Compression fractures affect many individuals worldwide. An estimated 1. Although these fractures rarely require hospital admission, they have the potential to cause significant disability and morbidity, often causing incapacitating back pain for many months.
This review provides information on the pathogenesis and pathophysiology of compression fractures, as well as clinical manifestations and treatment options. Among the available treatment options, kyphoplasty and percutaneous vertebroplasty are two minimally invasive techniques to alleviate pain and correct the sagittal imbalance of the spine.
Vertebral compression fractures VCFs Casita En Canada (Fox-Trot) - Katyna Ranieri - Cachito the thoracolumbar spine are common in the elderly, with approximately 1. However, their risk is Helloween - Light The Universe less than that of women of the same age.
Although less severe than hip fractures, VCFs can cause severe physical limitations. Chronic back pain, which is associated with these kinds of fractures, leads to functional limitations and significant disability. Multiple adjacent VCFs can lead to progressive kyphosis of the thoracic spine, resulting in a number of comorbidities, such as decreased appetite resulting in poor nutrition and decreased pulmonary function.
Decreased bone mineral density because osteoporosis disrupts the bone microarchitecture and alters the contents of noncollagenous proteins in the bone matrix. It is estimated that approximately 44 million Americans have osteoporosis and that an additional 34 million Americans have low bone mass. Lindsay et al reported that, irrespective of bone density, having 1 or more VCFs leads to a 5-fold increase in the New Days - Morbid Death - Spinal Factor: Maintaining Alive (DVD) risk of developing another vertebral fracture.
Compression fractures of the thoracolumbar spine have a flexion compression mechanism of injury. This mechanism usually involves the first column anterior longitudinal ligament and anterior half of the vertebral body. Pain is the main symptom Table 1 ; neurologic deficits tend to be quite infrequent, because such a fracture does not involve retropulsion of bone fragments into the vertebral canal.
Compression fractures of the vertebral bodies are particularly worrisome in patients with severe osteoporosis. Fractures occur in these patients during trivial events, such as Raphael - Algo Mas. a light object, a vigorous cough or sneeze, or turning in bed.
It has been hypothesized that fractures in vertebral bodies occur because of an increased load on the spine cause by contraction of paraspinal muscles. The most likely cause of a spinal compression fracture in those without osteoporosis is severe trauma, such as an automobile accident or a fall from a great height.
When patients younger than age 55 years present with compression fractures, malignancy should be considered as a possible cause of the fracture. Symptoms and complications of vertebral compression fractures 112130—31 Vertebral compression fractures have an insidious onset and may produce only low-grade back pain. Over time, multiple fractures may lead to progressive loss of stature and continuous contraction of the paraspinal musculature to maintain posture.
This combination results in fatigued muscles and pain that may continue even after the original compression fractures have healed. Patients with multiple compression fractures and progressive loss of vertebral body height may develop excessive thoracic kyphosis and lumbar lordosis. Other complications of compression fractures include constipation, bowel obstruction, prolonged inactivity, deep vein thrombosis, increased osteoporosis, progressive muscle weakness, loss of independence, kyphosis and decreased height, crowding of internal organs, respiratory disturbances eg, atelectasis, pneumonia, and prolonged painlow self-esteem, and emotional and social problems; these patients are also more likely to be admitted to a nursing home.
With one segment collapsed to the point of instability, the adjacent levels have to support the additional load. This segment is between T12 and L2 and is considered a transition zone from the more rigid thoracic vertebral column to the relatively mobile lumbar vertebral column.
This anatomic relationship makes the thoracolumbar junction more prone to fractures than the rest of the spine. The most important risk factor for VCF is osteoporosis, but there are a number of others, both modifiable and nonmodifiable 33 Table 2. Modifiable risk factors include activities and behaviors that the patient can change, such as alcohol consumption, tobacco use, osteoporosis, estrogen deficiency, early menopause or bilateral salpingo-oophorectormy, premenopausal amenorrhea for more than one year, frailty, impaired eyesight, insufficient physical activity, low body weight, dietary calcium deficiency, and dietary vitamin D deficiency 3334 Table 2.
Nonmodifiable risk factors include advanced age, female sex, Caucasian race, dementia, susceptibility to falling, history of fractures in adulthood, history Various - Impressed fractures in a first-degree relative, previous steroid treatment, 35 and previous treatment with anticonvulsants Table 2.
Managing modifiable risk factors, including treatment for osteoporosis, is the first step in preventing VCFs. Risk factors for vertebral compression fractures 7New Days - Morbid Death - Spinal Factor: Maintaining Alive (DVD) Interestingly, obesity is protective against fractures, as it decreases the risk of bone loss: high stress on the bone induces a stronger bone remodeling response.
The hyperinsulemia associated with obesity leads to decreased production of insulin-like growth factor binding protein-1 IGFBG-1thus increasing levels of IGF-1 protein, which Teenage Fanclub - Sparkys Dream the proliferation of osteoblasts.
The most reliable method of detecting osteoporosis, and thereby identifying patients at risk for compression fractures, is to measure bone mineral density. Bone mineral density T scores represent the standard deviation from the mean peak value in young adults. According to the World Health Organization, a T score less than —2.
VCFs can be classified in three categories: wedge, biconcave, and crush. In these fractures, only the middle portion of the vertebral body is collapsed, whereas the anterior and posterior walls remain intact. The least common VCFs are crush compression fractures. X-ray images of vertebral compression fracture: a x-ray images of vertebral compression fracture with anterior wedging white arrow b computed tomography scan of biconcave Best Of My Love - Various - Die Hits Der 70er - Disco Edition compression fracture black arrow c T2 weighted magnetic resonance images of wedge vertebral compression fracture white arrowand biconcave vertebral compression fracture black arrow.
