What are the different types of spinal fractures. How are spinal fractures diagnosed and treated. What are the potential complications of vertebral fractures. How can spinal fractures be prevented.

Understanding Spinal Anatomy and Fractures

Spinal fractures are complex injuries that can have serious consequences for a person’s mobility and overall health. Unlike fractures in other parts of the body, spinal fractures present unique challenges due to the spine’s critical role in supporting the body and protecting the spinal cord.

The spine consists of 33 vertebrae, each with three main components:

• Body: The weight-bearing surface that also attaches to the intervertebral discs
• Vertebral arch: Forms the spinal canal, which houses and protects the spinal cord
• Processes: Bony projections that serve as attachment points for muscles and ligaments

When a spinal fracture occurs, it can potentially compromise the integrity of these structures, leading to instability, pain, and in severe cases, damage to the spinal cord or nerves.

What causes spinal fractures?

Spinal fractures typically result from high-energy traumatic events, such as:

• Car accidents
• Falls from heights
• Sports-related injuries
• Acts of violence (e.g., gunshot wounds)

However, in individuals with weakened bones due to conditions like osteoporosis, even minor traumas or everyday activities can lead to vertebral compression fractures.

Types of Spinal Fractures and Their Characteristics

Spinal fractures can be categorized into three main types, each with distinct characteristics and implications for treatment:

1. Compression Fractures

Compression fractures are the most common type of spinal fracture. They occur when the vertebral body collapses under sudden downward force. These fractures are often seen in the thoracolumbar region (T12-L1) and can range from mild to severe.

In a severe case known as a burst fracture, the vertebral body shatters, potentially sending bone fragments into the spinal canal. This can pose a significant risk to the spinal cord and surrounding nerves.

2. Flexion-Distraction Fractures

Flexion-distraction fractures, also known as Chance fractures, typically result from severe flexion (bending forward) of the spine. These injuries are often seen in high-speed accidents where the upper body is thrown forward while the pelvis is fixed in place, such as in car crashes where the person is wearing a lap belt but no shoulder restraint.

3. Fracture-Dislocations

Fracture-dislocations are the most severe type of spinal injury. They involve both bone fractures and ligament tears, leading to significant instability of the spine. These injuries often result from high-energy traumas and can cause the vertebrae to shift out of alignment, potentially causing severe damage to the spinal cord.

Diagnosing Spinal Fractures: Symptoms and Imaging Techniques

Recognizing the symptoms of a spinal fracture is crucial for prompt diagnosis and treatment. Common signs include:

• Severe back pain that worsens with movement
• Tenderness and swelling around the affected area
• Difficulty walking or standing upright
• Numbness, tingling, or weakness in the limbs (if nerves are affected)
• In severe cases, paralysis or loss of bowel/bladder control

To accurately diagnose a spinal fracture, healthcare providers typically use a combination of physical examination and imaging studies:

What imaging techniques are used to diagnose spinal fractures?

1. X-rays: Provide an initial view of the spine’s alignment and can detect most fractures
2. CT (Computed Tomography) scans: Offer detailed 3D images of the bone structure, helping to assess fracture patterns and severity
3. MRI (Magnetic Resonance Imaging): Visualizes soft tissues, including the spinal cord and nerves, to check for any compression or injury

These imaging techniques help doctors determine the type, location, and severity of the fracture, which is essential for developing an appropriate treatment plan.

Treatment Approaches for Spinal Fractures

The treatment of spinal fractures depends on several factors, including the type and severity of the fracture, the patient’s overall health, and the presence of neurological deficits. Treatment options can be broadly categorized into conservative management and surgical interventions.

Conservative Management

For stable fractures without significant deformity or neurological involvement, conservative treatment may be sufficient. This typically includes:

• Pain management with medications
• Bracing to immobilize the spine and promote healing
• Gradual physical therapy and rehabilitation
• Rest and activity modification

The duration of conservative treatment can vary from a few weeks to several months, depending on the fracture’s severity and the patient’s response to treatment.

Surgical Interventions

Surgery may be necessary for unstable fractures, those causing significant deformity, or cases where there is neurological compromise. Surgical options include:

1. Vertebroplasty and Kyphoplasty: Minimally invasive procedures for treating compression fractures, particularly in osteoporotic patients
2. Spinal Fusion: Joins two or more vertebrae together to provide stability
3. Decompression Surgery: Removes bone or disc material that may be compressing the spinal cord or nerves
4. Internal Fixation: Uses hardware such as rods, screws, and plates to stabilize the spine

The choice of surgical approach depends on the specific characteristics of the fracture and the patient’s individual circumstances.

Complications and Long-Term Prognosis of Spinal Fractures

While many spinal fractures heal successfully with appropriate treatment, there are potential complications that patients and healthcare providers must be aware of:

What are the possible complications of spinal fractures?

• Chronic pain: Some patients may experience persistent pain even after the fracture has healed
• Neurological deficits: Damage to the spinal cord or nerves can lead to long-term sensory or motor impairments
• Deformity: Severe fractures may result in spinal deformities such as kyphosis (excessive forward curvature)
• Adjacent segment disease: Increased stress on vertebrae above and below the fracture site can lead to further degenerative changes
• Post-traumatic arthritis: Damage to joint surfaces during the injury can accelerate arthritic changes

The long-term prognosis for patients with spinal fractures varies widely depending on the severity of the initial injury, the effectiveness of treatment, and the patient’s overall health and compliance with rehabilitation protocols.

Factors influencing long-term outcomes

1. Age and overall health status
2. Severity and location of the fracture
3. Presence of neurological deficits at the time of injury
4. Timeliness and appropriateness of treatment
5. Adherence to rehabilitation programs

Regular follow-up with healthcare providers and ongoing management of any residual symptoms are crucial for optimizing long-term outcomes.

Prevention Strategies for Spinal Fractures

While not all spinal fractures can be prevented, there are several strategies that can help reduce the risk of these injuries:

How can individuals reduce their risk of spinal fractures?

• Practice proper safety measures:
  • Always wear seatbelts while driving or riding in vehicles
  • Use appropriate protective gear during sports and recreational activities
  • Implement fall prevention strategies, especially for older adults
• Maintain bone health:
  • Ensure adequate calcium and vitamin D intake
  • Engage in weight-bearing exercises to strengthen bones
  • Avoid smoking and excessive alcohol consumption, which can weaken bones
• Manage underlying health conditions:
  • Seek treatment for osteoporosis or other conditions that weaken bones
  • Control chronic diseases that may affect bone health
• Practice good posture and body mechanics:
  • Learn proper lifting techniques to avoid excessive stress on the spine
  • Maintain good posture during daily activities

By implementing these preventive measures, individuals can significantly reduce their risk of experiencing a spinal fracture and maintain better overall spinal health.

Advances in Spinal Fracture Treatment and Research

The field of spinal fracture treatment is continuously evolving, with ongoing research and technological advancements aimed at improving patient outcomes. Some notable areas of progress include:

What are the latest developments in spinal fracture treatment?

1. Minimally invasive surgical techniques: These approaches offer reduced surgical trauma, faster recovery times, and less postoperative pain compared to traditional open surgeries
2. Biologic therapies: Research into growth factors and stem cell treatments shows promise for enhancing bone healing and regeneration
3. Advanced imaging and navigation systems: Improved intraoperative imaging and computer-assisted navigation allow for more precise and safer surgical procedures
4. Novel biomaterials: Development of new materials for vertebral augmentation and spinal instrumentation that better mimic natural bone properties and promote integration
5. Personalized treatment algorithms: Utilizing artificial intelligence and big data to tailor treatment plans to individual patient characteristics and fracture patterns

These advancements offer hope for improved outcomes and quality of life for patients suffering from spinal fractures. However, it’s important to note that many of these technologies are still in various stages of research and development, and their long-term efficacy and safety continue to be evaluated.

Living with a Spinal Fracture: Rehabilitation and Lifestyle Adjustments

Recovery from a spinal fracture often extends beyond the initial treatment phase. Rehabilitation plays a crucial role in restoring function and preventing future complications. Additionally, patients may need to make certain lifestyle adjustments to accommodate their recovery and maintain spinal health.

What does rehabilitation after a spinal fracture involve?

Rehabilitation typically includes:

• Physical therapy: Exercises to improve strength, flexibility, and mobility
• Occupational therapy: Training in activities of daily living and adaptive techniques
• Pain management strategies: Both pharmacological and non-pharmacological approaches
• Psychological support: Counseling to address the emotional impact of the injury and recovery process

The duration and intensity of rehabilitation vary depending on the severity of the fracture and individual patient factors.

Lifestyle adjustments for long-term spinal health

Patients recovering from spinal fractures may need to make several lifestyle changes to support their recovery and prevent future injuries:

1. Ergonomic modifications: Adapting work and home environments to reduce stress on the spine
2. Regular exercise: Incorporating spine-friendly exercises into daily routines
3. Nutritional adjustments: Ensuring adequate intake of nutrients crucial for bone health
4. Stress management: Practicing relaxation techniques to reduce muscle tension and promote overall well-being
5. Regular follow-up care: Maintaining ongoing communication with healthcare providers to monitor recovery and address any emerging issues

By actively participating in rehabilitation and making necessary lifestyle adjustments, patients can optimize their recovery and improve their long-term prognosis following a spinal fracture.

In conclusion, spinal fractures represent a significant challenge in the field of orthopedics and neurosurgery. While these injuries can have severe immediate and long-term consequences, advances in diagnosis, treatment, and rehabilitation offer improved outcomes for many patients. Understanding the types of spinal fractures, their causes, and available treatment options is crucial for both healthcare providers and patients. By focusing on prevention, timely intervention, and comprehensive rehabilitation, the impact of spinal fractures can be minimized, allowing individuals to maintain or regain their quality of life.

