What is a compression fracture of vertebrae. Vertebral Compression Fractures: Causes, Symptoms, and Treatment Options

19.10.202208.06.2023 by alexxlab

What are the main causes of vertebral compression fractures. How are vertebral compression fractures diagnosed and treated. What complications can arise from untreated vertebral compression fractures.

Содержание

Understanding Vertebral Compression Fractures: An Overview

Vertebral compression fractures (VCFs) occur when the vertebrae in the spine collapse or compress due to excessive force or weakened bone structure. These fractures primarily affect the anterior portion of the vertebral body, resulting in a characteristic wedge-shaped deformity. VCFs are considered stable fractures as they only involve the anterior column of the spine, distinguishing them from more severe burst fractures.

Who is most at risk for developing vertebral compression fractures? The two main groups affected by VCFs are:

Older adults with osteoporosis
Younger individuals involved in high-energy trauma

This bimodal distribution highlights the importance of understanding both age-related and trauma-induced causes of VCFs.

The Anatomy and Biomechanics of Vertebral Compression Fractures

To comprehend the nature of vertebral compression fractures, it’s crucial to understand the structure of the spine. The spinal column is traditionally divided into three sections:

Anterior column: Includes the anterior longitudinal ligament, anterior annulus, and the anterior portion of the vertebral body
Middle column: Comprises the posterior vertebral body, posterior annulus, and posterior longitudinal ligament
Posterior column: Contains the ligamentum flavum, neural arch, facets, and posterior ligamentous complex

In a vertebral compression fracture, only the anterior column is compromised. This limited involvement is why VCFs are generally considered stable fractures. How does this differ from other spinal fractures? In more severe injuries, such as burst fractures, the middle column is also affected, leading to greater instability and potential neurological complications.

Epidemiology: The Prevalence and Impact of Vertebral Compression Fractures

Vertebral compression fractures represent a significant health concern, particularly among older adults. Consider these striking statistics:

1 to 1.5 million VCFs occur annually in the United States
25% of women over 50 have experienced at least one VCF
40% to 50% of individuals over 80 have sustained a VCF

Where do these fractures most commonly occur? The thoracolumbar junction (T12 to L2) accounts for 60% to 75% of VCFs, while another 30% occur in the L2 to L5 region. This distribution is crucial for healthcare providers to consider when evaluating patients with back pain or suspected spinal injuries.

The Growing Concern of Osteoporosis-Related VCFs

As the population ages, the incidence of osteoporosis-related vertebral compression fractures is expected to rise. Currently, 10 million Americans have been diagnosed with osteoporosis, and another 34 million have osteopenia. How does this translate to fracture risk? Population studies show an annual incidence of 10.7 VCFs per 1000 women and 5.7 per 1000 men.

Pathophysiology: Understanding the Mechanics of Vertebral Compression Fractures

Vertebral compression fractures occur when the vertebrae are subjected to forces that exceed their structural capacity. In osteoporotic patients, even minor trauma or everyday activities can lead to fractures due to weakened bone structure. What happens during a VCF?

The anterior portion of the vertebral body compresses
The anterior longitudinal ligament may be compromised
A wedge-shaped deformity forms, with the anterior height of the vertebra reduced compared to the posterior height

In younger patients, high-energy trauma is typically required to cause a VCF. These injuries often result from motor vehicle accidents or falls from significant heights. How do these mechanisms differ in their impact on the spine? High-energy trauma can lead to more severe fracture patterns and potentially involve multiple vertebral levels.

Clinical Presentation and Diagnosis of Vertebral Compression Fractures

Recognizing the signs and symptoms of vertebral compression fractures is crucial for timely diagnosis and treatment. What are the common presenting features of VCFs?

Acute onset of back pain, often described as sharp or knife-like
Pain that worsens with standing or walking
Limited spinal mobility
Height loss over time (in cases of multiple VCFs)
Kyphotic deformity (“dowager’s hump”) in severe cases

How are vertebral compression fractures diagnosed? The diagnostic process typically involves:

Thorough patient history and physical examination
Imaging studies, including X-rays, CT scans, and MRI
Bone density scans to assess for underlying osteoporosis

The Role of Imaging in VCF Diagnosis

Imaging plays a crucial role in confirming the diagnosis of vertebral compression fractures and assessing their severity. What can different imaging modalities reveal?

X-rays: Show vertebral height loss and wedge-shaped deformities
CT scans: Provide detailed information about bone structure and fracture patterns
MRI: Useful for detecting acute fractures and assessing soft tissue involvement

These imaging studies not only confirm the presence of VCFs but also help guide treatment decisions based on the fracture’s stability and potential for progression.

Treatment Options for Vertebral Compression Fractures

The management of vertebral compression fractures aims to relieve pain, prevent further fractures, and maintain spinal stability. What are the primary treatment approaches for VCFs?

Conservative management
Minimally invasive procedures
Surgical intervention (in select cases)

Conservative Management

For many patients with stable VCFs, conservative treatment can provide significant relief. What does this approach typically involve?

Pain management with analgesics and anti-inflammatory medications
Bracing to provide support and limit painful movements
Physical therapy to improve strength and mobility
Lifestyle modifications to reduce fracture risk

Minimally Invasive Procedures

In cases where conservative management is insufficient, minimally invasive procedures may be considered. What are the main options?

Vertebroplasty: Injection of bone cement into the fractured vertebra
Kyphoplasty: Creation of a cavity within the vertebra using a balloon, followed by cement injection

These procedures aim to stabilize the fracture, relieve pain, and potentially restore some vertebral height. How effective are these interventions? Studies have shown that both vertebroplasty and kyphoplasty can provide significant pain relief and functional improvement in carefully selected patients.

Surgical Intervention

While most VCFs do not require surgery, certain cases may benefit from more extensive intervention. When might surgery be considered for vertebral compression fractures?

Neurological deficits due to spinal cord or nerve root compression
Progressive deformity or instability
Failure of conservative and minimally invasive treatments

Surgical options may include spinal fusion or the use of expandable implants to restore vertebral height and alignment.

Prevention and Long-Term Management of Vertebral Compression Fractures

Preventing future fractures is a crucial aspect of managing patients with VCFs, particularly those with underlying osteoporosis. What strategies can help reduce the risk of additional fractures?

Osteoporosis management, including medication and lifestyle changes
Fall prevention programs
Regular weight-bearing exercise and strength training
Adequate calcium and vitamin D intake
Smoking cessation

How effective are these preventive measures? Studies have shown that comprehensive osteoporosis management can significantly reduce the risk of subsequent fractures, improving patients’ quality of life and reducing healthcare costs.

