If during an injury the height of the vertebral body becomes less, then such a fracture is called a compression fracture. This is the most common type of fracture and is sometimes difficult to diagnose. However, a compression fracture needs treatment and rehabilitation of the patient.

Compression fracture of the spine

Compression fractures can occur in both older people and children. There are two types of fractures:

1. Simple compression fracture - can occur due to minor trauma. There are no bone fragments.
2. A compression fracture, which is explosive in nature, appears under the action of a sufficiently brute force. Multifragmented and may be accompanied by compression or damage to the spinal cord.

The main causes of compression fractures are:

• Various kinds of injuries, such as falling on your feet. The height of the fall determines what kind of injury will occur.
• Osteoporosis of the bones. The fracture occurs, as a rule, unexpectedly - during physical exertion or leaning forward.
• Hormonal disorders - this rather predisposes to fracture due to significant loss of calcium in the bones.
• Metastases in the spine from cancerous tumors.

A compression fracture, along with other spinal injuries, is considered a very dangerous disease. Since during a fracture, the body of the damaged vertebra is pressed into the spinal canal, and this leads to compression of the spinal cord.

The nerve endings are compressed, the intervertebral disc is destroyed, and this provokes the development of radiculitis and osteochondrosis, as well as paralysis of the limbs.

Treatment of a compression fracture of the spine

After a thorough diagnostic examination and the establishment of an accurate diagnosis, the attending physician draws up a treatment and rehabilitation plan. The whole process of treatment is quite lengthy and requires self-discipline and adherence to the regimen.

Besides requires constant supervision by an experienced specialist. Simple vertebral compression fractures are usually treated conservatively, while severe fractures may require surgery.

Conservative treatment

Therapy of this kind consists of a complex of special exercises and analgesic therapy.

The very first action in case of a fracture of the spine, the patient must be placed on a hard bed, which is equipped with the necessary inclination in the upper part, and completely excludes any physical activity for a certain period in order to have enough time to restore the spine.

The subsequent stages involve the use of massage, a special set of exercises and physiotherapy procedures for a compression fracture.

In case of a compression fracture of the spine, a therapeutic and physical exercise complex is used., taking into account the time from the moment of obtaining a fracture, age-related features and the nature of the disease.

Strengthening the entire muscular corset of the trunk and back, restoring the natural curves of the spine and its axis, restoring the flexibility and mobility of the spine can be done with the help of special gymnastics for compression fractures.

Therapeutic exercise for a compression fracture of the spine

1. The first seven days after injury should be devoted to exercises to improve the activity of the gastrointestinal tract, respiratory organs, heart and a set of exercises to prevent a decrease in muscle strength.
2. Over the next one and a half to two months, the patient must perform exercises to strengthen the corset of muscles and prepare for further strengthening of the motor regime. Just at this stage, the load increases due to additional exercises, an increase in the duration of classes and the number of sets of exercises.
3. The next period is a certain stage of preparation for vertical loads. Exercises that have resistance and weights are performed to a greater extent.
4. On final stage conservative treatment with the help of exercise therapy involves the transition to standing exercises, that is, a direct vertical load is carried out.

The duration of the last two treatment periods for gymnastics after a spinal fracture is determined strictly in individually. All exercises can be done at home, but only under the supervision of a specialist.

After about six months of training, the working capacity of patients who have undergone a compression fracture of the spine is restored to normal.

Features of conservative treatment

In a full three months, the fusion of the vertebra takes place, which is why every month the doctor is obliged to conduct an X-ray examination of the spine in order not to miss a single detail of the fusion process.

For the fastest fusion of the vertebra, doctors recommend that the patient be at rest, while limiting any motor loads as much as possible. The patient must be minimally in a sitting and standing position, try to lie as much as possible. It is strictly forbidden to lift weights and take any actions that lead to a load on the spinal column.

For older patients (over fifty), full bed rest is recommended due to the slow fusion of the bone structure.

Medicines and orthopedic corset

Medications are used to relieve pain. Such drugs do not affect the rate of recovery of the diseased vertebra in any way. But it can fully relieve the patient from pain, sometimes quite strong.

Special orthopedic corsets are used for compression fractures of the spine to secure it in a stable position in order to avoid shifts during the patient's motor activity.

