What Are Vertebral Body Fractures?

The spinal column protects the bundle of nerves, called the spinal cord, which send neurological impulses, giving direction to the body. Damage to these bones is unmistakably a very serious condition. When individuals suffer a total break in the bone or a dislocation of the vertebrae in the cervical spine, or the neck area, death or paralysis can result. This occurs because of the damage to the nerves in the spinal cord. Minor fractures will not usually cause death, but can create chronic pain in the back and neck.

The vertebral body is the main part of the bone in the spinal column. Between these areas of the vertebrae are the intervertebral discs, which support the vertebrae above and cushion the area between the bones. The major portion of the vertebra faces the body, in front of the spinal cord, in humans.

Causes Of Vertebral Body Fractures

When the vertebral body fractures, splits, or ruptures, it is usually a result of an injury or accident, such as a motor vehicle accident, diving accident, or gun-related injury. Fractures in which the bone appears as if it has been shattered into small pieces are called burst fractures. Split fractures are single breaks through the vertebral body. Both types of vertebral body fractures are more highly associated with men between 15 and 24 years and men and women who are 55 years and older. Medical treatment for fractures that are the results of trauma, such as car accidents and falls, require immediate attention to reduce the potential damage from the injury.

Vertebral fractures can also occur with some types of bone cancer, or osteoporosis. Women who suffer from osteoporosis have a reduction in bone density that increases the likelihood of bone fractures from weakness. These fractures are a source of chronic pain and, when left untreated, can result in paralysis when the fractured bone injures the spinal cord.

Treatments For Vertebral Body Fracture

The primary treatment for a vertebral fracture is vertebroplasty. During this procedure the area is first anesthetized and then a thin needle is inserted into the bone and an acrylic cement compound is injected. This procedure repairs the break and restores the integrity of the vertebral body.  One variation of this procedure to repair the break in the vertebral body is a kyphoplasty in which a small balloon is inserted and inflated. This is designed to support the bone or broken sections of the vertebral body as the cement is injected to affect the repair.

Vertebroplasty and kyphoplasty are effective in repairing fractures and have minimal risks associated with them. In some patients the cement may leak out of the bone, which creates an inflammatory process and increases the perception of pain. A secondary risk when the procedure is carried out on the spines of elderly patients is the possibility of a secondary fracture, most often associated with osteoporosis.

Other treatments to manage pain may be considered if the fracture is not a threat to injure the spinal cord. These treatments include non-steroidal anti-inflammatory medications (NSAIDs), nerve blocks, and radiofrequency ablation. Using a nerve block, the physician will inject steroids and a local anesthetic directly to the spinal cord nerves that are the source of pain. This option offers effective pain relief for some patients with fractures. When radiofrequency ablation is used, the physician introduces a thin probe through the skin to the spinal nerves and delivers electro-thermal impulses to destroy the fibers of nerves transmitting the pain. This treatment will prevent the perception of pain from the fractures to be sent to the brain. This procedure also carries the risk of infection, bleeding, and may cause inadvertent damage to the motor nerves resulting in paralysis.

Conclusion

Consistent with the proximity of the vertebral body to the spinal cord, fractures to the vertebral body can be serious and result in death or paralysis. Fractures can either be single breaks in the vertebral body called a “split” or multiple fractures that look like the bone has been shattered, called a “burst.” These vertebral body fractures are often the result of accidental injury or from osteoporosis, or weakness associated with reduction in bone density. Procedures such as vertebroplasty and kyphoplasty may be used to seal the break, stabilize the broken vertebrae, and reduce pain. In these instances, NSAIDs and nerve blocks may be the best options to manage pain. Radiofrequency ablation of the spinal nerve fibers may also be an effective method of treating vertebral body fractures.

References

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