Treatment of a spinal fracture is a complex process. Rehabilitation of a patient after an injury takes quite a long time, and sometimes a lifetime. Fractures in which the spinal cord is not damaged are divided into three degrees:
- The first is the height at which the vertebra is reduced by less than half;
- Second - the height is reduced by half;
- Third, a reduction in vertebral height by more than 50% is determined.
A spinal fracture may be accompanied by a disruption of the integrity of the spinal cord, which is responsible for transmitting impulses to peripheral nerve endings and back. When it is damaged, the connection is interrupted, and the organs and systems of the body begin to work incorrectly or shut down. A common occurrence after a spinal fracture is incomplete and complete paralysis. Diagnosis and treatment of spinal fractures using modern techniques are carried out by doctors at the Yusupov Hospital.
Traumatologists provide emergency care around the clock to victims with spinal fractures of any complexity. The Yusupov Hospital has created conditions for comfortable treatment of patients using conservative methods. Traumatologists are fluent in the techniques of all surgical interventions. In cases of spinal cord injury, patients are consulted by a neurosurgeon. Rehabilitation clinic specialists use innovative methods of rehabilitation therapy. Rehabilitation measures begin from the first day of the patient’s admission to the hospital. After discharge from the hospital, the patient receives individual recommendations for rehabilitation treatment developed by rehabilitation clinic specialists.
Compression fracture of the lumbar vertebrae
A compression fracture of the spine occurs as a result of intense pressure (compression) on the vertebrae. There are stable and unstable compression fractures of the spine. With a stable fracture, only the anterior or posterior part of the vertebra is damaged. After an injury, it does not shift, and the spinal column remains stable. With an unstable fracture, both the posterior and anterior parts of the vertebra are affected, which can lead to its displacement.
A compression fracture of the spine occurs as a result of a road traffic accident, a fall from a height, or a jump. Quite often the lumbar spine suffers. It has 5 vertebrae, which can be damaged singly or multiple times. A comminuted fracture of the spine is the most dangerous because in this case, parts of the bone can move forward and damage the spinal cord.
Provoking factors for the occurrence of a lumbar spine fracture are various diseases of the musculoskeletal system (osteochondrosis, radiculitis, osteoporosis). In the presence of degenerative-dystrophic changes, bone tissue loses normal strength and undergoes destruction. In some cases, a spinal fracture develops gradually (the bone tissue of the vertebra is destroyed) and the patient does not consult a doctor for a long period of time, since the clinical manifestations are weak. This is the danger of degenerative-dystrophic pathologies: their treatment begins in the later stages, when it is quite difficult to cure a person.
When a fracture occurs in the lumbar spine, the following symptoms may occur:
- Severe sharp pain;
- Numbness of the lower body;
- Impaired motor function of the lower extremities;
- Intestinal dysfunction (after a fracture, patients may develop paralytic intestinal obstruction, when there is no bowel movement, the abdomen becomes very painfully distended, nausea and vomiting appear);
- Paralysis of the lower body.
Rehabilitation after a lumbar spine fracture requires a lot of effort and time. The duration and intensity of rehabilitation will depend on the extent of the spinal injury. For full recovery, more than one course of rehabilitation may be required.
What types of orthopedic corsets are there?
The location of the problem area is the first parameter that distinguishes corsets. According to its purpose, the corset can be upper thoracic, thoracolumbar - these are sometimes called orthopedic systems - lumbar and sacrolumbar.
The degree of fixation is the second characteristic: the more serious the problem and the stronger the pain syndrome, the better the fixation should be. Corsets are soft - with medium fixation, semi-rigid - with strong fixation, and hard - with full fixation. There is also a so-called adjustable fixation, when flexible stiffening ribs in the back of the corset are replaced with inflexible metal ones.
Upper thoracic and thoracolumbar corsets are sometimes prescribed to correct posture. The thoracolumbar variety also includes hyperextension models - they are used when it is necessary to transfer the load from the vertebrae and in cases of injuries associated with the vertebrae. They are prescribed only by a doctor. You can choose only soft or semi-rigid corsets yourself. Corsets differ in the areas they fix and the degree of fixation rigidity
This is what three types of corsets look like based on the location of the problem area and the degree of fixation
Fracture of the thoracic spine
The thoracic spine has 12 vertebrae, which are located between the neck and lower back. A thoracic fracture can occur as a result of trauma, severe pressure (compression) on the spine, or degenerative changes. Depending on the number of damaged vertebrae, fractures can be single or multiple, and according to severity - stable and unstable. With an unstable fracture, as well as with damage to several vertebrae as a result of the progression of a degenerative disease, the curvature of the spine is clearly visualized, and the formation of a “hump” is observed.