Corsets of this type are made to a greater extent individually to order, since the product must correspond to the shape of the body of the victim. Only the right corset can fully fulfill its function perfectly. The corset is able to hold the body in the required position, while taking the main load on itself from the spinal column.

Surgery

Surgical intervention is rarely required if a compression fracture of the spine occurs in the thoracic region. But here's the chance surgical intervention increases if there is a spinal injury in the lumbar region.

Surgical treatment of spinal fractures is necessary when squeezing nerve structures such as the spinal cord, nerve endings, as well as spinal instability and especially pronounced pain.

As an example, as a result of a decrease in the height of the vertebral body, exceeding the norm by 50%(this is noticeable on radiographs) - instability of the spine may occur, and this will lead to compression of the nerve structures associated with movements.

In such situations, surgery is necessary to prevent damage to the nerve roots and spinal cord.

Vertebroplasty and kyphoplasty

Among the most relevant and new methods of treating spinal fractures, vertebroplasty and kyphoplasty are distinguished.

Using kyphoplasty, specialists restore the normal natural height of the vertebrae. During such an operation, the doctor inserts a special balloon into the vertebrae. Then the balloon is to be inflated, thereby raising the vertebra to its original position. Further, when a cavity is formed in the spine using a balloon, the doctor injects bone cement directly into it, thereby fixing the vertebra in its original position.

Vertebroplasty involves a similar injection of bone cement into the body of an injured vertebra. This procedure is designed primarily to reduce pain and increase the strength of the injured vertebra.

As you can see, despite the seriousness of the disease, there are enough methods for treating a compression fracture of the spine so as not to change your usual lifestyle. And even in severe cases, it is possible in our time to quickly restore a person's vigorous activity after an injury.

Modern medicine quite successfully copes with the treatment of spinal fractures, which is why it is necessary to seek professional help from specialists in time.

The human spinal column performs many functions, providing cushioning, all kinds of body movements, and protection of the spinal cord. The vertebrae are spongy bone tissue, therefore, with a simultaneous pronounced axial load and the position of flexion of the spine, they can undergo compression. In this case, the vertebra acquires a wedge-shaped shape with a decrease in the height of the anterior section. Compression "explosive" fractures are possible, when the spongy bone tissue inside the vertebra is destroyed due to the depression of the nucleus pulposus of the intervertebral disc into its body, these fractures are more severe. If the patient suffers, i.e. he has reduced bone density, compression of the vertebra can happen with the slightest load. Moreover, not always a compression fracture, especially a pathological one, is detected on time.

Causes

Compression fractures often occur in the setting of osteoporosis.

1. Mechanical impact on the spinal column, such as falling from a height onto the legs, lifting weights, car crashes, less often - a blow to the back.
2. Pathological fractures against the background of tumors of the vertebrae. leads to loss of bone mass, the bone becomes rarefied and unable to withstand the load. In postmenopausal and senile osteoporosis, as a rule, several vertebrae are compressed, more often in the lower thoracic and upper lumbar regions.

Classification

Uncomplicated compression fractures are classified according to the degree of compression:

• 1 degree - lowering the height of the vertebral body by less than half;
• 2 degree - its height is reduced by half;
• 3 degree - the height is reduced by more than half.

Complicated fracture is characterized by trauma to the spinal canal. The stability of the vertebral segments is disturbed, the vertebrae undergo dislocations or subluxations, as a result, the bone tissue injures the nerve roots, is pressed into the canal where the spinal cord passes.

signs

• Back pain, usually intense at the time of the fracture, then constant, aching, aggravated by walking, sitting. It can radiate to the arm or leg, depending on the location of the fracture. In addition to pain, the patient often feels numbness of the limb. If the compression of the vertebra occurs gradually (with osteoporosis), the pain syndrome is moderate, slowly increasing.
• Tension of the paravertebral muscles in the form of painful bands along the spine (the so-called "symptom of the reins").
• With multiple fractures, there may be a state of shock: pale skin, sweating. The patient lies with the legs brought to the stomach.
• If the fracture is complicated, paralysis develops, and death is also possible if measures are not taken in time.

