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Vertebral fractures

Overview

Your spine consists of individual bones called vertebrae. Fractures in the spine most commonly occur in the middle and lower back. These fractures tend to be caused by high-energy trauma, such as a car crash, falling from a height, sports accidents or violence such as gunshot wounds. Fractures in these areas can cause damage to the spinal cord which can affect the function of nerves, the spinal cord or brain.

Other possible causes of spinal fractures are osteoporosis (progressive bone disease), tumours and other underlying conditions that weaken the bone and can cause vertebrae to be fractured during normal daily activities.

Vertebral fractures are most common in older patients, who are at risk due to weakened bones from osteoporosis. How the fractures are classified is based on the pattern of injury, which helps determine the proper treatment. The three major types of spine fracture patterns are flexion, extension and rotation.

 

Symptoms

If you have a vertebral fracture, the primary symptom you will experience is moderate to severe back pain that is made worse by movement. If the fracture affects your spinal cord, you may experience numbness, tingling, weakness, bowel or bladder dysfunction and shock in the affected area. Injuries to the middle and lower spinal cord are likely to affect the function of nerves, the spinal cord and brain as well as the genital area and lower extremities.

 

Diagnosis

Your doctor will diagnose you based on a full physical examination, including using laboratory tests, imaging and testing your reflexes. If the fracture is a result of major trauma, you will need repeated blood tests to check blood circulation. If you have metastatic bone disease, you will need a calcium test to check the level of calcium in your blood.

Imaging techniques are useful for diagnosis. Plain radiographs can be used to screen for spinal fractures. It is sometimes difficult to detect hairline fractures and non-displaced fractures (meaning pieces of the fractured bone are still aligned) using spinal X-rays alone, so CT can be used to detect vertebral fractures and assess the extent of the fractures.

MRI is usually the method of choice for determining the extent of damage to the spinal cord and if the bone has become enlarged. MRI is the most sensitive tool for detecting lesions in bones and the spinal cord.

 

Treatment

If you have a minor vertebral fracture, you may be treated non-surgically, such as with a spinal orthotic vest, which is a firm vest that can be worn to stabilise the spine.

If you have a major or unstable fracture or your spinal cord is affected, however, you will need surgical treatment and stabilisation of your spine to prevent spinal deformity. You may also need to have steroids administered intravenously, depending on the nature of the fracture.

There are also minimally invasive treatments available, such as vertebroplasty and kyphoplasty, in which cement is injected into the area surrounding the fracture. The cement stabilises the fracture, reducing pain.

 

Bibliography

1. McAfee PC, Yuan HA, Fredrickson BE, Lubicky JP. The value of computed tomography in thoracolumbar fractures. An analysis of one hundred consecutive cases and a new classification. J Bone Joint Surg Am. Apr 1983;65(4):461-73.

2. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine. Nov-Dec 1983;8(8):817-31.

3. Haczynski J, Jakimiuk A. Vertebral fractures: a hidden problem of osteoporosis. Med Sci Monit. Sep-Oct 2001;7(5):1108-17.

4. Bracken MB, Shepard MJ, Collins WF, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med. May 17 1990;322(20):1405-11.

5. Goel VK, Pope MH. Biomechanics of fusion and stabilization. Spine. Dec 15 1995;20(24 Suppl):85S-99S.

6. Schreiber D. Spinal Cord Injuries. Medscape Reference Journal [serial online]. 2003.

 

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