore the normal position of the vertebrae and the body is fixed to consolidate the bone using a plaster cast, a special bandage or an orthopedic corset. They help to reduce the stress on the spine, reduce the risk of complications and create the right conditions for a favorable recovery.

Patients are prescribed bed rest for several weeks. In some cases, with a low intensity of recovery processes, it has to be adhered to for several months.During this time, hardware traction of the spine is periodically performed.

The mattress is replaced with a rigid board. It is on it that you have to spend almost all the time lying on your back.

Traditionally, you can get up and move independently after 2 months, and sit not earlier than after 4 months.

Also, patients are prescribed:

  • drug therapy;
  • Exercise therapy;
  • physiotherapy procedures;
  • massage.
Drug therapy

The use of drugs is a mandatory component of therapy, even if surgery is planned and after it.Patients with compression fractures of the spine are prescribed:

  • analgesics (often narcotic) – used to eliminate severe pain;
  • novocaine blockade – have a pronounced and long-term analgesic effect;
  • antibiotics – used to eliminate the risk of developing infectious complications of trauma;
  • corticosteroids – used to eliminate the inflammatory process;
  • chondroprotectors – promote the activation of regeneration processes in the affected vertebrae and cartilaginous bodies;
  • immunomodulators – necessary to strengthen weakened immunity;
  • calcium and vitamin D preparations – help to strengthen bone tissue.

The complex of medicines, as well as the method of their administration, is selected individually by the doctor for each patient. During the hospital stay, the necessary medications can be administered intravenously and intramuscularly.

Exercise therapy

Patients, even in the first time after injury, are shown regular exercise therapy, since the muscles will inevitably weaken due to the forced preservation of bed rest and immobilization of the spine. Initially, they are performed from a prone position and consist in performing simple breathing exercises and working out the joints.This allows you to avoid muscle atrophy, the development of congestion in the lungs and tissue trophism disorders caused by circulatory disorders.

Gradually the complexity of the lessons increases. As the patient recovers, more active exercises are added. They allow you to work out your back muscles. This will strengthen them and reduce stress on the spine.

Physiotherapy treatments

Physiotherapy sessions are indicated approximately 45 days after injury. The most effective are:

  • UFO;
  • electrophoresis with alternating calcium and phosphorus preparations;
  • UHF;
  • reflexology;
  • paraffin or ozokerite wraps;
  • electrostimulation;
  • Sollux;
  • ultrasound therapy.

Typically, a course of physiotherapy treatment includes 10-12 procedures, the duration of each of which is 10-15 minutes.

Massage

The first massage sessions can be performed no earlier than 2 months after the start of rehabilitation. At the same time, it is important to find a qualified specialist whose actions will contribute to the restoration of the spine, and not provoke the destruction of the results already achieved.

Surgery for compression fracture of the spine

The patient’s condition and the nature of the injury do not always allow for non-surgical treatment.Surgical intervention is indicated for:

  • 2 and 3 degrees of compression fracture;
  • injuries complicated by the displacement of the vertebrae, the formation of fragments;
  • Compression of nerve roots and stenosis of the spinal canal;
  • no effect of conservative therapy.

Modern surgery and neurosurgery in particular have made great strides forward. Today, surgical treatment of compression fractures of the spine is possible in extremely gentle ways through a puncture of soft tissues, which does not even require suturing.These include vertebroplasty and kyphoplasty. These microsurgical interventions are practically devoid of intra- and postoperative risks, are highly effective and provide quick recovery.

In more complicated situations, when kyphoplasty or vertebroplasty cannot be applied, patients are prescribed surgical fixation of the vertebrae with special plates, meshes, laminar contractors, or transpedicular fixation is performed.

The most difficult and traumatic is the complete replacement of a broken vertebra with an artificial implant or autograft.In such situations, it is possible to carry out all the necessary manipulations only during a laminectomy.

But the operation is only the first stage in the treatment of a compression fracture of the spine. After it, the patient needs to receive full-fledged conservative therapy and rehabilitation.