First aid

If there is a suspicion of a vertebral fracture, it is advisable to leave the victim at the scene until the ambulance arrives, not to let him sit down, get up. If, nevertheless, transportation is necessary, it should be careful, on a shield or a rigid stretcher, observing the axis of the spinal column. A soft roller should be placed under the injured spine. If a non-rigid stretcher is available, the patient should be gently placed on their stomach.

Diagnostics

X-ray of the spine reveals a compression fracture.

It is very important to quickly make the correct diagnosis, because qualified medical care for a compression fracture of the spine should be provided immediately.
The doctor conducts a general and neurological examination of the patient, assessing his condition, including the function of the spinal cord. An x-ray of the interested spine section is prescribed in two projections. As an additional method, computed tomography may be shown. This study will help to study in detail the nature of the fracture. It may be performed in conjunction with myelography to determine the condition of the spinal cord at the level of a broken vertebra. In case of trauma to the nervous structures, a magnetic resonance imaging is performed. Routinely, all females over 50 years of age, especially if the injury is low-energy, is performed (to determine bone density).

Treatment

The tactics depend on the degree of compression: with the first and second - conservative therapy, always in a hospital, with the third - surgical treatment. For complicated fractures, treatment is also surgical.

Methods of conservative treatment

1. First of all, anesthesia. For this purpose, the doctor prescribes anti-inflammatory drugs, such as movalis, diclofenac, ketoprofen, arcoxia, nise and others. It is better to put cold on the fracture site for 10-15 minutes, and so 4-5 more times every 15 minutes. With a strong pain syndrome, the traumatologist performs a paravertebral injection of 15-20 ml of 0.5% novocaine on each side of the broken vertebra.
2. Position on a rigid shield with a 30-degree inclination of the foot end, with a roller under the back at the fracture site. This is necessary to unload the vertebra and relieve the axial load that occurs in the vertical position of the body. Bed rest usually lasts for one to two months after the injury, depending on the location of the fracture. In case of injury of the cervical spine, Glisson's chin loop is stretched.
3. The following shows fixation with a rigid hyperextension corset (reclinator). It supports the spinal column at the fracture site in a state of slight extension, thus eliminating pressure on the anterior section of the fractured vertebra. If transpedicular fixation is performed, the patient does not need a brace. Sitting, prolonged vertical position is prohibited.
4. Already during the period of bed rest and wearing a corset, the doctor prescribes physiotherapy (magnetic therapy, laser therapy, electrophoresis, UHF, electromyostimulation) in order to activate blood circulation, relieve pain, enhance reparative processes.

Surgical treatment

If the compression of the vertebra is pronounced, it is necessary to restore its normal height. For this purpose, the following methods are used:

• Vertebroplasty. A special bone cement is injected into the vertebral body, thus restoring its shape.
• Kyphoplasty. The surgeon corrects the shape and position of the vertebra, fixing it with cement.

All interventions are performed minimally invasively, through small incisions using an endoscope device, at the end of which there is a miniature video camera.

In a complicated fracture, open surgery is indicated. The neurosurgeon performs decompression, ie. removes fragments of the vertebra that put pressure on the spinal cord and nerve roots, then fixes the vertebral segment with a metal structure to ensure stability. If necessary, he fills the vertebral body with bone cement.

Rehabilitation after a compression fracture of the spine

Massage and regular exercise therapy will help you recover from illness.

If the fracture was uncomplicated and was treated conservatively, exercise therapy should begin early after the injury, in the first week the patient should do breathing exercises and movement in the joints of the arms and legs. The next month after the injury, the exercises become more difficult and are aimed at strengthening the muscular corset of the back, the muscles of the limbs. The patient is taught to roll over in bed, he can alternately raise his legs to an angle of 45 degrees and hold them on weight for a while. In parallel, physiotherapy, limb massage are shown. When the patient begins to walk (1-2 months after the fracture), more complex elements of exercise therapy are connected: exercises in a kneeling position, dosed walking, starting from 15 minutes. A back massage is scheduled. After 3.5-4 months (after the control radiograph of the spine), you can start a short stay in a sitting position (5-10 minutes several times a day with a gradual increase in duration), using unloading circles or special pillows, perform body bends forward, exercises in the aquatic environment. good effect provides spa treatment. Estimated terms of disability for compression fractures range from 4 to 12 months, depending on the severity of labor. Up to 2 years after the injury, shock loads (running, jumping), carrying significant weights are contraindicated.
After surgery (transpedicular fixation), rehabilitation proceeds somewhat differently. Corset is not required. Physical therapy begins on the 2-3rd day after the intervention, first these are exercises for the limbs, and after 10 days they are aimed at strengthening the back muscles (from lying on the stomach, kneeling). A month later, the exercise therapy complex becomes more complicated, the terms of disability after surgical treatment are reduced.

