THORACIC COMPRESSION FRACTURES

Understanding the Spine’s Anatomy

To grasp the nature of compression fractures, it’s essential to understand the spine’s anatomy, particularly the thoracic and lumbar regions. Compression fractures often occur at the lower part of the thoracic spine, specifically at vertebrae T11 and T12, and can extend to the first vertebra of the lumbar spine, L1.

How Compression Fractures Happen

These fractures typically result from excessive pressure on the vertebral body. Imagine a scenario where you fall from a chair, landing in a seated position. As your head moves forward and your buttocks hit the floor, the spine bends forward. This bending concentrates pressure on the front of the spine—the vertebral bodies—leading to potential fractures.

When such pressure causes the bone to collapse, the front of the vertebral body forms a wedge shape. Inside, the cancellous bone is crushed or compressed. In severe cases, the back of the vertebral body might even push into the spinal canal, although this is rare.

By understanding these details, you can better appreciate the complexities involved in diagnosing and treating compression fractures.

Key Components of the Spine

Each vertebra within these regions consists of important components:

• Vertebral Body: This is the weight-bearing part of the vertebra.
• Vertebral Arch: Encloses the spinal canal where the spinal cord resides.

Intervertebral discs function as shock absorbers, cushioning the spine during activities such as walking, running, and jumping. Surrounding the spinal cord are protective layers of tissue called meninges, which safeguard against injury and trauma.

The spine also features bony processes that protrude from the vertebral arch. These serve as attachment points for muscles, ligaments, and tendons, which are vital for both stability and mobility.

Understanding these elements provides insight into how compression fractures can affect the structural integrity and function of the spine, leading to potential complications if not properly addressed.

When to Seek Medical Attention for Potential Spinal Compression Fractures

If you’re experiencing symptoms that could indicate spinal compression fractures, knowing when to consult a healthcare professional is crucial. Here’s what to watch for:

• Persistent or Severe Pain: If you notice continuous or intense back pain that doesn’t ease with rest, it warrants a medical evaluation.

• Difficulty in Movement: Struggling with mobility or experiencing pain while standing, sitting, or walking should be a red flag.

• Height Loss or Stooped Posture: A noticeable decrease in height or developing a hunched back are signs you should not ignore.

• Numbness or Weakness: Experiencing numbness, tingling, or weakness in your limbs may indicate nerve involvement.

Seeking medical attention promptly can lead to an early diagnosis, which is vital for managing symptoms effectively, preventing further issues, and improving recovery outcomes. If you encounter any of these symptoms, consider scheduling an appointment with a qualified healthcare provider, such as those found through reputable medical institutions or trusted clinics.

How Do Spinal Infections and Tumors Cause Spinal Compression Fractures?

Spinal Infections

Spinal infections, such as osteomyelitis and discitis, can severely compromise the integrity of the spine. When bacteria or fungi infiltrate the bone or intervertebral discs, they create inflammation and deterioration. This weakening of the vertebrae makes them more susceptible to cracks or fractures even under normal stress. As the infection progresses, the structural damage increases, significantly elevating the risk of a spinal compression fracture.

Spinal Tumors

Spinal tumors, whether benign or malignant, pose a significant threat to spinal stability. These tumors can originate in or near the spine and exert pressure on the vertebrae. Cancerous tumors, in particular, can lead to bone loss or destruction by disrupting normal bone remodelling processes. The resulting loss of bone density renders the spine vulnerable to compression fractures, which can occur with minimal force or even spontaneously. Both spinal infections and tumors require vigilant medical attention. Early diagnosis and intervention are crucial in preventing fractures and maintaining spinal health.

How Does Prolonged Use of Corticosteroid Medications Lead to Spinal Compression Fractures?

Corticosteroids are often prescribed to manage chronic conditions such as arthritis or autoimmune disorders due to their powerful anti-inflammatory effects. However, extended use comes with certain risks, especially concerning bone health.

• Impact on Bone Density
  Corticosteroids can decrease the body’s ability to absorb calcium and impair the function of bone-forming cells. This results in a reduction of bone density over time, making bones more fragile.

• Weakening of Bone Structure
  The deterioration in bone strength due to prolonged corticosteroid use can cause the vertebrae in the spine to become more susceptible to fractures. Over time, even minor stress or a simple fall can lead to compression fractures.

• Altered Hormonal Balance
  These medications can alter the balance of hormones that regulate bone remodeling, accelerating bone loss.