The Role of Bone-Strengthening Medications

For patients with osteoporosis-related VCFs, bone-strengthening medications play a crucial role in preventing future fractures. What are the main classes of drugs used in this context?

Bisphosphonates (e.g., alendronate, risedronate)
RANK ligand inhibitors (e.g., denosumab)
Anabolic agents (e.g., teriparatide, abaloparatide)

These medications work through different mechanisms to increase bone density and reduce fracture risk. How should healthcare providers approach medication selection? The choice of treatment should be individualized based on the patient’s age, fracture risk, and potential side effects of each medication.

Complications and Long-Term Consequences of Vertebral Compression Fractures

While many patients recover well from VCFs with appropriate treatment, these fractures can lead to significant complications if left untreated or poorly managed. What are the potential long-term consequences of vertebral compression fractures?

Chronic pain and disability
Progressive spinal deformity (kyphosis)
Reduced lung function due to altered thoracic mechanics
Increased risk of future fractures
Decreased quality of life and social isolation

How can these complications be mitigated? Early diagnosis, appropriate treatment, and comprehensive follow-up care are essential in preventing or minimizing these long-term consequences. Healthcare providers should maintain a high index of suspicion for VCFs, particularly in at-risk populations, to ensure timely intervention.

The Impact of Multiple Vertebral Compression Fractures

Patients who experience multiple VCFs face additional challenges. What are the cumulative effects of recurrent vertebral compression fractures?

Significant height loss
Severe kyphotic deformity
Compromised balance and increased fall risk
Gastrointestinal issues due to altered abdominal anatomy
Psychological distress and reduced self-esteem

These compounding effects underscore the importance of aggressive fracture prevention strategies in patients who have already experienced a VCF.

The Role of Interprofessional Care in Managing Vertebral Compression Fractures

Effective management of vertebral compression fractures requires a coordinated effort from various healthcare professionals. What specialties are typically involved in the care of patients with VCFs?

Primary care physicians
Orthopedic surgeons or neurosurgeons
Pain management specialists
Physical therapists and occupational therapists
Radiologists
Endocrinologists (for osteoporosis management)

How does this interprofessional approach benefit patients? By combining expertise from multiple disciplines, healthcare teams can provide comprehensive care that addresses not only the immediate fracture but also underlying risk factors, rehabilitation needs, and long-term prevention strategies.

The Importance of Patient Education and Empowerment

Educating patients about their condition and involving them in treatment decisions is crucial for successful outcomes. What key information should be conveyed to patients with vertebral compression fractures?

The nature of their injury and its potential impact on daily life
Treatment options and their respective benefits and risks
Strategies for pain management and activity modification
The importance of adherence to medication regimens and follow-up appointments
Lifestyle changes to reduce future fracture risk

By empowering patients with knowledge and involving them in their care plan, healthcare providers can improve treatment adherence and long-term outcomes.

Vertebral Compression Fractures – StatPearls

Continuing Education Activity

Vertebral compression fractures of the spinal column occur secondary to an axial/compressive load with resultant biomechanical failure of the bone, resulting in a fracture. Vertebral compression fractures by definition compromise the anterior column of the spine, thereby resulting in compromise to the anterior half of the vertebral body and the anterior longitudinal ligament. This activity outlines the evaluation and management of vertebral compression fractures and underscores the role of the interprofessional team in improving care for the patients with this condition.

Objectives:

Explain the common physical exam findings associated with vertebral compression fractures.
Review the pathophysiology of vertebral compression fractures.
Describe the typical imaging findings associated with vertebral compression fractures.
Explain the importance of improving care coordination among the interprofessional team to enhance the delivery of care for patients with vertebral compression fractures.

Access free multiple choice questions on this topic.

Introduction

Vertebral compression fractures (VCFs) of the spinal column occur secondary to an axial/compressive (and to a lesser extent, flexion) load with resultant biomechanical failure of the bone resulting in a fracture. VCFs by definition compromise the anterior column of the spine, thereby resulting in compromise to the anterior half of the vertebral body (VB) and the anterior longitudinal ligament (ALL). This leads to the characteristic wedge-shaped deformity. [1][2][3]

VCFs do not involve the posterior half of the VB and do not involve the posterior osseous components or the posterior ligamentous complex (PLC). The former distinguishes a compression fracture from a burst fracture. The implications of these compression fractures are related to the stability of the resulting structure and potential for deformity progression. Compression fractures are usually considered stable and do not require surgical instrumentation. [4][5]

Etiology

The most common etiology of VCFs is osteoporosis, making these fractures the most common fragility fracture. However, compression fractures demonstrate a bimodal distribution with younger patients sustaining these injuries secondary to high energy mechanisms (fall from a height, MVA, etc.). [6][7][8]

Due to the ligamentous and anatomical changes noted as one travels from the thoracic to the lumbar level, inherent areas of instability make this a frequent site of injury.

For the spinal column, traditional teaching is that the column can be divided into three sections: (1) anterior column (anterior longitudinal ligament, anterior annulus, the anterior portion of the vertebral body, (2) middle column (posterior vertebral body, posterior annulus, and posterior longitudinal ligament), and (3) the posterior column (ligamentum flavum, neural arch, facets, posterior ligamentous complex). If two of these three columns are compromised, the injury is considered unstable, and the patient potentially needs surgery.

Compression fractures by definition only involve compromise to the anterior column alone. Thus, VCFs are considered “stable” fracture patterns. When the fracture pattern involves the middle column they are classified as burst fractures and lack the stability of a VCF.

Epidemiology

VCFs are the most common fragility fracture reported in the literature. Approximately 1- to 1.5 million VCFs occur annually in the United States (US) alone. Based on the age- and sex-adjusted incidence, it is estimated that 25% of women 50 years of age and older have at least one VCF.[9] Moreover, it is estimated that 40% to 50% of patients over age 80 years have sustained a VCF either acutely or recognized incidentally during clinical workup for a separate condition.[10]

Recent reports cite the thoracolumbar junction (i.e., the segment from T12 to L2) as the location afflicted with 60% to 75% of VCFs, and another 30% occur at the L2 to L5 region.

In younger patients, about 50% of spine fractures are due to motor vehicle collisions with another 25% being due to falls.

