Compression Fracture of the Spine

Introduction

Compression fracture of the spine is a type of bone fracture that occurs in the spinal bones called as vertebrae.

Although it can occur in any vertebra of the spine but it is more frequently seen with the lower thoracic especially the T11 & T12 vertebrae. When the vertebra develops fracture the bony fragments may collapse into the vertebral body itself or get displaced into the adjacent regions like epidural space for example.

Common causes for vertebral fracture

• Osteoporosis
• Traumatic spine injury
• Metastatic tumors to the spine

Osteoporosis causes thinning and makes the bone weak so that even trivial traumas can precipitate bone fractures including that of the vertebrae.

Spinal traumas especially of severe intensity can produce a break in the vertebral bones.

Metastatic spinal tumors (cancers) when lodge in the vertebra they erode the bone, make it weaker and susceptible to fracture.

How does a patient present?

The following are some of the commonest manifestations;

• Pain in the back corresponding to the area of fracture
• Muscle stiffness in and around that area
• If pinching of the spinal nerve roots took place then pain may shoot down to the limbs from the back or neck area
• Sensory symptoms like tingling (pins and needles), numb feeling of the limbs
• If myelopathy (spinal cord damage) is present then bowel and/or bladder disturbances, paralysis of limbs, sensory loss etc may occur

Diagnosis

Radiological studies are the mainstay of diagnosis. Generally you start with a plain x ray then depending upon the severity and clinical manifestations you get a CT and/or MRI of the spine.

Both CT and MRI have their own plus and minuses. MRI is especially chosen when there is suspicion to the damage to spinal cord.

If osteoporosis or metastatic spinal cancers is suspected then relevant investigations are obtained.

Treatment

If any bony fragment is in the epidural spaces and there is myelopathy then surgery is immediately indicated. In less serious cases conservative approach is generally adopted. This would include back brace (to limit back movements), pain killers etc.

Generally the compression fracture of the spine heals in about 2 to 3 months time.

Kind of controversial treatments like kyphoplasty/vertebroplasty where a cement material is injected into the fracture site to unite the bone fragments may be tried if the back pain is persisting after several months of conservative treatment. When conservative measures fail surgical treatment is an option too.

Conditions like osteoporosis, tumors etc are to be treated appropriately.



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