Compression Fracture of the Spineback to "Crash"

from: DynoMed   (Another interesting site is Spine University - has a good diagramme of a compression fracture.)

A Quick Overview of the Spine:
Your spine, or backbone, consists of the column of 33 bones and tissue that extends from your skull down to your pelvis.  Providing the support of your head and body, your backbone encloses and protects a cylinder of nerve tissues, called the spinal chord.  The 33 bones in your spine are called vertebrae (one is called a vertebra).  The upper 24 vertebrae join together like links in a chain.  In between each vertebra is an intervertebral disk, a band of cartilage that acts as a shock absorber between the vertebrae.  When someone has a “slipped disk,” he or she has an intervertebral disc that has slipped out of position, thus causing friction between two vertebrae and extreme pain from nerves being exposed.  The lowest nine vertebrae are fused (joined) together in two groups, forming the sacrum and coccyx.

The cervical vertebrae are the seven vertebrae that form the upper part of your spine, between the skull and the chest.

The thoracic vertebrae are the 12 bones between your neck and your lower back.  Thoracic vertebrae have cup-shaped surfaces called facets, in which the ribs rest and connect to the spine.  These ‘joints’ help the ribs to move up and down during breathing.

The lumbar vertebrae are the five largest and strongest of all vertebrae.  They are found in your lower back between the chest and hips.  The strong muscles of the back are attached to the lumbar vertebrae.

Your sacrum and coccyx are the bones found at the base of your spine.  The triangular sacrum—made up of five vertebrae fused together—supports the spine and connects it to the pelvis.  Your coccyx, or tailbone, is formed from four fused vertebrae and has little function.

The vertebral foramen is the hollow part of the vertebrae where the spinal chord (nerve tissues) attaches to your brain and sends signals all over your body.

What is a Compression Fracture of the Spine?
Compression fractures of the spine, also known as vertebral compression fractures, are a specific kind of bone break involving the vertebrae of the spine. With spinal injuries, the location of the damage is generally described in terms of the nearest affected vertebrae.  Compression fractures most often occur in what is known as the ‘thoracolumbar’ range of bones in the back: specifically, they happen at the point where the thoracic (thoracolumbar) vertebrae of the midback meet those of the lumbar region of the lower back.

There are 12 thoracic vertebrae, numbered T1 – T12, and 5 lumbar vertebrae, numbered L1 – L5. Fractures can occur in one or more bones from a single injury. Compression fractures almost always affect the T12 and L1 vertebrae together, as in an injury that occurs after jumping or falling from a height. In a compression fracture of the spine, the bone tissue of the vertebral body collapses into itself and has a smaller volume.

Causes of a Compression Fracture of the Spine?
Compression fractures are the most common type of fracture found in the thoracolumbar spine, occurring in 9 out of 10,000 people. They happen as a result of force pushing together the anterior (towards the front of the body) part of the vertebrae. Hyperflexion, the extreme bending of the spine in one direction, sometimes plays a part in the fracture. If the injury occurs while falling from a height, the heel bones are often fractured at the same time.

Because an injury of this type is generally caused by significant trauma, other damage may result as well, such as ligament damage, nerve root or spinal cord damage. Because the bones in the back are positioned so close to the spinal cord, spinal injuries are always serious.

Sometimes compression fractures occur despite minimal trauma, usually as an outcome of osteoporosis, a condition reflecting the loss of bone density that primarily affects post-menopausal women. They may also be the result of a malignant tumor.

Symptoms of a Compression Fracture of the Spine?
Symptoms of a compression fracture include:

   * lower back pain with sudden onset, sometimes beginning hours after an injury
   * limited motion
   * lack of feeling or strength in legs
   * shortened height
   * swelling present at the fracture site
   * compression fractures typically do not compress the spinal cord or nerve root
   * sometimes there are no obvious symptoms

When the fracture occurs as a result of osteoporosis, the lower vertebrae are usually affected and symptoms are often worse with walking. With multiple fractures, a forward hump-like curvature of the spine known as kyphosis may result. There may be pressure on the spinal cord that results in symptoms of numbness, tingling, or weakness--also called a myelopathy.  Most compression fractures are relatively stable, however, without producing neurological symptoms.

