Vertebral compression fracture

Vertebral compression fracture
Vertebral compression fractures occur when bone (vertebral body) in the spine collapses leading to severe pain and deformity. These fractures usually result from trivial fall, because bones are brittle (osteoporosis) commonly seen in the lower dorsal spine.
The treatment depends upon the severity of pain and degree of compression (loss of height). Progressive worsening pain despite a period of rest and medication, progressive loss of vertebral body height (> than 50 %) suggests the need for surgical intervention. Since there is a collapse of vertebral body height, height is restored by injecting a cement-like material and is performed in a percutaneous fashion and is known as balloon kyphoplasty.

What is vertebral compression fracture?
The spinal column is made up of 33 vertebrae. Each vertebra is made up of vertebral body, a cylindrical shaped structure that lies in the front and vertebral arch forming the roof of the spinal canal to protect the spinal cord
The collapse of the vertebral body after minor trauma in elderly people (post-menopausal) in whom bones are weak and brittle (osteoporotic bones) results in vertebral compression fracture(VCF ) VCF results in significant back pain, deformity of the spine and altered the shape of body vertebrae (loss of normal vertebral body height. A compression fracture occurs in both thoracic and lumbar spine, most commonly in the lower part of the thoracic spine.

What are the symptoms of compression fracture?
Sudden onset of back pain after minor fall.
Increasing back pain while standing and walking, affects mobility.
Relieving back after lying down.
Local tenderness at the fracture site.

How is it diagnosed?
Routine standing and dynamic (flexion/extension) x-rays of the spine
Computed tomography – a better understanding of bony anatomy
Magnetic resonance imaging – better delineation of fracture morphology and also helps in estimating the age of fracture
Dual-energy x-ray absorptiometry ( DEXA) or bone densitometry - for measuring bone mineral density and can determine if osteoporosis exists

What are treatments options?
Bed rest – recommended for a short period, until acute pain subsides.
Pain management – NSAIDs and Analgesic.
Spinal bracing – Not much help full.
Most patients get better with these methods, in case of persistent pain affecting daily activities, progressive spinal deformity (loss of body height) surgery is necessary.
When surgery is necessary, a minimally invasive technique called percutaneous balloon kyphoplasty is performed which involves creating a space by balloon and implantation of bone cement to stabilize the fracture.
Kyphoplasty is done under general anaesthesia and the patient is positioned face down on a radiolucent table. Through a 1 cm incision, a hollow instrument (trocar) is guided into the fractured vertebrae under fluoroscopic guidance. A small inflatable balloon is passed into the vertebrae through the trocar. Once the balloon is in the right position, the balloon is slowly inflated to create space needed for the bone cement. After enough space is created in the vertebrae, the balloon is deflated and removed, bone cement (Polymethyl methacrylate ) is filled into the cavity with help of bone filler device in a graded fashion and once cement sets in, filler device is removed and the wound is closed with sutures.
Post-surgery treatment includes calcium and vitamin D supplements, bisphosphonates, and physiotherapy.

What are the benefits of balloon kyphoplasty?
It is a minimally invasive procedure
Balloon kyphoplasty not only restores the vertebral height but also reduces eliminates fracture-related pain.
Patients are mobilised the same day

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