Treatment of compression and pathological fractures of the thoracic spine begins immediately, since damage in this department affects the internal organs located in the chest. A fracture of the thoracic spine may be accompanied by impairment of the following functions:
- Breathing (to the point of suffocation);
- Heart function (arrhythmia, tachycardia);
- Swallowing.
When the spinal cord is damaged in the thoracic region, weakness occurs in the upper and lower extremities. If the integrity of the brain substance is significantly damaged, paralysis of the body area below the damage zone may develop. Rehabilitation after a fracture of the thoracic spine takes several months. This is a complex injury that requires significant effort by the attending physician and the patient to achieve a positive result.
The most vulnerable vertebrae
Fractures can be of traumatic origin, occurring in a healthy spine due to trauma and pathological etiology, when a violation of the integrity of the thoracic vertebrae occurs due to internal processes (for example, osteoporosis). Compression fractures (CFs) are widespread.
Under such conditions, significant pressure occurs on the anterior zones of the vertebral body, followed by cracking of its structures and compression (subsidence) of the vertebra in height. With a critically severe wedge-shaped deformity of the thoracic segment, compression develops on the spinal cord and nearby nerve endings, which causes acute neurological symptoms. According to the ICD (International Classification of Diseases), this category of injuries is assigned the following codes:
- S22.0 if only one thoracic vertebra is damaged;
- S22.0 – with a fracture of several vertebral elements in the thoracic region.
Types of fractures.
Compression fractures occur at the border of the thoracolumbar junction, at any of the levels such as T11, T12, L1 and L2. The area within T11-L2 experiences significant load forces and is characterized by complex biomechanics. T11 and T12 are the most vulnerable points of the thoracic region. The T6 segment is affected somewhat less frequently, and in the rarest cases the lesion occurs on the remaining elements.
Cervical spine fracture
The consequences of a fracture of the cervical spine are the most serious. When a vertebrae is fractured, the spinal cord is more often damaged, and less often the medulla oblongata. Violation of the integrity of the spinal cord can lead to complete paralysis or death.
There are 7 vertebrae in the cervical spine. The first three are injured much less frequently than the others, but it is their damage that leads to the most severe consequences. A fracture of the first vertebra (atlas) is also called a Jefferson fracture. With this injury, a person feels a sharp pain in the neck and back of the head. There is a high chance of spinal cord damage.
Another type of cervical injury is the “executioner’s” fracture. In this case, the cervical vertebra changes its position relative to other vertebrae and is displaced. The injury occurs as a result of sudden movement of the neck or severe compression of the spine. When the second cervical vertebra is fractured, a person may lose consciousness and there is a loss of sensitivity in the upper extremities. A severe fracture of the second cervical vertebra often leads to death.
Restoration of the spine and relief of pain after a fracture is performed in a hospital setting. The patient will need to undergo a long course of treatment and rehabilitation after a compression fracture of the cervical spine.
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Symptoms
The main symptoms that accompany compression fractures of the spine:
- Pain at the site of the fracture, usually in the lower back.
- Patients with complex compression fractures usually assume a forced posture with the torso tilted forward.
- Possible pain in the lower extremities
- Numbness, tingling and weakness in the extremities usually indicate the presence of root or spinal cord compression
- Urinary or urinary incontinence or inability to urinate voluntarily is a sign that the fracture is accompanied by compression of the spinal cord.
- Compression fractures of the vertebrae, associated with weakening of the strength of bone tissue, may manifest with slight pain or be completely asymptomatic. Sometimes the pain is localized in the area of the fracture. Changes in vertebral height place excess stress on the spinal muscles, leading to fatigue and muscle pain. As a rule, such pain disappears after a few weeks.
- Traumatic compression fractures can cause severe back pain that radiates down to the legs. If a fracture severely damages the vertebral body, bone fragments can protrude into the spinal canal and cause compression of the spinal cord. In such cases, corresponding neurological symptoms (paresis or paralysis, sensory disturbances, dysfunction of the pelvic organs) will appear below the site of spinal cord compression. Traumatic fractures often lead to the development of kyphosis.
Consequences
The consequences of a compression fracture of the spine can be very serious. Their severity depends on the severity of the injury, the extent of damage to the spine, and the adequacy of the therapy performed. Complications after a spinal fracture can occur due to severe trauma, improper transportation of the victim, or the provision of unprofessional assistance to him. Therefore, if you suspect a spinal fracture, you must call an ambulance and not touch the victim (of course, if his situation is not life-threatening).