Spine fracture, Spinal fractures, vertebral fractures, compression fractures Mayfield Brain & Spine Cincinnati, Ohio

Overview

Spinal fractures are different
than a broken arm or leg. A fracture or dislocation
of a vertebra can cause bone fragments to pinch
and damage the spinal nerves or spinal cord.
Most spinal fractures occur from car accidents,
falls, gunshot, or sports. Injuries can range
from relatively mild ligament and muscle strains,
to fractures and dislocations of the bony vertebrae,
to debilitating spinal cord damage. Depending
on how severe your injury is, you may experience
pain, difficulty walking, or be unable to move
your arms or legs (paralysis). Many fractures
heal with conservative treatment; however severe
fractures may require surgery to realign the
bones.

Spinal column and spinal cord

To understand spinal fractures,
it is helpful to understand how your spine works
(see Anatomy of the
Spine). Your spine is made of 33 bones called
vertebrae that provide the main support for
your body, allowing you to stand upright, bend,
and twist. In the middle of each vertebra is
a hollow space called the spinal canal, which
provides a protective space for the spinal cord
(Fig. 1). The spinal cord serves as an information
super-highway, relaying messages between the
brain and the body. Spinal nerves branch off
the spinal cord, pass between the vertebrae,
to innervate all parts of your body.

Figure 1. Vertebrae have 3 main parts. The body (purple) is a weight-bearing surface and an attachment for the disc. The vertebral arch (teal) forms the spinal canal through
which the spinal cord runs. The processes (beige) arise
from the vertebral arch to form the facet joints
and processes for muscle and ligament attachments.

What are spinal fractures?

Spinal injuries can range from
relatively mild ligament and muscle strains
(such as whiplash), to fractures and dislocations
of the bony vertebrae, to debilitating spinal
cord injuries. Spinal fractures and dislocations
can pinch, compress, and even tear the spinal
cord. Treatment of spinal fractures depends
on the type of fracture and the degree of instability.

Fractures can occur anywhere along
the spine. Five to ten percent occur in the
cervical (neck) region. Sixty four percent occur
in the thoracolumbar (low back) region, often
at T12-L1.

There are numerous classifications
for fractures. In general, spine fractures fall
into three categories:

Fractures: when more pressure
is put on a bone than it can stand, it will
break. The most common type of spine fracture
is a vertebral body compression fracture (Fig.
2). Sudden downward force shatters and collapses
the body of the vertebrae. If the force is great
enough, it may send bone fragments into the
spinal canal, called a burst fracture.

Figure 2. (Left) Normal spine. In a compression fracture (right), sudden downward
force shatters the body of the vertebra (arrow).

People affected by osteoporosis, tumors,
and certain forms of cancer that weaken bone
are prone to vertebral compression fractures
(VCF). The fracture appears as a wedge-shaped
collapse of the vertebra. Multiple VCFs can
cause a forward hunch of the spine called
kyphosis.

Dislocations: when the
ligaments and/or discs connecting two vertebrae
together are stretched or torn, the bones may
come out of alignment (Fig. 3). For example,
when the rapid forward motion of the upper body
against a seat belt pulls apart the vertebra
and stretches the ligaments. A dislocated vertebra
can cause instability and spinal cord compression.
They usually require stabilization surgery or
a brace.

Figure 3.
In a dislocation, the ligaments are stretched
or torn (arrows) allowing the vertebra to come
out of alignment.

Fracture-dislocations:
occur when bone is broken and the ligaments
are torn (Fig. 4). These fractures are usually
unstable, tend to be very debilitating, and
are often surgically repaired.

Figure 4.
In a fracture-dislocation, both the bone and
ligaments are disrupted (arrows).

What are the symptoms?

Symptoms of a spinal fracture
vary depending on the severity and location
of the injury. They include back or neck pain,
numbness, tingling, muscle spasm, weakness,
bowel/bladder changes, and paralysis. Paralysis
is a loss of movement in the arms or legs and
may indicate a spinal cord injury. Not all fractures
cause spinal cord injury and rarely is the spinal
cord completely severed.

What are
the causes?

Car accidents (45%), falls (20%),
sports (15%), acts of violence (15%), and miscellaneous
activities (5%) are the primary causes of spinal
fractures. Diseases such as osteoporosis and
spine tumors also contribute to fractures.

Who
is affected?

• 80% of patients are aged 18-25 years
• Men are 4 times more likely to have a traumatic
  spinal fracture than women

How is a diagnosis made?

In most cases of a spinal injury,
paramedics will take you to an emergency room
(ER). The first doctor to see you in the ER
is an Emergency Medicine specialist who is a
member of the trauma team. Depending on your
injuries, other specialists will be called to
assess your condition. The doctors will assess
your breathing and perform a physical exam of
the spine. The spine is kept in a neck or back
brace until appropriate diagnostic tests are
completed.

X-ray test uses x-rays
to view the bony vertebrae in your spine and
can tell your doctor if any of them show fractures.
Special flexion and extension x-rays may be
taken to detect any abnormal movement.

Computed Tomography (CT) scan is a safe, noninvasive test that uses an X-ray
beam and a computer to make 2-dimensional images
of your spine. It may or may not be performed
with a dye (contrast agent) injected into your
bloodstream. It is especially useful for viewing
changes in bony structures.

Magnetic Resonance Imaging (MRI) scan is a noninvasive test that uses a magnetic
field and radiofrequency waves to give a detailed
view of the soft tissues of your spine. Unlike
an X-ray, nerves and discs are clearly visible. It
may or may not be performed with a dye (contrast
agent) injected into your bloodstream. MRI is
useful in evaluating soft tissue damage to the
ligaments and discs, and assessing spinal cord
injury.

What
treatments are available?

Treatment of a fracture begins
with pain management and stabilization to prevent
further injury. Other body injuries (e.g., to
the chest) may be present and need treatment
as well. Depending on the type of fracture and
its stability, bracing and/or surgery may be
necessary.

Braces
& Orthotics do three things, 1)
maintains spinal alignment; 2) immobilizes your
spine during healing; and 3) controls pain by
restricting movement. Stable fractures may only
require stabilization with a brace, such as
a rigid collar (Miami J) for cervical fractures,
a cervical-thoracic brace (Minerva) for upper
back fractures, or a thoracolumbar-sacral orthosis
(TLSO) for lower back fractures. After 8 to
12 weeks the brace is usually discontinued.
Unstable neck fractures or dislocations may
require traction to realign the spine into its
correct position. A halo ring and vest brace
may be required.

Instrumentation & Fusion are surgical procedures to treat unstable fractures.
Fusion is the joining of two vertebrae with
a bone graft held together with hardware such
as plates, rods, hooks, pedicle screws, or cages.
The goal of the bone graft is to join the vertebrae
above and below to form one solid piece of bone.
It may take several months or longer to create
a solid fusion.

Vertebroplasty & Kyphoplasty are minimally invasive procedures performed
to treat compression fractures commonly caused
by osteoporosis and spinal tumors. In vertebroplasty,
bone cement is injected through a hollow needle
into the fractured vertebral body. In kyphoplasty,
a balloon is first inserted and inflated to
expand the compressed vertebra before filling
the space with bone cement.

Clinical trials

Clinical trials are research studies in which new
treatments – drugs, diagnostics, procedures,
vaccines, and other therapies – are tested in people
to see if they are safe and effective. You can find
information about current clinical investigations,
including their eligibility, protocol, and participating
locations, on the web at: the National Institutes of
Health (NIH) at Clinicaltrials. gov and Centerwatch.com.

Sources
& links

If you have more questions, please contact Mayfield Brain & Spine at 800-325-7787 or 513-221-1100.

Links

Spineuniverse.com
Spine-health.com

Glossary

bone graft: bone harvested
from ones self (autograft) or from another (allograft)
for the purpose of fusing or repairing a defect.

fusion: to join together
two separate bones into one to provide stability.

kyphoplasty: a minimally
invasive procedure used to treat vertebral compression
fractures by inflating a balloon to restore
bone height then injecting bone cement into
the vertebral body.

spinal cord: part of the
central nervous system enclosed and protected
by the spinal vertebrae; conducts messages,
or impulses, back and forth between your brain
and body to control sensation and movement.

spinal instability: abnormal
movement between two vertebrae that can cause
pain or damage the spinal cord and nerves.

vertebral compression fracture (VCF): a break in the vertebral body of the
spine causing it to collapse and produce a wedge-shaped
deformity.

vertebroplasty: a minimally
invasive procedure used to treat vertebral compression
fractures by injecting bone cement into the
vertebral body.

whiplash: an injury to
the ligaments and muscles of the neck resulting
from rapid acceleration or deceleration (as
in an auto accident).

updated > 9.2018
reviewed by > Michael Kachmann, MD, Mayfield Clinic, Cincinnati, Ohio

Mayfield Certified Health Info materials are written and developed by the Mayfield Clinic. We comply with the HONcode standard for trustworthy health information. This information is not intended to replace the medical advice of your health care provider.

Vertebroplasty | Johns Hopkins Medicine

Vertebroplasty is a procedure in which a special cement is injected into a fractured vertebra — with the goal of relieving your spinal pain and restoring your mobility.Not all people with fractured vertebrae are candidates for the procedure, however. Some studies also suggest that vertebroplasty provides little benefit over a more conservative approach, which can include:

• Bed rest

• Pain relievers

• Muscle relaxants

• Back braces

• Physical therapy

Patients should talk with their doctor about vertebroplasty’s risks and benefits. Some doctors may recommend the procedure if:

• Traditional methods of treating your fractured vertebra or back pain fail

• You suffer from severe or prolonged pain or immobility

• The fractured vertebra has led to more serious complications, including: Deep vein thrombosis, acceleration of osteoporosis, respiratory problems, loss of height and emotional or social issues.

Vertebroplasty Risks

Vertebroplasty is generally well tolerated, with complications usually minor and occurring at a rate of 1 percent to 3 percent. But patients can face risks such as:

Vertebroplasty can worsen the pain for a few hours while the cement cures, but that rarely happens and does not last long. You may face other risks depending on your specific condition, so talk to your doctor beforehand about any concerns.

