It is known that the spine and vertebrae can withstand significant loads. But, unfortunately, the influence of traumatic factors, such as, for example, exposure to significant force, a fall on the back or legs, or a decrease in bone density due to osteoporosis, can lead to compression fractures of the vertebrae in children and adults. This type of spinal fracture is characterized by a decrease in the height of the vertebrae due to their mechanical compression or flattening. Adequate treatment of spinal compression fractures in children is of fundamental importance due to possible irreversible changes in the spine after injury.
Degrees and classification of injury
Doctors classify compression fractures into three grades, depending on the decrease in vertebral height.
- I – the vertebra has become smaller by more than a third.
- II – decrease within half of the previous height.
- III – the decrease was more than 50% of the previous vertebral size.
The greater the degree, the more difficult the treatment and rehabilitation will be, and the more noticeable the consequences for the patient’s entire body. There are five main locations of injury:
- thoracic region;
- lumbar region;
- cervical region;
- sacral region;
- coccygeal section.
Symptoms of a vertebral compression fracture in children will vary depending on the location. As a result of strong impact - axial deviation, compression or stretching - the vertebra takes a wedge-shaped shape. In such a situation, the spinal cord suffers. In particularly severe cases, the patient may experience paralysis.
Symptoms of a spinal fracture in a child
Signs of a spinal compression fracture in children will vary depending on the area affected. Let's look at the three most common locations of injury.
Thoracic region
Sometimes the symptoms of such damage are mistaken for signals from other parts of the musculoskeletal system, in particular from the ribs. The fact that a compression fracture occurred in the thoracic spine is said:
- Back pain in the chest area. More often it is acute and interferes with normal breathing and movement. The child cannot turn the body from side to side.
- Strong tension in the muscle frame. Sometimes the patient cannot spread his arms to the sides, again, problems arise with normal breathing, shortness of breath appears.
- Numbness of the skin at the fracture site. This symptom can be transmitted to the hands - the fingers go numb, and complete paralysis of the limbs occurs. Grade 1 vertebral compression fractures in children often manifest as tingling in the fingers and weakening of the hands.
Cervical region
It is often diagnosed in children due to the specific nature of their games and high mobility. It can occur when someone in the class hits the child hard with a textbook or he himself falls on his head or neck. Many doctors are urging parents to limit their visits to untested trampoline parks because they are prone to compression fractures due to improper landings. The list of main manifestations:
- Severe neck muscle tension. The patient's head is often fixed in one position, and he cannot turn it because something is in the way or severe pain occurs. Tilts to the side, forward or backward also become impossible.
- The appearance of tinnitus, dizziness, nausea and lightheadedness. They appear both at the time of injury due to painful shock and subsequently.
- Unnatural head position.
Lumbar and coccyx
Such a fracture can occur due to an incorrect landing after a jump. In children it is diagnosed as a result of playing sports, sometimes earned in physical education lessons. The fact that such an injury has been received is said:
- Severe pain in the lower back and tailbone. The baby cannot straighten up or sit down.
- Numbness or complete paralysis of the lower extremities. It often begins with numbness in the fingers or loss of sensation in the area near the affected vertebra.
- Difficulty urinating and defecating.
- Marked change in posture.
Why does pathology occur?
The occurrence of a compression fracture is often noted in the lumbar region and rarely in the sternum. Injury to the lumbar region is caused by increased axial stress in this area, which occurs during a sharp bend, jump or fall.
The main sources of the problem are:
- Reduced strength of spinal tissues. In normal condition, the spinal column is able to cope with heavy physical load and the force impulse transmitted during impact. When the bone structure is weakened, fracture development is possible even with minimal stress.
- Presence of osteoporosis. Against the background of this pathology, bone mass decreases, as a result they weaken, and the risk of deformation due to stress increases.
- Lack of essential microelements. If the body does not have enough vitamins and minerals, it weakens, which affects the structure of the bones, which lose the ability to withstand stress.
- Increased mechanical impact. If a child falls from a height or puts excessive stress on the spinal column, the vertebrae may become deformed.
- Regarding the mechanism of injury, a fracture often occurs during a sharp buckle or an inaccurate fall.
First aid for a spinal fracture in a child
When a compression fracture of the thoracic spine occurs in children or damage to other parts of the spinal column occurs, the baby may not immediately understand what happened to him. The reason is the shock that a person experiences at the time of receiving such an injury. He may try to move around and even say that nothing hurts, but this impression is deceptive.
The main thing you should do if there is a suspicion of injury is to completely immobilize the child. There is only one acceptable position - lying on your back.
After this, you need to immediately call an ambulance. While the doctors are traveling, check the condition of the little patient - you need to understand whether he is conscious, count his pulse, check his breathing and inquire about pain. If the child is conscious and able to answer your questions, write down his answers in detail. If you were not there at the time of the injury, thoroughly clarify what he did before the pain appeared and how it arose.
When a child complains of pain, you should refrain from taking tablet analgesics. Doctors use only injections because damage to the spinal cord can make swallowing difficult.
If the baby does not have a pulse or is breathing, immediate cardiopulmonary resuscitation will have to be performed. Free the victim's mouth from vomit and breathe mouth to mouth.
