Why Choose Cedars-Sinai Marina del Rey Hospital for Vertebral Fracture Treatment?
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.
Vertebral Fracture Surgical Procedures Performed at Cedars-Sinai Marina del Rey Hospital
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:
- To bring back the bone into the previous position
- To remove pressure on the spinal cord and nerves
During the surgery performed to treat a vertebral fracture, the surgeon uses a type of internal fixation method to maintain the broken vertebrae in the 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.
- Anterior approach: An operation is performed using the front approach to the spine when removal of pressure over the spinal cord is necessary. In this approach, an incision is made in the chest region to allow visualization of the front portion of the spine. Then, the vertebra that has been broken is located, and the bone fragment that exerts pressure on the spinal cord is removed. Once the bone pieces are removed, a spinal fusion is performed. During the anterior spinal fusion surgery, the broken vertebra is replaced with a bone graft to keep the parts above and below the fractured vertebra together. The bone graft fuses the vertebrae into a single bone, eventually. A combination of metal screws, plates, and rods are used during the operation to stabilize the spine in a proper position to facilitate the fusion. These implants remain in the body until they pose any problem to the patient.
- Posterior approach: This approach is used when the aim of surgery is to prevent further collapse of the fractured vertebra, and there is no concern regarding pressure on the spinal nerves. An incision is made in the back to allow the surgeon to place metal screws or rods to stabilize the broken vertebrae in proper alignment while the bone healing takes place.
Drugs and Other Treatment Needed for Vertebral Fracture
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.
Decreasing Activity »
Pain Relieving Medications »
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.
Rotation Fracture Pattern »
Flexion Fracture Pattern »
Extension Fracture Pattern »
Symptoms of Vertebral Fracture
Vertebral fractures caused by a sudden injury can cause the following symptoms:
- Sharp, severe pain in the back, legs, and arms that become worse on movement.
- Loss of bowel/bladder control with weakness or numbness in the limbs if the spinal nerves are injured.
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:
- Pain in the back that worsens on walking and relieves on rest
- Gradual height loss of almost 6 inches
- Kyphosis or stooped over posture
Diagnosis of Vertebral Fracture
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 a vertebral fracture from major trauma include serial hemoglobin determinations to check for hemodynamic stability. Other laboratory studies include:
- Urinalysis: To preclude associated injury to the kidney
- Amylase and lipase levels: Increased amylase or lipase levels suggest injury to the pancreas
- Cardiac-marker levels: Increased cardiac marker levels in conditions of chest injury indicate a cardiac contusion
- Urine myoglobin and serum creatine kinase levels - Elevated levels of these in case of a crush injury indicates an evolving rhabdomyolysis
- Serum calcium level: To detect hypercalcemia in patients with metastatic bone disease and resultant pathologic fractures, a serum calcium determination is done
- Radiography: Plain radiographs can detect fractures but hairline fracture and undisplaced fractures cannot be identified.
- Computed tomography (CT) scanning: It can detect bone fractures and help with the detailed assessment of the fracture extent
- Magnetic resonance imaging (MRI): This is done to evaluate the extent of damage to the spinal cord.
A bone density test may be advised in patients with osteoporosis.
Risk Factors for Vertebral Fracture
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.
Causes of Vertebral Fracture
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 is 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.
- Acupuncture: Acupuncture has been effective in the relief of low back pain. Certain areas of the body are identified and pierced with fine needles. This causes relief of symptoms close to the needles and in distant areas of the body. Most patients do not feel any pain during the procedure, although in some people, there may be a dull, aching sensation. In some people with spinal fractures, acupuncture may provide pain relief only during treatment, and pain may reoccur once treatment is completed.
- Pilates: Pilates consists of a program of exercises that improve the flexibility and strength of an individual. It focuses on correct body alignment. It concentrates on utilizing the body's deep core muscles present in the trunk and pelvis that support the skeletal structure of our body. It may be of help in patients with spinal fracture due to osteoporosis. It is important to avoid any stretching exercise or movement that requires forward bending or touching toes, which could be unsafe for people with a fracture.
- Tai Chi: Tai Chi is an ancient form of Chinese martial arts, which involves the use of deep breathing and relaxation techniques combined with slow controlled movements.
- Yoga: Yoga is a system of exercises that encourages physical as well as mental well-being. It involves performing a series of different movements, physical postures, breathing techniques, and meditation. Yoga serves as an alternative exercise activity for elderly people and those with 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.