Vertebral compression fracture cause significant pain and alter the mechanics of the posture. Trauma is major cause of compression fracture in young adults. In older patient, due to osteoporosis, even the minor falls can result in compression fracture.
In addition to this, malignancy may result in spinal fracture Infections like tuberculosis may also cause compression fractures.
Presentation of Compression Fracture
Backpain is the main symptom of compression fracture. The pain is axial, nonradiating, aching, or stabbing in quality and corresponds to the compression fracture site on xray. In elderly patients with severe osteroporosis, there may be no pain at all.
Lower extremity weakness or numbness may sometimes occur. So can the referred pain.
Many compression fractures are painless. Metastasis and multiple myeloma are most common malignancies causing compression fracture and should be considered in presence of pathological compression fracture.
General malaise, fever, or severely increasing pain may suggest infection.
A detailed neurologic examination should be performed including rectal tone and sensation in trauma patients. This is important because lack of tone and sensation would indicate neurological deficit which is a contraindication to pain relieving procedures.
Spine examination may reveal kyphus and angular kyphosis.
Complete blood count with differential count, prostate-specific antigen testing , and erythrocyte sedimentation rate should be done.
Serum protein electrophoresis and urine Bence Jones proteins estimation are done for multiple myeloma.
Imaging Studies for Compression Fracture
Anteroposterior and lateral views of the lumbar and thoracic spines are needed. Evaluation of the entire spine is important as fracture can be multiple in about one fifth of these patients.
Compression fracture in the lateral radiograph show decreased vertebral body height. The anteroposterior view is important because the presence of increased interpedicular space may indicate an unstable fracture.
CT scanning is very helpful to evaluate complex nature of fractuers and visualize fractures not seen on xrays. CT scanning accurately visualizes the amount of spinal canal compromise and middle canal involvement.
CT is also able to pick burst fractures in fractures diagnosed as wedge compression fractures on xray. [Patients with more than 50% loss of vertebral height should undergo CT scanning.]
CT is the best test to visualize fractures of the posterior elements and laminae.
MRI is required in cases where neurological deficit is present or there is radiculopathy or canall compromise is suspected.
DEXA or other tests for measuring bone mineral density are done to assess osteoporosis.
Vertebral biopsy is indicated in cases of malignancies.
Treatment of Compression Fracture
Non Operative Treatment
Traumatic compression fracture with neurologic deficit require inpatient treatment and rehabilitation. For other compression fractures consists of pain relief, bracing, and rehabilitation can be done as outdoor treatment.
Medications are used for pain relief and to prevent further osteoporosis.
If a compression fracture is as a result of systemic disease like malignancy, it should be treated accordingly.
Surgical intervention is required when neurologic dysfunction and/or instability occurs.
Surgical procedure used depends on bony canal compromise, the angulation, the level of fracture, neurologic examination findings, and the patients health status.
Surgery includes fixation of the fracture and decompression whenever indicated.
Vertebroplasty and kyphoplasty, are procedures for the patient with a compression who continues to experience pain despite conservative treatment. These procedures have met with success and are offered earlier in the treatment period as early as 2-6 weeks.
Vertebroplasty has been available for many years. This involves injecting a form of cement polymer into the fractured vertebral body making it resist better to physiologic loads and reduce pain.Kyphoplasty is similar to vertebroplasty, except a balloon is used to expand the volume of the fractured segment prior to introducing the cement polymer.
Physical therapy and Fracture Preventiop
Weight-bearing exercises, extension exercises of spine may help speed healing of the fracture. Prevention of osteoporosis is extremely important to prevent fractures.
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