Vertebral Body Fracture

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Vertebral Body Fracture 2016-11-03T11:12:16+00:00

What is Vertebral Body Fracture?

Vertebral Body Fracture Explained by Las Vegas, Summerlin, and Henderson Nevada’s Top Pain Doctors

Vertebral Body FractureBone damage in the spine is an unarguably serious condition. Total breaks or dislocations in the cervical spine (i.e. the neck) often result in death or paralysis, due to the extreme damage to the spinal cord they cause. However, minor fractures can be survived, but will cause chronic pain in the neck or back. The vertebral body is the main part of the bone, where the intervertebral disc is also located. This disc supports the vertebra above it. Most of the vertebral body faces into the body cavity, in front of the spinal cord.

Causes of Vertebral Body Fracture

OsteoporosisFractures (splits or bursts) in the vertebral body are usually a consequence of motor accidents, firearm-related injuries, or diving. Splits are single fractures through the vertebral body. Bursts are multiple fractures that appear as though the bone has shattered into small pieces. Both types most often occur in men 15-24 years and people of 55 years or older. Vertebral fractures are often the result of car accidents, falls, or other traumas. In these cases, medical treatment should be sought straight away. Fractures are also associated with some bone cancers in the body of the vertebra and with osteoporosis. This is a loss of bone density that increases the probability of bone fractures. Vertebral fractures are a source of chronic pain, and may cause spinal cord injuries and/or paralysis if left untreated.

Treatment of Vertebral Body Fracture

The main treatment for vertebral fractures is vertebroplasty. In this procedure, the area of the back above the broken vertebra is anesthetized. Then, a thin needle is inserted into the bone and acrylic cement is injected. This repairs the break and restores vertebral integrity. A variation on this procedure is kyphoplasty. In this procedure, a small balloon is inserted and inflated to support the bone or broken sections. Then, the cement is injected.

Vertebroplasties are effective in repairing spinal fractures. They have minimal risks, such as infection and bleeding at the site of needle insertion. There is also the possibility that the cement may “leak” out of the bone, causing inflammation and thus further pain. Another risk factor is that procedures carried out on the spines of older patients may increase the probability of another type of vertebral fracture—a compression fracture. These are associated with osteoporosis.

RadioFrequency Ablation - XRAYAnother technique to reduce pain in conditions such as vertebral body fractures is radiofrequency ablation. This technique involves the introduction of thin probes through the skin to spinal nerves. These deliver electro-thermal impulses to destroy the pain-transmitting fibers of nerves. This prevents the pain of fractures being conducted to the brain. Much like vertebroplasty, this procedure carries the risk of infection and bleeding. Ablation may also cause inadvertent motor nerve damage that can result in paralysis.

If the fractures are not a threat to the spinal cord, other treatments that manage the pain arising from them may be considered instead. These include oral painkillers such as non-steroid anti-inflammatory drugs (NSAIDs). Nerve blocks are injections of steroids and local anesthetics such as lidocaine, given via needle directly to spinal nerves that are the source of pain. Targeting nerves in the lower back are effective in pain relief for patients with fractures.

Conclusion

Vertebral ColumnVertebral body fractures can be serious, due to their immediate proximity to the spinal cord. The vertebral body is the large part of an individual spinal bone that holds the disc located between two vertebrae. It is located to the front of the spinal cord. Fractures can come in the form of “splits,” which are single breaks along the bone, or “bursts.” Burst fractures are multiple fractures that give the bone the appearance of having been shattered or burst apart.

Fractures can be the result of accidental injury, e.g. in the course of car accidents. In these cases, a procedure to seal the breaks will be carried out. This is called a vertebroplasty. It involves the injection of acrylic cement into broken vertebrae to seal breaks. A variation on this is kyphoplasty, in which a balloon is inserted and inflated prior to the cement. This supports the broken vertebrae while they are being sealed.

Vertebral fractures are also associated with osteoporosis (low bone density) and with certain bone cancers, which cause weaknesses and breakage in bones. In these cases, vertebroplasty may not be advisable, due to the risk that other types of fracture may be caused by the procedure. NSAIDs and nerve blocks may be enough to manage the pain associated with vertebral fractures in these cases. Radiofrequency ablation of spinal pain fibers may also be effective in treating vertebral body fractures.

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References

  1. Lee DG, Park CK, Park CJ, Lee DC, Hwang JH. Analysis of risk factors causing new symptomatic vertebral compression fractures after percutaneous vertebroplasty for painful osteoporotic vertebral compression fractures: A 4-year follow-up. Journal of Spinal Disorders & Techniques. Oct 30 2013.
  2. Huwart L, Foti P, Andreani O, et al. Vertebral split fractures: Technical feasibility of percutaneous vertebroplasty. European Journal of Radiology. Oct 9 2013.
  3. Bach SM, Holten KB. Guideline update: what’s the best approach to acute low back pain? The Journal of Family Practice. Dec 2009;58(12):E1.
  4. Minne HW, Pollahne W, Pfeifer M, Begerow B, Hinz C. Weeks of pain, vertebral body fractures during sleep, invalidism. Save your osteoporosis patients from this fate. MMW Fortschritte der Medizin. Oct 31 2002;144(44):41-44.
  5. Ohtori S, Yamashita M, Inoue G, et al. L2 spinal nerve-block effects on acute low back pain from osteoporotic vertebral fracture. The Journal of Pain. Aug 2009;10(8):870-875.
  6. Sun G, Jin P, Li M, et al. Percutaneous vertebroplasty for treatment of osteolytic metastases of the C2 vertebral body using anterolateral and posterolateral approach. Technology in Cancer Research & Treatment. Aug 2010;9(4):417-422.
  7. Hoffmann RT, Jakobs TF, Trumm C, Weber C, Helmberger TK, Reiser MF. Radiofrequency ablation in combination with osteoplasty in the treatment of painful metastatic bone disease. Journal of Vascular and Interventional Radiology. Mar 2008;19(3):419-425

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