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At Cedars-Sinai Marina del Rey Hospital, the well trained spinal surgeons manage vertebral fractures successfully with either operative or non-operative means of treatment, depending on the severity of spinal cord damage and the general well-being of the patient.
The vertebrae or the bones of the spine are strong enough to resist fracture. Sometimes, a vertebra may undergo fracture due to certain conditions such as osteoporosis, major traumatic injury to the spine, and excessive pressure. When there is a crack in the vertebra of the spine, it is called vertebral fracture or broken vertebrae. Most vertebral fractures happen in the thoracic (middle portion of the spine) and lumbar spine (lower back) or at the junction of the thoracic and lumbar spine (thoracolumbar junction). Vertebral fractures vary in severity as some cases are very serious traumatic conditions causing damage to the spinal cord requiring emergency treatment while other broken vertebrae may be a result of weakened bones due to osteoporosis.
Surgical intervention may be considered if the pain does not get relieved with conservative treatments, and has been debilitating lasting for more than 2 months. Surgery is also indicated when there is sudden serious instability of the spine, for example, if the vertebral fracture causes a decrease of up to 50% of the vertebral body height.
The goals of spinal surgery to treat vertebral fracture are:
During the surgery performed to treat a vertebral fracture, the surgeon uses a type of internal fixation method to maintain the broken vertebrae in proper position until bone healing takes place. In cases where there are signs of pressure on the spinal nerves, the fragments of bone exerting pressure on the spinal cord are removed.
Based on the type of fracture, the surgeon decides on the approach to be used to perform the procedure. This includes an anterior (front), lateral (side), or posterior (back) approach or a combination of the three approaches. Different kinds of sophisticated tools are used in spinal surgery, which includes metal rods, screws, and cages to stabilize the spine.
Surgical techniques include balloon kyphoplasty, vertebroplasty, and spinal fusion.
The most common non-surgical methods used to treat vertebral fractures include pain relieving medications, activity restriction (bed rest), and bracing. It takes about 3 months for a vertebral fracture to heal completely. The healing progress will be checked on an X-ray taken every month.
In order to determine the most appropriate treatment more easily, doctors classify the vertebral fractures based on the very pattern of the fracture and whether there is an injury to the spinal cord. The 3 major fracture patterns are rotation, extension, and flexion.
Vertebral fractures caused by a sudden injury can cause the following symptoms:
Vertebral collapse due to osteoporosis (bone thinning) is gradual, and may not cause any symptoms. The pain will be milder, and over the years, the following symptoms may appear:
Your doctor will do a careful physical examination during which signs such as kyphosis (humpback) and tenderness at the affected spinal portion are checked.
The laboratory studies performed on a patient with vertebral fracture from major trauma include serial hemoglobin determinations to check for hemodynamic stability. Other laboratory studies include:
A bone density test may be advised in patients with osteoporosis.
There are certain risk factors that predispose the thoracic portion of the spinal cord to injury. Firstly, the thoracic spinal cord is the longest increasing its probability of injury when compared to other portions. Secondly, the spinal canal and the vertebral bodies are comparatively smaller when compared to the lumbar region. Lastly, the blood supply is more conditional with few collateral vessels and small anterior spinal and radicular arteries. All these risk factors increase the vulnerability of the thoracic spinal cord to injury.
The lumbar spine is less susceptible to trauma due to its better vascular supply and more generous spinal canal.
Vertebral fractures may result from trauma caused by:
Vertebral fractures may sometimes be caused due to bone insufficiency, for instance, patients with osteoporosis, tumors, or other conditions that make the bone weak can fracture a vertebra even while performing low-impact activities such as bending or twisting.
Complementary and alternative medicine are a healthcare branch becoming popular as most patients have found pain relief and improved quality of life with such therapies. Currently, there is no sufficient evidence to support that these therapies increase bone density and reduce the risk of fractures. This treatment approach may provide additional relief of pain and other symptoms in patients who have suffered fractures due to osteoporosis.
Overall, the alternative exercise methods such as Pilates, Tai Chi, and Yoga make use of well-controlled and focused movements that can help improve posture and develop muscle strength in patients with vertebral fracture.
The only most effective measure to prevent vertebral fractures is to manage osteoporosis or bone thinning. Performing regular load-bearing exercises such as walking can help avoid bone loss and thereby compression fractures of the spine.
To know more about the treatment of vertebral fractures, please consult our specialty-trained, skilled spinal surgeons at Cedars-Sinai Marina del Rey Hospital.
Robert S. Bray, M.D.See Profile »
Eli Baron, M.D.See Profile »
Fardad Mobin, M.D.See Profile »
Amir Vokshoor, M.D.See Profile »
Jared Ament, M.D., M.P.H.See Profile »
Brian Gantwerker, M.D.See Profile »
Albert Wong, M.D.See Profile »
Sasan Yadegar, M.D.See Profile »
Paul Dwan, M.D.See Profile »
Donald Miller, M.D.See Profile »