Understanding these risks is crucial. If you are on long-term corticosteroid therapy, it might be beneficial to discuss preventative measures with your healthcare provider to safeguard your bone health.

How Do Metabolic Conditions Like Paget’s Disease Affect the Risk of Spinal Compression Fractures?

Metabolic conditions, such as Paget’s disease and hyperparathyroidism, play a significant role in influencing bone health, particularly affecting the spine. These disorders can disrupt normal bone remodeling processes, leading to weakened bone structures.

• Impact on Bone Density: Paget’s disease causes the body to generate new bone faster than normal, resulting in disorganized, softer bone tissue. Consequently, the bones become fragile, increasing susceptibility to fractures.

• Hyperparathyroidism and Calcium Regulation: This condition leads to an overproduction of parathyroid hormone, which elevates calcium release from bones into the bloodstream. As a result, bones may lose density and strength over time.

These alterations make the spine more vulnerable to compression fractures, where the vertebrae can collapse under normal pressure or minor trauma. Maintaining bone health through appropriate medical interventions and lifestyle adjustments is crucial for individuals with these metabolic conditions.

How Degenerative Disc Disease Can Lead to Spinal Compression Fractures

Degenerative disc disease is a condition where the spinal discs lose their structural integrity and functionality over time. As these discs deteriorate, they become less effective at cushioning the vertebrae.

• Reduced Shock Absorption: Healthy intervertebral discs act as shock absorbers, distributing pressure evenly along the spine. When these discs degenerate, they lose this capability, leading to increased stress on the vertebrae.

• Increased Pressure on Vertebrae: Without the proper distribution of weight and shock, the vertebrae are exposed to excessive pressure. This condition weakens the bones over time, making them more susceptible to fractures.

• Bone Fragility: Degenerative disc disease can exacerbate osteoporosis, a condition that weakens bones. In a fragile state, the vertebrae can easily fracture under stress or minor trauma.

Overall, as the cushioning effect diminishes, the chance of spinal compression fractures rises, posing a significant risk to individuals with this condition.

Diagnostic Tests for Confirming a Thoracic Compression Fracture

Several steps and tests are essential to diagnose a compression fracture to ensure accurate identification and appropriate treatment.

Initial Assessment

• Collection of detailed information about the onset, duration, and nature of the pain.
• Questions about possible injuries, pain location, intensity, aggravating, and alleviating factors.
• Family history of similar issues, such as osteoporosis.

Physical Examination

After taking your history, the physician will give you a physical examination. This allows the doctor to rule out possible causes of pain and to try to determine the cause of the problems. The examination of your body depends upon where there is pain – neck, lower back, arms, legs, etc. Neurological problems appear rare except in younger patients who experienced a violent injury, such as a car crash.

If a doctor suspects a compression fracture, the doctor will also test for point tenderness near specific vertebrae. Testing specific areas for unusual tenderness allows the doctor to narrow down the cause of your pain.

Diagnostic Imaging and Tests

X-ray:

• If a fracture is suspected, an X-ray of the spine will generally confirm its presence.
• This painless process uses radioactive materials to take pictures of bones, showing fractures clearly.

CAT Scan:

• If there is a fracture, your doctor may suggest a CAT scan to ensure the fracture is stable.
• This test can show both bones and soft tissues, producing cross-sectional images of the spine.

MRI: If there’s a chance nerves are involved or if the cause of pain is unclear, an MRI might be recommended.This test uses magnetic and radio waves to generate detailed images of soft tissues, such as nerves and ligaments.

• An MRI is a powerful diagnostic tool, especially when it comes to spinal issues. Unlike traditional imaging methods that use radiation, MRI leverages magnetic and radio waves, making it a safer option for repeated use. This technology allows for the creation of computer-generated images that can delve through multiple layers of the spine.

  By providing a comprehensive view, the MRI can reveal abnormalities in soft tissues, including nerves and ligaments. These insights are crucial when evaluating conditions involving nerve damage or unexplained pain. The ability to visualize these complex structures with precision makes MRI an invaluable asset in diagnosing and managing spinal health concerns.

Neurological Exam

A neurological exam will also be given. This allows the doctor to test your neurological responses, such as reflexes, muscle strength, and sensory perception. Abnormalities in this examination can point to nerve damage, affecting body movement and responses.

