What Is the Treatment for Lumbar Compression Fractures?
Compression fractures of thoracolumbar vertebrae generally refer to the compression of the anterior half (anterior column) of the vertebral body due to anterior flexion, the vertebral arch (rear column) of the posterior part of the spine is normal, and a few have traumatic injuries. The vertebral body is usually wedge-shaped and is the most common type of injury in spinal fractures.
- Compression fracture of lumbar spine
- Visiting department
- Surgery, orthopedics
- Common locations
- Lower thorax
- Common causes
- Trauma, osteoporotic fractures in the elderly
- Common symptoms
- Back pain
Causes of thoracolumbar compression fractures
- Thoracolumbar vertebral compression fractures are mostly caused by trauma, and elderly osteoporotic fractures are also mostly compression fractures. The latter is generally mildly injured, and can also be manifested as a stress fracture, which is caused by repeated light injuries. Pathological fractures usually refer to bone tuberculosis, bone tumors that invade the vertebrae with minor injuries, or fractures without trauma. Osteoporotic fractures can also be considered pathological fractures.
Clinical manifestations of thoracolumbar compression fractures
- Compression fractures of the thoracolumbar vertebrae occur in the lower thorax and upper waist. The injury history should be carefully understood. The patient complains of back pain and is afraid to move, which can prevent standing and walking. If the degree of compression is severe, the spinous processes or ligaments of the posterior column are damaged, localized kyphosis is deformed, or swelling and bruising appear. Tenderness and throbbing are common and thoracolumbar motion is limited. Most of thoracolumbar vertebral compression fractures are stable fractures, and there are few patients with spinal cord paralysis.
Diagnosis of thoracolumbar compression fracture
- X-ray filming is the most commonly used inspection method, but it is found that the compression of the vertebral body, the wedge-shaped deformation does not necessarily mean that it is a fracture or a fresh fracture, the spinal developmental deformity can have a vertebral body wedge-shaped change, and old fractures remain. It is necessary to pay attention to the vertebra outline and trabecular structure. CT is helpful to observe the trabecular bone fracture and cortical rupture. For fresh compression fractures, MRI shows diffuse low signal on T 1 WI, iso-signal or high signal on T 2 WI, and high signal on lipostatic phase, which can still show vertebral arch damage and soft tissue damage. For bone tumors, especially pathological fractures caused by malignant tumors, MRI has a high diagnostic value. It should be noted that tumor bones at the posterior edge of the vertebral body often have spherical bulges, pedicles are often invaded, and epidural and paravertebral soft tissue masses are in the spinal canal. form.
Treatment of thoracolumbar compression fractures
- Simple thoracolumbar vertebral compression fractures are mostly stable fractures without symptoms of nerve injury. A few vertebral bodies are severely wedge-shaped. Attachments located behind the spine, that is, vertebral arches may have tension injuries, are shown as unstable fractures. In the acute stage, it is necessary to lie flat on a hard board and turn over in a balanced manner, that is, the caregiver holds the patient's shoulders and hips and rolls at the same time to avoid twisting the trunk. The patient cooperates with the muscles of the torso.
- After a fracture, visceral nerves are often stimulated by retroperitoneal hematomas, causing bowel movement disorders, and abdominal distension and abdominal pain. After the injury, it is often necessary to fast water and rehydration support, and gradually drink water and eat depending on the recovery of bowel sounds.
- After the pain is alleviated and the abdominal distension subsides, the position can be reduced according to the degree of compression of the fracture under the guidance of a doctor. For example, the pillow is gradually cushioned on the back of the injured vertebra. This is used as a fulcrum to maintain the back extension by using the trunk's gravity spine to stretch the wedge-shaped compressed The body, improved correction of deformity, is the reduction of fractures. Chest and back braces are required for standing and walking.
- Regularly turn over, pat and massage your back, encourage patients to cough and expectorate, keep skin clean and dry, and prevent lung infections and bedsores.
- For a few unstable fractures, open reduction and internal fixation can be taken.
- For elderly osteoporotic fresh fractures, X-ray CT guidance can be combined with position reduction, and bone cement can be injected into the fractured vertebral fracture space, or the airbag can be injected first, and then the bone cement can be inflated to expand the compressed vertebra Shaping, strengthening the injured vertebra and avoiding further collapse of the vertebral body, as the injured vertebra stabilizes, the patient's pain will be relieved and eliminated.