Compression fracture of the lumbar spine
Content:
- What is a spinal compression fracture?
- Signs of a spinal fracture
- Fracture of the vertebrae
- Vertebral fracture diagnosis
- Lumbar spine fracture treatment
What is a spinal compression fracture?
A compression fracture of the lumbar spine is an injury to bone structures as a result of compression. Most often, it is this part that suffers, so it takes on the maximum load.
The mechanism of injury is that the structural elements of the lumbar spine, which has five vertebrae, are damaged as a result of pressure. It is the vertebral body that undergoes a fracture. If viewed in section, the vertebra looks like a wedge or triangle. Its apex is directed forward, and its base is directed backward, towards the spinal canal. The main danger of a compression fracture is that the fractured part of the vertebra can move further and damage the spinal cord.
This is a fairly common injury, despite the fact that bone tissue is normally strong. But its limit is not unlimited.
There are several degrees of compression fractures of the lumbar spine, depending on their severity:
- A grade 1 fracture is defined when the height of the vertebra decreases by no more than 1/4 of its original size;
- Fracture 2 degree - this diagnosis can be heard when the segment has decreased by one third;
- A grade 3 fracture is characterized by a decrease in the vertebra by more than half.
Sometimes a compression fracture can occur in an uncomplicated, latent form. The pain will bother the injured person, but not too much. In the initial stages, the victim may not go to the doctor. The danger of this type of fracture is in its consequences - osteochondrosis and radiculitis. In all other cases, the pain is so severe that the person immediately seeks help.
The cause of the injury lies either in the fact that a huge pressing force was directed to the lumbar spine, or in the fact that it was already subject to certain degenerative changes. In the latter case, no extra heavy load is required. A fracture occurs when falling from a height, in an accident, when jumping, etc. The disease leading to spinal injury, even without a significant load, is osteoporosis. Elderly women are more likely to suffer from it.
Signs of a compression fracture of the spine
Symptoms that suggest that a person has suffered a spinal injury:
- If the fracture occurs as a result of a sharp blow, then the victim will begin to experience severe, acute pain, which at the time of injury will be localized in the lumbar spine. After that, it will almost instantly be transmitted to the lower limbs;
- Weakness will rapidly build up, a feeling of numbness in the back, legs or arms will appear. This is because there has been a complete rupture of the nerve fibers, or damage to them;
- Dizziness may occur;
- Sometimes, immediately after the injury, regardless of whether the back was touched to the brain or not, a person may experience paralytic intestinal obstruction. This symptom is characterized by the absence of gas and stool, while the abdomen is swollen, a feeling of nausea and even vomiting may appear;
- Traumatic shock is not always observed, but it can be one of the signs of a compression fracture;
- If a compression fracture of the lumbar spine is the result of a slowly progressive pathology, then the painful sensations are quite tolerable. They become stronger gradually, in the process of further deformation of the spine. Often in such patients, multiple fusion of the vertebrae is found, which have broken more than once. As a result - the formation of a hump;
- If the injury is very serious, it can lead to paralysis not only of the limbs, but also of the entire lower body.
Fracture of the lumbar vertebrae
The lumbar spine consists of five vertebrae, each of which can be injured. Sometimes the fracture affects several segments, sometimes only one. The localization of painful sensations will depend on which vertebra is damaged. If the last and fourth vertebrae are damaged, the person will experience lower back pain with the transition to the groin area. If the vertebrae located above are injured, the pain will be concentrated in the lumbar spine, but with irradiation to the upper body.
Fracture of 1 lumbar vertebra
The first lumbar vertebra is the most vulnerable, and most often the destruction of its named body occurs. Therefore, doctors call this place "critical point". If the fracture is not complicated by a spinal cord injury, and treatment was started on time, then the prognosis for full recovery is quite favorable.
Since the greatest load falls on the first vertebra, it suffers more often both in injuries caused by osteoporosis and in injuries due to strong mechanical stress.
