Trauma to the spine is a serious matter. It can lead to spinal vertebral fracture and those could be excruciatingly painful and lead to potential complications.
The most common type of vertebral fracture is the compression fracture, which occurs when the normal vertebral body of the spine collapses. Trauma-related to fall is one of the main causes of spinal compression.
Another common cause is osteoporosis.
The common clinical presentation of the spinal compression fracture is back pain, which is typically sudden and severe. Multiple spinal compressions without a discrete history of trauma are likely due to osteoporosis and may lead to kyphotic deformity or dowager’s hump.
Rarely, there will be nerve complaints but typically nerves are spared as they are behind the vertebra. These are seen in burst fractures that occur around the spinal cord and nerves. This is a serious condition and often require immediate surgical intervention to preserve the spinal cord or nerves.
The first goal of management is pain relief and the second is the patient’s ability to stand and walk. A physical exam should determine if there is nerve damage.
X-ray imaging demonstrates the structure of the vertebrae and the outline of the joints. It helps to assess the bone alignment, disc degeneration and bony spurs which may irritate nerve roots. CT scans show the shape and size of the spinal canal, its contents, and the surrounding structures. A contrast-enhanced myelogram of the spine may be considered for assessment of the spinal cord. An MRI shows the spinal cord, nerve roots, and surrounding areas.
Pain control is typically achieved through bed rest, medications, bracing or invasive spinal surgery. But the pain can still last two to three months. Prolonged inactivity is discouraged in order to avoid complications, such as bed sores and pulmonary embolism. Over-the-counter NSAIDs are commonly recommended. But narcotic pain medications and muscle relaxants may need to be prescribed for effective pain control. However, given the risk of addiction, it is prescribed for short periods of time. Back bracing for external support to limit the motion of fractured vertebrae and help reduce pain.
When conservative treatment fails, minimally invasive procedures, such as vertebroplasty and kyphoplasty, may be considered. Vertebroplasty is done typically as an outpatient procedure. The procedure is performed under x-ray guidance, where a small needle containing acrylic bone cement is injected into the collapsed vertebrae, in order to strengthen and stabilize the fractured vertebra. Kyphoplasty is a newer procedure and is performed before the cement is injected into the vertebra. In comprises making two small incisions to insert the probe into the vertebral space at the level the fracture. After the bone is drilled and one balloon is inserted on each side, which is then inflated with a contrast medium. The spaces created by the balloons are then filled with the cement. That way, the lost height is also restored.