This is in stark contrast to the elderly mechanism of injury at presentation. Studies have reported an estimate of 30% of VCFs occurring while the patient is in bed. As the population continues to age, the population at risk of sustaining low energy fragility fractures will continue to increase as well. Currently, 10 million Americans are already diagnosed with osteoporosis, and another 34 million have osteopenia. The number of patients aging and having a diagnosis of osteoporosis is projected to rise.[9] Population studies have shown that the annual incidence of VCFs is 10.7 per 1000 women and 5.7 per 1000 men.

Pathophysiology

During a fall or trauma, the spinal column will rotate around a center of axis for this rotation. There is also an associated axial force applied due to this flexion/extension of the spine. An axial force more than the forces tolerable by the vertebral body leads initially to a compression fracture with more significant forces resulting in a burst fracture. The resulting kyphotic (forward flexion of the spine) deformity of the compression fracture may alter the spine biomechanics, placing additional stresses on other spine levels. The altered biomechanics risk additional fractures and progressive deformity. The occurrence of an osteoporotic compression fracture increases the risk of an additional compression fracture.

History and Physical

Initial evaluation of spine fractures, once the patient has been stabilized, includes an evaluation of the neurologic function of the arms, legs, bladder, and bowels. The keys to a thorough exam are organization and patience. Of note, many high-energy compression fractures have associated abdominal, cerebral, and extremity injuries, and these all should be evaluated. One should not only evaluate strength in addition to sensation and reflexes. It is also important to inspect the skin along the back and document the presence of tenderness to palpation. Documentation is paramount as these initial findings will likely be used as a baseline for all future evaluations.

Evaluation

Evaluation of patients with suspected back trauma includes anterior-posterior (AP) and lateral radiographs of the impacted area. In the trauma setting these initially, should be obtained supine with spine precautions until cleared by the spine team or bracing has been provided. At some point, standing radiographs in the brace are helpful to guide treatment as a supine position may artificially reduce a displaced fracture.[11][12][13]

A CT should also be obtained in all trauma settings. If there is a suspected posterior column injury not able to be confirmed on CT, an MRI will indicate disruption of the posterior ligamentous complex. Radiographs showing 30 degrees of traumatic kyphosis (forward flexion of the spine) and 50% vertebral body height loss are historically thought to be unstable fractures, but new evidence is changing this belief. Furthermore, any neurologic deficit necessitates an MRI for additional evaluation. Elderly patients with low energy compression fractures likely will not require an MRI. Serial standing lateral radiographs obtained in the clinic will help track the fracture progression and healing.

Treatment / Management

Determining the need for surgery is at times controversial. In 2005, a classification system was introduced to provide more uniformity in management and provide simple treatment recommendations. The Thoracolumbar Injury Classification and Severity (TLICS) Scale uses the integrity of the PLC, injury morphology, and neurological status of the patient to provide a score (one to ten) that can guide intervention: a score less than four leads to non-surgical treatment, greater than four suggests surgical treatment, and a score of four being managed either surgically or nonsurgically depending on the physicians’ clinical acumen. Of course, these are general guidelines, predominantly for trauma patients, and each case should be evaluated carefully. Interestingly, newer studies have shown that historical considerations such as loss of vertebral body height, segmental kyphosis, and canal compromise, do not correlate with the need for surgery in neurologically intact patients. Of note, currently, there have been no randomized trials evaluating surgery versus brace treatment in “unstable” compression fractures.[14][15][16][17]

Orthosis/bracing modalities accomplish conservative management for a period of four to 12 weeks. Discontinuation of the bracing can be considered when there is radiographic evidence of healing, and the patient no longer is tender over the fracture site. While midthoracic and upper lumbar VCFs can be treated with a thoracolumbosacral orthosis (TLSO), lower lumbar VCFs may need a lumbosacral corset for adequate immobilization. Bracing is not benign and can be difficult in a barrel-chested patient, a patient with pulmonary compromise or in an obese patient. These factors must be taken into consideration. Analgesic medications and bracing can be poorly tolerated in some patients. If bracing is not effective or poorly tolerated, the physician may alternatively consider percutaneous procedures for stabilization of the fracture.

Surgical options are largely dependent on fracture characteristics and neurologic injury. Rarely would compression fractures require instrumented stabilization. Cement augmentation in the form of vertebroplasty or kyphoplasty is the common surgical considerations for these patients. Initially developed for spinal hemangiomas, vertebroplasty is a minimally invasive procedure during which cement is injected into the vertebral body through the pedicle. Spinal alignment is improved during the procedure by supine positioning with extension; the vertebroplasty itself is not meant to restore alignment. Kyphoplasty is a procedure in which the wedge-shaped vertebra is first reduced to improve the residual local kyphotic alignment through inflation of a balloon; once vertebral height is restored, cement is injected. For patients that have failed a trial of conservative treatment or are hospitalized due to pain and decreased function associated with a VCF, cement augmentation should be considered.[9] Recent randomized controlled trials have shown kyphoplasties allowing for significantly more rapid improvement in the quality of life, function, pain, and mobility. [18]

Differential Diagnosis

When evaluating a patient with back pain and a suspected VCF, several other diagnoses must be excluded. Prior to imaging, one must think of nonspinal etiologies for the pain such as musculoskeletal, pulmonary, abdominal, renal or vascular depending on the location of the pain. If a vertebral body fracture is identified on imaging, a close inspection of the posterior vertebral body cortex and of the posterior spinal column structures must be performed to rule out a more unstable fracture pattern.

Prognosis

In elderly patients with osteoporotic compression fractures, there is an increase in mortality compared with age-matched controlled. Survival rates have been cited to be 53.9% at 3 years, 30.9% at 5 years and 10.5% at 7 years.[19]

Complications

Nonoperative management of these fractures can lead to continued back pain and progression of a kyphotic deformity. There is a high likelihood of patients having a progression of vertebral body collapse in addition to having additional fractures in the future.

With cement augmentation, there have been several complications identified. There have been case reports of neurologic injury during the procedure, but this a rare occurrence. The increased stiffness of a vertebral body filled with cement causes increased stress on the adjacent levels which can lead to secondary fractures. As mentioned above, however, the patients in this population are often at risk for this regardless of operative treatment. Most patients will experience cement extravasation, but this does not seem to have much clinical significance. Embolization of the cement occurs rarely, but it can lead to devastating complications such as pulmonary embolism or stroke.[9]

Pearls and Other Issues

The most important consideration when evaluating fractures of the spine should be the neurologic exam as compression of the spinal canal may alter treatment options. Regarding a kyphoplasty treatment for compression fractures, several contraindications should be remembered. These include current neurologic compromise, burst fractures (fractures of the posterior vertebral body wall), spine infections, current sepsis, or underlying bleeding diatheses. Not addressed above are patients with diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS). Both of these result in brittle spinal columns and a fracture of any type should be considered unstable and require CT, MRI, and potentially surgery.