The consequences of a spinal fracture include:
- Instability of the vertebrae in the spinal column;
- Impaired conduction of nerve fibers as a result of compression of the nerve roots of the spine;
- Radiculitis;
- Rachiocampsis;
- Formation of kyphosis (hump);
- Constant back pain;
- Breathing disorders;
- Callus;
- Intervertebral hernia;
- Infection of the damaged area;
- Inflammation and suppuration;
- Paralysis of limbs.
Urological consequences of a spinal fracture include disruption of urination and the functioning of the urinary system. In some cases, patients experience erectile dysfunction.
Corset fit
The lower edge of the product should hug the upper part of the pelvis. In this case, the top layer of the corset fits tightly to the lower back.
Important! Women with a pronounced waist need to use special orthopedic corsets, which are designed specifically for the fair sex.
It is recommended to wear the corset over underwear and not over the naked body. This will help avoid friction.
After wearing a neoprene corset in the hot season, the lower back is wiped dry after using the product. This helps prevent you from catching a cold and aggravating your back problems.
In conclusion, it should be noted that it is recommended to wash the orthopedic corset on a delicate cycle. In this case, the product must be fastened with all hooks. You can additionally use a special laundry bag. When caring for an orthopedic product, follow the appropriate instructions indicated on the packaging.
Diagnostics
In the Yusupov Hospital, if a spinal fracture is suspected, a comprehensive examination of the patient is carried out. It includes the following studies:
- Computed tomography – for a detailed study of the structure of all damaged vertebrae;
- X-ray of the spine - to identify a damaged vertebra;
- Myelography – makes it possible to assess the general condition of the spinal cord in the area of injury;
- Magnetic resonance imaging – determines the presence of soft tissue damage.
After receiving the research results, the attending physician analyzes them and makes a final diagnosis.
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How to determine the comfort of a corset
It is impossible to say unequivocally which corset is better - the main thing is that you feel comfortable in it.
If you can’t move at all in a corset, there is a risk of muscle atrophy, because the corset will work instead of them. This is bad: the purpose of the corset is to support the muscles during a difficult period, but not to completely replace them. Therefore, a properly selected corset needs a balance between the ability to move and protection from pain - it signals that something has gone wrong.
Sometimes it makes sense to purchase two corsets - a semi-rigid one in case of exacerbation and a soft one - to prevent pain during exercise. A soft corset will help you exercise moderately and pump up your muscles to strengthen your back and avoid problems.
The size of the corset is of great importance: usually you need to study the recommendations for a specific model and, if possible, try on the product.
Important: you cannot select orthopedic corsets for children on your own. They grow, and their body and figure are formed, so any children's orthopedic products should be purchased only as prescribed by a doctor.
Treatment and rehabilitation
Recovery after a spinal fracture requires many manipulations and a responsible approach on the part of the patient and the attending physician. Treatment for a spinal fracture can be conservative or surgical. Conservative therapy consists of complete immobilization of the back and ensuring complete rest for the patient (lying down). Conservative treatment is used for minor, non-severe injuries. For fractures of the second and third degrees, with displacement, with multiple or comminuted fractures, surgical intervention is required. During the operation, the vertebrae are stabilized, fragments that can damage the spinal cord are removed, and spinal tissue is reconstructed.
A patient with a spinal fracture is placed on a special bed with a hard surface under the mattress. The patient's spine is fixed and measures are taken to ensure that bedsores do not develop during a long stay on bed rest. Treatment of a spinal fracture is carried out in combination with physical therapy and physiotherapeutic procedures. To restore respiratory function, the patient, under the guidance of a physical therapy instructor, performs breathing exercises every day. To improve blood circulation, special beds are used on which the head and limbs can be raised and the patient’s body position can be constantly changed without harming him.
The duration of the course of rehabilitation therapy after the end of the main stage of treatment ranges from several weeks to several months. Rehabilitation after a compression fracture of the spine in older people takes longer, since tissues heal less well in older people. It includes the following activities:
- Drug blockade;
- Acupuncture;
- Wearing a special corset;
- Physiotherapy;
- Reflexology;
- Massage;
- Therapeutic exercise.
A corset for compression fractures of the thoracic and other parts of the spine additionally fixes the spinal column. It helps stabilize the vertebrae and reduce the impact of stress on them. The use of a corset is mandatory for a compression fracture of the spine. It can be made of plaster or modern elastic materials with stiffening elements that provide complete immobilization of the spine. When using such fixation products, the rigidity of the fixation can be weakened over time, which contributes to the gradual restoration of motor activity. A corset after a spinal fracture is usually worn for 3-4 months, depending on the severity of the fracture.
