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Lumbar Compression Fracture

Compression Fracture of Lumbar Spine

A lumbar compression fracture involves the lumbar vertebrae and occurs typically secondary to bone demineralization. It is seen in postmenopausal women and in the elderly due to osteoporosis but may also be associated with malignancies. Therefore a thorough workup is essential to detect the fracture and its cause.


Presentation

Although compression fractures can occur anywhere along the vertebral column, they are most common at the thoracolumbar junction involving the T8-T12, L1, and L4 vertebrae [1]. The incidence of this condition increases steadily with advancing age [2]. Lumbar compression fractures can be asymptomatic and may be detected incidentally in the elderly on lumbar X-rays or may present insidiously with a backache. The pain is typically in the midline, aching or stabbing in quality, non-radiating and severe enough to cause disability and interfere with activities of daily living. The pain is usually relieved by lying supine and is aggravated by standing or walking. The pain often persists even after the fracture has healed [3]. However young adults with lumbar compression fractures may be diagnosed with a severe back pain of sudden onset and neurologic deficits in the lower limbs following a vehicular accident. The incidence of associated radiculopathy increases with descending spinal levels [4]. In the elderly, multiple fractures over a period of time lead to decrease in height and stature with subsequent paraspinal muscle shortening, lumbar lordosis, and thoracic kyphosis. As a result, the individual has to actively contract the paraspinal muscles to maintain posture leading to fatigue and in severe cases, it can lead to impaired lung function, abdominal protuberance, compression of abdominal organs with early satiety and loss of weight [5].

Individuals with lumbar compression fractures secondary to malignancies like multiple myeloma or metastasis may present with fever of unknown origin, night sweats, anorexia, weight loss or a history of a previous breast or prostate malignancy.