Vertebroplasty

Vertebroplasty is a modern, gentle microsurgical operation that belongs to the number of percutaneous procedures. It involves increasing the strength of a broken vertebra by introducing a special polymer composition called bone cement into it.Since the bone tissue of the vertebrae is spongy, filling its voids with polymer allows to achieve reliable consolidation of bone fragments and prevent compression fractures of this vertebra in the future.

Bone cement is a specially developed material based on polymethyl methacrylate. It is characterized by high safety and biocompatibility with high viscosity and strength.

For its introduction, a special puncture needle is used, which is inserted into the damaged vertebra under X-ray control.As a rule, a CT or image intensifier is used for this purpose.

Bone cement is prepared only after the cannula is in the correct position, as it hardens very quickly. It falls into the hands of a neurosurgeon in the form of two separate components: a liquid monomer and a powdery polymer. At the moment of their connection, a chemical transformation reaction occurs, accompanied by an active release of thermal energy. As a result, a creamy mass is formed, which spreads well over all cavities of the vertebral body and hardens in 8-10 minutes.As a result, a high-strength conglomerate is formed, which is not subject to compression fractures in the future.

Antibacterial and X-ray contrast agents are specially included in the composition of the bone cement. The former are necessary to eliminate the risk of developing infectious and inflammatory complications after surgery, and the latter to assess the quality of filling the vertebral body with bone cement.

Vertebroplasty is an operation with proven high efficiency. After it, in 85% of patients, an improvement in their condition is observed almost instantly, and in the remaining 15% – after some time.At the same time, the total duration of vertebroplasty does not exceed 40 minutes, it does not require general anesthesia, which eliminates the associated risks, and avoids prolonged hospitalization.

But restoration of the integrity of the spine using this technique is impossible with:

  • compression fractures, accompanied by a decrease in the height of the vertebra by more than 70%;
  • individual intolerance to the substances that make up the bone cement;
  • Spinal lesions with metastases of malignant tumors.

After vertebroplasty, only a tiny needle wound remains, which does not require stitches. Therefore, after the operation, no scars remain, and the wound is closed with a sterile plaster.

Kyphoplasty

For compression fractures, kyphoplasty is often used, which can be called a more advanced version of vertebroplasty. This is due to the fact that it is able not only to restore the integrity of the vertebra and strengthen it, but also to return to its normal size.Therefore, kyphoplasty is performed for compression fractures with a decrease in the height of the vertebra by more than 70%.

This becomes possible due to the preliminary introduction of a special balloon into the vertebral body. A saline solution is injected into it, in which an X-ray contrast agent is dissolved. This makes it possible to monitor the nature of the restoration of the size and position of the injured vertebra using an X-ray machine and, if necessary, correct it.

After the anatomically normal position of the vertebra has been restored, the balloon is removed, bone cement is immediately prepared and immediately filled in the formed space.After 10 minutes, it hardens, after which the cannula is removed, and the wound is closed with a sterile bandage.

Kyphoplasty, in contrast to vertebroplasty, has a minimal risk of bone cement spreading beyond the operated vertebra, and also allows you to simultaneously eliminate kyphotic deformity of the spine.

Transpedicular fixation

For unstable fractures, microsurgical interventions are not indicated. In such situations, it is possible to fix the vertebrae in the desired positions by means of transpedicular fixation.This surgical technique has been used since the middle of the last century and is well studied.

The operation involves performing a soft tissue incision and exposing the spinous processes and arches of the vertebrae. Each vertebra has a specific point at which the transverse and articular processes intersect. A hole is made in it with a special probe, into which titanium screws of the required type and size are screwed.

Titanium is a tough metal with high strength. Therefore, the screws installed in the spine securely fix the bone structures and eliminate the risk of their deformation.There are caps on the surface of the screws, which eliminate the risk of their distortion and the development of undesirable consequences.

After all the screws have been installed in the desired points, spring rods are inserted into them. As a result, the load on the structure is evenly distributed.