In cases where nerve involvement is suspected, the combination of these diagnostic tools helps in forming a complete understanding of the patient’s condition and in planning appropriate treatment.

Summary

To diagnose a compression fracture, medical professionals use a combination of patient history, physical examinations, and sophisticated imaging techniques such as X-rays, CT scans, and MRIs. Additional tests like neurological evaluations and nuclear bone scans may also be necessary to provide a comprehensive assessment. For more information on all these tests, you may wish to review Diagnostic Tests for Spine Problems.

Why Are Many Vertebral Fractures Not Accurately Diagnosed or Treated?

Vertebral fractures often slip under the radar for several reasons. Firstly, the symptoms can be misleading. Patients typically experience general back pain, which is frequently misattributed to muscle strain, soft tissue injuries, or the natural aging process. This misidentification plays a significant role in the underdiagnosis of these fractures.

Key Factors Leading to Misdiagnosis:

• Symptom Overlap: The pain associated with vertebral fractures is often similar to more common conditions, leading healthcare providers to overlook the possibility of a fracture.
• Generalization of Pain: Many clinicians may categorize pain as a standard part of aging, especially in older adults, which prevents further investigation.
• Lack of Specific Screening: Regular screenings for back pain often focus on more widely recognized issues, thereby missing underlying fractures.

Due to these reasons, approximately two-thirds of vertebral fractures remain undiagnosed annually. The lack of accurate diagnosis subsequently means these fractures also go untreated, ultimately compromising patient care and quality of life.

How Spinal Compression Fractures Impact Self-Image and Daily Activities

Spinal compression fractures can significantly alter a person’s life. These fractures may cause chronic pain and physical deformities, such as a hunched back or a decrease in height.

Impact on Self-Image

• Physical Changes: The curvature of the spine can become more pronounced. These visible changes can lead to feelings of embarrassment or self-consciousness.
• Emotional Consequences: Constant pain and discomfort can make individuals withdraw from social interactions, negatively affecting their self-esteem and sense of identity.

Effect on Daily Living Activities

• Mobility Issues: Pain and limited spinal flexibility can restrict movement. Simple tasks like bending over or lifting objects may become difficult and painful.
• Reduced Independence: Individuals might struggle with everyday routines such as dressing, taking care of personal hygiene, or participating in recreational activities. This dependency can further impact their mental health and sense of autonomy.

In summary, spinal compression fractures not only cause physical discomfort but also lead to profound emotional and practical challenges, altering both self-image and the ability to engage in daily activities.

Potential Long-Term Consequences of Untreated Thoracic Compression Fractures

Untreated vertebral fractures can lead to a range of long-term health issues. Here’s a breakdown of what can happen if these fractures aren’t addressed:

Persistent Pain and Deformity

• Chronic Back Pain: Initially, you’ll experience acute back pain, which can evolve into chronic discomfort. This persistent, localized pain is often the most noticeable symptom of a spinal compression fracture.
• Pain with Movement: The discomfort may worsen with any type of movement, even during simple activities like coughing or sneezing. Such reactions highlight the sensitivity of the spine when affected by fractures.
• Persistent Pain and Deformity: It’s essential to make an appointment with your healthcare provider if you experience these symptoms, especially if your pain is persistent or severe. Early diagnosis and treatment can significantly alleviate pain, prevent further complications, and improve overall outcomes. Identifying the issue promptly ensures that you can manage the condition effectively and maintain your quality of life.
• Deformity: Over time, the spine can develop thoracic kyphosis, commonly known as a dowager’s hump.
• Height Loss: Repeated vertebral fractures may cause a noticeable reduction in height.

Impact on Internal Organs and Physical Condition

• Organ Compression: The deformity and height loss can lead to crowding of internal organs, affecting their function.
• Reduced Physical Activity: Pain and discomfort often discourage regular exercise, leading to loss of muscle mass and aerobic conditioning.

Psychological and Lifestyle Changes

• Self-Image and Self-Esteem: The physical changes can negatively impact self-image, leading to diminished self-esteem.
• Daily Life: The combined physical and psychological effects may make it challenging to perform daily activities.

By understanding these potential outcomes, it’s clear that timely and effective treatment for vertebral fractures is crucial.

Understanding the Prevalence of Thoracic Compression Fractures from Osteoporosis

Spinal compression fractures, particularly those caused by osteoporosis, are alarmingly prevalent. Roughly 700,000 individuals in the United States experience these fractures annually. This condition disproportionately affects postmenopausal women, with estimates indicating that about 25% of this demographic has suffered from a vertebral compression fracture.

