Compression Fractures
Fractures of the Thoracic & Lumbar Spine
What it is
Vertebral compression fractures are quite common in the general population and are mainly due to osteoporosis. In many cases, an accurate diagnosis is not made, with the symptoms being attributed to advanced age or spondyloarthritis. Due to osteoporosis, they are more frequent in women. The risk increases after menopause, around the age of 50.
The fractures caused by osteoporosis are usually compression fractures, which means that each vertebra loses about 20% of its height in the anterior part, acquiring a wedge shape.
These fractures are more common in the thoracic vertebrae, but there is a possibility that they also appear in the lumbar spine. If they appear in the lumbar spine, they are more likely to be due to accidents or falls.
Compression Fractures
Symptoms
The first symptom is sudden pain of high intensity that worsens with any movement and is located in the midline of the spine. In some cases, it may also radiate to other parts of the trunk, always around the level of the fracture.
If diagnosis is delayed, then the pain gradually becomes more tolerable and shifts to chronic, presenting with deformed spinal column, loss of height and muscle mass, as well as pressure on intra-abdominal organs. The result of this is the development of kyphosis.
Compression Fractures
Diagnosis
Diagnosis is based on history taking, clinical examination, and radiological assessment.
Most bone fractures are revealed by plain X-ray, including details on the degree of vertebral height loss and further deformation in the upright position.
Usually, an MRI scan follows, which reveals the presence or absence of bone edema, clarifying how old the fracture is and whether there is spinal cord compression from the resulting deformation.
Compression Fractures
Treatment
Treatment begins with conservative management, which includes taking simple analgesics and anti-inflammatory drugs.
For mobilization of the patient, the use of a special belt/brace is required.
If pain persists for more than a month and a half, or if there is a possibility of spinal deformity, then surgical intervention may be the best option.
The technique the doctor will choose is individualized in each patient’s case.
It may be the classic open method (rarely) or, more commonly, minimally invasive.
Vertebroplasty – Kyphoplasty
Vertebroplasty is a method where, through the injection of acrylic cement, the fracture that has formed is stabilized.
Kyphoplasty is exactly the same method with some additional elements.
Specifically, before the cement injection, a special balloon is inserted into the fracture, which is inflated and lifts the roof of the vertebra, forming at the same time a cavity, which is then filled with the special cement.
The main indications for choosing these methods are osteoporotic fractures, metastatic disease, multiple myeloma, and hemangioma.
Posterior Percutaneous Fracture Stabilization
The purpose of the surgery is to stabilize the fracture using a posterior minimally invasive approach, so that mobilization of the patient can begin as soon as possible.
With this technique, spinal fusion is achieved with smaller incisions over each vertebra.
The procedure is performed with the least possible iatrogenic trauma to the paravertebral muscles.
The total surgery time does not exceed two hours, and hospitalization does not need to be more than 1 day.