How Vertebroplasty Works

Before the procedure:

• Your doctor will likely order an X-ray, take a complete medical history and do a physical exam to determine the precise location and nature of your vertebra-related pain. Your doctor might also use Magnetic Resonance Imaging (MRI) or a Computed Tomography Scan (CT or CAT scan).

• Tell your doctor about all prescription and over-the-counter medications and any herbal supplements you are taking.

• Tell your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin or other medications that affect blood clotting.

During the procedure, your doctor:

• Gives you sedation medication to help you relax and keep calm during the procedure, or general anesthesia for severe pain.

• Uses a continuous X-ray to guide the needle into the fractured vertebra, with your body protected from the radiation.

• Slowly injects cement into the vertebra. Depending on how the cement enters the vertebra, your doctor might apply a second injection to completely fill it.

After the procedure:

• You will probably lie on your back for 1 hour while the cement hardens.

• You will likely remain in an observation room for an additional 1 to 2 hours.

• You may experience pain relief almost immediately after the procedure, but it might take up to 72 hours. Your doctor can provide you with over-the-counter pain relievers for the temporary discomfort.

• Your doctor will assess your pain and check for any possible complications.

• You may need to continue wearing a back brace, but it’s usually unnecessary.

• You will come back for a follow-up appointment in a few weeks.

Symptoms of Spinal Compression Fractures

The main symptom you’ll notice with a spinal compression fracture is back pain. It may start gradually and get worse over time or come on suddenly and sharply. But regardless of how it happens, it’s important to let your doctor know about it, especially if you’re a woman who is near or over age 50.

Most compression fractures — tiny cracks in the bones of your spine, or vertebra — in women at this age happen because of osteoporosis, a condition defined by bones that are weak and brittle. Treatment of a compression fracture can help lower your risk for more fractures.

Symptoms

Along with back pain, spinal compression fractures also can cause:

• Pain that gets worse when you stand or walk but with some relief when you lie down
• Trouble bending or twisting your body
• Loss of height
• A curved, stooped shape to your spine

The pain typically happens with a slight back strain during an everyday activity like:

• Lifting a bag of groceries
• Bending to the floor to pick something up
• Slipping on a rug or making a misstep
• Lifting a suitcase out of the trunk of a car
• Lifting the corner of a mattress when changing bed linens

Different Signs of Spinal Compression Fractures

For many people, a spinal compression fracture will hurt less as the bone heals. That can take up to 2 or 3 months. Other people will still have pain after the fracture has healed.

Some people feel almost no symptoms from spinal compression fractures. The cracks may happen so gradually that the pain is relatively mild or unnoticeable. For others, the pain may turn into a chronic backache in the injured area.

Signs of Multiple Spinal Compression Fractures

When you have multiple spinal compression fractures, your spine will change a lot. Part of your vertebrae may collapse because the cracks mean it can’t support the weight of your spine. That can affect how your body works. Symptoms include:

• Height loss. With each fracture of a spinal bone, the spine gets a little bit shorter. Eventually, after several vertebrae have collapsed, you will look noticeably shorter.
• Kyphosis (curved back): When vertebrae collapse, they form a wedge shape, which makes the spine bend forward. Eventually, you’ll have neck and back pain as your body tries to adapt.
• Stomach problems: A shorter spine can compress your stomach, causing digestive problems like constipation, a weak appetite, and weight loss.
• Hip pain: The shorter spine brings your rib cage closer to your hipbones. If those bones are rubbing against each other, it can hurt.
• Breathing problems: If the spine is severely compressed, your lungs may not work properly and you can have trouble breathing.

Symptoms are different for everyone, so let your doctor know if you’re feeling back pain or other problems. They can help you find out what’s causing it.

Diagnosing Spinal Compression Fractures

Symptoms are different for everyone, so let your doctor know if you’re feeling back pain or other problems.  They may ask questions like:

• How long have you had this back pain?
• What caused it?
• What were you doing when it started?
• Is the pain getting worse or better?

Your doctor may also prescribe tests including:

• A spinal X-ray to determine whether a vertebra has collapsed
• A CT scan to provide detail of the fractured bone and the nerves around it
• An MRI scan to show greater detail of nerves and nearby disks

A spinal compression fracture may be seen on a bone density exam (DEXA) if an additional test called a vertebral fracture assessment (VFA) is done at the same time.

Also, rarely, a bone biopsy may be done in a small percentage of people who have compression fractures to determine if the fracture is caused by cancer.

Anatomy of Spinal Fractures

For spinal fractures, the most important part of the spinal anatomy for you to understand is the vertebrae. These are the bones that make up your spinal column. Spinal fractures can also affect the other parts of the spine—the nerves, spinal cord, ligaments, etc.—and this article will discuss those later.

The image below shows the different regions of the spinal column. After reading about how the vertebrae stack up, you’ll learn about the different parts of the vertebrae.

• Cervical Spine: This is your neck, which begins at the base of your skull and ends at the top of the thoracic spine (around the level of your shoulders). Where your skull joins your neck is called the occipitocervical junction, and it’s possible to have a very serious fracture there.

  The cervical spine contains 7 small bones (vertebrae), which doctors label C1 to C7 (the ‘C’ means cervical). The numbers 1 to 7 indicate the level of the vertebrae. C1 is closest to the skull, while C7 is closest to the chest.

  C1 is also called the atlas—it’s called that as a reference to Atlas from Greek mythology, who had to support the weight of the world on his shoulders. The atlas in the cervical spine is the first vertebra, the one that supports the weight of the head.

  C2 is also called the axis. It got that name because it helps the atlas rotate, giving the neck incredible mobility. On the axis, there is a special bony projection called the odontoid process; that’s the pivot point for the C1 vertebra, or the atlas.

• Thoracic Spine: Your mid-back has 12 vertebrae that are labeled T1 to T12 (the ‘T’ means thoracic). Most vertebrae in your thoracic spine connect to your ribs, making this part of your spine relatively stiff and stable.

  It’s possible to fracture a thoracic vertebra due to trauma, but it isn’t as common. It is more common to have a traumatic fracture in the region where the thoracic spine and the lumbar spine come together. That’s called the thoracolumbar region.

  The thoracic spine is the most common area for spinal fractures caused by osteoporosis. It’s also the most common area for spinal fractures caused by metastatic tumors—cancer cells that have metastasized from the original tumor location. The thoracic spine has the most blood flow of any region of the spine, so it’s more likely that cancers will metastasize to that spinal region, as compared with the other spinal regions.

• Lumbar Spine: In your low back, you have 5 vertebrae that are labeled L1 to L5 (the ‘L’ means lumbar). Some people have 6 lumbar vertebrae. These vertebrae are your largest and strongest vertebrae, responsible for carrying a lot of your body’s weight. The lumbar vertebrae are also your last “true” vertebrae; beneath this region, your vertebrae are fused by the time you stop growing. In fact, L5 may even be fused with part of your sacrum.
• Sacrum/Coccyx: The sacrum has 5 vertebrae that usually fuse by adulthood to form one bone; the coccyx—most commonly known as your tail bone—has 4 (but sometimes 5) fused vertebrae. The sacrum and coccyx are also part of your pelvis.

  Now, take a look at the image below. It’s a close-up of vertebrae, and it shows how the vertebrae fit together in the spinal column.

• Vertebral body: This is the largest part of your vertebra, and it’s somewhat cylindrical in shape. The vertebral bodies are on the anterior side (front—and in this case, that means facing into your body) of your vertebrae. You can fracture the vertebral body.

• Facet joints: Your spine also has facet joints, which are on the posterior side (back) of your vertebrae. These joints (like all joints in your body) help facilitate movement and are very important to your flexibility. The facet joints work like hinges, and they help stabilize your spine and control your movements. They’re composed of the superior and inferior articular processes. Two superior articular processes are on the top of the vertebra, and two inferior articular processes are on the bottom. The facet joints can fracture, and if they break, it’s likely that your spine will be unstable. Fractured facets aren’t as capable of controlling your movements.

• Pedicle: The pedicles come out from the vertebral body, and they are on the posterior side (back) of your vertebrae. You have one pedicle on each side of the bone, and they help form the ring that protects the spinal cord. It is possible to fracture the pedicles.

In between your vertebrae, you have intervertebral discs. These discs function like cushions, absorbing shock from your movements. The discs are what allow your spine to move in multiple directions. They are made up of two parts: the center of the disc is called the nucleus pulposus, and the outer part is the annulus fibrosus. It helps to think of the disc as a jelly donut: the nucleus is composed of a gel-like substance, and surrounding it is the tougher annulus that holds in the “jelly.”

The intervertebral discs and the vertebrae create the spinal canal, which protects the spinal cord and spinal nerves. You can see the spinal cord running down the center of the vertebrae in the above image, and you can see the nerves exiting the spinal canal and going to various parts of the body, where they help you feel and move.

The spinal cord tapers as it travels down the spinal canal, and it ends between the first and second lumbar vertebrae. Below that point, there’s a cord-like extension and various nerves travelling to the legs.

Because the spinal cord and spinal nerves are so close to the vertebrae, if you have a spinal fracture, it is possible to damage the spinal cord or nerves. If you have a fracture below the L1-L2 (first and second vertebrae in the lumbar spine), you won’t have a spinal cord injury, but it’s still possible to injure the nerves.

Your back also has muscles, ligaments, tendons, and blood vessels. Muscles are strands of tissues that power your movement. Ligaments are the strong, flexible bands of fibrous tissue that link the discs and bones together, and tendons connect muscles to bones. Blood vessels provide nourishment. These parts all work together to help you move.

Herniated Disc Diagnosis & Treatment | Mount Sinai

Herniated disc disease can be very painful. The intervertebral discs are the shock-absorbing cushions between each pair of vertebrae in your spine. Each disc has a strong outer ring of fibers, called the annulus, and a soft, gelatinous center, called the nucleus pulposus. The disc’s nucleus serves as the main shock absorber for the adjacent vertebrae.

