Compression fracture of the spine is an injury accompanied by squeezing of the vertebrae as a result of external compression and flexion forces. Bone structures crack and somewhat compress, mainly in the anterior sections, and the vertebra thus acquires a wedge-shaped shape.
If a person suffers from osteoporosis, then the density of bone tissue is significantly reduced, and compression can happen even with minimal load. It is worth noting that a fracture is not always detected on time, which is why various kinds of dangerous consequences can occur.
Injury feature
At the time of the injury, a protective reaction occurs, namely: the muscles of the abs and flexors of the chest are contracted. However, there is a slight tilt of the upper limbs forward. In this case, high pressure is exerted on the vertebrae.
The main feature of a compression fracture of the spine is the stability of mechanical or neurological damage. The named injury may be affected by the upper lumbar and lower thoracic regions.
Classification and Degree
There are 3 degrees of compression fracture of the spine:
- At 1 degree, a decrease in the vertebra is observed by less than 50%.
- With the 2nd - by 50%.
- At 3 degrees, the vertebra is compressed by 51% or more.
By the nature of the course, such an injury can be complicated and uncomplicated. The first type is characterized by the presence of various kinds of neurological disorders.
The most dangerous is a comminuted fracture, since there is a high risk of damage to the bone fragments of the nerve endings. Such damage can occur after a certain time.
In case of damage to the thoracic region (for this type of compression fracture of the spine according to ICD-10, code S22), such an injury may initially not disturb the victim, delivering only minor inconvenience. The consequences of untimely contacting a doctor may be osteochondrosis or radiculitis.
In appearance, such injuries are divided into the following types:
- wedge-shaped;
- fragmentation;
- tear-off compression.
The wedge-shaped type is characterized by the fact that the vertebral body is flattened on one side. Its wide part is directed to the central part, and the narrow - to the sternum.
Tear-off compression fractures are accompanied by separation of a part of the vertebra. You can determine it on an x-ray.
The fragmentation type of injury is characterized by the fact that the vertebra is compressed and somewhat expanded, being divided into several parts.
Causes of occurrence
Often a compression fracture of the spine is a consequence of a jump from a considerable height with a landing on straight legs or on the buttocks. Such injuries can result in injuries in the workplace, as well as a car accident. Among other reasons, the following can be distinguished:
- the course of osteoporosis;
- metastases;
- any disease accompanied by an increase in bone fragility;
- violation of metabolic processes.
In elderly women, this kind of injury is quite often observed, which occurs when the hormonal background changes.
Main symptoms
There are common signs of a compression fracture of the spine:
- pain of varying severity;
- general weakness and dizziness;
- back pain when moving.
In itself, the main cause of injury is already a characteristic feature. A compression fracture of the thoracic spine is accompanied by shortness of breath, up to its complete stop. In some cases, pain can be given to the stomach or other area. Pain decreases in a horizontal position, and intensifies when you try to move or in a standing position. Tension of the muscles of the back is noted, especially in the affected area.
Compression fracture of the lumbar spine is characterized by the occurrence of involuntary urination. Additionally, the patient may complain of nausea, vomiting, severe headache, dizziness. Depending on the area of damage, sensory and motor disturbances are possible.
If the fracture was provoked not by trauma, but by osteoporosis, then painful sensations increase gradually. Initially, the patient pays absolutely no attention to discomfort and consults a specialist only with the development of neurological disorders.
Diagnostics
Unrelenting pain in the back is the main symptom of a compression fracture. However, this is a non-specific sign, and that is why it is absolutely necessary to conduct a comprehensive diagnosis, which includes:
- X-ray
- tomography;
- myelography;
- densitometry.
It is from the correctness of the diagnostic measures and the determination of the severity that determines what treatment will be carried out and how long it will take to recover.
Treatment features
If the first signs of a compression fracture occur, you should immediately call an ambulance. Before the doctor arrives, the victim must be laid on a flat and hard surface. To do this, you can use the means at hand. If you suspect damage to the vertebrae of the cervical spine, you need to try to fix this area as much as possible. In case of a fracture of the lumbar or thoracic vertebrae, a roller should be placed under the damaged area.
Therapeutic measures should be aimed at:
- elimination of pain;
- restriction of physical activity;
- fixing the damaged area.
To eliminate the pain, the doctor will recommend the use of anti-inflammatory drugs, in particular, such as Nimesulide, Aceclofenac, Ketoprofen. At the recovery stage, it is recommended to additionally connect drugs that help accelerate the recovery of affected tissues, such as calcium and Chondroitin preparations.
The activity of the victim should be minimized, weight lifting, as well as prolonged sitting and standing. For people over 50 years of age, it is recommended that long bed rest be maintained due to the presence of osteoporotic changes in the body.
In addition, the doctor recommends wearing a corset for compression fracture of the spine, since it allows you to unload the affected area and helps to create favorable conditions for the restoration of the affected section.
The average period of full recovery is approximately 3-4 months. X-ray control should be carried out monthly. Physiotherapy is prescribed after 1.5-2 months from the start of therapy. Recovery after an injury occurs after 6 months.
Fracture treatment in children
Compression fracture of the spine in an infant has its own specific features. Most often, their lesion is localized in the middle chest region. Basically, several neighboring vertebrae are injured at the same time, and sometimes 1-2 whole vertebrae are located between two broken vertebrae.