Weight Loss
  • Individuals with lumbar compression fractures secondary to malignancies like multiple myeloma or metastasis may present with fever of unknown origin, night sweats, anorexia, weight loss or a history of a previous breast or prostate malignancy.[symptoma.com]
  • This symptom can be caused by the shorter spine putting pressure on the stomach leading to stomach and digestive issues such as loss of appetite, constipation and weight loss.[apmhealth.com]
  • Multiple compression fractures can lead to reduced lung function, weight loss, depression and significant spinal deformity.[depuysynthes.com]
  • loss Pain while sleeping is worse than when awake In a child under 12 years of age Seek medical help at a hospital's emergency department if you have the following symptoms with back pain : Loss of control of urine or defecation Severe pain, numbness[emedicinehealth.com]
Fatigue
  • As a result, the individual has to actively contract the paraspinal muscles to maintain posture leading to fatigue and in severe cases, it can lead to impaired lung function, abdominal protuberance, compression of abdominal organs with early satiety and[symptoma.com]
  • This in turn leads to fatigue, shortness of breath, and loss of appetite. Neurological Complications If the fracture causes part of the vertebral body to place pressure on the spinal cord, the nerves and spinal cord can be affected.[thebackcenter.net]
  • In addition, the brace allows for less fatigue of the paraspinal musculature and muscle spasm relief. (Level of Evidence: 2B) [1] Fractures in the thoracic spine may be treated with thoracolumbar orthesis.[physio-pedia.com]
  • This forces the back muscles to work harder, causing muscle fatigue and pain. When pain does occur, it usually goes away after a few weeks. However, back pain sometimes escalates to the point that patients seek medical help.[humpalphysicaltherapy.com]
Fever
  • Individuals with lumbar compression fractures secondary to malignancies like multiple myeloma or metastasis may present with fever of unknown origin, night sweats, anorexia, weight loss or a history of a previous breast or prostate malignancy.[symptoma.com]
  • You may also need any of the following: Medicines: NSAIDs, such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor's order.[drugs.com]
  • […] sleeping is worse than when awake In a child under 12 years of age Seek medical help at a hospital's emergency department if you have the following symptoms with back pain : Loss of control of urine or defecation Severe pain, numbness, or weakness High fever[emedicinehealth.com]
Fever of Unknown Origin
  • Individuals with lumbar compression fractures secondary to malignancies like multiple myeloma or metastasis may present with fever of unknown origin, night sweats, anorexia, weight loss or a history of a previous breast or prostate malignancy.[symptoma.com]
Coronary Artery Disease
  • However, they do have gastric toxicity and an increased risk of cardiac events for patients with hypertension and coronary artery disease (Level of Evidence: 2C) [3] Opioids and muscle relaxants may provide strong relief when NSAIDs are inadequate but[physio-pedia.com]
Constipation
  • This symptom can be caused by the shorter spine putting pressure on the stomach leading to stomach and digestive issues such as loss of appetite, constipation and weight loss.[apmhealth.com]
  • These fractures can result in other complications, however, such as: Reduced spinal range-of-motion Lung disorders, such pneumonia or a collapsed lung Crowding of internal organs Constipation Bowel obstruction Progressive muscle weakness Deep venous thrombosis[paindoctor.com]
  • […] is needed to avoid problems with kidneys and stomach Should not be taken for long periods if possible Opiates (medications related to morphine) These are very strong painkillers Available only on prescription Can cause drowsiness, confusion, falls, constipation[bsir.org]
Early Satiety
  • As a result, the individual has to actively contract the paraspinal muscles to maintain posture leading to fatigue and in severe cases, it can lead to impaired lung function, abdominal protuberance, compression of abdominal organs with early satiety and[symptoma.com]
Night Sweats
  • Individuals with lumbar compression fractures secondary to malignancies like multiple myeloma or metastasis may present with fever of unknown origin, night sweats, anorexia, weight loss or a history of a previous breast or prostate malignancy.[symptoma.com]
Back Pain
  • We present an unusual case of vertebral fracture due to an undiagnosed hemangioma presenting as postpartum back pain following epidural analgesia.[ncbi.nlm.nih.gov]
  • METHODS: An 83-year-old male presented with low back pain two years after sustaining osteoporotic compression fracture at L3 due to a fall.[ncbi.nlm.nih.gov]
  • However young adults with lumbar compression fractures may be diagnosed with a severe back pain of sudden onset and neurologic deficits in the lower limbs following a vehicular accident.[symptoma.com]
  • The investigators determined that back pain improved in 92% of the study’s 673 patients, who underwent single-level or multilevel vertebroplasty.[emedicine.medscape.com]
  • NSAIDs are often first-line drugs for back pain as they do not have sedating effects.[physio-pedia.com]
Low Back Pain
  • METHODS: An 83-year-old male presented with low back pain two years after sustaining osteoporotic compression fracture at L3 due to a fall.[ncbi.nlm.nih.gov]
  • The patient suffered severe low-back pain, left-sided sciatica, and profound left L2-4 distribution weakness and numbness.[ncbi.nlm.nih.gov]
  • A Colour atlas of LOW BACK PAIN. F.A. Davis‬‬ Clinical Bottom Line Lumbar compression fractures, whether from trauma, osteoporosis, infection or neoplasm, occur often enough to be worthy of adequate research with focus on healing procedures.[physio-pedia.com]
  • Vertebral fractures may appear as low back pain, loss of height, or spinal deformities such as kyphosis. Symptoms can be damaging to a patient’s quality of life.[my.clevelandclinic.org]
  • back pain that worsens with movement.[morphopedics.wikidot.com]
Lordosis
  • In the elderly, multiple fractures over a period of time lead to decrease in height and stature with subsequent paraspinal muscle shortening, lumbar lordosis, and thoracic kyphosis.[symptoma.com]
  • The vertebra starts at the thoracolumbar junction in the beginning of the lumbar lordosis and extend to the promontorium of the sacrum.[physio-pedia.com]
  • L4 and L5 verterbrae in addition to there discs account for 50% of lumbar lordosis. L4 and L5 lumbar vertebrae are stabilized by the pelvis, muscle, and ligament attachments.[morphopedics.wikidot.com]
Severe Osteoporosis
  • osteoporosis. 2-4 Old vs.[dynamicchiropractic.com]
  • In severe osteoporosis, the vertebrae become so weak that they collapse upon themselves, leading to spinal deformity. Statistics Though osteoporosis occurs in both men and women, women are 4 times more likely to develop the disease than men.[my.clevelandclinic.org]
  • In cases of severe osteoporosis, the trauma may be minimal, such as, stepping out of a bathtub or lifting a heavy object. Moderate trauma is usually required to create a fracture in patients with mild to moderated osteoporosis.[spineuniverse.com]
Suggestibility
  • A magnetic resonance imaging scan revealed an acute fracture of the second lumbar vertebra (L2) with epidural extension and mild compression of the dural sac, suggesting hemangioma as the underlying cause.[ncbi.nlm.nih.gov]
  • Some type of internal fixation may be suggested to hold the vertebra in the proper position while it heals.[depuysynthes.com]
  • Kyphoplasty, also referred to as “balloon vertebroplasty,” is similar to vertebroplasty, but (as its name suggests) uses a balloon.[weillcornellbrainandspine.org]
  • Early MRI findings suggested that the existence of posterior vertebral damage was correlated with vertebral collapse, kyphotic deformity, and continuous back pain.[ci.nii.ac.jp]
Urinary Retention
  • Symptoms of a spine injury in the thoracic, lumbar and sacral regions can include: Neck or back pain, especially when moved Tenderness Numbness Tingling or a pricking sensation of the skin Paralysis Urinary or fecal incontinence Urinary retention To diagnose[chop.edu]
  • Losing control ( incontinence ) of urine or stool or inability to urinate (urinary retention): If these symptoms are present, the fracture may be pushing on the spinal cord itself.[emedicinehealth.com]

