The vertebral column, also known as the spinal column or simply spine, is a column of 26 bones in an adult body (24 vertebrae interspaced with cartilage in addition to the sacrum and coccyx). In adolescents, the column consists of 33 bones as the sacrum's five bones and the coccyx's four do not fuse together until after adolescence. The spine is further divided into regions: cervical (the neck), thoracic (upper back), lumbar (lower back), sacral, and coccygeal. In between the vertebrae are thin regions of cartilage known as intervertebral discs, which are made of a fibrous outer shell (annulus fibrosus) and a pulpy center (nucleus pulposus).These cartilaginous intervertebral discs, which act as "shock-absorbers," help distribute weight, and keep vertebrae oriented in the correct spacing.
The thoracic spine commonly referred to as the upper and middle back, is the part of the spine that connects the cervical spine (the neck) to the lumbar spine which starts about five to six inches below the shoulder blades, and is built for stability. This stability is important for holding the body upright and providing protection to the vital organs in the chest cavity. The spinal cord runs throughout most of the thoracic spine, therefore, if an injury to the thoracic spine affects the spinal cord, there is a risk for temporary or permanent paralysis or damage to the spinal cord.
The lumbar spine commonly referred to as the lower back, is the part of the spine that curves inwards towards the stomach. The lumbar spine connects with the thoracic spine at the top and extends down to the sacral spine, and is built for flexibility and power, enabling the body to lift, bend, and twist. The spinal cord stops at the point where the thoracic spine meets the lumbar spine and continues to branch out to form the cauda equnia, which is a network of nerves that extend to the lower extremities of the body. Since the spinal cord does not run through the lumbar spine, it is very rare that an injury to the lower back would result in paralysis or damage to the spinal cord.
The most common fractures of the spine occur either in the thoracic or lumbar spine or at the point where the two meet - thoracolumbar junction and are usually caused by acute trauma such as motor vehicle accidents or a fall from a great height. These fractures, called compression fractures, are four times more common in men than woman especially after the age of 50 due to weakened bones from osteoporosis.
Compression fractures are usually associated with the following signs and symptoms:
- Severe, stabbing back pain that worsens with activity or movement
- Inability or difficulty walking or moving around
- Numbness or tingling in your limbs or other areas of the body
- Development of a hump on the back due to extensive stooping due to pain
A compression fracture is diagnosed with a combination of patient history discussion, physical examination and imaging studies. After discussing the individual's symptoms, the physician will examine the spine to see if there is any visible development of a hump. The physician may then order an X-ray to look for broken bones or any other neck problems. In some cases, the physician may also order a CT scan or MRI scan to look for damage to the skull, brain, or the spinal cord and to check for osteoporosis.
Since compression fractures typically occur as a result of a motor vehicle accident or a major fall, the immediate treatment is done by the EMS workers who will check for vital signs and immobilize the individual prior to transporting them to the ER. Commonly, osteoporotic compression fractures occur with minor trauma such as a ground level fall or lifting injury. Treatment of a compression fracture will depend on the severity, location, and specific pattern of the fracture. Once the trauma team ensures that the individual is out of danger or in a non-life-threatening state, the physician will evaluate the spinal fracture patter to determine the need for surgery.
Non-Operative Treatment - Most non-operative treatment methods utilize a brace or cast of some sort to temporarily immobilize the affected area of the spine to allow for natural heal for up to 12 weeks. It may also involve physical therapy to strengthen the spine as well as increase range of motion
Operative Treatment - If the non-operative treatments have been exhausted and the fracture hasn’t healed, the physician may recommend an operative approach. The exact procedure will vary based on the severity of the fracture as well as the location of the fracture. However, the main goal of surgery is to achieve adequate reduction to make sure the bones fit together, relive pressure on the spinal cord or any spinal nerves, and increase range of motion.
Recovery will vary based on the severity of the compression fracture as well as the chosen treatment approach. Each patient is unique, so the therapy program will vary based on his/her level of pain, extent of injury, and desired level of activity they would like to return to. There are several complication associated with compression fractures and the treatment methods, therefore options must be discussed extensively with the physician.
CALL 911 IMMEDIATELY IF YOU ARE HAVING A MEDICAL EMERGENCY!
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