A vertebral fracture is the fracture of a vertebra. This affects the vertebral body, the vertebral arch or the spinous process.
What is vertebral fracture?
A vertebral fracture is when a part of the vertebra is broken. This includes the vertebral arch, the vertebral body or the spinous process. Most often, vertebral fractures are the result of a minor accident. However, they can also occur spontaneously as a result of a disease. These primarily include pronounced bone loss (osteoporosis) or tumor metastases in the spinal region. Vertebral fractures most frequently occur in the lumbar spine and thoracic spine. In Germany alone, approximately 6000 vertebral fractures occur every year. In the case of severe spinal injuries, there is even a threat of permanent paralysis in the worst case.
Causes
The causes of vertebral fractures vary. In young people, they often occur as a result of traffic accidents, accidents at work, accidents in the home, falls, sports injuries such as skiing or horseback riding, or after physical violence. In seniors, however, vertebral fractures are also possible without a specific external impact because their bone structure is already suffering from previous damage. Osteoporosis is considered the most common cause of a disease-related vertebral fracture. However, other pathological causes such as osteitis (bone inflammation), bone softening (osteomalacia), rheumatism, bone cancer or metastases to the skeleton are also possible triggers. The vertebral fracture sets in without an identifiable cause such as an accident. Thus, even everyday stresses lead to a fracture of the vertebra, because the bone can be loaded significantly less due to the disease.
Symptoms, complaints and signs
A typical symptom of a vertebral fracture is back pain that starts abruptly. Even at rest, the pain is more or less pronounced. When moving, the discomfort usually intensifies. If a fracture occurs in the cervical vertebrae, the patient is no longer able to move his head properly. For this reason, he holds it in a forced posture. Other possible indications of a vertebral fracture are abrasions, a hematoma (bruise), and malpositions. Sometimes the spinous processes at the fracture site are at a greater distance from each other than usual. If the nerves or the spinal cord are also affected by the vertebral fracture, further symptoms occur. These may include muscle weakness, muscle paralysis, numbness or incontinence. Paraplegia is also a possibility. An indication of a vertebral fracture caused by osteoporosis is a rapid onset of loss of height of the affected person. Thus, the patient loses several centimeters in height.
Diagnosis and course of the disease
If a vertebral fracture is suspected, the doctor first looks at the patient’s medical history and gets a detailed description of the accident that caused it. Symptoms and the nature of the injuries can also provide important information about the affected person’s condition. A possible indication of a vertebral fracture is pressure or knocking pain at a certain section of the spine. After a physical examination, the nerve functions are assessed. An x-ray examination is also performed to confirm the diagnosis. X-rays of several spinal sites may be taken to determine a vertebral fracture. Instabilities can be detected with this procedure. If the patient suffers from unconsciousness, the entire spine must be subjected to an X-ray. If the X-ray examination actually reveals a vertebral fracture, a computed tomography (CT) scan then takes place to determine damage to other body structures such as the spinal canal. The course of a vertebral fracture depends on its extent. For example, certain malpositions cannot always be prevented. Similarly, overload symptoms are possible, but do not always result in pain. If osteoporosis is present, there is a risk of further vertebral fractures.
Complications
Usually, there is a good chance of recovery from a vertebral fracture. However, in some cases, complications can occur, sometimes with serious consequences. This is especially the case if nerve tissue is injured. Sometimes narrowing of the spinal canal also occurs. Neighboring segments may also be degenerated.Whether complications occur also depends on the type of vertebral fracture. There are stable and unstable vertebral fractures. A stable vertebral fracture is characterized by undamaged soft tissues and ligaments in the vicinity of the fracture. In this case, no neurological disorders occur. In unstable vertebral fractures, entire vertebral segments are deformed. Here, there is a great risk that displaced bone fracture fragments will injure the spinal cord. In extreme cases, the unstable vertebral fracture can therefore even cause paraplegia. In addition to spinal cord injury, late effects of a vertebral fracture may include balance disorders and post-traumatic kyphosis or post-traumatic scoliosis. When the vertebrae collapse forward, one of the consequences is a so-called widow’s hump, also known as kyphosis. Scoliosis (lateral bending of the spine) occurs when the lateral edges are depressed. This leads to an increased load on the intervertebral discs present in this area. The spinal deformities may also be associated with restricted movement and pain.
When should you see a doctor?
