Vertebral Compression Fractures

 

Thoracic and lumbar compression fractures are common due to osteoporosis of aging or steroid use. 

They are very painful, producing extreme pain in the midline of the back when sitting or standing and much less when lying down.  The onset is sudden.  While most compression fractures heal spontaneously, the pain from the fracture can cause severe debility including compromise of the lung function, muscle wasting at a rate of 15% per week, accelerated osteoporosis, difficulty with eating, blood clots in the legs and lungs, etc. 

Most fractures occur in the front of the vertebral body because that part bears the most weight. 

Fractures may occur from simply stepping off a curb, walking, falls, etc.  Pain can continue for a year after the fracture.   This is partially because the compression fracture, which occurs in the weak, spongy part of the bone, continues to fracture over and over again, causing further decrease in the bone height. 

The diagnosis is by physical exam, plain x-ray, then often MRI and bone scans are performed to assure bone fragments are not in the spinal canal. 

Treatment is by percutaneous vertebroplasty (cementing of vertebrae), kyphoplasty (very expensive cementing of vertebrae), or grey ramus communicans procedures (blocks and RF destruction).  The success rates on treatment of the pain from these fractures is very high approaching 90%.

 

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