Enhancing Healthcare Team Outcomes

Patients with vertebral fractures are often managed by an interprofessional team that includes an orthopedic nurse specialist, emergency department physician, neurologist, radiologist, neurosurgeon, physical therapist, and an intensivist. All patients with severe injuries and neurological deficits are monitored in the ICU by trauma nurses. Complications should be discussed and reported to the team. Mild injuries may be managed with conservative care but severe injuries with neurological deficits may require surgery. Due to the pain involved, the pharmacist should assist with pain management medication selection and monitoring for clinical effect. The prognosis of these patients is dependent on age, type and extent of the injury, other associated injuries, the presence of neurological deficits and the need for mechanical ventilation.[20][21] (Level V)

Review Questions

Access free multiple choice questions on this topic.
Comment on this article.

Figure

The Thoracolumbar Injury Classification and Severity (TLICS) Score. Contributed by Chester J Donnally III, MD

References

1.: Urrutia J, Besa P, Piza C. Incidental identification of vertebral compression fractures in patients over 60 years old using computed tomography scans showing the entire thoraco-lumbar spine. Arch Orthop Trauma Surg. 2019 Nov;139(11):1497-1503. [PubMed: 30900019]
2.: Liu J, Liu Z, Luo J, Gong L, Cui Y, Song Q, Xiao PF, Zhou Y. Influence of vertebral bone mineral density on total dispersion volume of bone cement in vertebroplasty. Medicine (Baltimore). 2019 Mar;98(12):e14941. [PMC free article: PMC6709149] [PubMed: 30896660]
3.: Shi G, Feng F, Hao C, Pu J, Li B, Tang H. A case of multilevel percutaneous vertebroplasty for vertebral metastases resulting in temporary paraparesis. J Int Med Res. 2020 Feb;48(2):300060519835084. [PMC free article: PMC7581983] [PubMed: 30880529]
4.: Chen YC, Zhang L, Li EN, Ding LX, Zhang GA, Hou Y, Yuan W. Unilateral versus bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures in elderly patients: A meta-analysis. Medicine (Baltimore). 2019 Feb;98(8):e14317. [PMC free article: PMC6408113] [PubMed: 30813133]
5.: Clerk-Lamalice O, Beall DP, Ong K, Lorio MP. ISASS Policy 2018-Vertebral Augmentation: Coverage Indications, Limitations, and/or Medical Necessity. Int J Spine Surg. 2019 Jan;13(1):1-10. [PMC free article: PMC6383452] [PubMed: 30805279]
6.: Maempel JF, Maempel FZ. The speedboat vertebral fracture: a hazard of holiday watersports. Scott Med J. 2019 May;64(2):42-48. [PubMed: 30426854]
7.: Zarghooni K, Hopf S, Eysel P. [Management of osseous complications in multiple myeloma]. Internist (Berl). 2019 Jan;60(1):42-48. [PubMed: 30560368]
8.: Donnally CJ, Rivera S, Rush AJ, Bondar KJ, Boden AL, Wang MY. The 100 most influential spine fracture publications. J Spine Surg. 2019 Mar;5(1):97-109. [PMC free article: PMC6465452] [PubMed: 31032444]
9.: Savage JW, Schroeder GD, Anderson PA. Vertebroplasty and kyphoplasty for the treatment of osteoporotic vertebral compression fractures. J Am Acad Orthop Surg. 2014 Oct;22(10):653-64. [PubMed: 25281260]
10.: Kim HJ, Park S, Park SH, Park J, Chang BS, Lee CK, Yeom JS. Prevalence of Frailty in Patients with Osteoporotic Vertebral Compression Fracture and Its Association with Numbers of Fractures. Yonsei Med J. 2018 Mar;59(2):317-324. [PMC free article: PMC5823836] [PubMed: 29436202]
11.: Expert Panels on Neurological Imaging, Interventional Radiology, and Musculoskeletal Imaging: Shah LM, Jennings JW, Kirsch CFE, Hohenwalter EJ, Beaman FD, Cassidy RC, Johnson MM, Kendi AT, Lo SS, Reitman C, Sahgal A, Scheidt MJ, Schramm K, Wessell DE, Kransdorf MJ, Lorenz JM, Bykowski J. ACR Appropriateness Criteria^® Management of Vertebral Compression Fractures. J Am Coll Radiol. 2018 Nov;15(11S):S347-S364. [PubMed: 30392604]
12.: Acaroğlu E, Nordin M, Randhawa K, Chou R, Côté P, Mmopelwa T, Haldeman S. The Global Spine Care Initiative: a summary of guidelines on invasive interventions for the management of persistent and disabling spinal pain in low- and middle-income communities. Eur Spine J. 2018 Sep;27(Suppl 6):870-878. [PubMed: 29322309]
13.: Musbahi O, Ali AM, Hassany H, Mobasheri R. Vertebral compression fractures. Br J Hosp Med (Lond). 2018 Jan 02;79(1):36-40. [PubMed: 29315051]
14.: Alpantaki K, Dohm M, Korovessis P, Hadjipavlou AG. Surgical options for osteoporotic vertebral compression fractures complicated with spinal deformity and neurologic deficit. Injury. 2018 Feb;49(2):261-271. [PubMed: 29150315]
15.: Bernardo WM, Anhesini M, Buzzini R., Brazilian Medical Association (AMB). Osteoporotic vertebral compression fracture – Treatment with kyphoplasty and vertebroplasty. Rev Assoc Med Bras (1992). 2018 Mar;64(3):204-207. [PubMed: 29641781]
16.: Parreira PCS, Maher CG, Megale RZ, March L, Ferreira ML. An overview of clinical guidelines for the management of vertebral compression fracture: a systematic review. Spine J. 2017 Dec;17(12):1932-1938. [PubMed: 28739478]
17.: Genev IK, Tobin MK, Zaidi SP, Khan SR, Amirouche FML, Mehta AI. Spinal Compression Fracture Management: A Review of Current Treatment Strategies and Possible Future Avenues. Global Spine J. 2017 Feb;7(1):71-82. [PMC free article: PMC5400164] [PubMed: 28451512]
18.: Anderson PA, Froyshteter AB, Tontz WL. Meta-analysis of vertebral augmentation compared with conservative treatment for osteoporotic spinal fractures. J Bone Miner Res. 2013 Feb;28(2):372-82. [PubMed: 22991246]
19.: Lau E, Ong K, Kurtz S, Schmier J, Edidin A. Mortality following the diagnosis of a vertebral compression fracture in the Medicare population. J Bone Joint Surg Am. 2008 Jul;90(7):1479-86. [PubMed: 18594096]
20.: Watanabe Y, Ishikawa S, Nagata H, Kojima M. Determinants Associated with Prolonged Hospital Stays for Patients Aged 65 Years or Older with a Vertebral Compression Fracture in a Rural Hospital in Japan. Tohoku J Exp Med. 2019 Jan;247(1):27-34. [PubMed: 30651405]
21.: Crouser N, Malik AT, Jain N, Yu E, Kim J, Khan SN. Discharge to Inpatient Care Facility After Vertebroplasty/Kyphoplasty: Incidence, Risk Factors, and Postdischarge Outcomes. World Neurosurg. 2018 Oct;118:e483-e488. [PubMed: 30257300]