Fracture of the 2nd lumbar vertebra
As for the second vertebra, it suffers a little less often than the first, but still quite often. This is due to the fact that the load on it is almost as high as on the element located above.
With a decrease in the vertebral body by more than half, segmental instability is observed. That is, if the second vertebra is severely damaged, this will entail "loosening" the entire segment. Hypermobility will be typical for both the first and third vertebra. If left untreated, this condition will further destabilize the upper and lower lumbar regions.
Fracture of the 3rd lumbar vertebra
The third vertebra is not as often prone to compression fractures as the first and second. This is due to its location. Most often, the third vertebra is injured as a result of a direct blow exactly at the place where it is localized.
Treatment takes place in a hospital. Surgery may be required depending on the severity of the injury. Inadequate therapy for a fracture in this area threatens spondylopathy, instability, and the occurrence of chronic pain.
Fracture of the 4th lumbar vertebra
The fourth vertebra breaks just as rarely as the third. Most often, cracks form in his body, but sometimes fractures are also observed. They are usually the result of compression when the second and third vertebrae are damaged.
Fracture of the 5th lumbar vertebra
The fifth vertebra is adjacent to the sacrum and connects to its base. Fracture of the fifth vertebra, as a rule, occurs when falling on the buttocks. In this case, the sacrum itself is damaged. The pain is mainly localized in the lumbar region, but often extends to the groin area. Treatment is prescribed by a doctor, depending on the severity of the injury.
Diagnostics of the vertebral compression fracture
A doctor can diagnose a "compression fracture" only on the basis of a thorough examination of the patient's condition. This is necessary in order to differentiate the injury from other pathologies that cause pain in the back.
To make a correct diagnosis, you need:
- Listen to all complaints of a person, study the medical history;
- Conduct a neurological examination, which includes checking the functionality of both the spinal cord and peripheral nerves;
- Perform x-ray examination of the spine in lateral and direct projection. This will help clarify which of the vertebrae was damaged;
- CT scan may be prescribed for a more detailed study of the injury if the x-ray does not give a clear picture;
- If there is a suspicion that nerve structures have been damaged as a result of the fracture, then an additional MRI scan is necessary;
- If a woman older than 50 comes to the appointment, and she has been diagnosed with a compression fracture of the spine, then she must be prescribed densitometry. This study will confirm or deny the presence of osteoporosis.
Lumbar spine fracture treatment
Most often, surgical intervention is not required, and the compression fracture is treated with conservative methods.
They can include:
- Prescribing drugs. Naturally, the victim will be tormented by painful sensations. The doctor will prescribe medications to relieve pain, but they will not affect the rate of healing in any way. Their intended purpose is pain relief;
- Physical activity should be reduced as much as possible. Moreover, this applies not only to walking, but also to any finding of the body in an upright position - standing or sitting. For elderly patients, bed rest is recommended unambiguously and for a long time, since the fusion process takes longer for them;
- To fix the lumbar spine to a person who has suffered from a compression fracture, it is imperative to use a special corset. This orthopedic construction relieves stress on the spine. It is better that the corset is custom made;
- Vertebroplasty is one of the modern methods of treating a compression fracture of the spine and allows you to restore and strengthen the damaged section. During the procedure, the doctor inserts a thin needle into the lower back, through which a special solution then flows inside. Control is carried out using X-ray. The patient will need a day to recover, then the limitation is only a decrease in motor activity;
- Kyphoplasty. The essence of the procedure is that a balloon is inserted through a couple of incisions into the vertebral body. It is inflated to the required size, then bone cement is “poured” into the damaged area. Due to this, a reliable fixation of the position of the vertebra occurs, and its size is normalized;
- Surgical intervention is required when nerve endings have been damaged. During the operation, the doctor removes those elements of the vertebra that pinch the nerves and the back of the brain. Natural bone fragments are replaced with metal implants.
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If all the recommendations are followed, the prognosis for recovery after a compression fracture of the lumbar spine is favorable, especially if modern methods of treatment are used.
Author of the article: Kaplan Alexander Sergeevich | Orthopedist
Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.