First aid
Competently provided first aid for a spinal fracture is of great importance for the prognosis of the disease, and sometimes the life of the child, especially for complicated injuries.
- First of all, you need to place the victim on a flat, hard surface and exclude any movement. If there is no suitable surface, then place the child on his stomach, placing a pillow made from scrap materials under his head.
- It is advisable not to give painkillers until the doctor arrives, as this can blur the symptoms and make it difficult to make a correct diagnosis.
- Call an ambulance to transport the victim to the hospital.
Treatment of spinal compression fracture
To begin treatment for spinal compression in children, you need to clearly know the location and extent of the lesion. Can be used:
- Conservative therapy. It consists of following a special regime of maximum restriction of movements, wearing special corset belts and reclinators. Along the way, he takes analgesics - this helps to cope with the pain.
- Surgical intervention. Aimed at decompressing nerve structures and removing fragments from paravertebral tissue. It is most often performed for a compression fracture of the third severity.
Diagnostics
Operations for diseases of the spine
- Cost: 100,000 - 250,000 rubles.
- Duration: 40-60 minutes
- Hospitalization: 2-3 days in hospital
More details
Since pain is not specific in this case, CELT specialists conduct diagnostic studies to differentiate compression fractures from other pathologies. To do this, the patient is given a referral to:
- radiography of the spine in direct and lateral projections;
- computed tomography;
- magnetic resonance imaging;
- densitometry;
- examination by a neurologist.
- examination by a neurosurgeon
- examination by a traumatologist
Rehabilitation after injury
A set of procedures allows the patient to regain motor ability, avoid muscle atrophy, relieve residual pain, and restore posture. This element of recovery is especially important if bed rest was indicated for a long time during treatment.
Massage
Different techniques are used - reflex, classical, point. The duration of the session is from 15 to 25 minutes, depending on the duration of rehabilitation and the severity of the injury. During the session, the massage therapist
gradually affects the chest, intercostal spaces, abdomen, thighs, forearms and arms.
Exercise therapy and gymnastics
The procedure takes place under the strict supervision of the attending physician. The course takes about two months. It all starts with dynamic and static breathing exercises, then the body is gradually turned, and standing exercises are introduced.
Corset
For several months, a person will have to wear a children's corset to correct the position of his back. It supports the body, preventing excessive deformation and changes in position. The more serious the injury and the higher the degree of damage, the longer you will need to wear the brace.
Surgical intervention
It is required if all rehabilitation methods have not yielded the desired results. To monitor the success of the recovery, the patient is sent for an MRI and his current condition is analyzed. Kinoplasty may be required - it relieves pain, restores the child’s posture, and allows you to be safe from worsening the condition in the future.
Results of work
Case 1: I degree compression fracture of three thoracic and two upper lumbar vertebrae
A 6-year-old boy fell on the playground from a height of approximately 1.5 meters. At the clinic, after an MRI, a diagnosis was made of a grade I compression fracture of three thoracic and two upper lumbar vertebrae. The parents turned to the specialists of Baltic Rehabilitation Technologies a month and a half after the end of bed rest. An individual rehabilitation program was drawn up for the child, which lasted 6 weeks. The following methods were included:
- Manufacturing and further wearing of an individual corset;
- Exercise therapy classes according to an individual scheme (the first three weeks at home 5 times a week, then 3 times a week in our center);
- Massage course (sessions were held before physical therapy classes);
- Physiotherapy.
After successful implementation of the program, our little patient’s pain syndrome completely disappeared and normal motor activity was restored.
Complications and consequences of injury
The consequences of a compression fracture of the spine in children can be very dangerous. Among them:
- Vertebral instability. The result is constant discomfort in the affected area and decreased ability to tolerate physical activity. The patient will be especially susceptible to protrusion and hernia, so he will have to follow a special regime of lifting heavy objects and take care of his back.
- Neurological changes. Can lead to paralysis, disruption of breathing and normal functioning of the heart muscle.
- Spinal shock. Occurs when the spinal cord is damaged. This has a complex effect on the body - reflexes worsen, sensitivity decreases, and other unpleasant symptoms arise.
Treatment of the consequences of a compression fracture of the spine in children is possible, but it is very important from the very onset of the injury to carefully approach the diagnosis and subsequent rehabilitation of the small patient. It will be necessary to conduct an MRI, draw up a conclusion based on its results, and prepare a detailed treatment plan using surgical and conservative methods. A small patient must strictly follow the regimen and instructions of orthopedic traumatologists , especially in terms of restriction of movements and a special regime - parents will need to monitor this. Some complications arise due to the fact that a deceptive improvement occurs and vigilance is weakened. It will be possible to return to normal life with activity and exercise only after the attending physician allows it.
Conservative treatment
Conservative treatment methods are aimed at:
- elimination of pain syndrome;
- rapid healing of the fracture;
- minimizing axial load on the spine.
In order to avoid complications, it is necessary to correctly fix the damaged part of the spine. The patient must remain in bed and wear a reclinator or orthopedic corset. The use of painkillers can minimize or eliminate pain symptoms. In order to prevent the formation of bedsores and strengthen muscles during prolonged bed rest, professional massage is used.