What is the danger of a compression fracture. Its consequences

• Post-traumatic with protrusions and hernias.
• Segment instability. The spinal motion segment consists of two vertebrae and their joints, a ligamentous apparatus, and an intervertebral disc between them. With a decrease in the height of the vertebral body, the function of the segment is disrupted, the vertebrae become more mobile in relation to each other, which leads to the rapid development of degenerative processes.
• (persistent deformity of the spine). This complication develops more often after osteoporotic compression fractures of the thoracic region. The patient complains of constant pain, possible shortness of breath,

To determine the tactics of treatment of vertebral fractures in children, it is necessary to distinguish groups of stable and unstable fractures.

According to the ideas of the American vertebrologist F. Denis (1981) about the "three-column" model of the structure of the spinal column, stable fractures should be considered in which the vertebral motor segment at the level of damage is able to resist anterior axial loads, resist posterior tensile forces and rotational deformities. This is possible only with intact elements of the middle and posterior columns of the spinal column ( N.A. Korzh et al., 2001).

At the same time, with stable fractures, macro- and microdamages of the intervertebral discs, vasculature, roots and membranes of the spinal cord are not excluded. This is due to the structural features of the most complex anatomical and physiological complex, which is the spinal column, which consists of individual vertebral motor segments (VMS).

Among injuries of the spinal column in a growing organism, a special place is occupied by stable (usually compression) fractures of the vertebral bodies and this is determined primarily by the elasticity of the intervertebral discs and the strength of the ligaments.

It should be noted that among all traumatic injuries of the musculoskeletal system, the frequency of stable compression fractures of the vertebrae in children has clearly increased over the past decade.

It's connected:

Improving diagnostics;

With a decrease in the index of health of the child population (juvenile osteoporosis, bone tissue dysplasia, malnutrition of children);

With ineffective prevention of injuries;

Urbanization of the environment.

According to the St. Petersburg Rehabilitation Center for Pediatric Orthopedics and Traumatology (SPb VTsDOiT) "Ogonyok", where almost all children in the city with stable compression fractures of the vertebrae receive staged non-surgical (conservative) treatment, the number of such patients has increased by 1.4 times over the past decade ( in 1995, 275 children and adolescents were treated, and in 2011 - 561 patients).

In such patients, a fracture of one vertebra occurs only in 6% of cases, two vertebrae - already in 16%, and the number of patients with an injury of three to five vertebrae reaches 75%. Six or more vertebrae are observed in only 3% of children. It makes one think that the number of children preschool age, as the most cared for by adults, make up 7.1% of the total contingent of this category of patients admitted to the clinic of St. Petersburg VTsDOiT per year.

Statistics also show that damage to the vertebral bodies in different parts of the spinal column has a distinctly different frequency: in cervical region- this is 1.6% of all children with this injury, in the upper thoracic - 5.8%, in the middle thoracic - 61.7%, in the lower thoracic - 21.5%, and in the lumbar - 9, 6%.

The experience of our Center, which has been working with such patients for more than 40 years, suggests that their treatment should be timely, comprehensive, staged and lengthy and thereby comply with the laws of chronobiology of damaged bone tissue. Only these principles in treatment will prevent severe complications that are present in patients who have brought timely or insufficiently complete treatment. in the world and domestic literature one can find information that post-traumatic deformities (kyphotic, scoliotic), post-traumatic osteochondrosis with persistent pain syndrome are observed in every third or fourth child in the late post-traumatic period. Another feature of such consequences is that they occur, as a rule, during periods of intensive growth of the child and can, in time, distance themselves from the moment of the acute period of trauma for a sufficiently long time.

