Vertebral fracture, also known as vertebral body fracture, involves damage to the part of the vertebra that is shaped like a plate. This part of the vertebra, which is located toward the inside of the body, can be injured due to disease or trauma, such as an accident. The vertebral body fracture is painful and, depending on the type or severity, injuries to the spinal cord, ligaments and tendons are possible.
What is a vertebral body fracture?
A vertebral body fracture affects only the disc-shaped vertebral body, which is also the bearing surface of the intervertebral discs. The vertebral body fracture itself is classified into different types that describe the nature of the fracture. The classification into A-type, B-type and C-type fractures also indicates the type of force that caused the vertebral body fracture. A distinction is made between compression fractures, which are caused by a compression of the vertebrae and are referred to as A-type fractures. Distraction fractures result in forward or backward hyperextension, while rotational fractures result from a twisting of the spine. These C-type rotational fractures are among the most severe forms of vertebral body fracture, as fractures of the rest of the vertebra often occur with this cause.
Causes
In many cases, vertebral body fracture is the result of a sports injury or accident. In these cases, excessive stress and force on the spine exposes the vertebral body to forces that result in a vertebral body fracture. In these cases, the intervertebral discs are not sufficient to protect the bony vertebral body and cushion the pressure suddenly acting on the structure at different points. In addition to vertebral body fracture in healthy patients, vertebral body fracture due to disease is also possible. This is particularly common among older people who also suffer from a disease that weakens the bone structure. In the case of existing osteoporosis, a vertebral body fracture can occur without any noticeable force acting on the bone. Also, some cancers attack bone stability and lead to a vertebral body fracture even with normal movement.
Typical symptoms and signs
- Back pain
- Movement restrictions in the area of the cervical spine
- Forced posture or malposition of the head
- Bruising
- Sensory disturbances
- Paralysis
- Muscle weakness
Diagnosis and course
Fracture of the vertebral body is manifested by a severe pain in the back. After an accident, this is always an indicator to consult a doctor for a closer examination. Patients with a known bone disease should also have the cause clarified by their treating physician if they experience new back pain. The physician will use imaging to examine the spine for damage and, in most cases, will already detect the vertebral body fracture on the X-ray. Even a vertebral body fracture that is initially only painful can cause sensory disturbances, paralysis of the extremities and permanent pain. Incontinence and bowel paralysis are also possible symptoms and consequences of the vertebral body fracture. If the vertebral body fracture heals, narrowing of the spinal canal due to changes in the surface along the fracture sites is a realistic late effect.
Complications
Complications associated with a vertebral body fracture are sometimes dependent on the type and complexity of the fracture and whether or not treatment has been given. Most vertebral body fractures, if recognized and treated in time, can heal without major sequelae, although possible causes must be considered. The most serious complication in this context is paraplegia, which can be caused by entrapment and injury of the spinal cord. This occurs mainly in the case of severely displaced fragments of the vertebral bodies or due to a collapse of individual vertebral bodies (usually in connection with osteoporosis). However, partial paralysis may also occur, depending on the level of the fractured vertebra. For example, the arms, legs, or bowel and bladder emptying can be affected. Spinal cord damage can also lead to breathing problems and neurological disorders. These include failures of conscious perception, sensory disturbances and the inability to use one’s own body parts purposefully.If a vertebral body is fractured in such a way that its structure will be permanently damaged, the result may be a tilted position of the back (hunchback formation), a reduction in body size and chronic pain. Surgical procedures to treat a vertebral body fracture may carry a risk of complications, depending on the location and fracture, primarily related to possible spinal cord injury.
When should you see a doctor?