: Disclosure: Chester Donnally III declares no relevant financial relationships with ineligible companies.
: Disclosure: Christine DiPompeo declares no relevant financial relationships with ineligible companies.
: Disclosure: Matthew Varacallo declares no relevant financial relationships with ineligible companies.

Vertebral Compression Fractures – StatPearls

Continuing Education Activity

Objectives:

Explain the common physical exam findings associated with vertebral compression fractures.
Review the pathophysiology of vertebral compression fractures.
Describe the typical imaging findings associated with vertebral compression fractures.
Explain the importance of improving care coordination among the interprofessional team to enhance the delivery of care for patients with vertebral compression fractures.

Access free multiple choice questions on this topic.

Introduction

Etiology

Due to the ligamentous and anatomical changes noted as one travels from the thoracic to the lumbar level, inherent areas of instability make this a frequent site of injury.

Epidemiology

Recent reports cite the thoracolumbar junction (i.e., the segment from T12 to L2) as the location afflicted with 60% to 75% of VCFs, and another 30% occur at the L2 to L5 region.

In younger patients, about 50% of spine fractures are due to motor vehicle collisions with another 25% being due to falls.

Pathophysiology

History and Physical

Evaluation

Treatment / Management

Differential Diagnosis

Prognosis

Complications

Pearls and Other Issues

Enhancing Healthcare Team Outcomes

Review Questions

Access free multiple choice questions on this topic.
Comment on this article.

Figure

The Thoracolumbar Injury Classification and Severity (TLICS) Score. Contributed by Chester J Donnally III, MD

References

1.: Urrutia J, Besa P, Piza C. Incidental identification of vertebral compression fractures in patients over 60 years old using computed tomography scans showing the entire thoraco-lumbar spine. Arch Orthop Trauma Surg. 2019 Nov;139(11):1497-1503. [PubMed: 30900019]
2.: Liu J, Liu Z, Luo J, Gong L, Cui Y, Song Q, Xiao PF, Zhou Y. Influence of vertebral bone mineral density on total dispersion volume of bone cement in vertebroplasty. Medicine (Baltimore). 2019 Mar;98(12):e14941. [PMC free article: PMC6709149] [PubMed: 30896660]
3.: Shi G, Feng F, Hao C, Pu J, Li B, Tang H. A case of multilevel percutaneous vertebroplasty for vertebral metastases resulting in temporary paraparesis. J Int Med Res. 2020 Feb;48(2):300060519835084. [PMC free article: PMC7581983] [PubMed: 30880529]
4.: Chen YC, Zhang L, Li EN, Ding LX, Zhang GA, Hou Y, Yuan W. Unilateral versus bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures in elderly patients: A meta-analysis. Medicine (Baltimore). 2019 Feb;98(8):e14317. [PMC free article: PMC6408113] [PubMed: 30813133]
5.: Clerk-Lamalice O, Beall DP, Ong K, Lorio MP. ISASS Policy 2018-Vertebral Augmentation: Coverage Indications, Limitations, and/or Medical Necessity. Int J Spine Surg. 2019 Jan;13(1):1-10. [PMC free article: PMC6383452] [PubMed: 30805279]
6.: Maempel JF, Maempel FZ. The speedboat vertebral fracture: a hazard of holiday watersports. Scott Med J. 2019 May;64(2):42-48. [PubMed: 30426854]
7.: Zarghooni K, Hopf S, Eysel P. [Management of osseous complications in multiple myeloma]. Internist (Berl). 2019 Jan;60(1):42-48. [PubMed: 30560368]
8.: Donnally CJ, Rivera S, Rush AJ, Bondar KJ, Boden AL, Wang MY. The 100 most influential spine fracture publications. J Spine Surg. 2019 Mar;5(1):97-109. [PMC free article: PMC6465452] [PubMed: 31032444]
9.: Savage JW, Schroeder GD, Anderson PA. Vertebroplasty and kyphoplasty for the treatment of osteoporotic vertebral compression fractures. J Am Acad Orthop Surg. 2014 Oct;22(10):653-64. [PubMed: 25281260]
10.: Kim HJ, Park S, Park SH, Park J, Chang BS, Lee CK, Yeom JS. Prevalence of Frailty in Patients with Osteoporotic Vertebral Compression Fracture and Its Association with Numbers of Fractures. Yonsei Med J. 2018 Mar;59(2):317-324. [PMC free article: PMC5823836] [PubMed: 29436202]
11.: Expert Panels on Neurological Imaging, Interventional Radiology, and Musculoskeletal Imaging: Shah LM, Jennings JW, Kirsch CFE, Hohenwalter EJ, Beaman FD, Cassidy RC, Johnson MM, Kendi AT, Lo SS, Reitman C, Sahgal A, Scheidt MJ, Schramm K, Wessell DE, Kransdorf MJ, Lorenz JM, Bykowski J. ACR Appropriateness Criteria^® Management of Vertebral Compression Fractures. J Am Coll Radiol. 2018 Nov;15(11S):S347-S364. [PubMed: 30392604]
12.: Acaroğlu E, Nordin M, Randhawa K, Chou R, Côté P, Mmopelwa T, Haldeman S. The Global Spine Care Initiative: a summary of guidelines on invasive interventions for the management of persistent and disabling spinal pain in low- and middle-income communities. Eur Spine J. 2018 Sep;27(Suppl 6):870-878. [PubMed: 29322309]
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15.: Bernardo WM, Anhesini M, Buzzini R., Brazilian Medical Association (AMB). Osteoporotic vertebral compression fracture – Treatment with kyphoplasty and vertebroplasty. Rev Assoc Med Bras (1992). 2018 Mar;64(3):204-207. [PubMed: 29641781]
16.: Parreira PCS, Maher CG, Megale RZ, March L, Ferreira ML. An overview of clinical guidelines for the management of vertebral compression fracture: a systematic review. Spine J. 2017 Dec;17(12):1932-1938. [PubMed: 28739478]
17.: Genev IK, Tobin MK, Zaidi SP, Khan SR, Amirouche FML, Mehta AI. Spinal Compression Fracture Management: A Review of Current Treatment Strategies and Possible Future Avenues. Global Spine J. 2017 Feb;7(1):71-82. [PMC free article: PMC5400164] [PubMed: 28451512]
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: Disclosure: Chester Donnally III declares no relevant financial relationships with ineligible companies.
: Disclosure: Christine DiPompeo declares no relevant financial relationships with ineligible companies.
: Disclosure: Matthew Varacallo declares no relevant financial relationships with ineligible companies.