When transpedicular fixation is performed by an experienced neurosurgeon, the risk of damage to nerve fibers and blood vessels is minimal. But this operation is not recommended for severe concomitant diseases or pregnancy.

Laminectomy

For severe fractures requiring the removal of bone fragments, laminectomy is indicated. This operation is the most traumatic for the body and involves a large incision. But it gives the surgeon good access to the injured vertebra, which makes it easier for him to work and allows you to remove sharp fragments.

During a laminectomy, both the spinous processes, the arches of the vertebra and its body can be removed. This allows you to eliminate compression of nerve fibers and eliminate bone fragments that threaten the spinal cord or vertebrae that cannot be restored by other methods.During laminectomy, intervertebral discs can also be removed, and a suitable implant is inserted into the resulting space. These can be bone grafts formed from the patient’s own bones and implants made from artificial inert materials.

Thus, during the operation, the height of the vertebra is increased due to the opening of its arches and the removal of bone fragments. But it implies a long and sometimes difficult recovery period.

Rehabilitation

Even the achievement of complete consolidation of bones is not a reason to stop carrying out rehabilitation measures.In total, it can take 6 months or more, up to several years. At the same time, complete recovery is not always possible, but the completeness of recovery is directly affected by how accurately the patient follows medical recommendations.

In the first 2 months, adherence to bed rest is shown, and the patient must be provided with a rigid orthopedic mattress, as well as wearing a corset. For severe compression fractures, rehabilitation is carried out in specialized centers.

Patients are advised to enrich their diet with foods containing calcium, phosphorus, B vitamins, zinc and magnesium.A sufficient amount of these microelements in the body will contribute to the strengthening of bones and rapid tissue regeneration. Therefore, enter the menu:

  • fermented milk products;
  • Nuts, in particular almonds;
  • seafood;
  • bananas, lettuce, beets, cabbage;
  • oat and buckwheat porridge;
  • liver;
  • legumes.

At the same time, you should refuse foods and dishes that interfere with the absorption of calcium, in particular fatty foods, alcohol, convenience foods, strong tea and coffee.It is also worth limiting the consumption of yeast baked goods, since patients are forced to lead a sedentary lifestyle, which requires fewer calories to maintain normal functioning.

It is important to follow nutritional rules. This will allow not only to optimize regeneration processes, but also to avoid digestive disorders associated with a sedentary lifestyle, stomach pain and constipation.

Within the framework of rehabilitation, the following are also shown:

  • Respiratory gymnastics is an effective method of preventing joint stiffness, which begins to be practiced from the first days of recovery.Classes are held in conjunction with a doctor who can choose the right load and take into account the features of compression fractures of the cervical and thoracic spine.
  • Exercise therapy – the first classes are carried out under the supervision of a specialist, and the intensity and duration of classes are increased at a slow pace. A set of exercises is always developed by a doctor, amateur performance in this matter is absolutely inappropriate. The nature of the exercises is selected depending on the location of the injury and the general physical fitness of the patient.
  • Physiotherapy – a complex physiotherapeutic effect of the above methods in combination with a properly performed massage accelerates the patient’s recovery and return to a normal lifestyle.

After the completion of the main stage of rehabilitation, patients are advised to resort to spa treatment, which will include hydrotherapy, paraffin, ozokerite or mud wraps and other procedures.

Possible complications

If you get a back injury or just sudden pain, you should immediately consult a doctor, especially the elderly and those who, due to their duty, have to regularly lift heavy objects.Only a timely started, well-chosen treatment of a compression fracture can minimize the risks of complications and subsequent disability.

Since the spinal cord passes between the vertebral bodies and their arches, its damage is the most dangerous complication of a compression fracture. It is he who is responsible for a person’s ability to fully move.

In compression fractures, especially when combined with the separation of fragments, it is possible to pinch the nerve roots of the spinal cord, which feed its blood vessels, as well as itself.In more severe cases, contusion or even rupture of the spinal cord is possible, leading to irreversible paralysis.

