Osteoporotic Compression Fractures
If the fracture is caused by a sudden, forceful injury, you will probably feel severe pain in your back, legs, and arms. You might also feel weakness or numbness in these areas if the fracture injures the nerves of the spine. If the bone collapse is gradual - such as a fracture from bone thinning, the pain will usually be milder. There might not be any pain at all until the bone actually breaks.
The bones, or vertebrae, that make up your spine are very strong, but sometimes a vertebra can fracture - just like any other bone in your body. Vertebra fractures are usually due to conditions such as: osteoporosis (a condition which weakens the bones), a very hard fall, excessive pressure, or some kind of physical injury.
When a bone in the spine collapses, it is called a vertebral compression fracture. These fractures happen most commonly in the thoracic spine (the middle portion of the spine), particularly in the lower vertebra of the thoracic spine (T11 and T12) and the first vertebra of the lumbar spine (L1), hence the term thoraco-lumbar fracture.
Causes of Compression Fractures
There is not one single cause of compression fractures, though the word compression would indicate that the fracture occurs because of too much pressure being placed on the bone. If the bone is too weak to hold normal pressure, it may not take much pressure to cause the vertebral body to collapse. Most healthy bones can withstand a lot of pressure and the spine will bend to absorb the shock. However, if the force is too great for the vertebrae to sustain, one or more of them can fracture. To understand a fracture, think about bending a pencil. If you place pressure on the pencil, it will bend a little then go back into place when the pressure is gone. However, if you bend the pencil too far - past its breaking point, it will crack or break apart. Similarly, the amount a vertebra collapses/fractures depends upon the amount of pressure it has to withstand.
A common cause of compression fractures is the disease osteoporosis. This disease thins the bones, often to the point that they are too weak to bear normal pressure. The thinning bones can collapse during normal activity, leading to a spinal compression fracture. In fact, spinal compression fractures are the most common type of osteoporotic fractures. Forty percent of all women will have at least one by the time they are 80 years old. These vertebral fractures can permanently alter the shape and strength of the spine. The fractures usually heal on their own and the pain goes away. However, sometimes the pain can persist if the crushed bone fails to heal adequately.
In severe cases of osteoporosis, actions as simple as bending forward can be enough to cause a “crush fracture”, or spinal compression fracture. This type of vertebral fracture causes loss of height and a humped back - especially in elderly women. This disorder (called kyphosis or a “dowager’s hump”) is an exaggeration of your spine, that causes the shoulders to slump forward and the top of your back to look enlarged and humped.
Trauma to the spinal vertebrae can also lead to minor or severe fractures. Such trauma could come from a fall, a forceful jump, a car accident, or any event that stresses the spine past its breaking point.
Another cause of vertebral fractures is a metastatic disease. Metastasis is a term that refers to the spread of cancer cells into other areas of the body. The bones of the spine are a common place for many types of cancers to spread. A compression fracture of the spine that appears for little or no reason may be the first indication that an unrecognized cancer has spread to the spine. The cancer causes destruction of part of the vertebra, weakening the bone until it collapses. This is a sign that something going on internally is harming the bones.
Thoraco Lumbar Fracture/Compression Fracture
The most common treatments for a thoracic compression fracture are: pain medications, decreasing activity, and bracing. Vertebral fractures usually take about three months to fully heal. X-rays will probably be taken monthly to check on the healing progress. In rare cases, surgery may also be necessary.
Mild pain medications can reduce pain when taken properly. However, remember that medications will not help the fracture to heal. The medication is simply to help with pain control.
You will most likely have to limit your normal activities. You should avoid any strenuous activity or exercise. You will definitely need to avoid heavy lifting and anything else that might place too much strain on your fractured vertebra. If you are elderly, your doctor might also put you on bed rest. Older bones take longer to heal and are typically thinner and weaker than younger bones. Treat this fracture as you would any other broken bone - carefully and seriously!
Another common form of treatment for some types of vertebral compression fractures is bracing. Your doctor may prescribe a back support (often officially called an orthosis). The brace supports the back and restricts movement; just as an arm brace would support a fracture of the arm. The brace is well molded to conform tightly to your body, like a cast for any other fracture. The brace used to treat a compression fracture of the spine is designed to keep you from bending forward. It holds the spine in hyperextension (meaning more extension, or straightening, than normal). This takes most of the pressure off the fractured vertebral body, and allows the vertebrae to heal. It also protects the vertebra and stops further collapse of the bone.
Surgery to fix most spinal compression is rarely needed. With vertebral fractures, surgery, or internal fixation, is only considered if there is evidence of sudden and serious instability of the spine. For instance, if the fracture leads to a loss of 50% of the vertebral body’s height, surgery might be necessary to prevent damage that is more serious to the spinal nerves.
If your doctor feels that surgery is necessary to treat your fracture, he or she will probably suggest using some type of internal fixation to hold the vertebrae in the proper position while the bone heals. If there are signs that there is too much pressure on the spinal cord, the bone fragments pushing into the spinal cord may also need to be removed.
When surgery is necessary to remove pressure from the spinal cord, your surgeon may suggest an operation from the front of the spine. During an anterior approach an incision is made in the chest to allow the surgeon to see the front of the spine and locate the vertebra that has been crushed. One the vertebra has been located, the bone fragments may be removed to remove the pressure from the spinal cord. Once this has been accomplished a spine fusion is usually performed.
The anterior spine fusion is performed by replacing the crushed vertebra with bone graft to hold the vertebra above and below the fractured vertebra apart. The bone graft eventually grows together with the vertebra above and below and fuses the vertebra together into one bone. During the operation a combination of metal screws, metal plates and metal rods are used to hold the spine in the correct position to allow the fusion to occur over the next several months. These metal implants will remain in the body and will not be removed unless they cause problems.
In some cases, an operation to stabilize the fractured vertebra can be performed through an incision in the back. This type of procedure can allow the surgeon to use metal screws and metal rods to hold the vertebrae in the correct alignment while the fractured vertebrae heals. The posterior approach is more useful when there is not a great deal of pressure on the spinal cord and the surgeon is trying to prevent the fractured vertebra from collapsing more.
Thoraco Lumbar Fracture/Compression Fracture Case Study
This 19 year old woman was involved in a motor vehicle accident. She sustained L2 and L3 burst fractures. Note the wedging of both vertebral bodies, as well as some scoliosis due to asymmetric collapse (Images A & B).
The CT scans (Images C & D) reveal the amount of bone in red pushing into the spinal canal in blue.
A lumbar instrumentation was performed from L1 to L4 (Images E & F). This resulted in complete correction of the deformity of the spine.
Instrumentation is usually accompanied by fusion to maintain the spine in the corrected position. In this young patient, however, instrumentation was done without fusion, and the instrumentation was removed 6 months later. This allowed this young woman to maintain the normal mobility of her lumbar spine.