Compression fracture
Compression fractures are the result of "crumbling or smashing of cancellous bone by forces acting parallel to the long axis of bone. It is applied particularly to vertebral body fractures."[1]
Cause / etiology
Compression type fractures can occur to any bone when an applied force overwhelms the ability of the trabecular structure of that bone to resist the pressure. Compaction of the bone occurs and a loss of height or size of the particular structure, most commonly a vertebra, results. A single traumatic injury may precipitate the fracture or, in the case of chronic disease, multiple tiny compressions occur over time with a slow loss of height. Under normal circumstances, healthy bone requires a significant fall or impact to cause compression, but more commonly, diseases that weaken the trabecular matrix within cancellous bone lower the threshold required to cause the bone to collapse. Spontaneous compression fractures appear to occur for no reason at all when a cough or a sneeze triggers the collapse. Essentially, the bone has become so weak that normal weight bearing is no longer possible. Conditions that can result in spontaneous compression fractures include those that cause osteopenia, or calcium loss within the bone, such as osteoporosis, metabolic diseases, metastatic cancer and lymphoma among others.
Diagnosis
Compression fractures of the spine are generally identified by the patient history of back pain, tenderness in the area of the fracture, and spasm or contracture of the surrounding musculature. The presence of hyperkyphosis (hunchback) may be a sign of an underlying compression fracture as about one third of cases have vertebral fractures.[2]
Xray is the most common test for detecting and confirming compression fractures, though Computed Tomography (CT scan) and bone scan can show early signs of disruption of the trabecular pattern especially in those resulting from underlying disease. A triple phase bone scan is particularly useful in determining the age of the compression when timing of the injury is critical for treatment purposes. Magnetic Resonance Imaging (MRI) will show an increased signal if inflammation is part of the process.
Treatment
Depending on the cause and severity of the vertebral compression fracture, treatment will include medication to control pain, inflammation or muscle spasm. Injection of calcitonin may reduce pain.[3] It might also include bracing or casting to prevent further collapse until healing can occur.
Invasive treatment
Invasive but nonsurgigal treatments may include balloon kyphoplasty and vertebroplasty.
Balloon kyphoplasty uses a specialized balloon in an attempt to restore as much of the original height of the vertebra as possible before applying the cement and removing the balloon, minimizing the spinal distortions. Balloon kyphoplasty may reduce pain according to an industry sponsored randomized controlled trial.[4]
Vertebroplasty injects a cementlike paste into the compacted vertebra in an effort to prevent further collapse. Vertebroplasty does not seem to help according to a meta-analysis of two trials..[5] One blinded randomized controlled trials was negative.[6][7] Vertebroplasty was helpful in a subsequent randomized controlled trial that was not blinded. [8]
Surgery
There are techniques, not using a balloon, for minimally invasive kyphoplasty surgery. In general, however, surgical treatment is an exception.
External links
- Fractures. compression - Information for patients from MedlinePlus (United States National Library of Medicine).
References
- ↑ National Library of Medicine. Fractures. compression. Retrieved on 2007-11-14.
- ↑ Kado DM, Prenovost K, Crandall C (2007). "Narrative review: hyperkyphosis in older persons". Ann. Intern. Med. 147 (5): 330–8. PMID 17785488. [e]
- ↑ Lyritis GP, Tsakalakos N, Magiasis B, Karachalios T, Yiatzides A, Tsekoura M (1991). "Analgesic effect of salmon calcitonin in osteoporotic vertebral fractures: a double-blind placebo-controlled clinical study". Calcif. Tissue Int. 49 (6): 369–72. PMID 1818759. [e]
- ↑ Wardlaw D et al (2009). "Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial.". Lancet: 1016-24. PMID 19246088. [e]
- ↑ Staples, M. P.; D. F. Kallmes, B. A. Comstock, J. G. Jarvik, R. H. Osborne, P. J. Heagerty, R. Buchbinder (2011-07). "Effectiveness of vertebroplasty using individual patient data from two randomised placebo controlled trials: meta-analysis". BMJ 343 (jul12 1): d3952-d3952. DOI:10.1136/bmj.d3952. ISSN 0959-8138. Retrieved on 2011-07-14. Research Blogging.
- ↑ Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH et al. (2009). "A randomized trial of vertebroplasty for osteoporotic spinal fractures.". N Engl J Med 361 (6): 569-79. DOI:10.1056/NEJMoa0900563. PMID 19657122. PMC PMC2930487. Research Blogging. Review in: J Fam Pract. 2009 Dec;58(12):654-6 Review in: Ann Intern Med. 2009 Dec 15;151(12):JC6-9
- ↑ Buchbinder R, Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt C et al. (2009). "A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures.". N Engl J Med 361 (6): 557-68. DOI:10.1056/NEJMoa0900429. PMID 19657121. Research Blogging. Review in: J Fam Pract. 2009 Dec;58(12):654-6 Review in: Ann Intern Med. 2009 Dec 15;151(12):JC6-8
- ↑ Klazen CA, Lohle PN, de Vries J, Jansen FH, Tielbeek AV, Blonk MC et al. (2010). "Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial.". Lancet. DOI:10.1016/S0140-6736(10)60954-3. PMID 20701962. Research Blogging.