If treatment is not started on time, the trauma can provoke secondary degenerative and neurological disorders:

  • segmental instability of the vertebrae;
  • Curvature of the spine or hump formation (kyphotic deformity), which is especially typical for the elderly;
  • persistent movement disorders;
  • protrusion and herniation of intervertebral discs;
  • scoliosis, sciatica;
  • formation of bone structure calluses;
  • Disruption of the functioning of internal organs, including the organs of the genitourinary system, which can provoke incontinence of urine and feces, and in men, in addition, erectile dysfunction;
  • Osteochondrosis and the formation of intervertebral hernias.

They tend to progress gradually and also lead to paralysis. Therefore, it is better not to hesitate and immediately contact a traumatologist or vertebrologist.

Predictions

In case of fractures of the 1st degree, with timely correctly selected treatment and strict adherence to all medical recommendations, the prognosis is favorable, especially if the injury occurred in a young man. In such situations, the ability to work is restored completely and in the future, the risk of intervertebral hernias is within the average.

With compression fractures of 2 and 3 degrees, the appearance of pain in the future is not excluded, the risk of developing osteochondrosis, radiculitis, protrusions and hernias of intervertebral discs significantly increases.

Thus, compression fractures of the spine are quite common, especially in elderly people, and at the same time, a dangerous injury that can lead to disability or even death. Treatment, begun from the first days, allows you to avoid such sad consequences and return a person to normal life.Therefore, if there are indications for surgery, you should not be afraid and refuse, because modern microsurgical methods are highly effective and safe.

15.01.2021

Compression fracture of the vertebra is common. This is a violation of the integrity of one or more vertebrae as a result of sudden movements of the spine or as a result of vertebral pathologies that thin bone and cartilage tissue.

A fracture is called a compression fracture, because as a result of an injury, the vertebrae are compressed and its height decreases.Damage can be caused by sharp bending, twisting, from a blow to the back and as a result of diseases such as osteoporosis or hemangioma.

The spine is made up of separate bones – the vertebrae, which are connected by ligaments, intervertebral joints and cartilage. Each vertebra consists of a body facing forward and an arch facing backward. The spinal cord is located in the space between them. The anterior and posterior segments are approximately the same in height and form a cylindrical shape. A compression fracture compresses the anterior segment, which causes the vertebra to become wedge-shaped.

Reasons

The cause of a vertebral compression fracture is often a jump from a height onto straight legs or a fall on the buttocks. Usually, when falls, one or more vertebrae are damaged in isolation, that is, without concomitant injuries or diseases.

But you can get injured in a car accident, at work or in a natural disaster. Then, in addition to a fracture of the vertebrae, craniocerebral trauma, bone fracture, blunt trauma of the abdomen, damage to the chest and bladder can be diagnosed.

When a patient has any pathology of the spine, then a compression fracture can be obtained with minimal impact, for example, a sharp bend forward. This is due to the fact that the bone tissue becomes thinner and becomes fragile. Osteoporosis is the most common cause of pathological fractures. Another cause is hemangiomas and metastases of malignant tumors in the bone tissue.

Multiple fractures significantly reduce the height of the anterior segments of the spine, which forms a hump and develops senile kyphosis.

Degree of damage

Traumatologists and orthopedists classify fractures according to their location in the spine. More often than others, the lower thoracic region is prone to damage, at the place of transition of the thoracic to the lumbar. The lumbar spine is rarely injured, and even less often the cervical spine. Due to the tightly fused bone of five vertebrae, fractures in the sacral region are almost impossible.

The degree of damage is determined by the altered height of the vertebra:

  • first – decrease by less than a third;
  • second – decrease by less than half;
  • third – decrease by more than half.

Symptoms

In case of pathological changes, the trauma does not reveal itself immediately. The patient may not be aware of its presence until there is constant pain while standing or sitting – short-term relief only comes from lying down. The pain accompanies the numbness of the limbs due to pinching of the nerve roots. At the time of the visit to the doctor, the patient complains of moderate pain on palpation of the damaged area, but, as a rule, there is no edema.