Key Statistics

• Prevalence in Women: Women are significantly more affected, with osteoporosis or low bone mass being four times more common in women than in men.
• Impact on Men: However, men are not immune. Approximately 25% of men over the age of 50 will encounter a bone fracture related to osteoporosis, such as those affecting the hip or spine.

Diagnosis Challenges

Unfortunately, these fractures often go undiagnosed. Many patients mistake the symptoms for routine back pain linked to muscle strains or aging. As a result:

• Undiagnosed Cases: Two-thirds of vertebral fractures annually remain unrecognized and untreated due to misdiagnosis.

These statistics highlight the need for increased awareness and better diagnostic practices to address this widespread but often overlooked health issue.

What Are the Different Types of Spinal Compression Fractures?

Spinal compression fractures can occur due to various reasons, including osteoporosis. Each type of fracture has its characteristics:

Wedge Fracture

A wedge fracture is the most common type. It typically happens when the front part of a vertebra collapses, resulting in a wedge-shaped bone. This type of fracture is usually stable and does not often lead to neurologic issues.

Crush Fracture

A crush fracture occurs when the entire vertebra breaks. Unlike a wedge fracture, which affects primarily the front of the bone, a crush fracture causes the collapse of the whole vertebra.

Burst Fracture

A burst fracture is more severe. It involves both the front and back walls of the vertebral body losing height. This type of fracture is potentially unstable and can lead to further deformities or neurological problems if not treated properly.

Key Points

• Wedge Fracture: Affects the front part of the vertebra, forming a wedge shape.
• Crush Fracture: Involves the collapse of the entire vertebra.
• Burst Fracture: Affects both the front and back walls of the vertebra, more likely to cause instability.

Understanding these distinctions can help in recognizing the severity of the injury and planning appropriate treatment.

How is Osteoporosis-Related Spinal Compression Fracture Assessed?

Assessing a spinal compression fracture, particularly when linked to osteoporosis, entails a comprehensive approach using both physical examination and advanced diagnostic tools.

Step 1: Physical Examination

Your healthcare provider will start with a thorough physical exam. This includes checking your spine for tenderness, assessing your range of motion, and identifying any visible deformities. They will also conduct neurological tests, which focus on evaluating sensation, strength, and reflexes in your arms and legs.

Step 2: Imaging Tests

Imaging is crucial in diagnosing spinal compression fractures.

• X-Rays: These are typically the first step in imaging. They help identify any fracture lines or changes in spinal alignment.
• MRI and CT Scans: These advanced imaging techniques are used to confirm the presence of a fracture and provide detailed visuals of the spinal cord and surrounding tissues.

Step 3: Assessing Bone Density

If osteoporosis is suspected as the cause, a bone density test, such as a DEXA scan, is performed. This test measures bone density and strength, helping to identify the extent to which osteoporosis has affected the bones.

Additional Tests

Depending on your overall health, additional tests like blood tests or a lumbar puncture might be conducted to rule out other medical conditions.

Through this multi-step process, healthcare professionals can accurately diagnose osteoporosis-related spinal compression fractures and develop an effective treatment plan.

Differences Between Wedge Fractures, Crush Fractures, and Burst Fractures

Understanding spinal fractures is crucial, especially when it comes to identifying the specific type of fracture involved. Here’s a detailed look at wedge fractures, crush fractures, and burst fractures:

Wedge Fracture

A wedge fracture is the most frequent type of compression fracture in the spine. It primarily affects the front part of the vertebra, causing it to collapse while leaving the back part intact. This results in a wedge-shaped vertebra, thus the name. These fractures are usually mechanically stable, meaning they do not typically lead to spinal instability.

Crush Fracture

In contrast to wedge fractures, a crush fracture involves the collapse of the entire vertebra rather than just the front. This means the bone is broken more uniformly. While similar to wedge fractures, crush fractures can occasionally be more severe due to the involvement of the whole vertebral body.

Burst Fracture

A burst fracture is more severe than both wedge and crush fractures. This type of fracture results in the loss of height in both the front and back parts of the vertebra. Due to this dual collapse, burst fractures are often considered unstable. They can lead to progressive deformity and may pose a risk to the spinal cord and surrounding nerves.

