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A vertebral fracture is a ruptured vertebra. The vertebrae consist of the following parts: the body in its anterior part, the pedicles in the median part, and the laminae, the joints, and the spines in the posterior part. Rupture of any of the parts that make up a vertebra is considered a vertebral fracture. It can affect the vertebrae of the cervical, thoracic, lumbar, sacrum or coccyx spine.
Vertebral fractures can have a variety of causes:
Fractures of the spine resulting from injury (car accident, work accident…) are the most common.
Another very frequent cause of vertebral compression fractures is this disease, which, as we know, is a problem related to bone metabolism causing the bones to lose density and therefore become more fragile.
A vertebral fracture can also be the result of another pathology, such as tumors. There are primary tumors (that originate from the bone) that directly affect the bone, weaken it until a fracture occurs, and also, there are secondary ones (metastases, when the tumor originates elsewhere and then travels to the bone).
Other causes of vertebral fractures are chronic treatment with corticosteroids, chemotherapy and radiotherapy, an infection (osteomyelitis, tubercolosis) that extends to the bone, hyperthyroidism not treated correctly, etc.
The symptoms of vertebral fractures will depend on their location, the type of fracture and the cause.
Without a doubt, the most common symptom is pain caused by broken bone. The pain may be located only in the area of the vertebral fracture or it can be irradiated, that is, it can be located remotely, due to the fact that some spinal cord or nerve area (medulla and/or nerves) is compressed by some broken bone fragment that has moved from its usual position as a consequence of the fracture.
In the most severe cases, in addition to pain with or without irradiation, the patient may also suffer some neurological deficit that can affect the sensory part (with loss of sensation in some area, trunk and or extremities) and/or motor function (with loss of movement of some anatomical area), which is usually due to the damage caused by the bone fragment displaced on the noble structures (medulla and nerves).
To make a diagnosis of a fracture, in addition to the information gathered from the symptoms previously described, and a physical examination, complementary imaging tests are used. Radiography (X-ray) has been the most commonly used method to identify a fracture and it is still very useful today, since it allows us to see the broken vertebra.
However, once a vertebral fracture has been identified, it is important to complete the study with a series of tests that will allow us to correctly classify the fracture and thus identify the most appropriate treatment for it. These tests, which we will see below, in some cases, also allow us to identify the fracture when the x-rays are inconclusive:
A CT scan allows us to see in detail the bone structures affected by the fracture.
Allows us to identify and confirm the fracture. With an MRI we can see if there is inflammation, current state or healing of the fracture (acute/chronic) and the soft tissues affected by the fracture (medulla, nerves, ligaments, tendons). In this way, we can classify it and choose the best therapeutic option.
Helps us study the fracture in the general context of the rest of the vertebral segments and the balance of the different curvatures (kyphosis, lordosis). This allows us to analyze different angles (such as that of the angular kyphosis of the fractured vertebra and of the adjacent-superior and inferior vertebrae), helping us to predict which fractures, even if they appear mild, can present complications and require more aggressive treatments from the beginning.
The treatment of vertebral fractures varies widely. It must be based on the type, cause, location and characteristics of the fracture, and on whether or not there are any neurological symptoms associated with spinal cord injury, compression of the medulla or nerves.
Treatment can either be conservative or surgical, or a combination of both.
Conservative treatment is used for those fractures that are not considered dangerous. That is, in which there is no risk of secondary complications and the patient has no neurological symptoms from the beginning.
This treatment is based on the use of pain-relieving medication. Sometimes it may be necessary to use a corset or orthopedic brace, which can be custom made depending on the type of fracture and its location. If there are metabolic or endocrinological problems, attempts will be made to correct the related causal problems, with or without the help of medications.
Surgical treatment varies, and will depend on the type of fracture, its cause and location. In some cases it may be necessary to inject cement into the vertebra (vertebroplasty, kyphoplasty), especially in the case of osteoporotic fractures, which are refractory to medical treatment.
In unstable fractures, it may be necessary to perform a posterior stabilization of the fracture with the placement of posterior screws, which can be done by percutaneous (minimally-invasive) surgery and/or open surgery. These screws, depending on the type of fracture, can be removed at the time the fracture is considered healed, generally between 8 months and one year.
In more severe cases, a vertebral fusion may be necessary to permanently stabilize the segment affected by the fracture. This surgery can be performed by stages, in addition to the surgical stage for the placement of the screws, mentioned above, it may be necessary to place implants in the anterior part of the spine, which serve to completely or partially replace the vertebra fractured (corporectomy).
In the case of a secondary tumor-related fracture, it may be necessary to remove the entire vertebra (vertebrectomy) for analysis, in which case the vertebra is replaced with an artificial one. In selected cases, just a biopsy will be taken instead of removing the whole vertebra, since there are some types of bone tumors that are treated with drugs (chemotherapy and/or radiotherapy).
Rarely, in cases of injury and/or other causes, urgent surgery is performed to avoid major complications, especially when there is direct compression on the neurological structures (medulla and/or nerves). In these cases, direct decompression of the affected structures may be necessary, performing a posterior laminectomy resection of the posterior elements of the vertebra). Decompression surgery with laminectomy is usually completed by stabilizing the segments with posterior screws with or without anterior support with an artificial vertebra.
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