Compression fractures (crush fractures) are most often the result of injuries and usually involve the lower thoracic spine (Th10-Th12) and the initial lumbar spine (L1-L2). What else could be the causes of compression fractures. What are the symptoms of a vertebral fracture and how is it treated?
Compression fracture of the spineis a relatively common and characteristic type of fracture in which the vertebra collapses.
It is often defined as a decrease in vertebral body height by 15-20%. Depending on the cause, it may differ in symptoms and treatment procedures.
Compression fractures: symptoms
The main symptom of a traumatic compression fracture is sudden, severe pain. It usually intensifies when standing and walking, and it is relieved to lie down.
Occasionally, fragments of the crushed vertebrae may travel to the spinal canal or intervertebral foramen, causing additional neurological disorders such as paresis or sensory disturbances.
In osteoporosis, compression-type fractures can be much easier. The energy of the injury does not have to be high - it can happen, for example, when bending or lifting a slightly heavier object.
Osteoporotic vertebral body compression fracture can also be slower and gradual. In this case, the pain may be less severe, chronic, or absent at all.
Characteristic, and sometimes the only symptoms may be: reduction in height and deformation of the figure (deepening of thoracic kyphosis, stooping) - as a result of a decrease in the height of the vertebral body.
- Osteoporosis Fracture Risk Assessment (FRAX® Calculator)
Compression fractures: causes
Compression fractures of the vertebrae occur primarily due to injuries. The most common fractures occur when sitting down on the buttocks (e.g. from a chair) or on straightened legs.
In this mechanics of injury, the vertebrae are subjected to a high compressive force along the long axis of the spine. When bone strength is exceeded, the vertebral bodies may collapse and reduce in height.
For fracturescompression is most common in the lumbar and lower thoracic spine.
The risk of this type of fracture is significantly higher in people with osteoporosis, a disease in which there is a gradual decrease in bone mineral density, which makes them more prone to fracture.
Osteoporosis typically develops in postmenopausal women, and less frequently in men of advanced age. The risk factors for the development of osteoporosis are:
- older age
- female
- white breed
- low BMI ( <18kg/m2)
- smoking
- genetic predisposition
- sex hormone deficiency - e.g. early menopause, premature decline in ovarian function (POF), late puberty
- calcium and vitamin D3 deficiency
- some medications: long-term glucocorticosteroids, high-dose thyroid hormones, heparin, antiepileptic drugs
In addition, diseases such as :
- hyperparathyroidism
- Cushing's syndrome
- acromegaly
- inflammatory bowel diseases
- RZS
- ZZSK
Compression fractures of the vertebral bodies may also occur as a result of pathological weakening of the bone tissue caused by neoplastic metastases to the spine.
Compression fractures: diagnosis
In addition to a clinical examination and medical history taking into account risk factors, a standard X-ray of the spine may suffice for diagnosis.
In the X-ray image, vertebrae that have been subjected to compression fracture take on a characteristic "wedge-shaped" shape. This is because the compressed vertebral bodies usually collapse in their front part.
Compression fractures: treatment
The choice of the appropriate method of treatment is influenced by several factors, such as the age of the patient, the nature of the fracture, the presence of neurological disorders or the coexistence of osteoporosis.
Treatment of a compression fracture may be conservative and include:
- rest
- relieving and stabilizing the spine - including the use of orthopedic corsets - Jevetta corset
- pain treatment
- rehabilitation treatments
- pharmacological treatment of osteoporosis
Surgical treatments include:
- classic methods of stabilization with e.g. screws
And mainly used in osteoporotic fractures:
- vertebroplasty
- kyphoplasty
The above two types of procedures are the domain of neurosurgeons and orthopedists. They are characterized by low invasiveness. They consist of introducing into the broken core of bone cement with the use of special trocars.
These treatments are performed under the control of X-rays, and to perform them, a small puncture of the skin is enough.
Patients quickly return to physical activity and in the vast majority of cases they experience a reduction in pain intensity.
Their main goals are stabilization, pain relief and restoration of the height of the shaft (in the case of kyphoplasty).
Vertebroplastyis usually performed under local anesthesia (this removes the risk of general anesthesia in elderly people with other diseases), but it only provides stabilization.
In kyphoplasty, the element of "expansion" of the collapsed circle with a balloon is additionally used, which allows for the reconstruction of its height. However, this requires the use of general anesthesia.