Vertebral Compression Fracture

Vertebral compression fracture occurs when a part in the vertebra collapses due to the compression of the bone in the spine. With age, vertebrae is weakened and loses its strength and leads to a condition called osteoporosis. Osteoporosis is a kind of bone loss that causes bones to break easily. Osteoporosis is the leading cause of vertebral compression fractures especially in the age group of 40 to 50 and above. Post menopausal women and men above the age of 65 years are at highest risk of suffering from vertebral compression fractures.

Apart from osteoporosis, there could be other reasons that lead to vertebral compression fractures. Young adults suffer from vertebral fractures due to spinal injuries during rigorous exercises, sports activities or accidents. These compression fractures normally heal within 8 to 10 weeks with good rest and pain medication. Vertebral compression fractures may also be attributed to cancer tumors associated with multiple myeloma and metastatic bone disease. In very rare cases, infection or Osteomyelitis of the vertebra also results in compression fractures.

Wedge fractures are the most common type of compression fractures wherein the front part of the vertebral body collapses and becomes wedge shaped. Other types of vertebral compression fractures include biconcave (collapse of central portion of vertebral body) crush fractures (collapse of entire vertebral body). These fractures happen most commonly in the thoracic spine (the middle portion of the spine), and lumbar spine (low back).

Symptoms of Vertebral compression fracture

Compression fractures caused by injuries produce sudden onset of sharp and throbbing pain. Fractures caused by osteoporosis may cause very mild to severe pain in the back. Normally the pain is intense in standing posture and there is respite when lying down.

Vertebral compression fractures also lead to kyphosis and loss of height especially with the fractures associated with osteoporosis.

Sometimes a severely fractured bone can impinge on the spinal cord. Thus, numbness or tingling in limbs or other areas of the body may occur if the spinal cord is affected. This can impair sensation in the areas supplied by the damaged nerve tissue.

Diagnosis

Doctor's evaluation of symptoms plays a major role in diagnosing compression fractures. Noting of complete history of the patient and clinical examination are necessary to determine the presence of vertebral compression fracture. When doctor suspects vertebral compression fracture, an x ray is ordered to confirm the diagnosis. If the X-Ray reveals a fracture, further imaging tests like CT scan and MRI are performed to rule out the involvement of spinal cord and also to understand the age of the fracture. A neurological exam may also be done to test for reflexes, muscle strength and sensory perception.

Treating Vertebral Compression Fracture

The conventional methods of treating vertebral compression fractures include pain medication, rest and bracing. While pain medication helps in alleviating the pain to some extent, back braces reduce the chance of further collapse of the bone, prevent deformity, and allow injuries to heal by taking the pressure off the fractured vertebral bone. Giving rest to the back by decreasing activities as much as possible helps in healing the fractures naturally and quickly.

There are also some minimally invasive methods used to treat vertebral fractures which are gaining popularity. Vertebroplasty and Kyphoplasty are two medical procedures that are increasingly being used to treat compression fractures. Here the fracture is treated by injecting a bone cement onto the collapsed bone through hollow needle. These are image-guided surgical procedures with minimum invasion that promise faster pain relief.

Further treatment also depends upon the underlying cause that is leading to vertebral fracture. If the osteoporosis is causing the bones to collapse, doctor may prescribe calcium and other bone strengthening supplements to avoid future compression fractures. If a tumor has caused compression fracture, more invasive surgery will be required remove sections of bone or tissue.

Kyphoplasty

Kyphoplasty is similar to Vertebroplasty with a bit of variation in the technique used in injecting cement into the collapsed vertebral bones. Both methods aim at alleviating the pain caused by recent vertebral fracture which has stopped responding to conventional treatment of pain medication and bed rest. Kyphoplasty makes use of an inflatable balloon to create a cavity inside the collapsed vertebrae and is eventually filled with special bone cement to stabilize the fracture.

Percutaneous Balloon Kyphoplasty (BKP) is primarily used to treat vertebral compression fractures arising out of issues like osteoporosis, metastases or trauma.

Kyphoplasty is believed to be a superior procedure/ Interventional radiologic technique when compared to vertebroplasty as it claims the additional advantage of correcting the kyphosis (stooped back) and regaining the height lost, to some extent. A balloon (bone tamp) that can withstand high pressures is inserted and inflated to achieve the height. When the height and alignment of spine are corrected, the stress in the adjacent vertebral segments is reduced. Then there are lesser chances of adjacent vertebral fractures.

Taking the aid of image guided X-Ray machine, a hollow needle called Trocar is passed through the spinal muscle and positioned at the fractured back bone. This needle is inserted at an angle to avoid the spinal cord. Once the needle reaches the right position, the balloon is inflated to help gain the normal height of the vertebrae. Most often, two balloons are used to provide good support while lifting the collapsed vertebrae back to its normal position.

