Compression Fractures of the Lumbar Spine
The lumbar spine is comprised of the five largest and strongest of all the vertebrae in the spine. The strongest stabilizing muscles of the spine are attached to the lumbar vertebrae therefore fractures of the lumbar vertebrae usually occur due to either trauma, weakening of the bone, or another underlying cause.
The trauma usually necessary to break the bones of this area of the spine is quite significant and may be the result of a fall in which a person lands on their feet or buttocks, a car accident in which other injuries may be present or in contact sports injuries. However, in the case of the elderly or in people with cancer, these bones can break with little or no force. Such is the case in people with osteoporosis commonly occurring in postmenopausal women or elderly men. Long term use of steroid medication such as prednisone can also cause loss of bone density making these people at risk for compression fractures. In the instance of a pathological fracture, there is a preexisting disease at the fracture site such as cancer in the bone that has traveled from other parts of the body.
Symptoms of a lumbar compression fracture may include:
- Pain in the lower back
- Possible pain in the hip, abdominal area or in the thigh.
- Numbness, tingling and weakness (due to compression of the nerves)
- Loss of bladder or bowel control or inability to urinate.
Diagnosis of a compression fracture begins with obtaining the patient's complete medical history. Unless evident, your doctor will want to know any recent injuries or activities that could of led to the fracture. It is important to know when the pain started and if it was sudden or gradual, the location and intensity of the pain. Whether or not different activities or positions make the patient feel better or worse and if the pain is radiating to the extremities or other parts of the body?
A physical examination will also be done to rule out other possible underlying problems. The doctor will also check to see if there is tenderness or sensitivity near specific areas of the spine. If a compression fracture is suspected, an X-ray, CT scan, MRI or a combination there of may be ordered to confirm the diagnosis as well as check for other issues that may be present.
Treatment of lumbar compression fractures may vary depending upon severity of the case. In many cases a home treatment of ice, rest and possible bracing may be enough to promote healing of the fractured vertebrae. Once approved by your doctor, a strengthening and stretching program can be started to strengthen muscles supporting the back.
However, traumatic injuries that result in neurological complications usually requires surgery and possible inpatient rehabilitation. At SCCNS we perform the most minimally invasive surgeries to treat chronic pain resulting from compression fractures. Both kyphoplasty and vertebroplasty are minimally invasive surgical procedures that may be performed to treat compression fractures. Although both procedures involve injecting orthopaedic cement into the fracture, the primary difference is that kyphoplasty uses a balloon which is inflated to create a cavity for the orthopaedic cement.
For severe fractures, the use of instrumentation (screws, rods, etc.) and fusion may be necessary. This type of surgery is performed by joining two or more vertebrae together to stop movement in order to stabilize the spine.
Your surgeon will discuss all surgical and non-surgical options with you as we want each of our patients to be involved with their treatment. This will ensure the success of the treatment option.