Several imaging modalities are available for evaluation of patients with suspected compression fractures. Plain radiographs are the initial diagnostic modality Figure injuries should have a complete spine series. This helps to avoid overlooking injuries, especially when patients present with other life-threatening injuries.
Kyphotic angulation is measured as the angle between the superior end plate one level above and the inferior end plate one level below the injured segment. Typically, upright films are used to measure kyphotic angulation and to monitor changes in and progression of kyphosis in patients with VCFs. CT scans are primarily used for areas where plain films suggest there may be injury. They can help detect instability of an anterior wedge compression fracture, and occult bony injuries.
CT is ideal for imaging complex fractures and determining the degree of vertebral. More complex imaging modalities, such as CT myelography and magnetic resonance imaging MRI are not necessary unless the patient has a neurologic deficit. In special cases where the compression fracture is because of an infectious or malignant process, more advanced MRI techniques can be used. MRI is helpful for better visualization of cord compression and ligamentous disruption.
High signal intensity indicates cord injury. New injuries can be identified by a T2 signal because of an increased signal intensity from water in the vertebral body. CT myelography for assessment of cord compression is indicated when MRI is contraindicated, such as in patients with a pacemaker.
Imaging modalities other than plain films should always be used in patients with neurologic deficits, as multiple compression fractures can cause enough kyphotic angulation to lead to cord compression and progression to complete loss of neurologic function. Prevention and treatment of osteoporosis is one of the first steps in managing VCFs.
Postmenopausal women with osteoporosis should be treated with mg calcium and IU vitamin D daily. Cigarette smoking should be discouraged, and alcohol should only be consumed in moderation. Nonsurgical management is one of the preferred approaches for treatment of VCFs. These braces are usually beneficial for the first few months, until the pain resolves. Although younger patients tolerate bracing well, elderly patients generally do not, 28 because of increased pain with bracing.
Thus, elderly patients tend to require more bed rest. Immobility predisposes patients to venous thrombosis and life-threatening complications such as pulmonary embolism. It can also lead to pressure ulcers, pulmonary complications, urinary tract infections, and progressive deconditioning.
In addition, it has been reported that bone mineral density decreases 0. Narcotics should be reserved for patients who receive inadequate relief from regular analgesics. A major concern with narcotics is physical dependence and other adverse effects, like gastrointestinal dysmotility and cognitive deficits.
Physical therapy and rehabilitation are also important factors that expedite healing. For patients with pathologic compression fractures, a Brothers In The Struggle - Holdin On of radiotherapy may be indicated if the tumor is radiosensitive.
Operative management of VCFs New Days - Morbid Death - Spinal Factor: Maintaining Alive (DVD) gained popularity, as it produces rapid, significant, and sustained improvements in back pain, function, and quality of life. There are several surgical options for the management of painful osteoporotic fractures. Vertebral augmentation through minimally invasive techniques such as kyphoplasty and percutaneous vertebroplasty are among the most popular.
More invasive techniques, such as anterior and posterior decompression and stabilization with placement of screws, plates, cages, and rods are also available.
These procedures, however, are challenging because it is difficult to New Days - Morbid Death - Spinal Factor: Maintaining Alive (DVD) adequate fixation in osteoporotic bone. Percutaneous vertebroplasty is one of the favored methods of treating painful VCFs. Its objective is not to restore the height of the vertebral body; in static fractures the average increase in anterior body height is only 2. Contraindications of this procedure include infection of the vertebral body, coagulopathy, bone fragment retropulsion, and allergy to any of the substances used during the procedure, including PMMA cement and sometimes contrast agent.
A number of potential serious complications of intraosseous injection of bone cement have been reported in the literature. In addition, there was an increased incidence of new VCFs in the adjacent segments after vertebral body augmentation procedures. Despite the early encouraging results of vertebroplasty for VCFs, in Buchbinder et al found that vertebroplasty offered no benefit to patients with fresh and painful VCFs.
Patients in both groups had similar, significant reductions in overall pain and similar improvement in physical functioning, quality of life, and perceived recovery. Immobility predisposes patients to venous thrombosis and life-threatening complications …. Another option for vertebral body augmentation is kyphoplasty. This involves placement of an inflatable balloon tamp in the fractured vertebral body.
The inflation creates a cavity that can later be filled with PMMA or other types of bone cement. The risks associated with this procedure are similar to those of percutaneous vertebroplasty, however lower rates of cement leakage into the spinal canal have been reported. New techniques have been developed to minimize the risks of complications from kyphoplasty.
Vesselplasty was developed in to decrease the rate of cement leakage: the inflatable balloon is left in the patient and filled with cement, thus reducing the risk of cement New Days - Morbid Death - Spinal Factor: Maintaining Alive (DVD). Compression fractures affect many patients worldwide and are most common in elderly populations, especially postmenopausal women. These fractures often cause incapacitating back pain and morbidity. The most important step in treating compression fractures is prevention and treatment of osteoporosis.
When vertebral compression fractures become symptomatic and cause disability, several treatment options are available, including kyphoplasty to alleviate pain and correct the New Days - Morbid Death - Spinal Factor: Maintaining Alive (DVD) imbalance Commonwealth - The Beatles - The Beatles (Black Album) the spine.
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