Diagnosis in this case is quite complicated, which is why most small patients do not undergo the required examination on the day of the injury. Children are characterized by damage to both cartilaginous plates. In this regard, the treatment they have has their own specific characteristics. These include:
- the use of simultaneous reduction;
- gradual reposition;
- functional technique.
After some time, the child is prescribed to wear a plaster corset. In compression fracture of the spine, the functional technique consists in unloading traction of the latter. Thanks to this, it is possible to prevent subsequent deformation of the spinal column. And as an additional technique, therapeutic gymnastics is appointed, which helps to strengthen muscles and promotes the formation of a muscle corset.
Operation
The treatment of compression fracture of the lumbar spine is mainly carried out by surgery to restore the normal height of the vertebrae. For this, kyphoplasty and vertebroplasty are used. During kyphoplasty, the doctor corrects the shape and location of the vertebra, fixing it with cement.
Vertebroplasty is characterized by the fact that a special bone cement is introduced into the vertebral body. As a result, its shape is restored. All interventions are performed in a minimally invasive way - through small incisions, using an endoscope.
With a complicated compression fracture of the thoracic spine, treatment is carried out using open surgery. The neurosurgeon performs decompression, that is, removes areas of the vertebra that press on the nerve endings and the back of the brain. After this, the affected area is fixed by using special metal structures.
Other therapies
Functional treatment of compression fracture of the thoracic spine is divided into inpatient, requiring hospitalization of the patient, and outpatient. In addition to stretching, massage, physiotherapy and exercise therapy are also used.
Due to the negative impact of bed rest on the structure of bone tissue, it is recommended to conduct early activation of patients. Physiotherapeutic procedures involve:
- electrophoresis;
- electrical stimulation;
- magnetotherapy;
- paraffin baths.
Strengthen the muscular skeleton with a massage. Thanks to its regular implementation, it is possible to normalize blood circulation and metabolism. You should take into account the danger of injury, which consists in the fact that a person can remain disabled for life.
When conducting treatment, you must follow a special diet. Foods rich in magnesium and calcium must be present in the diet. It is necessary to exclude alcohol, strong tea and coffee, as well as fatty dishes.
The goal of exercise therapy for compression fracture of the spine is to normalize the patient's psychoemotional state and increase the tone of the body. Exercises are prescribed after an acute period. The patient should always be under the strict supervision of a specialist and be extremely careful not to provoke an exacerbation. Physical therapy consists of breathing exercises, which is combined with elementary exercises.
Rehabilitation
After compression fracture of the spine, rehabilitation is required. It is required to restore the functionality of the affected area. When carrying out rehabilitation measures, physiotherapy should be performed once every six months. To do this, paraffin and electrophoresis are often used, and in some cases, radiotherapy. It is useful to combine similar procedures with massage.
For sleep, you only need to use orthopedic mattresses, and under the neck, according to the doctor's prescription, put a hard roller.
What is dangerous injury
The consequences of a compression fracture of the spine can be quite dangerous. They are:
- the occurrence of post-traumatic osteochondrosis with hernia and protrusion;
- the development of kyphoscoliosis;
- instability of the affected segment;
- the development of paralysis.
It is worth noting that the consequences can occur immediately or proceed gradually. Bone fragments lead to a narrowing of the spinal canal, where the spinal cord is located. As a result, numbness of the extremities, malnutrition and muscle weakness are observed.
Spinal instability
Among the unpleasant consequences of a compression fracture of the spine, it is necessary to note the instability of the affected area. This leads to the fact that a person often cannot perform even the simplest household work. In addition, the onset and significant increase in painful sensations, as well as degenerative changes in the damaged segment are observed. Often there is damage to the spinal cord and its roots.
Kyphotic deformation
One of the unpleasant consequences of the described violation occurring in the thoracic region is considered to be kyphotic deformation. Often this happens in old age, but in some cases it can also occur in young patients.
With severe kyphosis, in addition to impaired posture, there may be a certain restriction of movements in the spine. There is also a deterioration in the functioning of the cardiovascular and respiratory systems, and sometimes there may be neurological disorders. Changing the normal shape of the spine can lead to overstrain of its individual parts, which provokes the formation of muscle spasm and the formation of chronic pain.
Problems of a different nature
In addition to these problems, due to prolonged lying in the process of treating an injury, the patient experiences negative processes in the lungs and intestines. These include a tendency to gas formation, digestion and constipation. Sputum can accumulate in the lungs, which threatens the development of bronchitis and pneumonia.
One of the most serious consequences of this fracture is squeezing or rupture of the roots of the spinal cord. When injured, damage to nerve endings occurs. If compression has arisen in the distant period, then neurological disorders are caused by blood vessel pressure and deterioration of the nutrition of the spinal cord.
Among the frequent consequences of a neurological nature, the following should be highlighted:
- numbness;
- feeling of cold;
- painful sensations that occur after physical exertion.
When the nerve endings are crushed, which occurs with a severe fracture of the spine, irreversible paralysis of the limbs may occur. In children with a complicated form of trauma, paresis may occur, as well as a malfunction of the pelvic organs, in particular defecation and urination. In addition, bedsores, osteochondrosis, and intervertebral hernia may occur.
The higher the injury to the spinal cord, the greater the risk to the patient’s life, and the higher the likelihood of further disability. If the injury is very serious, then the victim may have bleeding and cerebrospinal fluid. In this case, infection and suppuration are simply inevitable.
After injury, the risk of cysts or fistulas is high.