Vertebral fractures with compression of the vertebral body

Vertebral fractures can occur in any area of the vertebra and at any level of the spine. However, there is one type of fracture that is very typical due to its frequency and location: vertebral body crush fractures, also called compression fractures, since they are produced by a compression mechanism.

Fractures with crushing of the vertebral body

They usually occur after a fall or an accident and are more common in women. The risk of suffering them increases with age and it is estimated that more than 40% of these fractures occur in women over 80 years of age due to the fact that crush fractures are closely related to osteoporosis which produces a weakness of the bones. Although women suffer more fractures of this type, adult men are not exempt from risk.

Characteristics

They are usually caused by a blow after a fall or an accident, but in people with severe osteoporosis they can occur with routine activities such as getting out of the shower, lifting a weight or even after sneezing. The mechanism that causes them is a compression mechanism on the vertebral body, which causes a crushing of the vertebral body. The most affected vertebrae are usually the last thoracic vertebrae or the first lumbar vertebrae, since they are the most weight-bearing.

Symptoms

Patients may experience the following symptoms (all or some of them):

  • Pain: this is the main and most constant symptom.
  • Pain increases when sitting or standing
  • Pain decreases when lying down
  • Limited mobility of the spine
  • Deformity
  • Tingling or lack of strength in the legs: in case of loss of strength in the legs, it is necessary to urgently consult a neurosurgeon specialist.

Diagnosis

After a clinical examination, the neurosurgeon may request the following tests:

  • Spine X-ray: in the X-ray the fracture and the alignment with the rest of the vertebrae can be observed.
  • CT: in this test the specialist will assess the extent of the fracture, the bony characteristics of the unaffected segments of the vertebra, and also the involvement of the spinal canal (duct in which the spinal cord is located).
  • MRI: the neurosurgeon will assess with MRI the involvement of the nerves and the spinal cord. It also makes it possible to observe the condition of the ligaments of the vertebral segments affected by the fracture.
  • Bone densitometry: evaluates the degree of osteoporosis of the patient.

Treatment: surgical or non-surgical?

In case of mild fractures, without deformity and with moderate pain (low-risk fractures), conservative treatment consisting of rest, pain relief medication and bracing may be performed. Conservative treatment may last up to 6 weeks. However, the pain should improve within days to 1-2 weeks. Otherwise, the treatment plan should be changed to surgical treatment.

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Surgical options are very effective in both almost immediate pain improvement and in avoiding fracture complications. The instability of the spine secondary to the fracture is responsible for the pain and the appearance of deformities. Surgical treatments consist of restoring to the spine the stability lost by the fracture and have a very low surgical risk. Surgery provides an effective and safe treatment for vertebral fractures.

The existing surgical treatments are:

  • Kyphoplasty

Kyphoplasty is a minimally invasive technique for the treatment of vertebral fractures. By means of a few simple punctures in the back, pain relief is achieved in patients with vertebral fractures with crushing of the vertebral body. It is a safe and quick procedure that is performed under local anesthesia and the patient can be discharged home within a few hours.

During the procedure the surgeon creates a cavity in the body of the vertebra that is filled with cement, all through the skin with a needle. This increases the strength of the vertebra and restores the shape, height and angulation of the vertebra.

  • Vertebroplasty

This is a procedure similar to kyphoplasty. Like kyphoplasty, it is performed under local anesthesia and patients are discharged within a few hours. A vertebroplasty is performed instead of a kyphoplasty when, due to the characteristics of the fracture, it is not possible to create a cavity within the body of the vertebra. In this case, the body of the affected vertebra is cemented in order to reinforce it.

  • Lumbar fusion

In the case of fractures of longer evolution, more serious or in those cases in which less invasive procedures are not possible, a lumbar fusion is performed. By means of this procedure, screws are implanted in the vertebrae above and below the fractured vertebra, so that it does not bear weight load and reinforcing the stability of the vertebral segment.

Prognosis

Surgery provides an effective and safe treatment for vertebral fractures, whether minimally invasive treatment or spinal fusion is performed. With proper treatment the prognosis is good, with pain disappearing and the fracture sealing (consolidating). Despite this, precautions should be taken, as treatment does not prevent new vertebral fractures at other levels.