Pathologic vertebral 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.
Bone fractures due to disease weakening the bone are called pathologic. This most common causes for pathologic fractures are cancer, osteoporosis and infection.
Pathologic vertebral fracture
CAUSE OF SYMPTOMS
Acute compression of the spinal cord and/or nerve roots
SYMPTOMS AND SIGNS
Total/partial paralysis and numbness from the site of the spinal cord damage downwoads
Pain, numbness and weakness in the limbs
Severe pain over the fracture
THE DIAGNOSIS IS BASED ON Medical history Clinical exam Computer tomography Magnetic resonance imaging (MRI) Radiographs
additionally you may have to do: Digital subtraction angiography Functional (dynamic) radiographs
Depending upon the primary cause, neurologically intact patients with a stable fracture could be treated non-surgically.
Non-surgical treatment may include Radiation therapy Chemotherapy
Immobilization with brace
WHEN SHOULD AN OPERATION BE PERFORMED?
Patients with signs of nerve root/spinal cord compression
Neurologically intact patients with a potentially unstable fracture
WHAT IS THE GOAL OF SURGERY?
To release the compressed nerve roots
To restore the protective function of the spine
HOW IS SURGERY PERFORMED?
Posterior decompression of the spinal canal + fusion
WHICH OTHER DISEASES SHOULD BE EXCLUDED (DIFFERENTIAL DIAGNOSIS)? Other fractures of the spine Ankylosing spondylitis (Bechterew's disease)
The condition is treated by medical spetialists in the field of: