Compression fracture of the spine - symptoms and treatment

The spinal column and its elements can withstand significant loads. Although due to injuries, namely the influence of great force, when falling on the back or lower limbs, a decrease in bone density due to osteoporosis, there is a possibility of obtaining a compression fracture of the vertebrae, both in an adult and in a child.

Such a spinal column injury is characterized by a decrease in the height of the vertebrae due to their mechanical compression or flattening. Proper therapy for a compression fracture in childhood is necessary, since such an injury can cause irreversible changes.

What are spinal fractures?

A spinal fracture or dislocation of one or more vertebrae in the spine is a severe orthopedic injury. Because the spine is directly connected to the spinal cord, and damage to the spinal cord can lead to paralysis or death. Spinal fractures can occur in the cervical, thoracic, or lumbar regions. Approximately 5-10% of these fractures occur in the neck, 64% in the thoracolumbar (lumbar) region, and often in the T12-L1 vertebrae.

Depending on the severity of the injury, a fracture may cause symptoms such as pain, difficulty walking, and inability to move your arms or legs. The most common sign of a spinal fracture is moderate to severe pain that gets worse with movement.

Treatment for spinal fractures depends on the type of fracture and the degree of spinal instability. Many fractures heal with conservative treatment. However, severe fractures may require surgery to realign the vertebrae.

Rehabilitation

Recovery from a spinal fracture is a long and often painful process. But an integrated approach to this issue ensures the return of lost functions partially or fully. There is a rehabilitation period both after surgery and with conservative treatment. In both cases, it is equally important to follow the doctor’s recommendations and not neglect exercise.

After surgical treatment, in most cases, patients are discharged from the hospital within 3–5 days. At first, they are advised to remain in bed to minimize vertical loads on the spine. Otherwise, there is a possibility of resorption of the damaged vertebral body and deformation of the spinal canal. This leads to the development of severe neurotic disorders, which in medicine is called Kümmel's disease.

In the future, patients are recommended to:

• Exercise therapy – performing a specific set of exercises under the guidance of a specialist, and then independently, helps strengthen the muscle corset and reduce the load on the spine. In the first week, breathing exercises and joint exercises are usually recommended, but gradually the complex becomes more complex to achieve optimal results.
• Reflexotherapy – impact on biologically active points leads to increased blood circulation and activation of regeneration processes of damaged tissues.
• Manual therapy is indicated 2 months after the start of rehabilitation and only if the dynamics are positive. Sessions should be conducted only by a highly qualified specialist who accurately understands the peculiarities of the body’s recovery after such severe injuries.

The final stage of rehabilitation is sanatorium-resort treatment. Sometimes cyclic rehabilitation courses are indicated for maximum recovery in severe cases.

With competent behavior during the recovery period, patients with 1st degree fractures are completely rehabilitated in 1–8 months, with 2nd degree fractures – in 10–12 months. If a person had a third-degree spinal injury, the prognosis depends on which part was damaged and what other structures were damaged. In such situations, it may take 1.5 to 2 years before returning to a normal lifestyle, and in especially severe cases, even the most experienced doctors are not able to prevent the onset of paralysis.

Introduction to the three-column division of the vertebral body

To classify types of vertebral fractures, doctors divide them into three areas. This classification is known as the Dennis classification. In this method, the spine is divided into three parts: posterior, middle and anterior, called tricolumnar vertebral division.

Front column

This area is the front of the spine, facing the front of your body and includes the front half of the vertebral body and intervertebral disc. At the front of the spine there is a ligament called the anterior longitudinal ligament, which is also part of the anterior column.

Middle column

This part is the central part of the spine for its stability and includes the posterior half of the vertebral body and the intervertebral disc. Behind the vertebral body there is a ligament called the posterior longitudinal ligament, part of the medial column. The middle column is a sensitive part and if the vertebrae are broken in this part, then the chances of nerve damage and spinal instability are very high.

Rear column

All parts of the vertebrae in the dorsal part make up the posterior column, including the pedicle, lamina, lateral joints and vertebral spines.

Most common classification of vertebral fractures

The different types of vertebral fractures are classified into different categories. The most common type of classification includes compression, tear, flexion-distraction, and fracture-dislocation.

Compression fracture

Compression fractures are more common in patients with osteoporosis or in patients whose bones have been weakened by other diseases (such as bone cancer). In this case, the bones are weak and cannot withstand pressure, and even slight pressure can cause cracks and fractures in them. Compression fractures are also divided into wedge fractures, crush fractures, and burst fractures.

Explosion fracture

Because of the importance of burst fractures, this type of fracture can be considered a separate branch from compression fractures. This type of fracture occurs when a strong blow crushes the vertebrae. This fragmentation scatters pieces of bone throughout the body and can cause damage to the spinal cord.

Flexion-distraction

This type of fracture usually occurs in motor vehicle accidents and is also known as a “seat belt fracture.” When a car falls, the upper part of the body moves forward, but the lower part, fastened by the seat belt, remains in place. Under these conditions, a gap occurs between the vertebrae and fracture distraction occurs.

Fracture-dislocation

If a vertebra moves significantly out of place during any fracture, it is called a dislocation fracture. A dislocation fracture causes a vertebra to move forward or backward, known as spondylolisthesis. This type of fracture causes instability of the spine.

Transverse process fracture

The transverse processes of the vertebra project in three directions behind the vertebra, on the right and left. These processes are connections between ligaments and muscles; In accidents where strong force is applied to the body, the muscles contract and prepare for the impact. These conditions can cause the spine to become uneven, resulting in a transverse process fracture (TPF).

Invasive surgical methods

If the vertebral height is lost by more than 50% and its stability is impaired, gentle (invasive) treatment methods are prescribed. In this case, the traumatic effect on tissue is minimal, hospitalization is not required, the procedure itself and the recovery period are short.

Vertebroplasty

The surgeon inserts a needle into the vertebral body, through which the internal cavity is filled with a special solution - bone cement. During this neuroradiological procedure, the support capacity of the spine is restored on the operating table. The operation is performed under local anesthesia and X-ray supervision, its effectiveness is approximately 90%.

After vertebroplasty, the patient needs to lie down for 2 hours and limit physical activity in the next 24 hours.

Kyphoplasty

The method is aimed at eliminating vertebral subsidence with subsequent fixation of the restored shape with bone cement.

Through two small skin incisions, the doctor gains access to the site of injury, inserts a deflated synthetic chamber into the vertebra, inflates it like a balloon, thereby restoring the height and geometry of the vertebra, then introduces a cementing compound and records the result.

Surgery

In case of aggravated compression fractures of the third degree, when fragments of bone tissue or a displaced vertebra affect the spinal cord and nerve endings, dicompression is necessary - removing the compressive effect, removing hard fragments and installing metal implants to replace the damaged vertebrae. Similar manipulations are performed on the open spine.

Other types of vertebral fractures

Stable and unstable fractures

Another type of classification of spinal fractures is common among doctors, according to which fractures are divided into two types: permanent and unstable.

With permanent fractures, the fracture does not deform the spine or cause nerve problems. Although as painful as the unstable type, this type of spinal fracture can still support and distribute the body weight well, but with unstable fractures, support and weight distribution are difficult for the spine. Unstable fractures are more likely to progress and become damaged. They can also cause spinal deformities.

Major and minor fractures

A minor fracture is a fracture of part of the dorsal elements of the vertebrae, that is, parts that have little effect on the stability of the spine.

A major fracture means a major part of the vertebrae, such as a pedicle or lamina, is broken. This type of fracture is necessary because the vertebral body bears most of the body's weight, and if they are broken, they are not in the correct position and cause instability of the spine.

What is the danger of pathology?

It is important to understand that any pathology that affects a vital anatomical formation, with an illiterate approach or lack of appropriate therapy, can result in dire consequences for a person. Timely treatment and rehabilitation after a compression fracture of the lumbar, thoracic or cervical spine will help to avoid all negative complications. We will talk about them further.

The spinal system serves as a container for the most important component of the central nervous system - the spinal cord. Thanks to the spinal substance, musculoskeletal functions are ensured, in other words, the overall ability to move and maintain a stable body position.

The spinal canal, its nerve roots, arterial and venous vessels affected by pathological pathogenesis, which is more often observed with compression-comminuted fractures, with traumatic excesses with the formation of wedge-shaped deformities and instability of elements, is not a joke. The degree of damage to the spinal cord can vary - from concussions, compression and contusions, to its complete rupture.

The worst thing that a neglected clinic can threaten is partial or complete paralysis of the body.

In addition, without urgent medical care and rehabilitation after compression fractures in the spine, secondary degenerative and neurological diseases develop, which will be very difficult to combat. These include:

• segmental instability in the damaged area;
• osteochondrosis and intervertebral hernia;
• kyphosis of the spinal column, or non-physiological curvature;
• radiculopathy, paresis and other neurogenic disorders;
• spinal canal stenosis;
• vascular malformations and development of hematoma in the epidural space;
• chronic pain, paresthesia;
• persistent movement disorders;
• dysfunction of the pelvic organs.

Therefore, do not risk feeling discomfort and pain in your back, especially if they appeared immediately or after a certain time after an injury or unsuccessful movement. You can’t hesitate here, believing that nothing serious has happened. It is better to be examined once and make sure that everything is really in order, than to ignore a dangerous problem and pay for your indifference at the cost of your own ability to work.

Most Critical Causes of Vertebral Fractures

Fractures of the thoracic and lumbar spine can result from a car accident (45%), falls from a great height (20%), sports injuries (15%), violence (15%), and other factors (5%). In many of these cases, patients suffer serious spinal injuries.

Sometimes vertebral fractures occur due to bone weakness. Osteoporosis, tumors and some related diseases cause bone weakness. These people can break their spine due to a minor injury or even a short fall.

Thoracic region

The main tasks of rehabilitation for compression fractures of the thoracic spine are solved through exercise therapy. By performing certain exercises, physiologically normal mobility is ensured not only of all central segments, but also of the entire back, muscle tone is restored, pain in the scapulothoracic zone is eliminated, and posture is normalized. Here are examples of some useful exercises. The average repetition frequency is 10 times.

1. Take a standing position. Place your feet hip-width apart, hands on your waist. As you inhale, bend back, slightly raising your shoulders and pushing them back; as you exhale, round your back, pointing your shoulders forward.
2. Now we complicate the task a little by doing the same thing, but with the body turning to the right/left: we turn to one side and spread the shoulder girdle, return to the starting position and round the back, turning the shoulders forward.
3. Let's move on to a new task. The position is the same, only the arms are extended along the body. Perform lateral bends: bend to one side, the arm of the bending part slides down the side of the limb, while simultaneously pulling the opposite arm towards the armpit. Similarly, we tilt the body in the other direction. Each side – 10 repetitions.
4. Get on all fours with your straightened upper limbs resting on your palms. As you inhale, we bend your back, your pelvis moves back, your head drops down. As you exhale, arch your back upward (like a cat), smoothly throwing back your head, while tightening your stomach.
5. We partially change the previous pose - the support in the hands now falls on the forearm area. We lift our right hand off the floor, take hold of the shoulder, slightly turn our chest to the right and make 5 springy movements with this glenohumeral part with the emphasis “up”. We work in a similar way with the left side.
6. Lie on the floor with your stomach down, resting on your forearms, chest open. When the thoracic fracture has healed, the “sphinx” pose has a beneficial effect on this line of the spine; ask your orthopedist whether your rehabilitation can include this type of warm-up. Method of execution: pull your head up towards the ceiling (feel your ribs straightening), stay in this position for a few seconds, then relax, lowering your head to the floor.
7. Lie on your side (head on the floor), bend your knees (knees together), stretch both arms forward in front of you, clasping your palms. Next, with a sliding movement of the upper hand, as if opening, we pass it along the inner surface of the adjacent arm, then along the chest, and finally place it on the floor. At the moment of the so-called “opening”, turn your head in the direction of movement of the limb, as a result the shoulder blades lie on the plane. The pelvis and legs should remain in position at all times. p. Then “get together” again and repeat the task. After five times, turn to the other side and repeat the exercise by analogy.
8. Lumbar part

Rehabilitation for compression fractures of the lumbar spine has similar goals. This is to restore the full functionality of the musculoskeletal system, make it resilient and strong, and balance your posture. What kind of exercise do physical therapy instructors and orthopedic doctors suggest their clients do?

1. Lying on your back, perform simultaneous flexion of the knee and hip joints. Thus, the lumbosacral region and abdominal muscles are excellently trained.
2. We do not change the IP. Raise your legs straight up. Extending the limbs to the sides followed by bringing them together. When your legs come together, you need to cross them slightly.
3. The well-known exercise called “bicycle” brings considerable benefits. We won’t dwell on the technique; we think everyone knows how to simulate riding a bicycle in a recumbent position.
4. Roll over onto your stomach, spread your arms to the sides. Lift your chest off the surface along with your arms, hold in this position for as long as your physical fitness allows, then lower and relax. Note that the feet do not come off the floor. If it is more convenient for someone, you can stretch your arms in front of you.
5. The position remains the same, but your legs need to be spread slightly and your arms should be extended straight in front of you. Lifting the sternal complex (along with the arms) and legs from the support, lift them simultaneously with a bend in the back. Fix the pose and stay in it for as long as possible. Lower yourself, rest a bit, then repeat.
6. Get on your knees. The pelvis and back are strictly vertical, hands on the belt. Walk on your knees in a straight line forward, then backward. We complicate the task: we begin to walk in a circle, first clockwise, and then in the opposite direction.

Symptoms of a spinal fracture

Most vertebral fractures, no matter where they are located, are associated with mild to severe pain that increases with each movement, depending on where the vertebral fracture is located. In more severe cases, a fracture can cause neurological symptoms such as numbness, tingling, muscle spasms, weakness, bowel and bladder problems, or even paralysis.

With impression fractures, movement increases pain, which is relieved by rest. Sometimes the pain from the fracture spreads to the legs and abdomen. In cases where the fracture is not treated, the person sees that his growth is shortened.

Flexion-distraction is associated with severe back pain that worsens with movement. If the severity of the injury is high, it can lead to brain damage and loss of consciousness.

Forecasts

For grade 1 fractures, with timely, correct treatment and strict adherence to all medical recommendations, the prognosis is favorable, especially if the injury occurred in a young person. In such situations, the ability to work is fully restored and in the future the risk of intervertebral hernias is within the average range.

With compression fractures of degrees 2 and 3, the appearance of pain in the future cannot be ruled out; the risk of developing osteochondrosis, radiculitis, protrusions and herniated intervertebral discs increases significantly.

Thus, compression fractures of the spine are quite common, especially in older people, and at the same time a dangerous injury that can lead to disability or even death. Treatment started from the first days allows you to avoid such sad consequences and return a person to normal life. Therefore, if there are indications for surgery, you should not be afraid or refuse, because modern microsurgical methods are highly effective and safe.

Methods for diagnosing spinal fractures

Patients who have suffered a spinal fracture as a result of a severe accident require immediate treatment. When first assessed, it may be difficult to assess the extent of their damage.

At the scene of an accident, rescuers first examine the patient's vital signs, including alertness, ability to breathe, and heart rate. Once vital signs have been established, they evaluate bleeding and damage that led to the deformity of the limb. The victim's spine is held in place with medical neck braces and lumbar braces before being transported to the hospital.

Clinical examinations in the hospital begin with a physical examination. The patient's nervous status will be checked and their reflexes and ability to move will be assessed. If your doctor suspects a spinal fracture, he will conduct a more detailed examination.

Fractures of the cervical, thoracic or lumbar spine can be detected using x-rays. If necessary, computed tomography will be used, an effective way to visualize any changes in the bone structure. An MRI may also be done to evaluate the surrounding soft tissue, ligaments, intervertebral discs, or to identify any damage to the spinal cord.

Possible complications

Spinal fractures often lead to complications, especially if proper treatment is not carried out. Thus, compression fractures with a decrease in vertebral height by more than 50% can lead to their increased mobility, which is called segmental instability. This condition is characterized by:

• the appearance of constant pain;
• rapid degenerative changes in the affected spinal motion segment;
• damage to nerve structures, which leads to the appearance of typical symptoms and their persistence (paresis, paralysis of the limbs, convulsions, sensory disturbances, problems in the functioning of internal organs).

In people of the older age group, the formation of the so-called senile hump is possible, which becomes a consequence of kyphotic deformity. This also leads to constant pain of varying intensity. It is these that people often attribute to age-related changes and do not even suspect the presence of a spinal injury.

But the most severe complication of a spinal fracture is rupture or compression of the nerve roots of the spinal cord and itself. This can happen either immediately at the time of injury or subsequently against the background of degenerative changes. Often in such cases, the blood vessels that supply the spinal cord are damaged and compressive myelopathy is observed. This is accompanied by increasing neurological disorders, which can only be eliminated through surgery.

Thus, a spinal fracture is a serious injury that can leave a heavy imprint on a person’s future life or even take it away. But immediate consultation with a doctor, a responsible approach to treatment and subsequent rehabilitation allows you to avoid the development of undesirable consequences or minimize them.

Treatment methods for spinal fractures

Treatment for a spinal fracture depends on the location and type of fracture, as well as the amount of pressure placed on the nervous system. Treatment of fractures begins with pain management and stabilization to prevent further injury. Depending on the type of fracture and its stability, a spinal brace may be required to stabilize the spine and limit its movement.

Small fractures can be treated with spinal braces, but more complex fractures where there is a possibility of damage to the spinal cord require surgery.

Fusion surgery is necessary for unstable fractures. In this type of surgery, by connecting the vertebrae and fixing them with implants, they are prevented from moving and the spine is healed.

Impression fractures often heal without surgery to repair the fractures. Non-surgical treatment includes rest, pain medications and spinal braces to limit movement, but if pain persists after non-surgical treatment, minimally invasive surgery options may be considered. Vertebroplasty and kyphoplasty are minimally invasive surgeries performed to treat impression fractures caused by osteoporosis and spinal tumors.

Non-surgical treatment for flexion-distraction involves immobilizing the spine using spinal braces and casts. These types of fractures often require surgery to relieve pressure and stabilize. Surgical procedures include vertebrectomy and fusion or transplantation.

A transverse process fracture can be treated non-surgically with rest and gradual increase in range of motion. A spinal brace may need to be used, but a fracture-dislocation requires surgery to correct it.

After the spinal fracture has healed, physical therapy and exercises such as walking, yoga, tai chi and leisurely dancing help the patient return to daily life.

Who is most at risk for spinal fractures?

• 80% of patients are 18-25 years old
• Men are four times more likely to have a spinal cord fracture than women.
• People with osteoporosis
• Athletes, especially in the fields of motorsports, football, horse jumping, gymnastics, rock climbing, bungee jumping and the like

Rehabilitation after surgical treatment of injury

The duration and complexity of the rehabilitation period depend on the nature of the resulting fracture. Immediately after surgery, patients are usually placed in a plaster cast or an orthopedic corset. How long you will need to wear it is determined by what surgical treatment tactics were used.

Drug therapy is also prescribed. After some time, the patient is recommended to undergo massage, exercise therapy and physiotherapy.

During rehabilitation, parents bear a lot of responsibility. They should closely monitor the child’s physical activity, correct use of the orthopedic corset and nutrition. It is recommended to enrich the diet with foods that contain high levels of calcium, magnesium, zinc and B vitamins.

How to prevent a spinal fracture?

Although not all accidents are preventable, there are a number of precautions you can take to reduce your risk of spinal fractures.

Always wear your seat belt in your car because seat belts and air bags are designed to protect you in the event of an accident. They protect the head, neck and chest.

Use calcium and vitamin D in your diet to prevent the progression of osteoporosis.

If you have osteoporosis or weak bones for any other reason, your bones may break if you fall even a short distance, so reduce the factors that cause you to fall. For example:

• Remove any rugs that could cause you to slip.
• Make sure there are no obstacles in your way.
• Place an anti-slip rubber mattress in the bathroom.
• The staircase should be well lit.
• Try to leave the stairs and all that to others.
• When performing exercises, be sure to use safety equipment.
• Prevent the progression of osteoporosis with proper exercise.

Conclusion

Spinal fractures are different from broken arm or leg bones. A fracture or dislocation of a vertebra can result in broken vertebral bones and damage to the spinal nerves. Most spinal fractures occur as a result of car accidents, falls, shootings or exercise. Injuries can range from relatively mild ligament and muscle strains to spinal cord injuries. Depending on the severity of the injury, a spinal fracture may cause pain, difficulty walking, or the inability to move your arms or legs. Many fractures heal with careful treatment. However, severe fractures may require surgery to realign the bones, and this treatment will vary depending on the type of fracture.

Conservative treatment

Treatment for I-II degree of compression does not require surgery.

Patients are prescribed

• painkillers,
• being in a horizontal position on a hard mattress at an angle of 30°,
• hood (gradually increasing the angle of the mattress),
• restoration of activity with the obligatory wearing of a fixing individually made orthopedic corset,
• restriction of physical activity,
• exclusion of prolonged periods of sitting and standing.

Restrictive measures and their duration are prescribed by the doctor individually. The patient must be in a hospital. With strict adherence to the instructions, gradual self-healing of damaged bone tissue occurs.

During treatment, physiotherapy and massage are included, and therapeutic exercises are used during the rehabilitation period.