THORACIC COMPRESSION FRACTURES

 

Questions and Answers

Diagnostic Tests for Confirming a Thoracic Compression Fracture

When diagnosing a compression fracture, several steps and tests are essential to ensure accurate identification and appropriate treatment.

Initial Assessment

Patient History:

• 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:

• Thorough examination of the affected area (e.g., neck, lower back).
• Check for point tenderness near specific vertebrae.

Imaging Techniques

X-rays:

• The primary tool for visualizing bone fractures.
• Simple, non-invasive, and can reveal breaks in bone structures.

Computed Tomography (CT) Scans:

• Advanced X-ray technique that offers cross-sectional images of the spine.
• Useful for assessing the stability of the fracture and its potential impact on nerves.

Magnetic Resonance Imaging (MRI):

• Uses magnetic fields and radio waves to produce detailed images of soft tissues, such as nerves and ligaments.
• Ideal for identifying any nerve involvement in the fracture.

Additional Diagnostic Tools

Neurological Evaluation:

• Assesses reflexes, muscle strength, and sensory responses.
• Detects possible nerve damage associated with spinal fractures.

Nuclear Bone Scan:

• Determines the age of the fracture and identifies other potential fractures.
• Useful in diagnosing conditions like osteoporosis, particularly in older adults.

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.
• 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.

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.

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.

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.

Please review the document entitled:

• Complications of Spine Surgery

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.

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.

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.

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