If pain occurs in the back after vigorous physical activity, an accident, fall or exposure to violence, action is often needed. For the time being, the affected person should check whether the discomfort recedes after sufficient rest and sparing. If after a few hours or a restful night’s sleep the patient is free of symptoms, in most cases no doctor is needed. However, if the health irregularities persist or increase in scope and intensity, a visit to the doctor is advisable. Pain in the area of the back, restrictions in mobility or disturbances in general movement patterns should be examined and treated. If the affected person experiences symptoms of paralysis, acute action is required. In particularly severe cases, an ambulance service should be contacted. To avoid consequential damage, the instructions of the rescue team must be followed. In the event of a sudden decrease in physical performance, the development of skin lesions or bruising, a doctor is required. These are signs of a health disorder that must be clarified and, if necessary, treated. If the affected person adopts a protective posture due to the complaints, a doctor should be consulted. There is a risk of long-term damage and, in some cases, action must be taken as quickly as possible to achieve long-term relief from the irregularities. Otherwise, some conditions may result in lifelong impairments.
Treatment and therapy
Vertebral body fracture is treated conservatively or surgically, depending on the type and severity. In the case of an accidental fracture, stabilization is first important until a more accurate diagnosis is made to prevent further damage to the vertebra and spinal cord. If the examination shows that the fracture can be treated with further stabilization, the patient must undergo the healing phase in relative rest, but not immobility, with good pain therapy. Triggering diseases such as osteoporosis are also treated in a combination therapy to effectively combat the causes. Vertebral body fractures in the thoracic spine are adequately supported by the thorax itself, and additional supports can usually be dispensed with. Only when it is feared that the spinal cord will be damaged or further impaired by the vertebral body fracture is surgical intervention necessary. In this case, the surgeon’s goal is to stabilize the vertebral body fracture again using various means such as plates, screws or the patient’s own bone material. Pressure is removed from the spinal cord when correcting the vertebral body fracture, and the resulting change in position of the spine is corrected as completely as possible.
Prevention
A vertebral body fracture can be prevented at least if good equipment and the correctly learned course of movement are emphasized in sports that are prone to accidents. Disease-related vertebral body fractures, on the other hand, can be well avoided by treating the underlying disease early and carefully. In this way, the impairments of the bone structure can be stopped or at least slowed down and a vertebral body fracture can be averted.
Follow-up care
If the vertebral body fracture occurs in the context of osteoporosis, alleviating the underlying disease is of great importance in aftercare. Calcium metabolism can be influenced and bone density improved by administering specific medications. Physical therapy can help relieve pain and specifically build up and strengthen the back muscles: This relieves pressure on the spine and minimizes the risk of a new fracture. In the case of vertebral body fractures after accidents that require surgical treatment, the operation should be followed immediately by rehabilitation. Light physiotherapeutic exercises can often be started as early as one day after the operation. With the help of targeted movements, the spine should be mobilized and normal mobility restored.Whether this can be fully achieved depends on whether and to what extent neurological deficits are present. For people of working age, the primary goal is to return to work: occupations with low to moderate physical stress can usually be resumed after a rehabilitation period of two to three months. For patients with a physically difficult job, retraining to a physically less stressful job often turns out to be useful. For vertebral body fractures that result in paralysis, the focus is on restoring independence as much as possible through physical therapy and useful assistive devices.
Here’s what you can do yourself
In the case of disorders of the skeletal system, the general movements in everyday life should be controlled and optimized at regular intervals. One-sided or rigid postures can lead to an increase in complaints. Therefore, they should be avoided if possible or compensatory movements should be performed. When lifting and carrying objects, care should be taken to ensure that they are only light. All physical movements should be performed slowly and with increased awareness during the recovery process. Jerky movements, jumping or running interfere with healing and can lead to complications. Therefore, sports activities or performing occupational activities should be refrained from. In everyday life, it is recommended to take help and support from relatives or people from the close social environment when performing daily duties. Physiotherapeutic training sessions can also be carried out independently outside of therapy. These help in coping with everyday life and at the same time promote the healing process. Drafts have an unfavorable effect on a vertebral body fracture. Therefore, the affected area should be adequately protected. The application of heat alleviates possible existing discomfort. The patient’s own weight should also be checked. If you are overweight, disorders can occur and an increase in complaints is possible. Therefore, dietary changes may need to be made as well as weight reduction to achieve long-term recovery.
