A Detailed Explanation of Spinal Compression Fractures
A spinal compression fracture is an injury to the spine. It occurs when a part or the complete vertebrae is fractured and collapses. This type of injury is most common in the thoracic spine. There are several causes associated with spinal compression:
- Osteoporotic disease: It can lead to the weakening of bones making them more prone to fractures
- Trauma: Physical blows can lead to minor fractures that can injure the vertebrae
- Spinal Tumors: Metastasis of cancer to the spinal region can lead to the destruction of vertebrae
Where do spinal compression fractures occur?
While they can occur anywhere in the spine, they are most common in the middle part of the spine, affecting particularly the lower thoracic vertebrae and the upper lumbar vertebrae. 60-75% occur at T12-L2 and 30% occur at vertebral levels L2-L5.
What are its types?
There are three types of spinal compression fractures:
- Wedge fracture: This is the most common type, where the front of the vertebrae collapses and the back remains intact. This creates a wedge shape. This often leads to a hunchback posture.
- Crush fracture: It is when there is a fracture of the entire vertebrae
- Burst fracture: It is when there is a fracture that leads to the shattering of the vertebrae such that pieces are sent out in every direction.
The former two are stable injuries but the burst injury is very dangerous due to the shattered pieces harming other surrounding structures. It is the one that requires immediate surgical intervention.
What are the signs and symptoms this injury?
- Limited movement
- Decrease in height if there are many fractures
- Visible deformity
- Redness and bruising of skin
The biggest indicator of a spinal fracture is back pain. The pain, however, is not the same for everyone. There are many factors that influence the quality of pain. These factors include the type of fracture, the number of vertebrae affected and if other surrounding structures are damaged.
The general quality of the pain of a spinal compression fracture is that it is a dull, deep pain in the area where there is the fracture. However on movements of the diaphragm such as while taking a deep breath or coughing, it becomes sharp. Feeling the skin above the fracture also leads to an increase in the severity of the pain.
While the pain is usually localized to the area of damage, it can radiate down towards your legs. This happens when there is an impingement of the surrounding nerves by the fracture. This changes the quality of pain from dull to a sharp, severe, stabbing pain at the site of the fracture. The damage to the nerve also causes makes walking difficult.
Visible deformity of the skin, such as redness and bruising is especially present when the cause of the fracture is a physical injury. Not only does the trauma lead to injury to the vertebrae it also harms the skin.
What activities can result in a spinal fracture?
While it is true that traumatic events like car accidents and certain physical activities such as rock climbing and hiking in steep regions can increase the possibility of a spinal fracture in case of a dangerous fall, it should be noted that most spinal injuries occur spontaneously.
This is because osteoporosis and cancers have significantly weakened the bone to the point where fractures can occur as a result of daily activities. If severe bone damage is already present, sneezing forcefully or lifting a light object is often enough to cause a fracture.
How can it be diagnosed?
Like most fractures, spinal fractures diagnosis is confirmed by X-ray imaging. They are also important in coming up with a treatment plan and, predicting the progression and healing of the injury. MRIs are also useful as it helps visualize any tumors that lead to the fracture and nerve compression that can occur as a result of the fracture. Most spinal fractures are a result of osteoporosis where there is a decrease in bone density. A DEXA scan is used to detect changes in bone mass.
How can it be treated?
This is the most recommended treatment plan.
- Pain medication such as NSAIDS and acetaminophen s are used to manage pain.
- Back brace is used to support the spine and reduce pressure off the vertebrae
- Physical Therapy regimen is designed keeping in mind the fracture and aims to stabilize the spine. This often includes light weight bearing exercises.
- Supplementary medications such as Vitamin D and bisphosphonates tablets are recommended in cases where the fracture is a result of osteoporosis.
These are needed when the spinal fracture is not stable.
- Vertebroplasty: In this procedure, special bone cement is injected into the fracture to stabilize it. This also prevents deformity from occurring and alleviates the pain. It is image guided and minimally invasive.
- Kyphoplasty: It is a procedure similar to vertebroplasty except that a small balloon is inserted into the fracture to expand space before the cement mixture is injected.
- Fusion surgery: In this procedure, a bone graft is placed at the region of the instability. This encourages the vertebrae to fuse and grow together. Screws and rods hold the spine in place to allow the bone to heal.
What other complications can there be as a result of spinal fractures?
- Kyphosis: This is the bending of the spine in a way that there is an exaggeration of normal curvature. The shoulders are titled too forward and this creates a hump. This bad posture can cause sciatica and other problems.
- Blood clots: Since healing of the spinal fracture includes long periods of bed rest, they can often lead to blood clots in the legs. Blood clots that break free and travel can cause pulmonary embolism
- Spinal canal injury: This can lead to the leaking of cerebrospinal fluid. Since the CSF plays an instrumental role in the protection of the spinal cord, leaking of it can expose the spinal cord to damage.
- Post- surgical complications: When surgeries are performed to treat spinal fractures, they can lead to an increased risk of infections and bleeding.