Workup

Lumbar compression fracture should be suspected in postmenopausal women and the elderly who present with sudden onset severe lumbar pain. Many patients may remember a specific injury [6] although the condition may present without any prior history of trauma. Tenderness is typically elicited on palpating directly over the fracture site and there may also be kyphosis [7]. A thorough neurological examination is necessary but may not reveal any deficits in uncomplicated fractures.

Plain X-rays of the spine will confirm the diagnosis and reveal the classic wedge deformity corresponding to the site of maximum tenderness. A reduction in vertebral height by 20% or a decrease of at least 4 mm compared to the baseline height is an indication of a compression fracture [6]. Ideally, the entire spine should be imaged to exclude multiple fractures and occasionally serial imaging may be required to detect the fracture.

Techniques like computed tomography (CT), magnetic resonance imaging (MRI) help in diagnosis by excluding the other etiologies of back pain. They also confirm the integrity of the posterior vertebral wall [8]. In addition, a CT can detect a compression fracture (not visualized on plain radiographs), spinal canal narrowing and differentiate between a compression fracture and a burst fracture. An MRI is indicated in patients with neurologic deficits, or if a malignancy is suspected as the underlying cause of the lumbar compression fracture. Positron emission tomography (PET) can also be ordered to differentiate between compression fractures of benign versus malignant etiology.

Laboratory tests like erythrocyte sedimentation rate, complete blood count (CBC), prostate-specific antigen testing, serum protein electrophoresis to exclude multiple myeloma and urinalysis for Bence-Jones proteins should be routinely performed. Bone density scanning is recommended to measure the severity of osteoporosis and for further patient management [9].

Treatment

  • Two related procedures, vertebroplasty and kyphoplasty, are available for the patient with a lumbar wedge fracture who continues to experience pain despite aggressive conservative treatment. [4] Vertebroplasty Vertebroplasty has been available for many[emedicine.medscape.com]
  • Medical Treatments For Back Injuries With Compression Fractures There are both surgical and non-surgical treatments for cervical/lumber compression fractures, depending on the severity and type.[rosenfeldinjurylawyers.com]
  • Interestingly, several medications for osteoporosis treatment also play a role in acute pain relief.[physio-pedia.com]
  • Compression Fracture Treatment Options: Compression fracture pain relief and treatment options include pain medicine, bracing and activity modification.[apmhealth.com]

Prognosis

  • Prognosis For Someone With A Compression Fracture In The Back & Neck Spinal fractures can lead to paralysis and even death. Most however are treatable. For non-surgical procedures, many of these types of fractures will heal in about three months.[rosenfeldinjurylawyers.com]
  • Treatment and prognosis Management options include: non-surgical observation/bracing medications: bisphosphonates for osteoporosis surgical vertebroplasty[radiopaedia.org]
  • Neurophysiological assessments are indicative of the prognosis. General treatment principles.[mauriziopiredda.it]
  • This is often associated with compression of nerve roots and carries a poorer prognosis in terms of pain free recovery. Radiographically; The lateral X-ray will show the anterior border of the vertebrae to be smaller than the posterior border.[gpnotebook.co.uk]
  • The purpose of this study was to evaluate the poor prognosis factor in patients with vertebral compression fractures. We radiologically investigated the degree of vertebral collapse and kyphotic curves in 43 patients.[ci.nii.ac.jp]