If you get a tear in the outer (annular) ring of the disc, the soft nucleus pulposus can protrude into the spinal canal. This common and painful disorder is called a herniated disc (also known as a ruptured disc or a prolapsed disc). The protrusion of the nucleus pulposus can press on a nerve root or the spinal cord. The damaged disc can also leak fluid, which may inflame nerve roots. For this reason, herniated discs can become extremely painful.

When a herniated disc occurs in the mid-back, it can be extremely serious. The smaller spinal canal in the thoracic (mid-back) region leaves very little space around the spinal cord. In severe cases, the pressure of a herniated disc on the thoracic spinal cord can lead to paralysis below the waist. Fortunately, most herniated discs happen in the lumbar or cervical spine, where the spinal canal is larger and paralysis is less likely.

Herniated Disc Disease Symptoms

If you have a herniated disc, you may feel pain in more than just your back. Because nerve roots carry signals throughout the body, a herniated disc that compresses a nerve root can cause pain elsewhere. For example, a herniated disc in the lower back may compress the sciatic nerve root, causing the pain and/or numbness known as sciatica, which runs down the back of the leg. A herniated cervical disc, on the other hand, can cause neck and arm pain. In fact, the hallmark of a herniated disc is radicular pain—pain that runs down into the arm or leg. You may also feel numbness or weakness in these areas.

Potential Causes of Herniated Disc Disease

Regular wear and tear, degeneration, and trauma can all cause a herniated disc. Like muscles and ligaments, discs heal from a tear by forming scar tissue, which is weaker than normal tissue.

A traumatic event can put too much pressure on a disc all at once, causing a sudden rupture. If you fall from a ladder and land in a sitting position, it can put tremendous pressure on your spine, which can result in a broken vertebra or a ruptured disc. A smaller amount of force can also rupture a disc, especially if the tough outer ring (annulus) has been weakened by repeated injuries that have added up over time. Once a disc is weak, it can rupture when you lift or bend, or do something that wouldn’t have caused a problem five years earlier.  Aging can make discs more vulnerable to ruptures and is the most common cause of disc herniation in the thoracic spine.

Diagnosing Herniated Disc Disease

To diagnose a herniated disc, your Mount Sinai doctor will begin with a medical history and physical exam. We may also use an imaging test, such as magnetic resonance imaging (MRI) to provide additional information.

Herniated Disc Disease Treatment

Your symptoms dictate how we treat your herniated disc. Since most herniated discs heal without surgical treatment, we may first suggest careful monitoring. If your symptoms improve, you may need no other treatment. But if your symptoms get worse, we may recommend surgery.

We may prescribe rest and observation to monitor the progression of the problem. Depending on how much pain you have, we may prescribe medications, and/or physical therapy. If you have severe pain from nerve root irritation, we may prescribe an epidural steroid injection, which is effective in about half of all cases.

Surgical Treatment for Herniated Disc Disease

If you need surgery, we will develop a treatment plan based on your individual symptoms and condition. The traditional surgical treatment for a herniated disc is a combination of laminotomy and discectomy. We perform a laminotomy by cutting an opening in the covering of the disc (lamina) to relieve pressure on the affected spinal nerves; a discectomy removes the herniated disc. Microdiscectomy achieves the same results as traditional discectomy, but it uses a less invasive technique, which speeds recovery. Endoscopic discectomy is an even newer, more technologically advanced version of the microdiscectomy.

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Kyphoplasty or Vertebroplasty: Repair of Vertebral Compression Fractures

Key Facts: Kyphoplasty and Elastoplasty following vertebral bone fracture

• Indication: Painful osteoporotic compression fracture of the vertebral spine (with potential to permanently alter the height of the spinal column and cause deterioration of nerve function)
• Strategy: Using a percutaneous technique (no suture or scar), the body of the collapsed vertebral disc can be augmented with a new type of silicone material (adapted to match the natural elasticity of natural bone structure). Kyphoplasty reduces the pain from a vertebral compression fracture immediately following surgery.
• Inpatient treatment: 5 days
• Outpatient treatment: 14 days of outpatient rehabilitation
• Earliest flight home: 7 days after surgery
• Recommended flight home: 14 days after surgery
• Time before showering: 1 day after surgery
• Recommended time off work: 2 weeks
• Time before driving a car: 1 week
• Bibliography

What is Kyphoplasty as a treatment for Vertrebral Compression Fracture?

Osteoporotic Fracture of the Vertebral Spine: Kyphoplasty enables the reconstruction of fractured vertebral bodies.© Bruce Blaus via Wikimedia Commons

Kyphoplasty is a way of repairing a damaged spine, by use of a minimally invasive surgical procedure.

It was designed to treat spinal fractures (separation and weakness of the bone material in the vertebral body). These fractures are often caused by osteoporosis.

Vertebroplasty or Kyphoplasty is a procedure with a long medical history. For decades Kyphoplasty has been performed as open spine surgery, in order to increase the volume of the fractured vertebrae and as pain relief. However, since 1984 this procedure has been performed as a minimally invasive procedure: the percutaneous vertebroplasty has become a standard procedure following osteoporotic cerebral fracture.

Terminology

Transcutaneous Vertebroplasty is the surgical repair of vertebral fracture with bone cement or a modern silicone material without restoring the height of the vertebral bone. The site of the fracture is treated and secured with an internal cast.
Transcutaneous Kyphoplasty is almost the same procedure, however before applying the cast, the height of the vertebral body is restored. This is achieved by inflating a balloon to create a cavity at the fracture site, this cavity is then filled with bone cement.
Elastoplasty describes the use of a more elastic silicone based filling agent for transcutaneous kyphoplastic surgery, instead of the traditional brittle bone cement (PMMA).

Symptoms of Osteoporotic Spinal Fractures

Symptoms of Vertrebral Fracture

• Spine deformity results in a forward bent posture
• Reduced diameter of vertebral bodies decreases body height
• Static changes of the spine impairs mobility and balance
• Reduced height impaires lung capacity, breathing, and leads to a deterioration in general metabolism
• Increased pressure in internal organs resulting from spinal deformity
• Potential for neurological impairment (palsy, numbness, loss of strength, impaired reflexes) due to increased pressure on spinal cord and nerve roots

In healthy patients a vertebral fracture can occure as a rare consequence of a serious accident.

In patients with osteoporosis the vertebral fracture can result from daily life. A situation as trivial as a stumble on stairs while carrying a bag, sneezing or coughing can result in vertebral fracture.

Pain after vertebral fracture

The result of vertebral fracture is immediately painful and irritating. Any bone fracture can lead to an edema (a build up of fluid causing a painful internal swelling).

The pain is always felt close to the site of the fracture, commonly near the waistline in the lumbar spine. It is in this area that the vertebral bodies suffer the highest pressure and crack most often. The pain worsens in a sitting or standing position. Patients experience pain relief by lying down. Mobility and therefore quality of life is naturally reduced by a vertebral compression fracture, as the patient will have a tendency to remain in a resting position.

Prolonged instability of a vertebral bone, has the potential to cause the fracturing of vertebral bones as ongoing process.

The pain resulting from vertebral fracture will continue until the bone fracture is stabilised, either by healing in it’s new position within a couple of months, or by being treated with either kyphoplasty or vertebroplasty.

Neurological consequences of Vertebral Fracture

As the vertebral spine mechanically supports the central nervous system, the loss of height resulting from the collapse of a vertebral body will put painful pressure on particular areas of the spinal cord. This has the potential to damage spinal cord and nerve roots.

Numbness, palsy, loss of reflexes and muscle strength after vertebral fracture, require particularly careful clinical supervision. A detailed MRI investigation after the detection of these neurological symptoms, has the potential to ascertain the exact location and nature of neurological trauma resulting from vertebral bone fracture.

Vertrebral fracture changes the shape and impairs the function of the skeleton

Osteoporotic vertebral fracture reduces the heigt of the spinal column. A dowager´s hump results in a number of disadvantages: reduced breathing volume, impaired nerve function, increased pressure on internal organs and loss of mobility. The microscopic part of the image demonstrates the reduced thickness and stability of the osteoporotic bone structure (right) in comparison with the healthy bone. © Bruce Blaus via Wikimedia Commons

The spine, as a central axis of the skeleton and nervous system (spinal cord), is affected by loss of height and stability.

The spine loses its shape and the volume of the lungs is decreased. Depth of breathing and respiratory function is impaired. This will ultimately lead to deterioration of the metabolism and vitality of the patient.

Depending on the location of the fracture, organ systems can be affected by the vertebral fracture through deteriorated nerve function. The reduced height of the spine as the central axis of the upper body, increases pressure on the digestive organs inside the body cavity.

Vertebral fracture can permanently change the shape of the patient, resulting in a “hunch” or humpback. The ability of the vertebral spine to carry weight will decrease. The elastic properties of the spine will be altered. The patient will have a tendency to look down at the floor, as deformity of the spine after vertebral fracture makes it increasingly difficult to raise the head. The ability to deal with daily life and general orientation will suffer as a result.

Nonsurgical treatment of vertebral compression fractures

Vibration (Biomechanical Stimulation) activates skeletal bone metabolism. Bone density is increased by continuous training exercises on the vibration plate. © Gelenkreha

Most cases of vertebral compression fracture heal naturally (8-12 weeks after the vertebral compression fracture occurs). A combination of rest and pain medication helps the patients through the painful episode.

In order to support the healing of the bone fracture, the spine may be immobilised with a back brace. However, bracing the spine and the continuous bed rest may lead to the significant weakening of muscles and a general deterioration of the patient. It needs to be recommended with care, especially in the elderly, who may already have a weakened general condition.

Bed rest and spinal braces may help in avoiding further pain after a vertebral compression fracture, but inactivity accelerates bone loss and weakens the surrounding muscles.

