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.
If you have any questions whatsoever regarding this procedure,
please do not hesitate to ask Lynne Carr Columbus, D.O.
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