Etiology

  • Positron emission tomography (PET) can also be ordered to differentiate between compression fractures of benign versus malignant etiology.[symptoma.com]
  • Often the patient will prefer to stand - reducing the axial load on the spine - instead of sitting. 1 If the patient is older than age 40, it is important to rule out pathologic weakening of the bone as an underlying etiology to the compression deformity[dynamicchiropractic.com]
  • […] fracture of unspecified lumbar vertebra, initial encounter for open fracture see all Compression fracture ICDF-10 coding Compression Fractrue ICD-9 805.4 (Fracture of vertebral column without spinal cord injury (lumbar, closed) Compression Fractrue Etiology[eorif.com]
  • Patients with lumbar compression fractures usually present with kyphotic posture that is unlikely to be corrected, hip flexor contractures, and moderate pain at the level of the fracture. 3 Potential Etiologies The following are types of fractures that[morphopedics.wikidot.com]
  • The lumbar disk works as a cushion for the mechanical loads. [5] Epidemiology /Etiology Most of the time the compression fractures are caused by trauma, osteoporosis, infection and neoplasm. [2] [6] [7] As mentioned before, most of the fractures occur[physio-pedia.com]

Epidemiology

  • ., Melton L.J. 3rd, "The worldwide problem of osteoporosis: insights afforded by epidemiology," Bone, 1995, 17(5 Suppl): p. 505S-511S. Melton L.J. 3rd., "Epidemiology of spinal osteoporosis," Spine, 1997;22:2S-11S.[spine-health.com]
  • […] of unspecified lumbar vertebra, initial encounter for open fracture see all Compression fracture ICDF-10 coding Compression Fractrue ICD-9 805.4 (Fracture of vertebral column without spinal cord injury (lumbar, closed) Compression Fractrue Etiology / Epidemiology[eorif.com]
  • The lumbar disk works as a cushion for the mechanical loads. [5] Epidemiology /Etiology Most of the time the compression fractures are caused by trauma, osteoporosis, infection and neoplasm. [2] [6] [7] As mentioned before, most of the fractures occur[physio-pedia.com]
  • Fratture osteoporotiche Maggiori informazioni sulla chirurgia vertebrale Maggiori informazioni sul chirurgo vertebrale Piredda Maurizio Versione in Italiano Epidemiology.[mauriziopiredda.it]
Sex distribution
Age distribution

Prevention

  • This is more serious and may require immediate treatment to prevent or relieve pressure on the spinal cord or nerves.[orthopedics.about.com]
  • Current recommendations revolve around prevention, basic core and lumbar muscle strengthening and postural taping.[physio-pedia.com]
  • Back to top Prevention and treatment of VCF Prevention and treatment of osteoporosis Treatment of tumours Pain relief for VCF Back to top Prevention and treatment of osteoporosis Osteoporosis is one of the main causes of VCF but not everyone with osteoporosis[bsir.org]
  • Prevention Taking steps to prevent and treat osteoporosis is the most effective way to prevent compression or insufficiency fractures. Getting regular load-bearing exercise (such as walking) can help you avoid bone loss.[mountsinai.org]
  • Taking steps to prevent and treat osteoporosis is the most effective way to prevent compression or insufficiency fractures. Getting regular load-bearing exercise (such as walking) can help you avoid bone loss.[nlm.nih.gov]

References

Article

  1. Patel U, Skingle S, Campbell GA, Crisp AJ, Boyle IT. Clinical profile of acute vertebral compression fractures in osteoporosis. Br J Rheumatol. 1991;30:418–21.
  2. Melton LJ 3d, Kan SH, Frye MA, Wahner HW, O'Fallon WM, Riggs BL. Epidemiology of vertebral fractures in women. Am J Epidemiol. 1989;129:1000–11.
  3. American Geriatrics Society. The management of chronic pain in older persons: AGS panel on chronic pain in older persons. J Am Geriatr Soc. 1998;46: 635–51.
  4. Kim DE, Kim HS, Kim SW, Kim HS. Clinical analysis of acute radiculopathy after osteoporotic lumbar compression fracture. J Korean Neurosurg Soc. 2015 Jan; 57 (1):32-5.
  5. Silverman SL. The clinical consequences of vertebral compression fracture. Bone. 1992;13Suppl 2: S27–31.
  6. Nevitt MC, Ettinger B, Black DM, et al. The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med. 1998;128:793–800.
  7. Bratton RL. Assessment and management of acute low back pain. Am Fam Physician. 1999;60:2299–308.
  8. Predey TA, Sewall LE, Smith SJ. Percutaneous vertebroplasty: a new treatment for vertebral compression fractures. Am Fam Physician. 2002;66:611–5.
  9. Ullom-Minnich P. Prevention of osteoporosis and fractures. Am Fam Physician. 1999;60:194–202.

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Last updated: 2019-06-28 09:57