Key Differences

Location of Collapse:

• Wedge Fracture: Only the front part of the vertebra collapses.
• Crush Fracture: The entire vertebra collapses uniformly.
• Burst Fracture: Both the front and back parts of the vertebra lose height.

Stability:

• Wedge Fracture: Generally stable.
• Crush Fracture: This can vary but is often more severe than wedge fractures.
• Burst Fracture: Typically unstable, with potential for spinal cord involvement.

Severity:

• Wedge Fracture: Less severe, primarily affecting the anterior vertebral body.
• Crush Fracture: More extensive than wedge fractures due to full vertebral involvement.
• Burst Fracture: Most severe, affecting both anterior and posterior sections of the vertebra.

Understanding these differences aids in diagnosing and choosing the appropriate treatment to ensure optimal patient care.

Treatment of Thoracic Compression Fractures

The most common treatments for a thoracic compression fracture are pain medications, decreasing activity, and bracing. In rare cases, surgery is recommended.

Pain Medications

It’s important to understand that while pain medications are effective in managing discomfort, they do not promote the healing of the fracture itself. These medications are primarily used to make daily activities more tolerable and improve quality of life during recovery. Proper adherence to prescribed dosages is crucial to avoid potential side effects and complications.

To review the types of pain medications used for back pain please review Medications for Back Pain.

Decreasing Activity

Doctors strongly recommend reducing daily activities to aid in healing. For example, doctors will tell their patients that they should avoid activities involving strenuous motion or heavy lifting to prevent additional strain on the already weakened vertebra. For elderly patients, or those with particularly severe fractures, doctors might recommend complete bed rest. This is because older bones are generally thinner and weaker, and thus take longer to heal.

Bracing

To support the spine and limit movement, your doctor might prescribe a back brace. This brace is designed to hold the spine in hyperextension, which means it keeps the spine straighter than usual. This position helps alleviate pressure on the fractured vertebra, allowing it to heal while also preventing further collapse of the bone. The brace is tailored to fit tightly and comfortably, much like a cast, ensuring that it provides the necessary support while being as unobtrusive as possible.

Physical Therapy

Your provider may recommend an orthopedic physical therapy program to complement the use of a back brace. This program focuses on improving strength, flexibility, and posture. By strengthening the muscles surrounding the spine, particularly the core region, physical therapy provides additional stability to the injured area. This added stability is crucial for both supporting the spine and facilitating the healing process.

Comprehensive Recovery Approach

These targeted treatments are part of a comprehensive approach designed to manage pain and facilitate the healing process while also aiming to maintain as much mobility as is safely possible. Each element of the treatment plan plays a crucial role in the overall recovery from a spinal fracture. Through a combination of bracing and physical therapy, patients can experience improved pain relief and enhanced spinal support, paving the way for a more effective and swift recovery.

To learn more about the different types of braces available to treat compression fractures you may wish to review the document entitled:

• Back and Neck Braces

Types of Braces for Treating Thoracic Compression Fractures

When it comes to treating certain types of vertebral compression fractures, braces play a crucial role. Here’s a closer look at the types of braces used and how they help:

Orthosis: The Backbone of Support

Doctors often prescribe an orthosis, a specially designed back support that ensures stability and limits movement. Think of it as a cast for your spine. It’s meticulously molded to fit your body, offering snug support similar to a cast for any other fracture.

Function and Design

The primary goal of these braces is to prevent forward bending, which can further injure the vertebrae. By holding the spine in hyperextension—keeping it more extended or straight than usual—the brace reduces pressure on the fractured vertebra. This positioning facilitates healing and protects against further bone collapse.

Benefits of Spinal Braces

• Stabilization: Keeps the fractured vertebra in place to avoid additional injury.
• Pressure Relief: Reduces the pressure on the broken vertebral body.
• Healing Support: Allows the bone to heal by maintaining proper alignment.

Braces are an effective, non-surgical option, providing the necessary support to help vertebrae heal naturally and prevent further damage.

Surgery for Thoracic Compression Fracture

Surgery to fix most spinal compressions does not normally occur. Vertebral fracture surgery, or internal fixation, is only considered if evidence of sudden and serious instability of the spine exists. For instance, if the fracture leads to a loss of 50% of the vertebral body’s height, surgery might occur to prevent further more serious damage.

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 removal.

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 crushed vertebra. Once the doctor locates the bone fragments, removal occurs to relieve the pressure. Following this, the surgeon will implement a spine fusion.

