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Wednesday, November 27, 2013

Patient Information: Lumbar Compression Fracture (Broken Low-Back Vertebra) - Part II

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       How are Vertebral Compression Fractures Diagnosed?

a. X-Ray

X-Rays can usually show a Vertebral Compression Fracture. The change in the shape of the broken Vertebra is usually easy to see.

This image is a Color X-Ray of the low-back (lumbar spine) taken from the side of the spine. The front of the spine is to the left, the back to the right. The normal vertebrae are shown in yellow-orange. A Vertebra suffering from a Vertebral Compression Fracture (VCF) is shown in red. The top of the Vertebra is collapsed.
b. MRI
MRI scans can show compression fractures. While MRI technology is not as good as a CT scan to show specific details of the vertebral bones, it is an excellent tool to see swelling inside a vertebrae from a VCF, and a potential compression of the spinal cord and spinal nerves.

                Here is an Interactive Color MRI Image which explains the Anatomy

c. CT Scans

CT scans are excellent tools to see the bone anatomy of the spine. VCFs can be seen clearly. A burst fracture and its pieces can also be seen. This can help doctors understand if the spinal cord could be compressed. When combined with a myelogram (dye injection into the spinal fluid), the spinal canal and spinal cord can be seen as well.

This image is a CT scan of the spine. The front of the spine is to the left, the back to the right. The arrow is pointing at a  Vertebra suffering from a Compression Fracture
d. Nuclear Bone Scan
Nuclear bone scans show the activity in a VCF which is created by the body’s attempt to heal it. It can be very specific for a VCF and show where in the spine it is located. However it cannot show any details about the fracture or the other structures which could be affected by it.
This image is a Nuclear Bone Scan of the whole body, taken from the front on the left and back on the right. An area if increased activity is seen in one of the vertebrae of the low-back (lumbar spine). This is often due to a severe compression fracture.
                    How are Compression Fractures treated? 
1.     Non-Surgical Care
a.     Activity Restriction
Typically for new compression fractures it is recommended to limit bending, twisting, lifting and any other higher impact activity such as running.

b.     Alternative Health Care
Alternative Health care options can often complement conventional medical care. Massage Therapy, Acupuncture, Meditation exercises and Herbal Remedies can all help with the pain from this condition. Massage Therapy has to be done in a very gentle fashion to avoid placing pressure on the fractured area of the spine. It may be more useful for an older, healed fracture.
c.      Nutrition and Weight Loss
Proper nutrition and weight loss can have a positive impact on many spine conditions. Excess weight on the spine often contributes to the symptoms of pain and spasms (Spine and Obesity).
d.     Chiropractic Care
Chiropractic care including manipulation and adjustments of the spine can help with the pain and spasms from this condition after the fracture is healed. Spine manipulation and adjustments are usually not recommended for a new fracture.
e.     Spine Exercises
Spine exercises can help with the muscle pain and tightness from this condition. Exercise also increases the amount of oxygen delivered to the spine which can help with healing. Pilates, Yoga and T’ai Chi can help maintain the spine’s flexibility. Only very gentle types of simple stretching exercises are recommended for new fractures.
f.       Physical Therapy (PT)
PT has many modalities to offer for this condition. They can range from gentle Manual Therapy and Exercises to gentle Traction and Ultrasound Treatments. PT can help mobilize patients who are suffering from the pain related to a VCF.
g.     Self Help Tools
Self Help Tools are items which can be purchased to help with back pain. They range from Neck and Back Braces to Back Mattresses and Ergonomic Devices such as chairs and computer accessories. Back braces can help with the pain from the fracture and provide some stability while the fracture heals
h.     Spine Medications
Here are some of the common groups of medications which are available for this condition: 
Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
Muscle Relaxants
Pain Killers
Nerve Pain Medications
Topical Medications
i.        Spine Injections
Here are some spine injections which can lessen the pain from a compression fracture:
1.     Lumbar Trigger Point Injections
2.     Lumbar Muscle Blocks
3.     Lumbar Interlaminar Epidural Steroid Injections

                          j.     Minimally Invasive Treatments

Minimally invasive treatment options can help with the pain and instability of the vertebra from VCF’s. They inject bone cement into the fractured Vertebra.

1.     Lumbar Vertebroplasty
Vertebroplasty Procedure: This Color MRI Image shows Bone Cement (green) being injected into the broken Vertebra to provide pain relief and stability.
2.     Kyphoplasty
Kyphoplasty Procedure: This Color MRI shows the Lumbar Spine (low back) from the side. The      front of the Spine is to the left. A Compression Fracture (broken Vertebra) is seen in red. A large       Needle (blue) has been placed into the broken Vertebra. A powerful balloon (green) has been inflated within the broken Vertebra in hopes of raising it back up. After the balloon is removed, bone cement is the injected just like it is seen in the Vertebroplasty Image above.

                                                  2. Surgical Treatments

Surgical treatments for VCFs are usually only required for fractures which are creating pressure on the spinal cord or spinal nerves, or those resulting in a lack of stability of the spine. Typically, these types of fractures are the result of significant trauma or cancer.
Here are some of the examples of surgical options:
1.     Lumbar Vertebrectomy/Corpectomy
2.     Lumbar Laminectomy and Fusion
3.     Lumbar Fusion



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