Treatment of a compression fracture of the spine in Moscow at the Dikul clinic: prices, appointments

Compression fractures of the spine are quite common, especially in the elderly. A compression fracture occurs with significant pressure on the spine and simultaneous flexion. The anterior sections of the vertebrae and discs are most damaged during compression. The anterior part of the vertebral body is flattened and takes on a wedge-shaped shape. In rare cases, compensatory extrusion of the posterior part of the vertebra into the spinal canal with compression of the spinal cord is possible. These fractures are very severe and are rare. ?? Compression fractures of the spine, most often, are located in the location of the 11th and 12th thoracic vertebrae, as well as the first lumbar vertebra. Localization in other areas of the spine is possible, but less common. Treatment of a compression fracture of the spine depends on the genesis and severity.

Types of compression fractures

Compression fractures according to severity are divided into: complicated and uncomplicated

Fractures without complications, that is, without the threat of damage to the spinal cord, are also divided into subtypes:

The height of the anterior part of the vertebral body decreases by less than 50 %;
Compression reduces the height of the vertebral body by half;
The height of the vertebra is significantly reduced – more than half.

Complicated compression fractures pose a health risk both in the short and long term. In a complicated compression fracture, not only the vertebrae are damaged, but also the structures inside the spinal canal. According to statistics, such fractures account for only 5-6% of all diagnosed injuries of the musculoskeletal system. Most often, the cervical vertebrae are subject to severe fractures, as they are the most vulnerable and fragile, but such fractures can also occur in the thoracic and lumbar spine. Rough, mechanical trauma to the cervical vertebrae C1 and C2 is considered fatal. The vertebrae of the thoracic spine with a complex form of a compression fracture are subject to dislocations and cracks, as a result, the expanded or broken edges of the vertebra put pressure on the soft tissues in the middle part of the back, and then on the spinal cord. Since the spinal canal in the thoracic spine has very little empty space, deformed parts of the vertebrae damage the spinal cord and cause it to dislocate. In the thoracic spine, the Th21 and Th22 vertebrae are most susceptible to compression fractures. In the lumbar region, where the greatest axial load, the vertebrae L (1 and 2) are damaged

Causes of a compression fracture of the spine

Compression fractures of the vertebrae occur due to the effect of a force vector on the axis of the spine, for example, during an injury episode (fall from a height onto the legs or buttocks).
Violations of the strength of bone tissue, for example, in osteoporosis, when the risk of a compression fracture increases sharply and can occur even with small power loads. These fractures are more common in older people or people with pre-existing problems in the spine that have contributed to the weakening of bone strength.
Bone infection such as osteomyelitis or tuberculosis (Pott’s disease) may also predispose to vertebral fracture.
When the bone structure is weakened, the vertebrae compresses under the weight of the vertebrae above, thinning the bone and causing a fracture. The reason for this may be various degenerative changes in the spine
Compression fractures of the spine may also result from motor vehicle accidents.
Malignancies leading to vertebral fractures are most often metastases rather than primary bone tumors. The primary foci of cancer, which often give hematogenous metastases to the spine, include prostate, kidney, breast and lung cancer. Melanoma is a less common but most aggressive cause of spinal metastasis. The most common primary spinal cancers are multiple myeloma and various sarcomas, which can also present with compression fractures.
Benign tumors such as aneurysmal bone cyst and hemangioma can also cause vertebral compression fractures.
Parathyroid disease can also lead to a decrease in bone strength due to increased release of parathyroid hormone, which is most often the case with an adenoma of the gland.

Symptoms

The main symptoms that accompany compression fractures of the spine:

Pain at the fracture site, usually in the lower back.
Patients with complex compression fractures usually assume a forced forward leaning posture.
Possible pain in the lower limbs
Numbness, tingling and weakness in the extremities usually indicate the presence of compression of the roots or spinal cord
Urinary or urinary incontinence or inability to voluntarily urinate is a sign that the fracture is accompanied by spinal cord compression.
Compression fractures of the vertebrae associated with a weakening of the bone tissue may present with little pain or no symptoms at all. Sometimes the pain is localized in the area of the fracture. A change in the height of the vertebra leads to excessive stress on the muscles of the spine, which leads to fatigue and muscle pain. As a rule, such pains disappear in a few weeks.
Traumatic compression fractures can cause severe back pain that radiates to the legs. If the fracture severely damages the vertebral body, bone fragments can protrude into the spinal canal and lead to spinal cord compression. In such cases, corresponding neurological symptoms (paresis or paralysis, sensory disturbances, dysfunction of the pelvic organs) will appear below the site of spinal cord compression. Traumatic fractures often lead to the development of kyphosis.

Diagnosis

Diagnosis is made on the basis of symptoms, medical history, examination and data from instrumental examinations.

X-ray

This is the standard test for diagnosing vertebral compression fractures. For a complete diagnosis, it is necessary to conduct anterior and lateral images. It is also possible to take pictures with flexion and extension to determine gross instability.

MSCT (CT)

CT scan is an invaluable method for diagnosing complex fractures and allows visualization of even minor violations of the integrity of the bone tissue of the vertebrae. CT scan also visualizes well the degree of narrowing of the spinal canal.