We consider each of the principles of treatment important.

Principle of timeliness treatment should be provided with early qualified diagnostics (clinical and instrumental), early hospitalization in a specialized hospital and early unloading of the spine.

The principle of complex treatment provides for the use of all factors of non-surgical therapy, such as: styling and orthoses, physiotherapy and drug therapy, therapeutic exercises and massage.

The principle of stages is based on the presence of continuity between different levels of medical care:

1. emergency room - primary clinical and radiological diagnostics →

2. hospital - identification of other possible injuries, including the organs of the abdominal cavity and the cardio-respiratory complex, since the circumstances of the injury that led to the fracture of the bone vertebrae are likely to lead to damage to the soft tissue organs →

3. rehabilitation center - with the obligatory observance of a long bed rest (we recommend up to 2 months of the post-traumatic period) conservative complex pathogenetic treatment, the arsenal of which should be related to the chrono-patho-morphology of the compressed vertebra →

4. polyclinic - observation of the victim in the late post-traumatic period, during which we recommend the joint work of an orthopedic traumatologist, pediatrician, cardiologist and neuropathologist, which is determined by the possible development in such patients of a rather delayed post-traumatic nephropathy, cardiodystrophy, idiopathic hepatopathy, etc.

The principle of long-term treatment based on the fact that the injuredvertebralsegment (PDS) needs a sufficient period of time, during which, with the most favorable course of the process of restoring all its damaged tissues (not only bone tissue is injured, but also the ligamentous apparatus, intervertebral discs, articular capsules, etc.), complete recovery occurs to the normal state of their original anatomical and morphological structure and basic functions of the SMS (support, spring and motor).

In St. Petersburg, in practice, after contacting the emergency room, the child is hospitalized in one of the city's multidisciplinary hospitals. The term of his stay in the hospital is determined by the tariff agreement with insurance companies (on average - 28 days) and then he is transferred to the Rehabilitation Center (RC).

In VC, patients with compression fractures of the vertebral bodies, according to indications, undergo additional diagnostic examinations, which makes it possible to clarify the localization, the number of injured vertebrae, and to identify the consequences of contusion lesions of other systems and organs. This is achieved using thermal imaging diagnostics of the back and limbs in dynamics, ECG, EMG, ENMG, EEG, biomechanical examination on tensometric platforms, etc.

When formulating a comprehensive treatment plan, we focus on the age of the patient, the level and degree of damage to the vertebral bodies, and most importantly, on the time elapsed since the injury (again, we draw attention to the chronobiology of the bone tissue of the compressed vertebra),

We would like to emphasize that during the diagnostic measures on the first day of a child's stay in the VC hospital, special attention is paid to the cardiovascular system, the tissues of which (this has already been noted above!) At the time of injury also receive contusion damage, however, their clinical manifestations (unmotivated rhythm disturbances, metabolic disorders myocardium, etc.), may not appear on the first day after the injury, but later - at 3-4-6 weeks after the injury.

In addition to attention to damaged vertebrae, the complex treatment carried out at the EC takes into account concomitant pathology of the musculoskeletal system (dysplasia, malnutrition, lagging bone age, osteopenia or osteoporosis of the axial skeleton, etc.).

Below is an approximate scheme of standards in the staged care of children and adolescents with uncomplicated compression fractures of the vertebral bodies. We distinguish the following stages in treatment based on the chronobiology of the restoration of damaged spongy bone tissue of a growing organism (the most inert of all tissues that form PDS).

The basis for the selection of these stages in the treatment are the results of studies obtained by the staff of the Novosibirsk Research Institute in the experiment in the study of reparative osteogenesis and vascularization of the body of the damaged ("broken") vertebra (Tsivyan YAL, Ramikh EF, Mikhailovsky MV. 1995) and the results of our long-term clinical observations.

I. Periodic compression, necrosis and resorption of damaged bone tissue

(from the first day to the 25th-30th day from the moment of injury) In the vast majority of cases, the child spends this period in the hospital of a multidisciplinary hospital.

The task of treatment during this period is the maximum unloading of the damaged spine and the creation of conditions for the maximum possible reduction of post-traumatic complications.