The Anterior Approach to Spine Fusion

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 crushed vertebra. Once the doctor locates the bone fragments, removal occurs to relieve the pressure. Once this happens, the surgeon will implement a spine fusion.

The doctor performs an anterior spine fusion by replacing the crushed vertebra with a 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 into one bone. During the operation, a combination of metal screws, metal plates, and metal rods is 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 unless they cause problems.

• Replacing the crushed vertebra with a bone graft.
• Holding the vertebra above and below the fractured vertebra apart.
• Using metal screws, metal plates, and metal rods to maintain the correct position of the spine.

The bone graft eventually grows together with the vertebra above and below and fuses the vertebrae into one bone. This process occurs over several months, during which the metal implants remain in the body unless they cause problems.

The Posterior Approach to Spine Fusion

In some cases, an operation to stabilize the fractured vertebra will occur through an incision in the back. This type of procedure, known as a posterior approach, allows the surgeon to:

• Use metal screws and metal rods to hold the vertebrae in the correct alignment.
• Aid the healing of the fractured vertebrae.

The posterior approach is particularly useful when there is not a great deal of pressure on the spinal cord. It helps prevent the fractured vertebra from collapsing further, offering a viable alternative when anterior surgery is not suitable.

This comprehensive approach to both anterior and posterior surgical techniques ensures that treatment is tailored to the specific needs and conditions of the patient, maximizing the likelihood of successful recovery and stability of the spine.

• Instrumented Lumbar Spine Fusion

Spinal surgery is a serious undertaking. Because of the risks and complications associated with spinal surgery, internal fixation is only done in serious cases.

Complications of Thoracic Compression Fractures

With any surgery, there is a risk of complications. When surgery occurs near the spine and spinal cord, doctors consider any complication exceedingly serious. Complications could involve subsequent pain and impairment and the need for additional surgery. You should discuss the complications associated with surgery with your doctor before surgery. The list of complications provided here does not provide a complete list and is not a substitute for discussing the risks of surgery with your doctor. Only your doctor can evaluate your condition and inform you of the risks of any medical treatment he or she may recommend.

Understanding the potential complications of spinal surgery is crucial for making an informed decision. Surgery near the spine carries unique risks due to the sensitive nature of the spinal cord and surrounding structures. Complications can range from chronic pain to more serious conditions that may necessitate further surgical intervention. It’s essential to have a thorough discussion with your healthcare provider to grasp the full extent of these risks.

Several specific complications can occur with a vertebral compression fracture. If you notice or suspect a complication, please contact your doctor immediately.

Segmental Instability

If a fracture leads to a vertebral body collapse of more than 50 percent, a risk of segmental instability exists. Each spinal segment works like a well-tuned part of a machine. All of the parts should work together to allow weight-bearing, movement, and support. A spinal segment is composed of two vertebrae attached by ligaments, with a soft disc separating them.

The facet joints fit between the two vertebrae, allowing for movement, and the foramen between the vertebrae allows space for the nerve roots to travel freely from the spinal cord to the body. When all the parts are functioning properly, all spinal segments join to make up a remarkably strong structure called the spine. When one segment deteriorates or collapses, to the point of instability, it can lead to localized pain and difficulties. The instability eventually results in faster degeneration of the spine in this area.

Kyphotic Deformity

Though the thoracic spine is curved (or kyphotic) and more than 40 to 45 degrees, it is considered abnormal. Sometimes this deformity is described as a “round-back posture” or “hunchback”. It occurs as a common disorder in elderly women who get osteoporosis and frequent fractures. The front of the vertebrae will collapse and wedge due to the lack of normal vertebral space. This condition leads to a more rounded thoracic spine.

Neurologic Complications of Thoracic Compression Fractures

If the fracture causes part of the vertebral body to place pressure on the spinal cord, the nerves can get affected. There is some space between the spinal cord and the edges of the spinal canal. However, this space can be reduced if the pieces of the broken vertebral body push into the spinal canal, potentially leading to a critical reduction in the space available for the nerves. The bony tube of the spinal canal cannot expand if the spinal cord or nerves require more space, making any encroachment particularly dangerous. If anything begins to narrow the spinal canal – such as if the vertebrae protrude into its space, the risk of irritation and serious injury of the spinal cord or nerves increases, emphasizing the severity of potential neurological complications that may arise.