In case of traumatic injury to the vertebrae, a sharp pain is felt.If the fracture occurs in the thoracic or lumbar region, breathing is difficult. The patient complains of pain in the damaged area, which is sometimes reflected in the abdomen. The pain increases with movement, coughing, deep breathing, and sitting. Severe or multiple fractures may cause headaches, nausea, vomiting, and numbness in the extremities.

Complications

Complications of a neurological nature rarely occur with compression fractures. They are caused by the fact that the fragments of the bone are displaced backward, putting pressure on the nerve roots, spinal cord and blood vessels.Such symptoms appear both immediately and over time, accompanied by pain and local numbness of the extremities.

A decrease in the height of the vertebra is fraught with the fact that excessive mobility of the injured segment may develop. This instability leads to lumbodynia (low back pain) or lumbar ischialgia (back pain and leg pain). A painless position is achieved only at rest. If the injury has resulted in a narrowing of the spinal canal, then compression of the roots of the spinal cord may occur.

Instability of the segment in the thoracic region causes pain between the shoulder blades, in the cervical – cervicalgia with reflected pain in the shoulder. In addition to everything, degenerative-dystrophic processes are accelerated, osteochondrosis, arthrosis of intervertebral joints, hernias and protrusions develop faster.

Diagnostics

The diagnosis is confirmed by radiographic examination in addition to MRI and CT and in rare cases requires surgery.

X-ray in two projections shows how reduced the height of the damaged vertebra and its deformation.

MRI and CT of the spine are needed to assess the condition of the spinal cord membranes, ligaments and cartilage surrounding the spine. If there are neurological disorders, then the patient is prescribed a consultation with a neurosurgeon or neurologist.

A more accurate assessment of damage is obtained using myelography.

Radionuclide research is used for a pathological fracture that has arisen as a result of a tumor or metastasis.

Serum protein densitometry and electrophoresis are prescribed for suspected osteoporosis.For young patients with this diagnosis, an appointment with an endocrinologist is additionally prescribed to exclude hyperparathyroidism.

First aid for compression fracture of the vertebra

  1. The victim should be laid on his back, on a hard and level surface and immediately seek medical help – taken to the department or call an ambulance.
  2. Fracture in the cervical spine: fix the neck by rolling a hard roller, making a sandbag or using the Shants collar.
  3. Fracture in the thoracic and lumbar spine: Place a roller under the injured area.
  4. Fracture of the tailbone: turn the victim onto their stomach, place a soft pillow or roller under the chest to relieve pressure on the injured part.
  5. In all cases, urgent medical attention is required.

Treatment

After treatment, the patient is hospitalized. In case of spinal injuries, a regular bed is replaced with a rigid one, with a shield instead of a mattress.Treatment is conservative, blocking pain, relieving inflammation and preventing the risk of developing further pathologies. Together, a special course of physiotherapy exercises is prescribed to strengthen the muscles.

Massage and physiotherapy are prescribed only after six weeks. To relieve pressure on the damaged area, it is recommended to wear a fixation brace for two months. You can return to a full life in six months, subject to all the recommendations of the attending physician.

If the spinal cord and its roots are damaged, an open-type operation is prescribed.In other cases, minimally invasive intervention is possible – kyphoplasty and vertebroplasty.

Puncture vertebroplasty is performed through a small incision in the skin in the affected area. A cannula is inserted into the incision – a surgical needle through which a special cement is injected into the site of injury to strengthen the bone. Before kyphoplasty, the shape of the vertebra is first corrected and then filled with cement as well.

In case of instability of the spinal segments, various metal structures are used, which are also installed surgically.They fix the vertebrae and do not allow the patient’s condition to worsen in the future. The destroyed vertebrae are replaced with bone grafts.

After minimally invasive operations, the patient undergoes a rehabilitation course with regular exercise therapy, massage and physiotherapy.

Forecast

Fractures of the first degree at a young age respond well to treatment without complications with timely access to a doctor and adherence to all recommendations for the prescribed course of treatment.