Treatment of a Compression Fracture of the Spine?
Because of the possibility of loss of stability over time following an injury, immediate treatment should be sought whenever a spinal injury is suspected.

First-aid treatment focuses first on immobilizing the spine to protect the spinal cord. Emergency personnel place the patient on a rigid backboard with a pad to protect the sacrum. X-rays are taken to determine whether there is a fracture and to what extent bones are displaced. Until the patient’s condition is fully assessed, the spine should remain immobilized. Depending on the type of trauma, several different types of fractures or multiple injuries may result.

The fracture will be classified as stable or unstable. Because a seemingly stable fracture can settle out of the correct position over time, care must be taken to insure that the spine is in fact stable. Your doctor will be able to somewhat assess the condition of your spine by feeling along the spinal column for unusual bone position. Location of pain will be taken into account, as well as any swelling that is present. X-rays more precisely identify the nature of the fracture. Compression fractions result in a loss of height of the vertebral body on x-ray.

CT (computed tomography) scans may also be ordered in order to better view some of the particular points of the vertebrae. MRI (magnetic resonance imaging) scans can indicate spinal cord damage and other soft-tissue trauma.

Because most compression fractures heal within 6 to 8 weeks with rest and pain relief, nonoperative treatment has remained the standard for many years. Treatment depends on the type, location, and exact nature of the injury. Some options include:

   * the use of a body cast, when the fracture is somewhat stable in relation to the spinal cord, but must be immobilized in order to promote successful healing
   * the use of a custom orthosis (brace), to stabilize spine during healing
   * non-steroidal anti-inflammatory medication (such as Motrin, Advil or Nuprin), often in time-released form
   * your physician may prescribe stronger medication, though the use of narcotics is generally avoided
   * a course of rehabilitation based on successful modes of treatment, such as traction, ultrasound, electrical muscle stimulation, whirlpool, and so on, proven beneficial to patients with spinal injuries

Where surgery is indicated, as in the case of compression on the nerve roots or spinal cord, the surgeon has the opportunity to correct any changes in position of the vertebrae due to the injury or other deformity. Various types of instruments, such as pedicle screws or steel rods, are used to hold the bones in place. Follow your surgeon’s directions carefully before and after any surgical procedure, keeping in mind that recovery depends not on surgery alone but also on commitment to the recovery process.

A rehabilitation program needs to be designed that includes exercise as soon as possible. Back muscles are just like other muscles adjacent to a fracture--they become weak and need exercise to regain previous strength.  Walking should be encouraged. Once the fracture has healed, a more vigorous program can be initiated to strengthen, stretch, and support the muscles of the mid-body.

Major surgery for compression fracture usually requires a recovery and rehabilitation period of at least 4 to 6 weeks. A spine operation may involve the specialized skills of both an orthopedic surgeon, whose expertise concerns bones and joints, and a neurosurgeon, someone familiar with spinal cord injuries.

People who have experienced a break in one of the bones of their spine, whether treated conservatively or with surgery, are advised to become knowledgeable about caring for their backs.  It is important to use proper lifting techniques, to practice a specific set of stretching and strengthening exercises as advised by a physical therapist, and to modify exercise and activities to protect the backbone.  All of these measures may significantly reduce the chance of repeated injury to the spine.

Possible Complications of Surgery for a Compression Fracture?
Outcomes of surgery for spinal compression fracture are dependent on the state of one’s general health, including mental and emotional health. It is important to work with your doctor to decide on the most effective treatment procedures, evaluating and comparing the risks of surgery with the expected benefits.

The use of alcohol, tobacco, or drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers, and corticosteroids, increases surgical risk.

Although surgery for compression fracture of the spine is usually without any significant problems, there may occasionally be unforeseen complications associated with anesthesia, including respiratory or cardiac malfunction.  The surgery itself may be complicated by infection, injury to and scarring about the nerves and blood vessels, fracture, weakness, stiffness or instability of the joint, pain, or the need for additional surgeries.

Serious neurological complications are very rare with contemporary surgical techniques. Whenever possible, surgery should be undertaken when the patient is in the best possible health, with any other chronic conditions under effective management.  Follow your surgeon’s directions carefully before and after any surgical procedure, keeping in mind that recovery depends not on surgery alone but also on commitment to the rehabilitation process.

The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician.

(c)2000, LLC, Indianapolis, IN

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