Nonsurgical treatment of osteoporotic compression fracture of the spine

• Pain Medication
• Medication to increase bone density
• Physiotherapy to activate calcium metabolism
• Biomechanical Stimulation (BMS or Matrix-Therapy ZRT) to stimulate the calcium metabolism of muscles and bones
• Vitamin and Mineral substitution
• Nutrition counseling
• Physiological Acid-base regulation
• Regular bone density measurement

Building bone mass through medication, is a frequently recommended treatment strategy. This will require a long term view on the developement of osteporosis.

Exercise of all kinds has been proven effective in stopping the progression of osteoporosis. Biomechanical stimulation treatment using a vibration plate is part of the physiotherapy regime used at the orthopaedic Gelenk-Klinik. It provides impulses for the bones and muscles, thereby improving calcium metabolism in bones.

This diagram shows the average development during the lifetime of a human. Loss of bone mineralisation and density often goes unnoticed by the individual. Female patients suffer a decrease in bone density due to the hormonal changes following menopause, which makes them particularly vulnerable to osteoporotic compression fracture. Only frequent monitoring of bone density and lifestyle adaptions can prevent the unnoticed occurence of osteopenia (thinning of bone structure and demineralisation). © OpenStax College via wikimedia commons

Expert Diagnosis of Vertebral Compression Fracture

Osteoporosis is often misdiagnosed

Vertebral compression fracture is one of the most misdiagnosed conditions: only 30% of all vertebral fractures as a consequence of osteoporosis are diagnosed. In many other cases, the sudden onset of back pain is attributed to nerve compression, muscle tension and other conditions.

Osteoporotic fracture of the spine is much more common than osteoporotic fracture of wrists and hips. Osteoporosis (as a silent disease that progresses without symptoms), the vertebral fracture is for many patients, the first sign of a weakened bone structure.

Clinical investigation of compression fracture of the spine

During the clinical investigation the spine specialist will inspect the patient and look for signs of a severely rounded upper body (visual inspection for straightness and the alignment of the spine).

By putting manual pressure on different parts of the upper body, the specilist will find out if the pain results from pinched nerves, strained muscles or other kinds of injury to muscles or degeneration of the bones. A neurological examination will follow to check for additional injury to nerves. This includes testing reflexes and strength.

Diagnostic imaging by X-ray, MRI and Bone Density Scanning

Finally the diagnosis of a vertebral compression fracture is confirmed by an X-ray image The presence and location of narrowed vertebrae can be clearly seen from a side on view. Other spinal problems such as spinal disc degeneration, scoliosis, spondylisthesis can also be idenitfied via X-ray.

The MRI investigation of a vertebral compression fracture will provide information about the time line. The amount of liquid (edema) at the site of the fracture gives an idea of how recently the fracture occurred and how far it has healed in it’s new position already. A decision about the aplicability of kyphoplasty depends on this information: only fresh fractures (no older that 8 weeks are treatable by kyphoplasty).

A bone Density Scan (or DEXA-Scan) can help to assess the overall bone structure and the degree of osteoprosis. The condition that is diagnosed by the DEXA-bone scan is called osteopenia: thinning of the bones. The DEXA scan can measure the degree of mineralisation remaining in the bone structure. it is a clear indicator of the future risk of additional vertebral compression fractures.

Who qualifies for treatment of an osteoporotic vertebral fracture with Kyphoplasty?

Kyphoplasty: Step 1: Tube is inserted. Step 2: Balloon is inserted and inflated. Step 3: Bone cement or silicone material is inserted into the fractured vertebral bone© via4spine

For many patients the change in body shape and height resulting from a vertebral compression fracture is not acceptable.

For other patients the activity modification and bed rest in combination with conservative therapy seems to increase the underlying condition of bone loss.

Patients who would rather not suffer the pain associated with osteoporotic compression fracture decide in favour of kyphoplasty: this not only augments the height of the compression fracture, but also brings immediate pain relief after surgery. Patients usually go home after 2 nights, but they are mobile and pain free immediately after the procedure.

According to Dr Frank Haberstroh, orthopaedic spine specialist, who has more than 10 years experience with kyphoplasty, this procedure is one of the most immediately gratifying spinal procedures. It brings immediate pain relief after compression fracture and preserves the natural shape of the spine, without the risks associated with major spine surgery.

How is Kyphoplasty performed – step by step

Insertion of a tube under X-ray guidance into the fractured vertebral bone, through which bone cement is injected. The surgery is performed under local anaesthesia as a typical minimally invasive spine procedure, without scarring or the need for sutures. © via4spine

• Kyphoplasty or Vertebroplasty is performed while the patient is lying face down.
• Local or general anaesthesia is possible
• A max 1 cm skin incision is made as the surgical opening
• Insertion of a tube (working channel) under X-ray guidance into the fractured vertebral bone.
• A thin tube with an inflatable balloon (called balloon tamp) is guided into the damaged vertebral bone.
• Balloon is inflated until the original height of the fractured vertebrae is restored.
• After a sufficient cavity is created the balloon is deflated and removed.
• Bone cement or silicone material injected onto the cavity.
• This bone cement hardens within 10 minutes. It secures the fractured bone particles, effectively acting as an internal cast.

Medical Benefits of Elastoplasty compared to the Kyphoplasty with bone cement

Benefits of Elastoplasty

• Silicone material has the same elasticity as the natural vertebral bone: less secondary vertebral fracture after kyhoplasty
• Close binding of silicone materials with the microscopic bone structure avoids breaking points
• Lower physiological toxicity than traditional bone cement (PMMA)
• Silicone Material is bone friendly and does not accelerate bone degeneration
• No exothermic reaction and heat generation during chemical reaction: safety for the circulatory system of the patient
• Silicone Material does not permeate into the vascular system (not thrombogenic)

Surgical procedure ELASTOPLASTY is performed the same way as traditional kyphoplasty. However, the stabilizing agent is not traditional bone cement (Poly-Methyl-Acrylate or PMMA), but an elastic silicone material.

What are the advanages of the silicone material in kyphoplasty?

Fracture and collapse of porous vertebrae is one of the most common consequences of osteoporosis. The vertebral bodies lose this height. The resulting vertebral fracture is very painful. The vertebral body can be re- erected and filled.
Until recently the gold standard in the treatment of vertebral fractures was filling with bone cement (PMMA).

This material is durable, but very hard and perfectly brittle and inelastic.
Secondary fractures of adjacent vertebrae after kyphoplasty with bone cement (PMMA) is one of the most severe side effects of kyphoplasty: 20-25 % of all patients with kyphoplasty on the basis with bone cement will experience a secondary vertebral fracture in the area adjacent to the treated area.

In response to this problem, an alternative elastic silicon-based filler material has been developed in the United States and tested since 2009.

The newly developed elastic silicone filler improves the reliability of the recovery after vertebral fracture.

It significantly reduces the rate of secondary vertebral fractures. For a definitive statement that operated in Germany case numbers are still too low. The patients in the Gelenk-Klinik hospital treated with this method have very promising outcomes and no subsequent compression fractures so far. The application of elastoplasty in England and Spain since 2009 has so far shown very good clinical results: Approximately 90 % of patients are pain-free after Elastoplasty immediately after surgery.

The elastic material provides a better static distribution of weight and impact within the osteoporotic verbral bone tissue. Elastic properties of bone tissue stay intact and are not changed by the use of a more elastic silicone material.

The main goal of transcutaneous kyphoplastic surgery after spinal fracture – to eliminate the severe pain of the patients fast – is achieved in a more reliable way with the silicone based elastoplasty.

When will your spine surgeon suggest an alternative procedure after spinal compression fracture?

When to look for alternative treatments?

• Significant spinal stenosis
• Spondylolisthesis
• Urinary tract or sexual dysfunction, significant neurological deficits

Please contact us for a thorough investigation and to discuss treatment alternatives.

Sometimes there is too much mobility between the vertebral bones. This situation is called Spondylolisthesis Fusion surgery is used to correct this is hypermobility.

Effectiveness and results of Kyphoplasty

Trial outcomes Kyphoplasty vs. Nonsurgical Patients

1. Patients treated with Balloon Kyphoplasty had fewer days in pain and restricted activity than non surgical patients with bed rest and pain medication only
2. Even after one year surgical patints with vertebral compression fracture are more active
3. Kyphoplasty patients have a lower intake of pain medication than the non surgical group even one year after the event
4. Safety: the surgical group had no increase in adverse events in comparison to the non surgical group.
5. There were two events of leaking bone cement from the broken vertebrae, this supports the use of silicone as a safer alternative material (as favoured by the Gelenk-Klinik).

Bibliography

Kyphoplasty is a highly specialised spine procedure that provides very fast relief of back pain and quickly restores mobility. Kyphoplasty also has the potential to restore body height, helps to straighten the spine and reduces deformity resulting from osteoporotic compression fracture. According to clinical studies, patients with vertebral compression fracture experience significant pain relief with kyphoplasty, in comparison to patients treated with nonsurgical options (pain medication, bed rest and braces).

Rehabilitation after Kyphoplasty

Successful Kyphoplasty usually provides almost immediate pain relief (the day following surgery). After Kyphoplasty no particular rehabilitation is required. The patients can continue with their daily lives without braces or bed rest. It is recommended that the patients continue outpatient physiotherapy to strengthen the back and address underlying osteoprosis.

Vertebroplasty and Kyphoplasty

Vertebroplasty and kyphoplasty are procedures used to treat painful vertebral compression fractures in the spinal column, which are a common result of osteoporosis. Your doctor may use imaging guidance to inject a cement mixture into the fractured bone (vertebroplasty) or insert a balloon into the fractured bone to create a space and then fill it with cement (kyphoplasty). Following vertebroplasty, about 75 percent of patients regain lost mobility and become more active.

Your doctor will likely first evaluate your condition using diagnostic imaging or a physical exam and will instruct you on how to prepare. Tell your doctor if there’s a possibility you are pregnant and discuss any recent illnesses, medical conditions, allergies and medications you’re taking. Your doctor may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners several days prior to your procedure and instruct you not to eat or drink anything several hours beforehand. Take regular medication with sips of water. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown. If you are not to be admitted to the hospital, plan to have someone drive you home afterward.

