Osteoporotic Vertebral Compression Fracture
ANATOMY OF THE SPINE
The human spine is formed by individual vertebrae and connective tissue discs in between. The vertebrae form the spinal canal. There are seven cervical, twelve thoracic, and five lumbar vertebrae. The intervertebral discs are the link between the individual vertebral bodies.
Normal anatomy of the spine. Longitudinal section and cross sections through the cervical, thoracic and lumbar spine.
The little joints that link the vertebrae together are known as facet joints. They help to stabilize the spine and, together with the intervertebral discs, allow a certain degree of mobility of the spinal cord. The spinal canal should be wide enough to allow nerve roots to float freely in cerebrospinal fluid.
The front border of the spinal canal is built by the vertebral bodies and intervertebral discs, the side by the intervertebral joints (facets) and back by the ligamentum flavum (yellow band) and vertebral arches. Discs consist of an outer fibrous ring (annulus fibrosus), which surrounds an inner gel-like center (nucleus pulposus).
The spinal cord and nerve roots lie within the spinal canal. The spinal cord extends downwards approx. to the 1st lumbar vertebra. Below, only nerve roots are present in the spinal canal. At the level of the intervertebral disc the nerve roots pass through the neural root foramina to exit the spinal canal. The spinal cord and nerve roots conduct electric-like signals from the skin and joints to the brain, and process of movement is initiated from the brain to the muscles.
Osteoporosis is a condition causing weakening of the bone due to loss of bone substance. Women are about four times more likely to be affected by osteoporosis than men. Osteoporosis may occur after the menopause or as a result of malnutrition, hyperthyroidism, alcoholism, kidney disease. Osteoporosis may occur after treatment with antiepileptic drugs, proton pump inhibitors, antidepressants, corticosteroids or chemotherapy.
Osteoporotic vertebral compression fracture
Osteoporotic vertebral body compression fractures might occur even after minor trauma or while twisting, bending or coughing.
CAUSE OF SYMPTOMS
Acute compression of the spinal cord and/or nerve roots
SYMPTOMS AND SIGNS
Severe pain along the spine over the fracture
Total/partial paralysis and numbness from the site of the spinal cord damage downwoads
THE DIAGNOSIS IS BASED ON Medical history Clinical exam
and at least one of the following tests: Computer tomography Magnetic resonance imaging (MRI) Radiographs
A computer tomography image of the lumbar spine of a patient with a osteoporotic vertebral compression fracture
The treatment may be non-surgical or surgical.
Non-surgical treatment may include Opioids
Immobilization with brace
WHEN SHOULD AN OPERATION BE PERFORMED?
Conservative treatment cannot relieve pain significantly
Neurological symptoms caused by compression of the spinal cord or nerve roots
WHAT IS THE GOAL OF SURGERY?
HOW IS SURGERY PERFORMED?
Vertebroplasty of an osteoporotic vertebral fracture
Posterior spinal canal decompression
WHICH OTHER DISEASES SHOULD BE EXCLUDED (DIFFERENTIAL DIAGNOSIS)? Ankylosing spondylitis (Bechterew's disease)