Against the background of laying aimed at unloading the ventral parts of the vertebral bodies (traction along the axis of the spine on a loop behind the head or on straps behind the armpits and rolls under the compressed parts of the spine), exercise therapy is carried out according to the method of E.F. Dreving and V.V. Gorinevskaya, developed for this period. All patients receive, according to indications, massage of the muscles of the lower extremities, gluteal region, abdomen and torso and physiotherapy, which helps to relieve pain, improve blood circulation, limit the area of ​​damage, and treatment aimed at accelerating the processes of resorption of damaged tissues (magnetotherapy, UHF therapy, DDT therapy. Local UV radiation, etc.) .

The method of therapeutic exercises and functional treatment of compression fractures was developed in detail and applied in 1932-1934 in the traumatology clinic of the Institute of Emergency Surgery. N.V. Sklifasovsky professor V.V. Gorinevskaya and a specialist in physical therapy of the institute, associate professor E.F. Dreving. Many years of experience in using this method in our clinic and adapting it for children and adolescents confirms its uniqueness, especially for the treatment of a growing organism. The use of this method makes it possible to exclude rigid immobilization of the spine and maintain the maximum mobility of the spinal column and its ability to grow and regenerate throughout the entire period of treatment, and most importantly, to prevent complications associated with a long period of bone tissue regeneration. The whole complex of therapeutic gymnastics, including static and dynamic exercises, breathing exercises is divided into stages (four of them) according to the temporary post-traumatic period

In the first period, classes in therapeutic exercises begin from 2-3 days after the child has become accustomed to the forced position on laying in bed. The patient is taught proper breathing, performs gymnastic exercises for the distal extremities. Gradually, the complex of exercises becomes more complicated and exercises are introduced aimed at strengthening the muscular corset of the body, and most importantly, at strengthening the extensor muscles of the body. Due to this, the main task of this period of treatment is fulfilled - the injured spine is unloaded. Gymnastics classes are held 2-3 times a day, the duration and pace gradually increase.

II. The period of intensive osteoreparation(from the 30th to the 60th day after the injury and at this time the child is already being transferred to the VC).

The first component task of this stage is to support and stimulate the bone formation process, as well as to restore the damaged ligamentous apparatus. The second component of the task of this stage is the preparation of the ODA of the affected child for verticalization. Each patient undergoes additional diagnostics of the functions of all systems and organs (cardiovascular, respiratory, musculoskeletal, etc.) and develops individual rehabilitation plans.

VTsDOiT "Ogonyok" has all the necessary equipment and qualified specialists for the accurate and complete implementation of these tasks.

To accomplish these tasks, against the background of constantly conducting exercise therapy according to the method of E.F. Dreving and V.V. Gorinevskaya, pathogenetic methods of physiotherapeutic treatment are used: medicinal electro- and phonophoroses, photo- and laser therapy, thermal procedures, stimulation of various muscle groups (magnetic and electrical) , exercise gymnastics using devices with Biofeedback, etc.

At this stage, the motor function of the spinal column is preserved and the prerequisites are laid for the successful restoration of the supporting function.

III. Restoration period of functional structural maturity of tissues of a compressed vertebra(3-10 months from the moment of injury) The task of this period is to restore the fully supporting function of the spinal column.

Part of this period, patients with compression fractures, as a rule, also spend in a rehabilitation center, and therefore they have the opportunity to receive adequate motor and pathogenetic therapy. Therapeutic physical training (4th period according to the method of E.F. Drewing and V.V. Gorinevskaya) ensures the formation of a good muscle corset in an upright position, the child learns the correct motor stereotypes of walking and sitting with the exception of flexion movements of the body, learns proper walking, self-service and wearing minimal weights with maximum unloading ventral spine. During this period, in the compressed vertebrae, the processes of osteogenesis are intensively going on, which can be stimulated and directed by various physiotherapeutic methods (a wide range of which is presented in the EC). By the end of this period, the structure of the body of the damaged vertebra is completely restored, its mechanical strength is restored. However, the shape of the body remains wedge-shaped and the restoration of its correct shape is associated and can only be ensured with the successful function of the growth zones of the bodies of damaged vertebrae. This process (4th period), under all favorable conditions, takes a period of 2 years from the moment of injury.

