What is Thoracic and Lumbar Vertebral Compression Fractures?
The 12 thoracic vertebral bodies and the five lumbar vertebral bodies form the foundation for weight distribution and shock absorption of the spine. The vertebral bodies are cubicle-shaped bones with projections on either side called the transverse processes, and a small protruding bony mass in the back called the spinous process.
Interspersed between these vertebral bodies are the shock-absorbing spinal discs.
Like any other bone the vertebral bodies are subject to wear and tear, arthritis at the joints, and osteoporosis and weakening.
A compression fracture of the vertebral body happens when the upper and lower part collapsed towards each other reducing the height of the vertebral body.
Many times this can happen insidiously without any obvious cause, in other instances, such as falling or hard sneeze in some instances can cause the bone to fracture.
In some cases, incidental findings are noted on routine x-rays. The patient never having realized that a bone has fractured.
In the instances where trauma or other conditions play a role in the bone being fractured, there is pain that is localized to the back increased with lying on that part of the body or with pressure over the spinous process.
If the fracture has caused irritation or mechanical compression of the exiting nerves on either side, the pain will be felt traveling along the distribution of that nerve.
In the thoracic region, the fracture can happen like a wedge-like deformity crunched up more in the front as opposed to the back. This fracture often causes the patient to have a forward stooped posture.
This is less common in the lumbar spine where the fractures tend to be more equal.
Vertebral compression fractures are more common in the sixth and seventh decades onwards.
The incidence is greater in women where osteoporosis plays a major role
Diagnoses involve a careful history and physical, combined with imaging studies such as thoracic and lumbar spine plain x-rays, CAT scans, and importantly MRIs which can detect edema around the bone and neural structures indicating a fresh fracture.
Incidental findings of vertebral compression fractures without edema suggest that the fracture is likely old and healed.
Treatment options include conservative management depending on symptoms, epidural injections to reduce swelling and inflammation in local neural tissues.
Kyphoplasty or vertebroplasty where cement is injected into the body of the vertebral bone in an attempt to stabilize the fracture fragments and also destroy any new nerve infiltration and pain filaments.
This procedure is done as an outpatient case, with patients often reporting a 75% pain reduction immediately.