The second and third degree of damage can affect future pain, the risk of developing sciatica, osteochondrosis and hernias increases.

Photo: ru.freepik.com

90,000 Osteoporotic Spinal Fractures – Causes and Treatment

Osteoporosis is one of the causes of spinal fractures

Osteoporosis leads to a decrease in bone mass and increases the likelihood of fracture. The so-called “bone mineral density” shows the ratio of mineralized bone mass to a specific volume of bone. With osteoporosis, density and mass decrease.In the case of low bone density, little strength is often enough to cause a fracture, especially in the spine and femoral neck.

Back pain can be very intense and debilitating. Therefore, great attention is paid to effective pain relief in the treatment of patients with spinal fractures.

Most often, spinal fractures are localized in the thoracic or lumbar spine

In osteoporosis, the most common fractures are the thoracic and lumbar vertebrae.In a healthy person, a spinal fracture occurs with many times more effort. Only in serious diseases do the vertebrae break from a small force, for example, in osteoporosis, tumors, incl. metastases.

Consequences of osteoporosis of the spine

Symptoms of a spinal fracture

Symptoms of a spinal fracture can be:

  • Pain on palpation or percussion of the spinous process at the level of the fracture
  • Unusually large distance between the spinous processes
  • Limitation of spinal mobility
  • Protective posture, muscle hypertonicity

Neurological disorders of the spinal cord appear below the level of the fracture, for example:

  • Paralysis
  • Impaired control of urination and defecation
  • Sensory disorders
  • Increased or weakened reflexes

Sometimes spinal fractures can be completely asymptomatic!

Treatment of spinal fractures

The choice of treatment tactics (operatively or conservatively) depends on the type of fracture (stable or unstable) and clinical manifestations.Also, the choice of the method of treatment is influenced by the age of the patient and the severity of the pain syndrome.

Conservative

For stable fractures, conservative treatment is usually chosen.

For stable fractures, according to the recommendations of the Osteoporosis Association, the use of orthoses that activate the patient is recommended.These orthoses include the Spinomed exercise-corrector.

Operational

Vertebroplasty and kyphoplasty are most often used for the surgical treatment of spinal fractures.

Vertebroplasty
Polymer cement is pumped into the fractured vertebral body. It fills the space between the fragments and cements the vertebra.After surgery, antiresorptive therapy is prescribed, such as bisphosphonates.

Kyphoplasty
A balloon is inserted into the fractured vertebral body, which is then filled with polymer cement. Unlike vertoplasty, during this operation, broken fragments are crushed as the balloon is filled with cement.

Rehabilitation time for spinal fractures

The prognosis of a spinal fracture is usually good.The decisive factor is the extent to which the fracture affects the spinal cord and nerves. In the case of a stable spinal fracture, the recovery period is usually several weeks to several months. In the case of unstable fractures, the recovery process is increased.

Diagnostics and treatment

Types, causes and treatment of back pain

Backache

Product Tips

Trainer-corrector for osteoporosis treatment

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Compression fractures | joimax

What is a compression fracture of the spine?

Compression fracture of the spine is a special form of vertebral fracture, in which its body collapses during compression, thus decreasing in height.Compression fractures of the spine are quite common and come with certain risks.

What can cause a compression fracture of the spine?

Most compression fractures of the spine occur when the bone structure is not stable enough to withstand daily stress. Risk factors for weakened bones are general bone diseases such as osteoporosis (more common in postmenopausal women) or metastatic malignancies in the vertebral bodies, smoking, excessive alcohol consumption, radiation therapy to the spine, long-term use of cortisone, or severe liver and kidney disease.As bones become fragile, often even minor factors can lead to destruction of the vertebral body.

What are the symptoms of a compression fracture of the spine?

Compression fracture of the vertebral body can cause sudden, very severe pain.

How to treat a compression fracture of the spine?

Previously, the treatment of compression fractures of the spine was not widespread and was not particularly effective.