How a vertebra breaks
The vertebral body is like a spongy cylinder that bears the weight of the body. With a sharp axial load - landing on the legs or buttocks, or bending forward strongly - the anterior part of the body is compressed and loses height, turning into a wedge. If only the anterior part is destroyed, and the posterior wall and ligaments are intact, the fracture is considered stable. When the middle and posterior columns are damaged, the fragment may move into the spinal canal: such a fracture is unstable and dangerous for the spinal cord. Separately, pathological fractures are distinguished when the bone is destroyed by osteoporosis, tumor or metastasis.
- Stable fracture - reduction in the height of the anterior sections
- Unstable (burst) fracture with damage to the posterior wall
- Pathological fracture due to osteoporosis or tumor
- Compression levels: up to a third, up to half and more than half of body height
- The vertebrae at the border of the thoracic and lumbar regions are most often affected
Causes and risk factors
In people under 50 years of age, significant force is required to fracture a vertebra. In the elderly, the picture is different: bone strength is reduced, and an everyday episode is enough. That is why any compression fracture in a person over 50 years of age is a reason to be examined for osteoporosis, even if the injury seemed serious. Fractures in cancer patients, long-term use of hormonal drugs and unexplained weight loss should also be on the alert: in these cases, tumor lesions of the vertebrae should be excluded.
- Fall from height, jump, road injury
- Osteoporosis and age-related bone loss
- Long-term use of glucocorticoids
- Metastases and myeloma
- Early menopause, low weight, smoking
- Recurrent falls in the elderly
Symptoms
A typical complaint is back pain at the level of injury, which intensifies when trying to sit, stand, or turn around and decreases while lying down. The pain often radiates forward, which is why it is confused with problems of the heart, kidneys or stomach. The muscles around the spine are tense, and pressure on the spinous process is painful. With an osteoporotic fracture, pain may be moderate and gradually increase over several days. Repeated fractures lead to a decrease in height and increased thoracic curve - a stoop is formed.
- Back pain that gets worse standing and sitting
- Local pain when pressing on the vertebra
- Girdle pain in the chest or abdomen
- Limiting tilts and turns
- Reduced height and increased stoop with repeated fractures
- Numbness and weakness in the legs due to compression of the nerve structures
Diagnostics
They start with radiography in two projections: it shows a decrease in the height of the vertebral body and a wedge-shaped deformity. CT more accurately assesses the integrity of the posterior wall and the presence of fragments in the canal, so it is prescribed for severe injury and before surgery. MRI answers two important questions: is the fracture fresh or old, and are the spinal cord and roots compressed? In patients over 50 years of age, densitometry and laboratory examination are additionally performed so as not to miss osteoporosis or a tumor.
- X-ray of the thoracic and lumbar regions in two projections
- CT scan for suspected unstable fracture
- MRI to assess the duration of the fracture and the condition of the spinal cord
- Densitometry for a fracture due to minor trauma
- Vitamin D, calcium, parathyroid hormone, complete blood count
- Examination by a neurologist for weakness and numbness in the legs
Treatment and recovery
A stable fracture can be treated without surgery. In the first days, you need rest on a hard surface and pain relief, then a gradual expansion of the regime in a corset, which relieves the anterior parts of the vertebrae. There is no need to wear a corset around the clock: the doctor indicates the time and duration. At the same time, osteoporosis must be treated, otherwise the next vertebra will break in the coming years. For persistent severe pain in the elderly, vertebroplasty and kyphoplasty are used - the introduction of bone cement into the vertebral body through a puncture. Unstable fractures and compression of nerve structures require surgery with spinal fixation. Massage, manual therapy and heating in the acute period are prohibited.
- Rest on a hard bed in the first days
- Painkillers as prescribed by a doctor
- Corset or reclinator for a period determined by a specialist
- Treatment of osteoporosis: calcium, vitamin D, specific therapy
- Vertebroplasty or kyphoplasty for persistent pain
- Surgical fixation for unstable fractures
- Therapeutic exercise for the muscular corset after the pain subsides