Gulf Coast Pain Management
COMPRESSION FRACTURES
 
 

These fractures of the spine usually result from a fall or an automobile accident.  Although the thoracolumbar junction is the most common site of compression fractures, the thoracic and lumbar vertebrae are also prone to injury.  The diagnosis is usually obvious, particularly from a lateral radiograph.  Even subtle compression fractures can be identified by a bone scan. Treatment is based on the patient’s symptoms.  Non-steroidal anti-inflammatory and perhaps a supportive device, such as corsets, are usually all that is needed.  Compression fractures may cause no pain, or they may cause excruciating pain.  They may take up to a year to heal and some never heal one hundred percent. 

Usually, significant trauma is necessary to cause enough damage to require surgery.  However, it is very important to realize the warning signs of a very serious compression fracture, which include:

• loss of bowel or bladder control

• loss of sensation in the area of the inner thigh and “private areas”

• loss of motor function in the lower extremities

If you experience these symptoms, further imaging studies are necessary, such as a CT scan or MRI, to identify the presence of bone or soft tissue fragments pressing on neural structures within the spinal canal.

In patients with osteoporosis, compression fractures may occur at several levels but are usually so minor that the neurological deficit is seldom serious.

Again, treatment of compression fractures is dependent on the patient’s symptoms:

Non- steroidal anti-inflammatory are the treatment with initial injury.  Some patients experience muscle spasms with their injury that may require muscle relaxants. If the pain is severe enough, narcotic medications may be required to control the pain.  It is very important to sleep well; in order to give your body a well needed break to heal at night and also to enable you to deal with your pain the following day.  If you suffer from a sleep disturbance due to your pain, consult your physician for a sleep aid.

Ice and heat therapy may also be beneficial.

TENS units may relieve pain in some cases.  Small generators attached to electrodes are placed over the area of a patient’s body that hurts.  The electrical stimulation then activates the body’s own pain-suppressing systems that block pain.

ESI’S (epidural steroid injections) are injections within the space that surrounds the spinal cord that decrease inflammation and decrease pain.  These are often used in conjunction with physical therapy or aquatic therapy to decrease pain while undergoing therapy and increase the benefits of the therapy.

Continuous epidural drug therapy - One method of pain treatment is to place a catheter in the epidural space, the space that surrounds the spinal cord that is filled with fat and blood vessels, and continuously infuse medications, to block pain signals.  This method is most effective when used to provide relief for acute pain due to the compression fracture.

Facet joint injections are injections into the joints surrounding the compression fracture to decrease inflammation.  These must be performed with fluoroscopy (X-ray).  If you receive pain relief with the facet joint injections, but the pain relief is only temporary, you may be a candidate for a more permanent treatment called radio frequency neurolysis. 

Radio frequency Neuroablation is a procedure that uses heat to destroy the tiny nerves that innervate the joints around the spine.

Intrathecal Drug Therapy - patients whose pain is refractory to all of the above therapies may require medications such as narcotics, to be delivered. A high concentration of the drug then turns off pain signals directly at the spinal cord level.

Stress may be caused by pain, but pain may be aggravated by stress.  When someone is under stress, the muscles tighten, which puts added tension on joints and connective tissues.  The nervous system becomes more active under stress, which can increase pain signals and pain sensitivity.  These factors can greatly increase pain, causing more stress and concern.  Stress also adds to depression.  Managing stress and chronic pain go hand in hand. 

In patients with osteoporosis, a disorder that occurs when bone resorption exceeds bone production, causing a decrease in bone mass per unit volume of bone, it is very important to initiate appropriate treatment.  This includes estrogen replacement therapy, other hormone replacement therapy, medications such as Fosamax, vitamin D, fluoride, or calcitonin.  Both weight-bearing exercise (which stimulates new bone formation and deters the loss of bone by normal metabolic turnover) and a balanced diet high in calcium are extremely important.