CT scanning is recommended for all patients with more than 50% reduction in vertebral height to rule out fractures in the middle and posterior parts of the vertebra.

MRI

MRI is necessary in cases where there is motor or sensory impairment in the lower extremities. Radicular pain or suspected spinal cord compression is also an indication for MRI.

Magnetic resonance imaging is important because it provides the best visualization of the spinal nerve structures. In addition, MRI can be performed using contrast, which allows for better diagnosis of conditions such as hemorrhage, tumor or infection with the greatest sensitivity.

Densitometry

The Dual Energy X-Ray Absorptiometry (DRA) scan more accurately identifies even small changes in bone mass and can be used to examine the spine and extremities.

Positron emission tomography (PET)

PET scan is used to differentiate benign compression fractures from malignant fractures of oncological origin.

Treatment

Conservative treatment

Most patients with spinal compression fractures do not require surgery and complete recovery occurs within a few months, with simple medical treatments, rest and a special brace.

Medications

Most patients with acute fractures receive analgesics. With the help of pain control, the patient can easily get up and move around and avoid problems arising from immobilization.

Corsetting

Most patients are prescribed a rigid corset, which is selected individually. The corset allows you to dramatically reduce the range of motion and fix a broken vertebra. Patients who wear a special brace may be able to move, but are significantly limited in strenuous activities such as lifting and bending.

Activity control . Bed rest is usually recommended for several days, as prolonged immobilization leads to weakening of the muscular corset, and in the presence of osteoporosis, to further loss of bone mass and progression of osteoporosis.

Correction of osteoporosis . Bone strengthening drugs such as bisphosphonates (Actonel, Boniva, and Fosamax) help stabilize or restore bone loss. This is a critical part of treatment that helps prevent further fractures from axial loads on the vertebrae.

Exercise therapy

Physical activity is of great importance in the rehabilitation of a patient after a compression fracture of the spine.

Rehabilitation periods can be divided into 4 stages:

The first stage lasts during the first or second week after the injury. The task of this period is to increase the patient’s motor activity and muscle recovery after immobilization.

The second stage starts one month after the injury. The main task of rehabilitation is to stimulate blood circulation in the damaged area, increase motor activity. It is possible to connect light exercises to restore the muscular corset.

Stage 3 starts a few months after the injury. The task of this stage of rehabilitation is to restore the mobility of the motor segments of the spine. During this period, the intensity and duration of exercise therapy increases. Gymnastic exercises can be supplemented with weight exercises.

Stage 4 lasts from the moment the patient resumes independent movements until the actual complete recovery. Complexes of exercise therapy exercises are aimed at the complete restoration of both the mobility of the spine and posture.

During this period of rehabilitation, there is a smooth transition to the full axial load of the injured spine.

Rehabilitation after traumatic vertebral fractures can be quite a lengthy process. As a rule, full recovery occurs within 6-12 months.

Surgical treatment

Surgical treatment of vertebral compression fractures is required for complicated fractures. They may be using open surgery techniques or using minimally invasive techniques. Open surgeries are performed for severe trauma when bone fragments damage the spinal cord and spinal roots.

Minimally invasive methods are used more widely, since muscle and bone damage is minor during surgery, which reduces the risk of complications and allows the damaged bone to recover faster. The main techniques are:

vertebroplasty
kyphoplasty

Vertebroplasty

This procedure is most useful for reducing pain. It also strengthens damaged bone, allowing patients to recover faster. Using a needle, under X-ray control, a cementing agent, polymethyl methacrylate (PMMA), is injected into the area of the vertebral fissure. The cement hardens within 15 minutes. This fixes the bone and prevents further destruction and reduces pain in more than 80% of patients.

Kyphoplasty

Kyphoplasty is another surgical treatment for vertebral compression fractures. As with vertebroplasty, this procedure reduces severe pain and strengthens the cracked bone. In addition, the technique avoids the development of kyphosis in the future.

Prognosis

In general, the prognosis after simple compression fractures is good for most patients who recover fully or with mild back pain. Vertebroplasty and kyphoplasty have improved the chances of recovery in patients with chronic back pain and conservative therapy failure. These procedures have proven to be effective and are widely used.
The prognosis for patients with traumatic compression fractures is largely based on neurological symptoms and is related to the degree of impact of the injured vertebra on the root or spinal cord.
Patients with compression fractures due to spinal cord infections have a generally favorable prognosis. According to statistics, two thirds of patients with fractures associated with purulent osteomyelitis have a good chance of recovery. At the same time, with tuberculous genesis of compression fractures in some patients, neurological symptoms do not disappear and patients lose their ability to work.
Most vertebral compression fractures caused by osteoporosis stabilize within eight weeks. With adequate medical correction and prevention of falls, repeated fractures can be avoided.

Treatment

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Compression fracture of the spine: causes, symptoms, diagnosis, treatment

Injuries to the spine can lead to disability, reduced quality of life and even disability of the patient. One of the most common spinal injuries is a compression fracture of the spine. This is the name of damage to the body of one or more vertebrae, accompanied by their compression and a decrease in height. In the injured areas, the nerve roots are infringed, blood circulation is disturbed, which in turn leads to a violation of the nervous regulation. The main symptom of a compression fracture is pain, aggravated by movement, and limited mobility in the damaged spine. The leading methods of rehabilitation are wearing a corset, physiotherapy exercises, a course of massage, physiotherapy.

What is a compression fracture of the spine

The vertebral column performs a supporting function for the human body, protects the spinal cord and participates in the movements of the trunk and head. It consists of five departments, together including 32 cylindrical vertebrae. The height of their anterior and posterior sections is the same. All vertebrae are interconnected by intervertebral discs, facet joints and ligamentous-muscular apparatus. This structure of the spine allows a person to keep his body in an upright position, while maintaining its mobility. The physiological curves of the spinal column increase its elasticity and help to soften the load created when walking, running, jumping.

A compression fracture occurs when there is simultaneous compression and flexion of the spine. A strong pressure is formed on the anterior sections of the vertebrae, which leads to their wedge-shaped deformation and a decrease in height. Damage exclusively to the anterior column of the vertebral bodies is a hallmark of compression fractures.

Neurological symptoms – paralysis and loss of sensation may be absent, since compression of the spine (compression due to traumatic force) does not always lead to damage to the spinal cord. However, if the spinal cord is compressed by displaced vertebrae or a disc, a neurological deficit will still occur.