Exercise therapy for a compression fracture promotes the resumption of spinal movements and normalizes muscle function. While wearing a rigid corset, the back muscles practically atrophy. To normalize its functioning, it is necessary to perform a special set of exercises.
After a compression fracture of the spine, exercise therapy promotes:
- Strengthening the back muscles;
- Normalization of spine flexibility;
- Restoration of metabolic processes in tissues;
- Improved coordination of movements.
Exercise therapy for compression fractures of the lumbar spine and other parts requires self-discipline from the patient. Exercises for compression fractures of the thoracic and other parts of the spine at the first stage of recovery will be painful and very unpleasant. However, without gymnastics it will not be possible to restore motor activity. Exercises are selected by the doctor together with the exercise therapy instructor. At the beginning of the rehabilitation course, exercises are performed under the supervision of the attending physician. When the patient masters the elements of gymnastics, he practices independently. After completing the main course, you must continue to do the exercises at home to avoid complications.
Rehabilitation after spinal surgery
Rehabilitation after spinal surgery includes not only physical therapy, massages, exercise equipment, drug therapy, but also the help of a psychologist, which is sometimes urgently needed. After an injury or surgery on the spine, the patient’s life changes dramatically; he cannot engage in his previous activities, experiences severe pain, and is limited in movement.
Recovery after spinal surgery begins with pain relief, then with light exercises, followed by a transition to higher loads. The help of a psychologist can bring the patient to peace of mind, help him believe in himself, and speed up the recovery process.
Rehabilitation after surgery (with metal structures)
In case of a spinal fracture, traumatologists often install metal structures during surgery. Using special metal plates, the patient is stabilized in the desired part of the spine. The rehabilitation period depends on the area and degree of damage.
After the operation, rehabilitation clinic specialists provide massage, physiotherapeutic procedures, and physical therapy classes. The patient wears a special medical corset for a period determined by the doctor, which helps adapt to the implant. Following all the doctor’s recommendations and performing special exercises every day helps restore the spine and speeds up the adaptation process.
Transportation and first aid rules
The essence of delivering a patient to a medical institution is to very carefully place him in a supine position on a flat, rigid stretcher, the surface of which does not bend, followed by immobilization of the body.
The main thing is complete stillness.
Before the ambulance arrives, a classic painkiller can be administered intramuscularly (into the buttock). Any oral intake is prohibited!
Long-term CP, which was not recognized in time and not treated, leads to severe curvature of the spinal column, progressive osteochondrosis, thoracic radiculopathy and other serious complications. Therefore, at the first appearance of even slight discomfort in the back, do not hesitate, urgently undergo an X-ray examination!
Rehabilitation after a spinal fracture in Moscow
High-quality recovery after spinal injury is performed at the Yusupov Hospital. The hospital operates a rehabilitation clinic, where the best specialists in the field of rehabilitation therapy work with patients. Rehabilitation of a compression fracture of the spine is carried out by experienced physiotherapists, massage therapists, and exercise therapy instructors.
At the Yusupov Hospital, rehabilitation of a spinal fracture is carried out strictly according to an individual plan, which allows us to obtain the best result in the treatment of the patient. To make an appointment with the specialists of the rehabilitation clinic, to clarify information about the work of the center and other questions of interest, you can call the Yusupov Hospital.
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Indications and contraindications
Experts recommend using a chest corset if the following indications exist:
- osteochondrosis;
- scoliosis;
Scoliosis - rehabilitation period after surgery or injury;
- kyphosis;
- presence of chronic pain;
- compression fracture;
- spondylosis;
- osteoarthritis;
- intervertebral hernias;
- intercostal neuralgia.
Intervertebral hernia
On a note! You can purchase and wear a corset without visiting a doctor, which is used by those whose physical work is quite hard and their back needs protection from excessive stress. The corset can also be used by those who do work while sitting in one place for a long time.
But you need to know that you can’t always wear a corset. When using this product, it is important to remember the contraindications, including:
- recently performed operations on those parts of the body where the corset is attached;
- allergic reactions to materials used in the manufacture of the corset;
- any diseases, one of the symptoms of which is swelling;
- diseases of the gastrointestinal tract.
It is not always possible to wear an orthopedic corset
On a note! Contraindications to wearing certain types of models may include cardiovascular and skin diseases localized in the area where product parts adjoin, and a number of chronic pathologies. Therefore, if any, consultation with a specialist is mandatory.