What is Vertebroplasty & Kyphoplasty?

Vertebroplasty and kyphoplasty are minimally invasive procedures for the treatment of painful vertebral compression fractures (VCF), which are fractures involving the vertebral bodies that make up the spinal column.

When a vertebral body fractures, the usual rectangular shape of the bone becomes compressed, causing pain. These compression fractures may involve the collapse of one or more vertebrae in the spine and are a common result of osteoporosis. Osteoporosis is a disease that results in a loss of normal bone density, mass and strength, leading to a condition in which bones become increasingly porous, and vulnerable to breaking easily. Vertebrae may also become weakened by cancer.

For a vertebroplasty, physicians use image guidance, typically fluoroscopy, to inject a cement mixture into the fractured bone through a hollow needle. During kyphoplasty, a balloon is first inserted into the fractured bone through the hollow needle to create a cavity or space. The cement is injected into the cavity once the balloon is removed.

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What are some common uses of the procedures?

Vertebroplasty and kyphoplasty are used to treat painful vertebral compression fractures in the spine, most often the result of osteoporosis.

Typically, vertebroplasty and kyphoplasty are recommended after less invasive treatments, such as bed rest, a back brace or pain medication, have been ineffective. Vertebroplasty and kyphoplasty can be performed immediately in patients with problematic pain requiring hospitalization or for conditions that limit bed rest and pain medications.

Vertebroplasty and kyphoplasty are also performed on patients who:

• are elderly or frail and will likely have impaired bone healing after a fracture
• have vertebral compression due to a malignant tumor
• suffer from osteoporosis due to long-term steroid treatment or a metabolic disorder

Vertebroplasty and kyphoplasty should be completed within eight weeks of the acute fracture for the highest probability of successful treatment.

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How should I prepare?

A clinical evaluation will be performed to confirm the presence of a compression fracture that may benefit from treatment with vertebroplasty or kyphoplasty. The evaluation may include:

You may be given bone-strengthening medication during treatment.

Tell your doctor about all the medications you take, including herbal supplements. List any allergies, especially to local anesthetic,
general anesthesia, or
contrast materials.
Your doctor may tell you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners before your procedure.

Tell your doctor about recent illnesses or other medical conditions.

You will need to have blood drawn for tests prior to the procedure to determine if your blood clots normally.

On the day of the procedure, you should be able to take your usual medications with sips of water or clear liquid up to six hours before the procedure. You should avoid drinking juice, cream and milk. Follow your doctor’s instructions.

In most cases, you should take your usual medications, especially blood pressure medications. Take these with sips of water on the morning of your procedure.

Other than medications, your doctor may tell you to not eat or drink anything for several hours before your procedure.

Plan to have someone drive you home after your procedure.

The nurse will give you a gown to wear during the procedure.

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What does the equipment look like?

For vertebroplasty and kyphoplasty procedures, x-ray equipment, a hollow needle or tube called a trocar, orthopedic cement, and a cement delivery device are used.

For kyphoplasty, a device called a balloon tamp is also used to make room for the balloon catheter.

Compact, portable x-ray machines can be taken to the patient in a hospital bed or the emergency room. The x-ray tube is connected to a flexible arm. The technologist extends the arm over the patient and places an x-ray film holder or image recording plate under the patient.

The orthopedic cement includes an ingredient called polymethylmethacrylate (PMMA). Its physical appearance resembles toothpaste, which hardens soon after placement in the body.

This procedure may use other equipment, including an intravenous line (IV), ultrasound machine and devices that monitor your heart beat and blood pressure.

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How does the procedure work?

When a vertebra breaks or fractures, bone fragments develop. Pain occurs when these fragments slide or rub against each other or protrude into the spinal cord.

Vertebroplasty involves injecting the bone with a cement mixture to fuse the fragments, strengthen the vertebra and provide pain relief.

First, the skin is numbed with a local anesthetic. Then, using imaging guidance, the hollow needle or trocar is passed through the skin into the vertebral body for injection of the cement mixture into the vertebra.

In kyphoplasty, after numbing the skin locally, a balloon is inserted through the trocar into the fractured vertebra where it is inflated to create a cavity for cement injection. The balloon is removed prior to injecting cement into the cavity that was created by the balloon.

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How is the procedure performed?

Image-guided, minimally invasive procedures such as vertebroplasty and kyphoplasty are most often performed by a specially trained interventional radiologist or neuroradiologist in an interventional radiology or neuroradiology suite, or occasionally in the operating room.

This procedure is often done on an outpatient basis. However, some patients may require admission following the procedure. Ask your doctor if you will need to be admitted.

The doctor or nurse may connect you to monitors that track your heart rate, blood pressure, oxygen level, and pulse.

A nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm to administer a sedative. This procedure may use moderate sedation. It does not require a breathing tube. However, some patients may require general anesthesia.

Your doctor may provide medications to help prevent nausea and pain and antibiotics to help prevent infection.

You will be positioned lying face down for the procedure.

The area through which the hollow needle, or trocar, will be inserted will be shaved, sterilized with a cleaning solution and covered with a surgical drape.

A local anesthetic is then injected into the skin and deep tissues, near the fracture.

The doctor will make a very small skin incision at the site.

Using x-ray guidance, the trocar is passed through the spinal muscles until its tip is precisely positioned within the fractured vertebra.

In vertebroplasty, the orthopedic cement is then injected. Medical-grade cement hardens quickly, typically within 20 minutes. The trocar is removed after the cement is injected.

In kyphoplasty, the balloon tamp is first inserted through the needle and the balloon is inflated, to create a hole or cavity. The balloon is then removed and the bone cement is injected into the cavity created by the balloon.

X-rays and/or a CT scan may be performed at the end of the procedure to check the distribution of the cement.

The doctor applies pressure to prevent any bleeding and covers the opening in the skin with a bandage. No sutures are necessary.

This procedure is usually completed within one hour. It may take longer if more than one vertebral body level is being treated.

The doctor or nurse will remove your IV line before you go home.

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What will I experience during the procedure?

The doctor or nurse will attach devices to your body to monitor your heart rate and blood pressure.

You will feel a slight pinch when the nurse inserts the needle into your vein for the IV line and when they inject the local anesthetic. Most of the sensation is at the skin incision site. The doctor will numb this area using local anesthetic. You may feel pressure when the doctor inserts the catheter into the vein or artery. However, you will not feel serious discomfort.

If the procedure uses sedation, you will feel relaxed, sleepy, and comfortable. You may or may not remain awake, depending on how deeply you are sedated.

The treatment area of your back will be cleaned, shaved and numbed.

During the procedure you will be asked questions related to your comfort. It is important for you to be able to tell your doctor whether you are feeling any pain.

The longest part of vertebroplasty and kyphoplasty procedures involves setting up the equipment and making sure the needle is perfectly positioned in the collapsed vertebral body.

You may feel a tapping sensation during the procedure as the trocar is advanced into the bone.

You may not drive after the procedure, but you may be driven home if you live close by. Otherwise, an overnight stay at a nearby hotel is advised.

You will be advised to increase your activity gradually and resume all your regular medications. At home, patients may return to their normal daily activities, although strenuous exertion, such as heavy lifting, should be avoided for at least six weeks.

If you take blood thinners, check with your doctor about restarting this medication the day after your procedure.

Pain relief is immediate for some patients. In others, pain is eliminated or reduced within two days. Pain resulting from the procedure will typically diminish within two to three days.

For two or three days afterward, you may feel a bit sore at the point of the needle insertion. You can use an icepack to relieve any discomfort but be sure to protect your skin from the ice with a cloth and ice the area for only 15 minutes per hour. Your bandage should remain in place for 48 hours. Do not immerse the bandage in water for 48 hours. This is to prevent infection. Taking showers is allowed.

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Who interprets the results and how do I get them?

Approximately one hour after the procedure, you should be able to walk. The interventional radiologist is often able to advise you as to whether the procedure was a technical success at that point.

Your interventional radiologist may recommend a follow-up visit.

This visit may include a physical check-up, imaging exam(s), and blood tests. During your follow-up visit, tell your doctor if you have noticed any side effects or changes.

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What are the benefits vs. risks?

Benefits

• Vertebroplasty and kyphoplasty can increase a patient’s functional abilities and allow return to the previous level of activity without any form of physical therapy or rehabilitation.
• These procedures are usually successful at alleviating the pain caused by a vertebral compression fracture; many patients feel significant relief almost immediately or within a few days. Many patients become symptom-free.
• Following vertebroplasty, about 75 percent of patients regain lost mobility and become more active, which helps combat osteoporosis. After the procedure, patients who had been immobile can get out of bed, and this can help reduce their risk of pneumonia. Increased activity builds more muscle strength, further encouraging mobility.
• Usually, vertebroplasty and kyphoplasty are safe and effective procedures.
• No surgical incision is necessary—only a small nick in the skin that does not need stitches.

Risks

• Any procedure that penetrates the skin carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
• A small amount of orthopedic cement can leak out of the vertebral body. This does not usually cause a serious problem, unless the leakage moves into a potentially dangerous location such as the spinal canal or the blood vessels of the lungs.
• Other possible complications include infection, bleeding, increased back pain and neurological symptoms such as numbness or tingling. Paralysis is extremely rare.
• Approximately 10 percent of patients may develop additional compression fractures after vertebroplasty or kyphoplasty. When this occurs, patients usually have relief from the procedure for a few days but develop recurrent pain soon thereafter.
• There is a low risk of allergic reaction to the medications.

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What are the limitations of Vertebroplasty & Kyphoplasty?