IV. The period of residual deformations (incomplete restoration of the body shape)(from 10 months to 2 years from the moment of injury). During this period, patients are observed and treated on an outpatient basis and, according to indications, receive course inpatient treatment in a rehabilitation center. As a rule, these are patients with a large number of damaged vertebrae, with a severe degree of their compression, with a slow course of osteoreparation processes, with a weakened muscular corset, with symptoms of osteopenia or osteoparosis. In our center, rehabilitation treatment complexes have been developed for these patients, which usually supplement and correct the treatment of the outpatient period. baths, magnetotherapy with low-frequency and combined fields, etc.)

Up to 2 yearsfrom the moment of injury, a dispensary observation of children with compression fractures is carried out. 2 years after the injury, the outcome of compression fractures of the vertebral bodies:

Full recovery;

incomplete recovery;

Post-traumatic osteochondrosis;

Post-traumatic scoliosis or kyphosis;

Kümmel's disease (traumatic spondylitis).

With an injury to the lumbar vertebrae, all periods of limitation of the motor regimen are doubled: walking - after 3 months, sitting - after 6 months.

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Household injuries

Vertebral compression fractures

Vertebrae, like other bony structures human body, normally have a significant margin of safety and can withstand significant loads. But sometimes, when exposed to an external force that exceeds the strength of the vertebra, the integrity of its bone structure is violated (fracture). Vertebral fractures in middle-aged and young people often occur when exposed to too much external force. The most common causes of spinal fractures in this age group are: "diver's injury", a fall from a great height, car accidents. If the injury causes a decrease in the height of the vertebral body, then such a fracture is considered compression. This type of vertebral fracture is the most common. Quite often, bone fractures, including those of the vertebrae, occur due to a decrease in bone density. This disease is called osteoporosis and is often found in older women. So, in 45% of women over 80 years old, at least once in their life, but there was a compression fracture of the spine. Often, all these fractures remain unrecognized, but they can cause developing spinal deformity (“senile hump”), as well as frequent persistent back pain. In osteoporosis, a very small force (eg, falling from a chair, awkward jump) is required to cause a vertebral fracture. Also enough common cause The formation of compression fractures is a metastatic lesion of the spine in malignant tumors of other organs (metastases - screenings of a cancerous tumor in other tissues and organs of the body). When the vertebral body is affected by tumor metastasis, progressive destruction of the vertebral body occurs, and a fracture can form with minimal external load. Radioisotope scanning is considered to be the most reliable information to confirm the diagnosis of a metastatic fracture. The most common localization of compression fractures is the lower part of the thoracic spine. Often, the 1st lumbar vertebrae, as well as the bodies of the 11th and 12th thoracic vertebrae, undergo fractures.

For a better understanding of the mechanisms of compression fractures, as well as the principles of treatment, it is necessary to study the basics of the anatomy of the spine. A compression fracture is formed due to the effect of high pressure on the vertebral body. Very often, the mechanism of injury is a combination of forward flexion of the spine with an axial load on it. This leads to a significant increase in pressure on the anterior sections of the spine - on the vertebral bodies and intervertebral discs. When a compression fracture occurs, the vertebral body in its anterior part is compressed, acquiring the shape of a wedge. With a significant decrease in the height of the anterior sections of the vertebral body, its posterior part can penetrate into the spinal canal, which contributes to squeezing the spinal cord. Fortunately, such significant fractures are much rarer.

If the fracture occurred due to the action of a significant external force, then at the time of injury, patients experience severe pain in the back. Sometimes the pain can radiate (give) to the upper or lower extremities. Damage to the nerve structures causes numbness and weakness in the arms and legs. A fracture of the vertebrae, already pathologically altered, occurring with a minor injury, may be accompanied by only moderate back pain.

After questioning the patient, the doctor conducts a physical examination. At this stage of the diagnostic search, a preliminary diagnosis can be made and a further plan for examining the patient can be determined. Palpation of painful areas (neck, back), assessment of muscle strength and sensitivity in the limbs, checking for symptoms of nerve root tension, tendon reflexes and other special tests are carried out.

