Therapy

Depending on its extent, a fractured vertebra can be a difficult situation. If several vertebral bodies are fractured, the spine may be unstable and there is a risk that parts of the vertebral body will splinter off and possibly injure the spinal cord. Therefore a quick treatment is necessary.

The first therapeutic measures include painkillers and the corset. Until an operation can be performed, the corset is worn as an orthosis to immobilize the spine. This is to prevent the fracture from worsening or important nerve tracts from being injured.

After surgical treatment of the vertebral fracture, a follow-up treatment is performed, often initially with the brace. Then it should prevent a wrong movement or excessive strain from provoking a new injury. A corset additionally protects the spine and promotes the healing process.

At the same time, targeted physiotherapy is used to train movement and slowly increase the load again. Surgery is performed either for unstable fractures or stable fractures with severe pain, paralysis or disorders of urinary and fecal incontinence. This often leads to complications of stable fractures in osteoporosis.

The aims of the operation are: If the bones are healthy, in most cases it is sufficient to fix and straighten the vertebral bodies with plates and screws. The operations are usually performed in two steps. Usually the operation is performed under general anesthesia.

In the beginning, the patient lies on his stomach, so that in the first step, surgery can be performed from behind. Then the patient is positioned on his side and the front part of the spine is reached with an access through the chest or abdominal cavity. Other methods are vertebroplasty and kyphoplasty.

These are minimally invasive procedures, which are often used for more stable fractures. These procedures are performed under constant X-ray control with the patient in the prone position. In vertebroplasty, a hollow needle is inserted into the vertebra with the fracture.

Cement is then applied to the site with high pressure through the needle. The cement is used to reconnect the bone fragments after the cement has set. Local anesthesia is sufficient for vertebroplasty, whereas general anesthesia is necessary for kyphoplasty.

In kyphoplasty, a balloon is pushed into the vertebral body and then inflated. Through this method, the vertebra is straightened and cement can now be poured in. Both treatment techniques should be carried out a maximum of four to six weeks after the vertebral fracture has occurred.

Complications in the procedures may occur if cement is released from the vertebral body during insertion of the cement. This is a particular problem in vertebroplasty, where the cement is injected at high pressure. The cement can flow into the spinal canal or even into the vessels, causing serious vascular occlusion and further complications (cement embolism).

A further problem is the frequent occurrence of connection fractures in adjacent vertebral body segments caused by the very hard cement.

The removal of fragments that may be pressing on nerves, spinal cord or vessels
Reconstruction of the normal spinal column shape
Stabilization of the spine after the fracture
First, the broken vertebrae are screwed to the adjacent vertebrae from behind and straightened up again. If necessary, the spinal canal is opened further as it narrows, or nerve and vascular structures are freed from the narrowing.
In the second operation step, the broken vertebral parts and intervertebral discs are removed from the front and a vertebral replacement is inserted.

As an alternative, elastoplasty has been used recently.In elastoplasty, the principle of the procedure is identical, but here elastic silicone is used as the injection material instead of cement.

The silicone is much closer to the bone structure than the very hard cement. Another minimally invasive procedure is the application by endoscopy. With this method, a 1.5 – 2 cm large skin incision is first made through which four plastic sheaths are inserted between the ribs.

It is possible to look inside the body via two monitors. Three sleeves are used to insert surgical instruments such as knives. To get a better overview during the operation, the affected side of the lung is not ventilated during the operation.

With special surgical instruments such as forceps, mills and punches, spinal fragments and intervertebral discs can be removed. It is also possible to relieve the strain if the spinal canal is narrowed. Then the vertebral body replacement, usually a titanium basket or a bone chip, is inserted.

In addition, a titanium plate is screwed in to ensure increased stability. A computer-assisted surgical navigation system makes it possible to work very precisely and control all steps. In the case of very severe vertebral fractures, the only remaining way to stabilize the spine is usually a stiffening of the spine, the so-called spondylodesis.

In this procedure, parts of the vertebra or the entire vertebra are removed from the spine and replaced with a cage if necessary. This is a cage made of different materials, mostly titanium. In addition, the vertebrae above and below are connected to each other by plates and screws.

After the operation, follow-up treatment is very important. For the time being, only a few days of bed rest are necessary. Sometimes it is necessary to wear a corset after the operation.

For operations on the cervical spine, there is a treatment with a cervical collar (cervical support) for a few weeks after the operation. There are also special rehabilitation programs after the surgery. After the operation, bending forward and carrying loads over 5 kg should be avoided, at least in the first few months.

As a rule, the fracture will heal after 6-9 months. The metal reconstructions are usually kept for a year or in some cases remain in the body for life. It is slightly different when using minimally invasive procedures such as vertebroplasty, kyphoplasty and endoscopy.

Here, the spine can be loaded immediately after the operation, as the bone cement becomes very hard and provides the necessary stability. In addition, the patient only has to stay in the clinic for a few days and special rehabilitation is not necessary. In addition, the pain and blood loss after the operation are significantly less than with more invasive procedures and the patient recovers from the operation much faster. An increased cosmetic effect is achieved in particular with the endoscopy procedure, where hardly any scars occur.