Inflated balloons, create a cavity/space inside vertebra while raising the collapsed bone. The balloons are slowly deflated and withdrawn. Bone cement (such as polymethylmethacrylate (PMMA)) is then carefully injected into the cavity under pressure filling the deeper side to the upper side of the cavity. Filling cement needs lot of care and skill as excess pressure or quantity may cause the cement to leak into adjacent areas. Cement hardens within 10 to 20 minutes forming an internal cast that holds the vertebral body. The needle is pulled off carefully before the cement hardens. The incision is closed with sterilized strips. The procedure takes about an hour to complete and is carried out both as inpatient or outpatient procedure. The patient is advised to take rest for a day even though he is discharged the same day after a brief period of observation. Some patients have reported Transient Hyperalgesia (abnormal sensitivity to pain) due to polymerization of the acrylic cement used in the procedure.

Bone Spurs

A bony growth formed on a normal bone is termed osteophyte or bone spur. It is an extra bone. Although bone spur can be smooth, it can cause wear and tear with pain in the area when a bone rubs with other bones or soft tissues such as ligaments, tendons or nerves in the body. The most common places in the body where bone spurs occur include the spine, shoulders, hands, hips, knees and heel.

Causes of bone spurs

The body tries to repair itself by building extra bones. These are formed in response to pressure, rubbing and stress that exist over a period of time. Bone spurs can also be formed due to the aging process. Cartilage breaks down and wears away with age. This leads to pain and swelling in some cases when bone spurs are formed along the edges of the joint. When ligaments get tight, bone spurs could be formed. Activities such as dancing and running that lay stress on the feet, excess weight or poorly fitting shoes could lead to formation of bone spurs.

During such times that long ligament gets inflamed and the bone tries to mend itself, a bone spur can form on the bottom of the heel. Pressure behind the heel from frequently wearing shoes that are too tight can cause bone spur at the back of the heel. This is also popularly called 'pump bump' as women who wear high heels suffer from this.

When tendons move through a narrow space between the top of shoulder and upper arm, they rub on the bones. Bone spurs can form in this narrow area. This can pinch the rotator cuff tendons resulting in irritation, inflammation, stiffness, weakness and pain. This condition is called rotator cuff disorder. It occurs with age and due to repetitive tearing of the tendons, especially among athletes, baseball players and in painters who frequently have to work with arms above their heads. Traumatic injury and poor posture can also be potential bone spur causes and can lead to spine bone spurs.

Bone spur symptoms

Signs and symptoms of bone spurs depend upon their location. A bone spur in the knee is painful to the extent that it can bend your legs and prevent the knee from operating smoothly. A bone spur on the vertebra can narrow the space that contains spinal cord and can cause weakness or numbness in the arms and legs. A bone spur in the hip can make movement painful and reduce the range of the hip joint. Bone spurs in the shoulder can hinder rotator cuff movement. Bone spur in fingers appear as hard lumps under the skin and they can make the joints in the fingers look knobbly. When bone spurs begin to press on other bones or tissues thereby causing a muscle or tendon to rub, they can break that tissue can cause swelling, pain, and tearing. Bone spurs in the foot can cause corns and calluses when tissue builds up to provide an added pad over the bone spur.

Bone spur diagnosis

A bone spur is visible through an x-ray. But it is rare to take x ray just to see whether a person has bone spur or not. For instance if an X ray is taken to evaluate, say, an arthritis problem, bone spurs should be visible. During physical exam the doctor can feel around the joints to determine exactly where the pain comes from.

Treatment of bone spurs

As such bone spurs do not require any treatment unless they cause pain and damage to other tissues. Treatment should be directed at the causes, symptoms rather than the bone spurs themselves. Such treatment aimed at the cause of bone spurs include weight loss to take the pressure off the joints and for stretching the affected area when bone spurs occur in the heel cord or at the bottom of the your feet. In the case of plantar fasciitis and shoulder pain, it is better to get an ultrasound done or deep tissue massage on the advice of a physical therapist. Treatment could include rest, ice, stretching and non steroidal anti inflammatory drugs such as ibuprofen. Learn to protect your joints in case you are suffering osteoarthritis. In case of bone spur on the foot, changing footwear or adding padding or a shoe insert may help. A podiatrist may be consulted if the corns and calluses become bigger problems. A doctor could suggest a corticosteroid injection at the painful area to reduce pain and inflammation if the spur continues to cause symptoms. Bone spurs can be surgically removed or treated as part of surgery to repair or replace a joint when osteoarthritis has caused considerable deformity or if the range of motion becomes limited.