By definition, vertebral compression fractures affect the anterior column of the spine, putting the anterior half of the vertebral body and the anterior longitudinal ligament at risk. This activity describes spinal compression fracture evaluation and management and emphasis the importance of the inter professional team in enhancing patient care.
Describe the typical physical examination findings connected to spinal compression fractures.
Have a look at the pathophysiology of spinal compression fractures.
Explain the typical imaging results for fractures that cause spinal compression.
Provide examples of how better care coordination across the multidisciplinary team can improve the treatment given to patients with spinal compression fractures.
Axial/compressive (and to a lesser extent, flexion) loads are secondary causes of vertebral compression fractures (VCFs) of the spinal column, which lead to biomechanical breakdown of the bone and a fracture. The anterior half of the vertebral body (VB) and the anterior longitudinal ligament are both compromised by VCFs, which by definition affect the anterior column of the spine. This results in the distinctive wedge-shaped deformity.
The posterior half of the VB, the posterior osseous components, or the posterior ligamentous complex are not affected by VCFs. A compression fracture and a burst fracture can be distinguished by the former. The stability of the resulting structure and risk of deformity progression are implications of these compression fractures. Typically, compression fractures are stable and don't need any special surgical equipment.
Etiology
Osteoporosis is the most typical cause of VCFs, making these fractures the most prevalent fragility fractures. However compression fractures have a bimodal distribution, with younger individuals suffering these wounds as a result of high energy processes (fell from a height, MVA, etc.
This region is a common location of injury because of the ligamentous and structural alterations that are seen when one moves from the thoracic to the lumbar level.
According to conventional wisdom, the spinal column can be divided into three parts: (1) Anterior column, also known as the anterior longitudinal ligament, anterior annulus, and anterior vertebral body.
(2) The posterior column, (3) the middle column (posterior vertebral body, posterior annulus, and posterior longitudinal ligament) (ligamentum flavum, neural arch, facets, posterior ligamentous complex). The injury is deemed unstable and the patient may require surgery if two of these three columns are damaged.
By definition, compression fractures only threaten the anterior column. VCFs are regarded as "stable" fracture patterns as a result. They are categorised as burst fractures and do not have the stability of a VCF when the central column is involved in the fracture pattern.
Epidemiology
The most typical fragility fracture described in the literature is a VCF. Around 1 to 1.5 million VCFs happen per year in the US alone. According to the age- and sex-adjusted incidence, 25% of women 50 years of age and older are thought to have at least one VCF. [9] Furthermore, 40% to 50% of people over the age of 80 are thought to have experienced a VCF, either acutely or incidentally, while receiving treatment for another ailment. [10]
According to recent reports, 60% to 75% of VCFs occur at the thoracolumbar junction (i.e., the segment from T12 to L2), and another 30% happen in the L2 to L5 region.
In stark contrast to the damage mechanism that was evident at the time of presentation, this. According to studies, 30% of VCFs are thought to happen when the patient is in bed. The population at risk of suffering low energy fragility fractures will increase as the population continues to age. Presently, osteoporosis affects 10 million Americans, while another 34 million have osteopenia. It is anticipated that more patients may develop osteoporosis as they age. [9] According to population research, there are 10.7 VCFs for every 1000 women and 5.7 VCFs for every 1000 men each year.
Around 50% of spine fractures in younger patients are caused by car accidents, while another 25% are caused by falls.
Anterior-posterior (AP) and lateral radiographs of the impacted area are used in the evaluation of individuals with suspected back injuries. They should first be acquired supine with spine precautions in the trauma situation until cleared by the spine team or bracing has been provided. While a supine position may artificially minimise a displaced fracture, standing radiographs in the brace are eventually helpful to direct treatment.
Every trauma setting should also get a CT. An MRI will show disruption of the posterior ligamentous complex if a suspected posterior column injury cannot be validated on CT. In the past, unstable fractures were believed to be present in radiographs with 30 degrees of traumatic kyphosis (forward flexion of the spine) and 50% vertebral body height loss.
Management / Treatment
Sometimes there is disagreement on whether surgery is necessary. A classification system was introduced in 2005 to improve management homogeneity and offer straightforward treatment suggestions. The Thoracolumbar Injury Classification and Severity (TLICS) Scale calculates a score (from one to ten) based on the PLC's integrity, the injury's morphology, and the patient's neurological condition. A score of less than four suggests nonsurgical treatment, a score of four suggests surgical treatment, and a score of four is managed either surgically or nonsurgically depending on the clinical judgement of the treating physician. These are obviously basic recommendations, primarily for trauma patients, and each case should be thoroughly assessed. Strangely, more recent research has revealed that historical factors such vertebral body loss.
For a period of four to twelve weeks, orthosis/bracing techniques achieve conservative treatment. When there is radiographic evidence of healing and the patient is no longer in pain at the fracture site, stopping the bracing may be an option. Lower lumbar VCFs may require a lumbosacral corset for sufficient immobilisation, but midthoracic and higher lumbar VCFs can be treated with a thoracolumbosacral orthosis (TLSO). Bracing is not harmless and can be challenging in patients with barrel chests, pulmonary complications, or obesity. These elements must be taken into account. Some patients may not handle bracing or analgesic drugs well. In the event that bracing is ineffective or poorly tolerated, the doctor may instead think about percutaneous methods for fracture stabilisation.
The extent of the brain impairment and the fracture's features will determine the surgical alternatives. Compression fractures hardly ever need instrumented stabilization. Common surgical options for these patients involve cement augmentation in the form of vertebroplasty or kyphoplasty. Vertebro plasty, a minimally invasive surgery, was initially created for spinal hemangiomas and involves injecting cement into the vertebral body through the pedicle. During the surgery, supine positioning with extension helps to align the spine; the vertebroplasty itself is not intended to do this. By inflating a balloon, a wedge-shaped vertebra is initially decreased to enhance the remaining local kyphotic alignment. Once vertebral height has been restored, cement is injected. Patients who have not responded to a course of conservative treatment or who are being treated at a hospital
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