Vertebroplasty and kyphoplasty are not:

• used for herniated disks or arthritic back pain.
• generally recommended for otherwise healthy younger patients, mostly because there is limited experience with cement in a vertebral body for longer time periods. These patients also tend to heal faster than elderly patients or those with osteoporosis.
• a preventive treatment to help patients with osteoporosis avoid future fractures. It is used only to repair a known, non-healing compression fracture if it is due to a recent fracture.
• used to correct an osteoporosis-induced curvature of the spine, but it may keep the curvature from worsening if it is due to a recent fracture.
• ideal for someone with severe emphysema or other lung disease because it may be difficult for such individuals to lie facedown for the one to two hours vertebroplasty requires. Special accommodations may be made for patients with these conditions.
• for patients with a healed (chronic) vertebral fracture.
• appropriate for patients with young healthy bones or those who have suffered a fractured vertebra in an accident.
• suitable for patients with spinal curvature such as scoliosis or kyphosis that results from causes other than osteoporosis.
• applicable for patients who suffer from spinal stenosis or herniated disk with nerve or spinal cord compression and loss of neurologic function.

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This page was reviewed on March, 23, 2021

Second life of broken and used disks from LBM

Hello to all lovers of homemade products! In our daily life, one way or another, we use various electrical tools, and in particular the angle grinder “grinder”. This is a very versatile tool, since in addition to cutting discs, you can also put grinding wheels on it. The service life of such grinding discs is rather short, they are erased very quickly, but their extreme part is erased the fastest, and it is most convenient for her to grind or clean it.Therefore, after the edge of the disc has been erased, do not rush to throw it away. This disc can be given a second or even a third life.

Restoration of the grinding disc for angle grinders

As you can see in the photo above, the edge of the disc is badly worn out and the quality of grinding has deteriorated, and to restore it you need to take an electric sharpener and at the same time start the grinder and the disc to grind off the worn part.

This procedure, on one disc, can be performed up to two times, personally verified. After that, the quality of the grinding increases.

But if the petals of the grinding disc flew off, as in the photo below, then you should not throw out such a disc either.

The first step is to independently separate all other petals from the disc and clean the base.

Next, we take a regular piece of sandpaper (ATTENTION! Do not take sandpaper on a paper basis, only on a rag, since the paper does not withstand high revolutions) , apply a disk, circle it and cut it out with scissors.

After that, make a hole in the middle, apply the emery wheel to the grinding disc and put it on the angle grinder.

After that, you can completely clean the necessary parts and it will not be inferior in quality to a conventional grinding disc.

Manufacturing of grinding discs for bur machines

Also, in addition to angle grinders, we quite often use a drill with small cutting discs, but the quality of such small discs is very poor, they break even from the slightest impact, so you can make such small discs from broken big.Just put a small disc, circle it, cut it out with metal scissors, make a hole in the center and you can use it.

One broken disc can make up to 10 pieces of small ones, depending on the size and quality and strength, they will be much better. With such discs, you can saw off rather thick metal and they will wear less.

I also advise you to look at the form on this topic:

Well, that’s all for me, I hope this post was useful.If you still know any methods or ideas on this topic, write in the comments, it will be interesting to read. Thank you all for your attention and to new homemade products! 90,000 Alloy wheels for scrap | What discs can be scrapped

It’s no secret that car rims, cast or stamped, are highly prized by pick-up points. And this is not surprising, because metal structures contain a large amount of aluminum and other metals. What discs can be scrapped and is it profitable to sell them? Read about this and much more in our article.

Reception of discs for scrap is the most rational way of recycling metal structures. This is explained primarily by the fact that reception points in Moscow, as well as in other regions, are ready to offer rather high prices for nonferrous metals. And due to the fact that the demand for non-ferrous metals never falls, the cost of aluminum car parts also remains high. This is the main benefit for car owners planning to take discs for scrap.

Classification of rims

The modern automotive industry does not stand still, new products are being developed for car owners, the quality of parts and materials is improving.Great attention is paid to the manufacture of car rims, on the reliability of which safety on the road largely depends. The modern classification can be represented as follows:

• stamped discs. One of the simplest options. For their manufacture, rolled carbon steel is used. Since this solution is quite budgetary, it is unlikely that such discs will be expensive to rent for metal, even despite their heavy weight.
• light alloy wheels.Their fundamental difference from stamped ones lies in materials and manufacturing technology. For their production, aluminum is used, for more expensive models – magnesium and titanium. Metal structures are produced by casting into a pre-prepared matrix. The main advantages are high strength and corrosion resistance. By handing over alloy wheels for scrap at the collection points, you can count on a fairly large reward.
• forged wheels. Materials of manufacture are aluminum alloys with the addition of titanium and magnesium.The main difference between the metal structures is their relatively low weight. Naturally, for a person who plans to scrap aluminum discs, this is a minus. However, it is compensated by the high content of valuable non-ferrous metal. Old forged metal structures can be sold for scrap at high prices.
• assembled discs. Such car parts are considered quite rare. Their main feature is that they consist of several parts, which in turn are made of different metals.As a rule, it is all the same aluminum, titanium, magnesium. The price of discs for non-ferrous metal is calculated taking into account the chemical composition.

How is the price of forged and alloy wheels for scrap calculated?

Each non-ferrous metal buying company establishes its own conditions and rules for accepting stamped, forged and cast discs for scrap. The pricing policy also differs. But, despite the difference, there are general criteria, taking into account which the price of scrap metal is calculated. So, the factors that can affect the cost of non-ferrous metals:

• the percentage of aluminum, titanium or magnesium in the alloy;
• the presence or absence of traces of paint, fuels and lubricants, rubber and other contaminants;
• general situation on the world market;
• batch size.

The price is calculated only after the chemical analysis of the alloy wheel scrap, which is carried out by the specialists of the collection point using special tools, for example, analyzers.

Where to scrap alloy wheels?

Scrap of aluminum disks in Moscow willingly buys up a huge number of collection points that are ready to offer attractive conditions. But in order to find a really profitable offer, which implies obtaining a good profit with a minimum of labor costs, it is necessary to correctly approach the choice of a company that buys non-ferrous metals.

First of all, pay attention to the experience in the market and the availability of licenses to operate. An important criterion is the compliance of prices with market ones. We also recommend that you familiarize yourself with the real reviews of customers who have used the offers of the reception points.

You can find out more about the delivery of discs for scrap, the price of stamped, cast and forged models and the terms of scrap sale at one of the collection points of the TsML company in Moscow or by calling +7 (499) 394-57-72.

90,000 5 advantages of solid state drives – Kingston Technology

1. Durability and Reliability of Solid State Drive

High temperature is the leading cause of hard drive failures. Continuous movement of moving parts of a hard drive generates enough heat to damage it over time. Since SSDs do not have such parts, they can maintain lower temperatures and much better performance.SSDs are also better protected from drops, shocks, bumps and everyday wear and tear, which reduces the chances of data loss.

2. SSDs are faster than hard drives

Solid state drives are hundreds of times faster than hard drives. Solid state drives make your computer boot faster, transfer data faster, and increase bandwidth. The increased performance means that solid state drives can handle data at the ultra-high speeds required in today’s business world, especially when running programs, such as the operating system, that access large amounts of data.In addition, solid state drives are very stable, which guarantees the safety of the stored data.

• SATA Solid State Drives: Only 50-120 MB / s write speeds were achieved for hard drives. In comparison, SSDs load the SATA bus up to 550MB / s. Despite the bus limitation, there is typically a 10-15x improvement in overall system performance when using SATA-based SSDs instead of legacy hard drives.
• NVMe Solid State Drives: NVMe technology uses the PCIe bus instead of the SATA bus, unlocking the enormous bandwidth potential for storage devices.PCIe 4.0 (current version) provides up to 32 lanes and can theoretically transfer data at speeds up to 64,000 MB / s, compared to the 600 MB / s SATA III specification limit.

3. Energy Efficiency

Because SSDs have no moving parts, they require less power to operate than HDDs with spinning platters. Energy efficiency provides a big benefit from SSDs when it comes to PCs and mobile devices, where battery longevity is a highly sought after feature.

4. Lighter weight and quiet operation

Smaller size means less weight for SSDs compared to larger hard drives with magnetic heads and metal plates. The compact design makes SSDs ideal for laptops, tablets, and other small electronic devices. The absence of moving parts means that SSDs are much quieter than hard drives, which can be very distracting for noise and vibration.

5. More practical size / form factor

Since their inception, hard drives have been limited to large sizes. On the other hand, there are various sizes of solid state drives available; the smallest of them has a 2.5-inch form factor.

These are the most common SSD form factors.

• The most common 2.5-inch form factor; provides the best price per GB; closed design.
• mSATA has a very small form factor; another type of connection; open-frame circuit board; great option when space is limited.

The

• M.2 is a bare-board circuit board; available with SATA and PCIe NVMe interface; small form factor; the size of a piece of chewing gum.

HOW TO RECOVER DATA FROM THE HARD DISK OF A BROKEN COMPUTER OR LAPTOP

Damage to a laptop or computer can have costly consequences. Fortunately, nine times out of ten, a broken computer or laptop does not damage your hard drive. In most cases, you’ll just be able to dismantle the device and plug it into something new, which will give you access to all of your data without much hassle.

However, if you’re unlucky enough to be one of the ten who can’t get their data using this simple technique, there are still options. Even on a hard drive that has undergone serious physical damage, information recovery is possible. In fact, deleting data is much more difficult than you might think. These tips will help you get started.

HOW TO OBTAIN FILES FROM HARD DISK

Either way, the first step to recovering your data is to remove your hard drive.Start by unscrewing the case and removing the mounting brackets – most laptops use 2.5-inch IDE or SATA hard drives.

• IDE: Hard drives with connectors with two rows of pins.
• SATA: hard drives that have two separate connectors; one for data transmission and one for power supply.

In most cases, you will be able to connect your old hard drive to the new system by either replacing the existing hard drive or plugging it into an additional port.If this is not possible, you will need to purchase a case that matches the type and size of your hard drive. Once in the case, you can connect the hard drive to another computer using a USB cable — which will allow you to transfer files and create backups.