It is necessary to see a doctor as soon as pain occurs in the back or mobility restrictions become apparent after an accident, fall or exposure to violence. If the back can no longer be moved as usual, action is required. Numbness, sensory disturbances and a sudden loss of physical performance indicate a health disorder. Since severe cases can lead to lifelong impairments, a doctor should be consulted as soon as possible. If incontinence occurs, this should be interpreted as a warning signal from the organism. If the affected person can no longer move around without help and assumes a forced posture of the body, a doctor is needed. In particularly acute cases, an ambulance service should be alerted. Until its arrival, first aid measures must be taken and the instructions of the emergency medical team followed. To avoid complications, it is important not to make jerky movements. Characteristic of a vertebral fracture are pain and discomfort that occur even at rest. Even minor movements can result in intense attacks of pain. If the head or limbs cannot be moved at all or only to a limited extent, this is also cause for concern and should lead to a visit to the doctor.
Treatment and therapy
A vertebral body fracture can be treated both conservatively and surgically. If the fracture was caused by an accident, the first step is to stabilize the fracture to prevent further damage to the vertebra or spinal cord. If there is no risk of instability, conservative therapy takes place. This requires the patient to remain on bed rest for a few days. Pain is treated with analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) or calcitonin. Supported by the application of a chest corset and with the help of a physiotherapist, the patient can usually get up again after a short time. Special exercises are also performed to train the back muscles. In addition, patients learn behaviors that have a positive effect on the back and are similar to back school. While the first part of the treatment takes place in the hospital, the remaining part is done in an outpatient way after two to four weeks. In case of a cervical vertebra fracture, the patient has to wear a so-called neck brace (cervical brace) for about 6 to 12 weeks. If an underlying disease such as osteoporosis is responsible for the vertebral fracture, its treatment is also performed. If it is a stable fracture, surgery is performed only in case of severe pain. The situation is different if there is an unstable fracture. In such cases, immediate surgical intervention is necessary. In this case, the unstable bone segments are bridged by the doctor with metal screws or rods. Furthermore, a correction of constrictions of the spinal canal is performed. Additional brace therapy is usually not necessary. After about 6 to 9 months, the stiffened segments are healed.
Prevention
A vertebral fracture can be prevented in many cases. Avoiding accidents is important in this regard. For this purpose, traffic safety measures such as back protectors or seat belts can be applied. In the case of osteoporosis, early therapy is recommended.
Aftercare
Aftercare plays an important role after the actual treatment of a vertebral fracture. It helps to achieve freedom from pain as well as optimal mobility of the affected vertebrae. If the vertebral fracture was treated surgically, one of the most important aftercare measures is restoring stability to the spine. Follow-up treatment takes place as soon as possible and includes physiotherapy as well as occupational therapy. It is not uncommon for aftercare to begin on the first day after surgery. Because only small skin incisions are usually made in the spine, no special care is required for the wound. In the course of physiotherapy, the patient exercises targeted and slow movements. However, attention must be paid to whether the vertebral fracture has resulted in neurological deficits. If the operation restored the stability of the spine, the patient undergoes rehabilitation. The purpose of rehabilitation is to enable the patient to return to work. In this process, it is determined whether it is still possible to carry out the previous work activity at all. For example, occupations that involve heavy physical strain are often considered an obstacle. In most cases, those affected can resume their usual activities after eight to twelve weeks. In some cases, the vertebral fracture results in paralysis. The follow-up treatment is then intended to restore the patient’s independence. If a wheelchair is necessary, this usually requires lifelong follow-up care.
Here’s what you can do yourself
In the case of a vertebral fracture, the organism must be spared to a sufficient degree. Physical stress and any overexertion should be avoided as a matter of principle. Sporting activities are to be refrained from in most cases during the recovery process or only performed in a reduced form. In order not to run any risks or to trigger secondary diseases, it should be discussed in cooperation with the attending physician which types of sports may be performed. At the same time, it should be checked to what extent occupational activities can take place during the healing process or whether a sick leave is necessary. Movement patterns in everyday life should not be jerky under any circumstances. Lifting and carrying heavy objects should be avoided. The performance of daily tasks should be restructured and should be performed by people from the social environment. At the first physical irregularities or abnormalities, movements should be slowed down and optimized. In particular, the adoption of one-sided postures should be reduced to a minimum. The musculature should be protected from hardening. Careful light massage or slow balancing movements help to relieve discomfort or prevent pain. Physiotherapeutic measures additionally support the healing process and can be helpful in preventing further disorders. In addition, sleep habits should be optimized and adapted to the current physical possibilities.