Most often, doctors encounter fractures in the lumbar and lower thoracic spine. Compression injuries of the cervical spine occur less frequently.

Types of compression fractures

Depending on the location of the injury, there are:

compression fracture of the cervical spine;
Compression fracture of the thoracic spine
compression fracture of the lumbar spine;
compression fracture of the sacral and coccygeal sections.

If several departments are damaged at once, the injuries are considered multiple.

Depending on the degree of deformation of the vertebra, there are:

fracture of the 1st degree — the height of the vertebra decreases by less than ½ of its size;
II degree fracture – height is reduced by 50%;
III degree fracture – height is reduced by more than 50%.

In case of injury of the 1st degree, the stability of the spine is not disturbed. Fractures II and III degree lead to a violation of the stability of the spinal column.

Depending on the presence of complications, there are uncomplicated and complicated types of fractures. Complicated ones are characterized by the development of neurological disorders.

Causes

Main causes of compression fractures:

jumping from a height on straightened legs;
falls from a height on the back, on the buttocks;
traffic accidents;
natural or industrial disasters.

In young and middle-aged patients, compression injuries may be the result of non-compliance with safety precautions during active sports, trampoline jumping.

Compression fractures in elderly patients are often associated with the development of osteoporosis. Bone tissue loses its density and becomes unable to withstand not only high, but also quite adequate loads.

Another likely cause of a compression fracture is the involvement of the spinal column by cancer metastases. Metastases destroy the vertebral bodies. Fractures can occur even with minimal loads, such as sharp bends.

Symptoms

The main clinical symptom of a compression fracture is pain in the injured area, such as the lumbar or thoracic region. The manifestations of the pain syndrome are quite diverse. Pain can be diffuse or localized, constant or intermittent. In the first days after injury, the following symptoms are possible:

forced adoption of a certain body position;
swelling, redness of the skin;
weakness in lower limbs;
desensitization.

Compression fractures of the cervical vertebrae may cause pain radiating to the back of the head.

The appearance of pathological reflexes (their presence can be determined by a neurologist during an internal examination), progressive muscle weakness, paralysis of the limbs, loss of sensation indicate damage to the spinal cord.

Complications

The risk of complications increases with grade 2 and 3 compression fractures. In the affected parts of the spine, increased mobility develops, which leads to increased pain both during movement and at rest. The long-term consequences of a compression fracture of the spine include the acceleration of degenerative processes in the intervertebral discs, which increases the risk of osteochondrosis, protrusions, and hernias.

Improper fusion of the vertebrae may cause kyphotic curvature of the spine (curvature in the anterior-posterior plane), formation of a hump

Diagnosis the vertebra remains intact

It is necessary to perform an x-ray of the spine, take pictures in two projections – frontal and lateral. Lateral projections have the greatest diagnostic value. The radiograph will show a decrease in the height of the vertebrae and their wedge-shaped deformity.

If necessary, assess the condition of the ligaments and cartilage of the spine, as well as the appearance of neurological symptoms, an MRI of the spine is prescribed. As a rule, when performing a tomography, only the damaged part of the spine is examined. But if there are indications, the entire spine can be scanned as well.

Treatment

Successful treatment of a compression fracture requires restriction of the patient’s mobility. For several weeks, bed rest may be prescribed (you can not sit, get up on your feet). Doctors also prescribe long-term wearing of a corset. The corset provides the spine with additional support, prevents displacement of the vertebrae, and promotes favorable fusion of the injury. To relieve severe pain, painkillers, anti-inflammatory drugs, blockades are used.

Treatment of compression fractures of the spine in elderly patients has its own difficulties associated with the rapid development of degenerative-dystrophic processes in them. This leads to the progression of neurological symptoms. Elderly patients are shown strict adherence to bed rest. Bed rest helps protect the back from stress, but at the same time provokes the formation of bedsores, congestion in the lungs. For these reasons, the rehabilitation of elderly patients may take a longer time – more than six months.

There are several basic methods for the rehabilitation of patients.

Therapeutic physical training (LFK)

Therapeutic gymnastics includes general developmental exercises for the muscles of the limbs and torso, breathing exercises.

The main goals of exercise therapy:

increase in the general tone of the body,
improvement of regenerative processes,
formation and strengthening of the muscular corset,
improving the functioning of internal organs,
gradual adaptation of the spine to vertical loading.

Exercises also train the vestibular apparatus, improve spinal mobility.

Physiotherapy

Physiotherapy procedures accelerate tissue regeneration, improve blood circulation, help relieve pain. Doctors use the following methods:

electromyostimulation – exposure to electric current pulses;
magnetotherapy – exposure to a constant or variable low-frequency magnetic field;
shock wave therapy (SWT) – the use of acoustic shock waves of low power;
UV – use of ultraviolet radiation;
electrophoresis – exposure to direct electric current in combination with the introduction of various medicinal substances through the skin.

The volume of the course of physiotherapy is determined by the severity of the injury.

Massage

Massage complements and reinforces the results of exercise therapy and physiotherapy. For the rehabilitation of patients, different types of massage are used: manual, segmental, acupressure, hardware.

Treatment can be supplemented with acupuncture, HILT-therapy (high-intensity laser exposure).

The average duration of treatment is up to six months. After 6 months, most patients recover their ability to work.

Prevention

Prevention of compression fractures involves reducing injuries at work and at home. When playing sports, outdoor activities, you must follow the general safety rules. In old age, it is advisable to pay more attention to the health of the musculoskeletal system. With confirmed osteoporosis, it is necessary to conduct complex treatment with a diet, taking hormonal drugs, calcium and vitamin D supplements.

Which doctor treats a compression fracture of the spine

For the treatment of compression fractures of the spine, you should contact an orthopedic traumatologist. Also, a neurologist, physiotherapist, exercise therapy doctor can take part in the rehabilitation of the patient.

Where can a compression fracture of the spine be treated? Qualified traumatologists-orthopedists and neurologists work here. The center has modern diagnostic equipment: x-ray machines, tomographs. With their help, you can determine the severity of the injury. The center’s specialists have developed rehabilitation programs designed for patients with spinal injuries and movement disorders. They include many techniques:

physiotherapy exercises;
manual therapy;
reflexology;
physiotherapy;
massage.

The benefits of contacting the Kuntsevo Center are the opportunity to undergo a complete diagnostic examination of the spine, get advice from several specialized doctors. Physiotherapy, physiotherapy exercises are carried out under the supervision of specialists. Appointments can be made by phone.