However, if you had a password-protected laptop or computer, Windows will automatically deny access to your hard drive. To work around this issue, you must take ownership of the user folder.It’s easy to do:

Open the files on your hard drive and right-click the Users or Documents and Settings folder (depending on the version of Windows you are using).
In the window that opens, go to the “Security” tab, and then click the “Advanced” button.
Go to the Owner tab and click the Edit button.
Left-click the Administrators group and select the Change Owner checkbox.
Click “OK” and select “Yes” when the Windows security pop-up window appears.
The process of taking over ownership may take some time, depending on the size of your hard drive. However, once the process is complete, you will be able to access all of your locked files.

Software problem

Software problems can severely damage your system. While your computer or laptop cannot be broken in the usual sense, boot failures and viruses can render it useless.If the problem is not physical, there are various ways to fix it without removing the hard drive itself.

First, try to boot your computer in Safe Mode. This will load only the minimum requirements required to get your system up and running.

• If you are using Windows 7, Press the F8 key at startup and select Safe Mode from the menu.
• If you are using Windows 8 or higher, press F8 or Shift plus F8 at startup and select Safe Mode from the menu.
• If you are able to open your system in Safe Mode, use Windows File Explorer to find your lost files and save them to an external device. After the transfer is complete, run your anti-virus software. With a little luck, this will help you find and fix the problem.

HOW TO GET DATA FROM HARD DISK

There are many data recovery software on the market specially designed to recover lost data.

Recuva is one of the most highly regarded free recovery software. It is even more effective than most premium options. To start the recovery process with Recuva, follow these steps:

Open Recuva to start the wizard. If it does not appear automatically, click the Options button and check the Show wizard on startup box.
Click Next to open the file type page.
Select all the file types you want to recover and click the “Next” button to open the file location page.
On the page, select Deep Scan if you want Recuva to do a more thorough scan. Click start.
When Recuva finishes scanning, select the files you want to retrieve and click the “Recover” button. Don’t forget to set your destination.
Click OK and wait for the restore to complete. This may take several hours. The
Recuva has several different scan options. While deep scans are the most thorough, standard or advanced scans may be suitable if you only want to recover newly created files.

Most data recovery software is capable of recovering deleted data from the hard drives of damaged computers and laptops, because the data itself will still be present. Even if you delete files manually, they will remain on your hard drive until something else appears to replace them.

Conclusion

Professional recovery services are available if you are truly at a loss. Prices change frequently depending on the size and level of damage.Specialized services will have access to industrial hardware and software that can maximize your chances of success. The only real danger when hiring a professional is that you may only have one chance to recover your files as they might have to take your hard drive apart to gain access to certain components.

In most cases – especially with regard to laptops – hardware problems will be associated with an external component such as a monitor or fan.Therefore, before you start taking out hard drives and spending money on repairs, try to establish a route for the problem. Sometimes the simplest solution, such as checking if the connections are secure, is all that is required.

It is important to set restore points and regularly back up all your data – for this we recommend using the cloud storage. Get in the
habit of doing this whenever you make significant changes to your system.Store all your data on an external hard drive to minimize risk to
.

Seagate Warranty Cancellation List

Back Surgery: When Do We Need It?

The necessity of undergoing a back surgery should always be decided after trying the nonsurgical options and processes like heat, ice, massage, etc.In cases where pain is directly related to mechanical problems in the spine and it is persistent

Back pain is a very common problem for everyone these days. Back surgery is believed to help address the causes of back pain, but is not always necessary. Back pain can be relieved on its own within three months. Back surgery may be an option if conventional methods do not work for the patient and the patient still has back pain.Back surgery is considered a solution mainly when back pain is disabling and persistent.

What signs do you need for back surgery?

The need for back surgery should always be resolved after testing non-surgical options and processes such as heating, ice, massage, etc. In cases where pain is directly related to mechanical problems in the spine and is persistent. Then it was time to speak with a specialist about the operation.

Back surgery is necessary when the nerves are compressed for many reasons, such as:

• Bone overgrowth: Bone spurs can develop on the patient’s spine due to osteoarthritis. This huge bone acts on the hinge joints at the back of the spine and narrows the space available for the nerves to travel through the holes in the spine.
• Disc Problems: Herniated or Bulging Disc – The pillows that separate the bones of the spine can sometimes cause the spine to malfunction when pressed tightly against the spinal nerve.
• Spinal arthritis. Arthritis of the spine may cause multiple movements between two vertebrae of a person; hence makes the spine very unstable. If the condition continues and the patient does not heal the problem, it can cause spinal stenosis and narrowing of the spinal canal.
• Broken vertebrae : Usually, broken vertebrae can heal on their own without any treatment, but if this does not happen, there is a need for spinal implants.A spinal implant will restore stability and be able to completely heal the vertebrae.

It is not easy to pinpoint the exact cause of back pain, even if x-rays show disc problems or even a bone spur.

Various types of back surgery

There are various types of back surgery such as:

• Discectomy : This removes a herniated disc. This process helps relieve irritation and inflammation of the nerve. Discectomy involves the removal of a complete or partial posterior portion of the lamina and allows access to the ruptured disc.
• Laminectomy: In this type of surgery, the bone that covers the spinal canal is removed. After this process, the spinal canal expands and performs the function of relieving nerve pressure caused by spinal stenosis.
• Fusion: By fusion of the spine, two or more bones are permanently connected in the spine. In this case, the pain is reduced by adding stability to the spinal fracture. Later, it sometimes eliminates painful movements between the vertebrae that are generated from a damaged or degenerated disc.
• Artificial Disc: is an alternative for the treatment of spinal fusion, which causes pain due to the movement of two vertebrae. Pain due to degenerated disc.

Before planning any surgery, consider a second opinion from a good and qualified spine surgeon. Symptoms can sometimes be misinterpreted as signs that back surgery is needed.

Spinal implants

Spinal implants play a vital role in the treatment of many forms of back pain and deformities.The main function of the implants is to unite two vertebrae and replace the natural disc material.

Implant functions as defined in Orthopedic and Laser Spine Surgery:

• Correction of spinal deformities.
• Improving and strengthening the stability of the spine.
• Facilitating the fusion of two vertebrae.

Spinal implants are classified into two groups:

• Fusion: is a surgical process that creates a connection between bones using a bone graft.Fusion spinal implants are again subdivided into three groups: cells, plates, and rods.
• Cells act as a holder of the space between two vertebrae and become part of the spine. After surgery, the cells provide support and stability and generally do not require screws.
• Plates, are usually attached to screws and help stabilize the movement of the spine.
• The rods also help stabilize the spine and connect it with hooks and pedicle screws.
• Non-fusion: is an alternative to traditional fusion. They permanently attach two or more bones in the spine.

Like any operation, a spinal implant has its pros and cons.

Advantages of spine surgery

The implant will have immediate pain relief. For many, this will be a rebirth and allow them to continue their lives normally. This implant is mainly considered when all other treatments and methods fail.A spinal implant is very cost effective in the long term. The process will then allow the patient to opt out of medication and doctor visits.

Cons of Spinal Surgery

This is an operation and has its own risks and dangers. The point is that the fusion of the spine is that it is very complex and may not bond as well as expected. Additional operations may be required later. Since this operation changes the entire anatomy of the spine, unforeseen consequences may arise in the future.There are risks of postoperative infection, as with all operations, but with the right guidance from doctors and appropriate precautions, everything will be fine. Those opposed to back surgery have other reasons why back surgery should be avoided.

Why should you avoid back surgery?

Back surgery is not a simple operation and it carries enormous risks. The first operation will not always give the best result, and there is a possibility that pain will return or the patient will need to re-operate.There are risks of infection, excessive bleeding, and nerve injury. In addition to all this, few people like to go under general anesthesia.

There have been cases where the pain was not healed after surgery and it got worse. Recovery after surgery will take a long time, up to several months. Chances are that the patient will be paralyzed and also lose flexibility. Because of all these problems, patients are not advised to directly undergo surgery. They are given alternatives and if they cannot satisfy the problem, surgery is recommended.

There is no age limit for back surgery, as back pain does not have a specific age; but this is mainly seen in the elderly. Patients over 65 and 80 years of age have benefited from back surgery and have continued their normal lives as usual. Hence, there is no age barrier for back surgery and spinal implants, and most back and spine problems can be treated with surgeries and implants in any age group.

Last but not least, it should be added that by 2024 the global spine implant market is expected to exceed more than $ 19.5 billion.US dollars. The goal of surgeons is to create smaller incisions and reduce recovery time and provide better care and outcome for patients.

More information on spinal implants and surgery can be found on the Monib-Health website.

Cannot Remove Recovery Checkpoint for Virtual Machine in DPM – Windows Server

• 09/24/2021
• Reading takes 2 minutes

This Article

This article describes an issue that is blocking the removal of a broken recovery point for a virtual machine in System Center 2012 Data Protection Manager.

Applies To: Windows Server 2012 R2
Original KB: 3059372

Symptoms

After Data Protection Manager (DPM) backup fails to remove broken recovery checkpoints for a virtual machine created by Hyper-V. If you try to do this, you will find that there is no choice for the virtual machine in the Hyper-V manager console interface.

The following command returns a list of snapshots for a VM and its type:

  Get-VMSnapshot -VMName 
  

The snapshots that Hyper-V usually takes are of the standard type.However, DPM creates snapshots of type Recovery. In the returned list, you need to delete the recovery snapshots as these are actually broken checkpoints.

Cause

How does DPM work?

Typically, DPM Hyper-V create a checkpoint for the virtual machine as part of the virtual machine backup process. After the backup is complete, DPM sends a full backup notification and then Hyper-V merges the checkpoint back into the main vhd file and deletes the file.avhd.

What Causes Broken Checkpoints?

There is a known issue whereby Windows Server leaves the virtual machine in a locked or standby state even after the backup is complete. To resolve this issue, we apply the hotfix described in Hyper-V to back up a virtual machine, leaving the virtual machine in a locked state.