Key Points to Consider:

• Pressure on Spinal Cord: Direct pressure from fractured vertebrae can impact nerve functionality.
• Reduced Space: Pieces of the broken vertebral body can invade the spinal canal, severely limiting the space necessary for the spinal cord and nerves.
• Lack of Expansion: The spinal canal’s inability to expand can exacerbate the effects of any intrusion.
• Increased Risk: Any narrowing of the spinal canal heightens the possibility of significant nerve damage and other neurologic complications.

By understanding both the general and specific risks associated with spinal surgery, you can better prepare for a discussion with your doctor, ensuring that all potential concerns are addressed and adequately managed.

Spinal Narrowing

The narrowing of the spinal canal due to a compression fracture can either lead to immediate injury to the nerves of the spine, or irritation of the nerves later. If the irritation on the spinal nerves comes later (even after the fracture has healed), it can cause pain and problems with the nerves not working right. The lack of space can also reduce the supply of blood and oxygen to the spinal cord. When the spine needs more blood flow during increased activity, the blood vessels may not swell to get more blood to the spine. This can lead to numbness and pain in the affected nerves.

When a compression fracture occurs, it can cause pieces of the vertebral body to push into the spinal canal, narrowing the space available for the spinal cord and nerves. The spinal canal, a bony tube, cannot expand to accommodate these displaced fragments. As a result, the risk of irritation and serious injury to the spinal cord or nerves increases. This narrowing, or stenosis, can cause immediate nerve injury or lead to delayed irritation long after the fracture has ostensibly healed.

If the fracture causes part of the vertebral body to exert pressure on the spinal cord, the nerves can be affected significantly. Initially, there is some space between the spinal cord and the edges of the spinal canal. However, if the fragments from the fracture extend into this space, the vertebrae can protrude into the canal, increasing the risk of nerve irritation and potential injury.

The narrowing of the spinal canal due to a compression fracture can either lead to immediate injury to the nerves of the spine or irritation of the nerves later, even after the fracture has healed. This lack of space can also impair the supply of blood and oxygen to the spinal cord. During increased activity, the blood vessels may not be able to expand sufficiently, potentially leading to numbness and pain due to reduced blood flow.

Immediate and Delayed Effects

• Immediate Injury: Compression fractures can immediately damage the spinal nerves.
• Delayed Irritation: Even after healing, the fracture site can later irritate the spinal nerves, causing ongoing pain and functional issues.

The nerves also lose some of their mobility when the space available to them becomes reduced. This leads to irritation and inflammation of the nerves. Doctors refer to this condition as spinal stenosis. For more information on spinal stenosis, you may wish to review the Lumbar Stenosis page and the Cervical Stenosis page.

Blood and Oxygen Supply

• Reduced Supply: The narrowing of the spinal canal reduces blood and oxygen flow to the spinal cord.
• Activity Impact: During increased activity, the blood vessels may not be able to expand sufficiently to supply the required blood flow, leading to numbness and pain.

Nerve Mobility

• Restricted Space: As the space for the nerves is reduced, they lose mobility.
• Inflammation: This lack of space can lead to nerve irritation and inflammation, further contributing to pain and discomfort.

Understanding these processes helps in recognizing the potential for a compression fracture to develop into spinal stenosis, stressing the importance of timely medical evaluation and intervention. For more information on spinal stenosis, you may wish to review the Lumbar Stenosis page and the Cervical Stenosis page.  All of these conditions may lead to the need for surgery to reduce pressure on the spinal cord or to stabilize the spine. To reduce pain and/or the danger of neurological problems, doctors could recommend surgery.

The Southwest Scoliosis and Pain Institute

Patients should choose to seek treatment from specialized centers. Our practice offers expertise in the diagnosis and treatment of this condition. Such centers like the Southwest Scoliosis and Spine Institute with offices in Dallas, Plano, and Frisco, Texas offer a multidisciplinary approach to treatment, which involves a team of specialists, including orthopedic surgeons, physical therapists, and pain management specialists. Additionally, the Southwest Scoliosis and Spine Institute offers access to advanced diagnostic tools and treatment options, such as minimally invasive surgery and spinal fusion. Patients may also benefit from a personalized treatment plan that takes into account their unique needs and medical history. Ultimately, the decision to seek treatment at a particular medical institution will depend on various factors, but for those wanting to get the very best, patients should consider our expert doctors as their first choice.

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Footnote:

Physiopedia: Thoracic Compression Fractures