Compression fracture of the spine

A compression fracture of the spine is a simultaneous pressure on the spinal column, both compression and bending. The pressure is excessive for the anterior structures of the spine, especially for the vertebrae themselves and the more vulnerable discs. The anterior part of the vertebral body is literally crushed and becomes like a wedge. The posterior part, compensating, begins to break through into the spinal canal and squeezes the spinal cord canal. This is the most dangerous form of fracture, which, fortunately, is not so common. Thus, not only is the spine refraction occurring, but also its compression. That is why the fracture is called compression, since the compressed anterior wall is compensated by the extrusion of the posterior part.

A compression fracture of the spine is typical for the area of the 11th and 12th thoracic vertebrae, as well as the first lumbar. Localization in other areas is possible, but occurs less frequently.

[ 1 ], [ 2 ]

Epidemiology

Elderly people are very susceptible to compression fractures due to the fragility of the bone system as a whole and the presence of many concomitant chronic diseases. Often, a compression fracture can be a consequence of pathological deformations of the bone system, as a result of which the process of decreasing bone density begins.

[ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ]

Causes spinal compression fracture

The most common cause of such injuries are unsuccessful landings after jumping from a height and various car and transport accidents.

Symptoms spinal compression fracture

Symptoms that characterize a compression fracture of the spine:

• A sharp blow or injury causes a characteristic sharp, piercing pain in the spinal column itself, instantly transmitted to the arms or legs, everything depends on the location of the fracture.
• Almost immediately, severe weakness and a feeling of numbness sets in, indicating a rupture of the nerve endings.
• With slow, chronic destruction, which occurs in the case of bone tissue destruction by osteoporosis, the pain is usually bearable, and it increases in parallel with the process of spinal deformation.
• The most severe, complicated injuries cause paralysis of the lower body.

[ 9 ]

Forms

A compression fracture of the spinal column can have two forms: complicated and uncomplicated.

Fractures without complications, that is, without threatening injuries to the spinal cord, are also divided into subtypes:

1. The body of the vertebra is compressed until the height is reduced to less than half;
2. The pressure causes the height of the vertebral body to be reduced by half;
3. The height of the vertebra is reduced significantly – by more than half.

Spinal fractures with complications are not only a health-threatening injury, but also a life-threatening injury. In a complicated compression fracture, not only the vertebrae but also the spinal canal are injured. According to statistics, this form occurs in only 5-6% of all diagnosed injuries related to the musculoskeletal system. Most often, the cervical vertebrae are injured, as they are the most vulnerable and fragile, followed by the sternum and lumbar vertebrae. A severe mechanical injury affecting the C1 and C2 vertebrae is considered fatal. In a complicated compression fracture, the vertebrae are not so much broken as they are dislocated and cracked, as a result of which the extended or broken arches are pressed into the soft tissues of the thoracic region, and then into the spinal cord. Since there is very little spare unfilled space in the sternum, the deformed parts of the vertebrae damage the spinal cord, compensating for their location. In the thoracic region, the vertebrae most susceptible to fractures are Th11 and Th12. In the lumbar region, where the axial load is greatest, the vertebrae of level L (1 and 2) are injured.

[ 10 ]

Diagnostics spinal compression fracture

• An initial visual examination by a physician and collection of anamnesis is mandatory in cases of uncomplicated fracture;
• Neurological tests are also mandatory, determining disorders of spinal cord functioning, the degree of damage to nerve endings and the state of the peripheral nervous system;
• The radiograph is performed in a comprehensive manner - in several projections, a standard direct and lateral image is taken, other projections are also possible according to indications;
• Most often, the initial X-ray is clarified and specified by a computer tomography examination. On a CT image, the structure of the damaged vertebrae, muscle and nerve tissue is visible quite clearly. Myelography is also possible - an X-ray of the cerebrospinal fluid canal of the spinal cord. Magnetic resonance imaging is indicated only if there is a suspicion of serious injury to nerve tissue.

Modern medicine, for the purpose of preventive measures and due to the extremely widespread prevalence of osteoporosis, strongly recommends that all representatives of the fair sex who have crossed the threshold of fifty years undergo densitometric examination. This method allows for an accurate assessment of the condition of the bone tissue of the spine and timely measures to prevent a compression fracture of the spinal column.

[ 11 ], [ 12 ]

Treatment spinal compression fracture

Conservative therapy

As a rule, uncomplicated fractures do not require surgical intervention. The first stage of conservative actions is the administration of strong analgesics.

Bed rest is mandatory, maintaining maximum immobility, including fixing the body with corset devices and recliners. Such fixation helps reduce compression pressure and neutralizes the possibility of displacement (collapse). This regimen lasts until the end of the fracture healing (consolidation) period, usually up to 14 weeks.

[ 13 ], [ 14 ]

Surgical treatment of compression fracture of the spine

Surgical intervention is indicated for compression injury of the spinal cord itself, and the operation also helps restore stability to the spinal column, crushed by fractures in several places. The operation helps release pinched nerve endings and prevent further compression of the spinal cord. Operations are performed in several ways:

• Using an anterior approach, when access to the spine is opened by incision of the anterior part of the sternum or its lateral zone. Often, an implant is immediately placed in place of the destroyed vertebra – a prosthesis of the vertebral body or disc (cage).
• Using the posterior approach, when the skin is cut from the back. This method is most often used for complicated fractures, when the spinal cord is injured. Fixing devices - screws - can be installed on the damaged vertebrae, so the spinal column is fixed and returns to the state of a single conglomerate.

A compression fracture of the spine, despite the fact that it also has an uncomplicated form, is considered a serious injury that requires immediate hospitalization and urgent therapeutic measures. Cases of complicated fractures are especially dangerous, when every minute counts. Minor injuries and bruises are inevitable for each of us, but more serious blows and damage to the spinal column can deprive a person of at least mobility, at most life. Therefore, you should be careful and careful about the main support of the body - the spine.