To refute or confirm the diagnosis of a vertebral fracture, an X-ray of the spine is necessary. This type of study allows you to visualize bone structures using X-rays on the display of an X-ray machine, on film or special paper. Sometimes, for a more thorough examination of the fracture area, to determine damage that indicates instability of the spinal motion segment, it is necessary to perform computed tomography (CT). In this study, in addition to diagnosing damage to bone structures, it is possible to determine changes in soft tissues. The image in this case is the result of digital processing of many X-ray images taken at various angles and at different levels using a CT scanner in the form of a series of transverse sections of the human body. If an injury to the nervous structures (nerve roots, spinal cord) is suspected, magnetic resonance imaging is necessary. This technically new painless study is today the "gold standard" in the diagnosis of damage to the soft tissues of the human body (ligaments, muscles, nerves, spinal cord, etc.). The principle of operation of magnetic resonance imaging is to study the structure of soft tissues using electromagnetic waves. This completely painless and safe examination method is currently widely used in neurosurgical practice and other areas of medicine. To confirm the diagnosis of a fracture of the vertebra (spine), as well as to determine the degree of compression of the nerve structures, other methods of studying the body are also used: radioisotope scanning (a type of study using radioactive isotopes), myelography (a type of study aimed at studying the spinal cord), discography (type study, which helps to detect changes in the intervertebral discs).

Treatment

Treatment of compression fractures of the spine most often includes the observance of a protective regimen and the use of special reclinators and corset belts, as well as the use of analgesic drugs. In some cases, surgery may also be needed.

Taking analgesics can reduce the severity of pain. But at the same time, you need to know that painkillers do not contribute to the healing of fractures. A significant improvement in well-being, the disappearance of pain after the start of pain therapy does not mean that the disease has been cured. For fracture consolidation normal timing protection must be observed. During the period of fracture healing (10-13 weeks), it is necessary to exclude any physical activity, which in one way or another can lead to an increase in the degree of deformation in the broken vertebral body. It is strictly forbidden to lift weights, make significant bends and turns of the body.

Often, your doctor may recommend bed rest for several weeks. This is especially important for elderly patients with osteoporosis, in whom fracture healing does not occur as quickly and easily as in younger people. In most cases, patients need to wear special corset belts. This external fixation device minimizes active and passive movements in the injured spinal segment, which helps to consolidate the fracture. Corset belts, which are used for fractures, fix the spine in the position of hyperextension (overextension). This reduces pressure on the anterior part of the injured vertebral body and reduces its collapse.

Compression fractures of the vertebrae are consolidated in most cases within approximately three months. To control the process of fusion of a broken vertebra, an x-ray of the spine is taken, which is approximately performed every month.

Surgery

Surgical treatment of compression fractures of the spinal column is indicated for compression of the nerve structures (spinal cord, nerve roots), instability of the spinal column, and severe pain. For example, with a decrease in the height of the vertebral body on radiographs by more than 50%, spinal instability occurs, which can lead to compression of the nerve structures. In this case, surgery is needed to prevent injury to the nerve roots and spinal cord. There are several types of operations that are performed for compression fractures of the spine. Depending on the type of vertebral fracture, the severity of compression of the nerve endings, the doctor may choose one or another type of operation. Basic Principles surgical operation in case of spinal injuries, the compression of the nerve structures is relieved (if there are symptoms of compression of the spinal cord or nerve roots by the bone structures), as well as stabilization (fixation in a physiologically advantageous position) of the damaged spinal segment.

Front access. When the spinal cord is compressed in front by a crushed vertebral body, the surgeon usually performs the operation from the anterior approach. In this case, the incision is made on the anterolateral surface of the abdomen or chest. Then the body of the damaged vertebra is exposed. Bone elements that compress the bone marrow are removed. After decompression, stabilization of the spinal column is performed. To do this, a bone graft is fixed in place of the removed destroyed vertebral body. To date, grafts made from the patient's own bone (autografts), as well as from a specially treated cadaveric bone (allografts) are widely used. Cages - artificial prostheses of the vertebral bodies or discs - are gaining more and more popularity for stabilizing the spine. Cages are made from durable artificial materials or titanium. The cage is clogged with bone chips, which are taken from the crest of the pelvic bone, with a special cutter. A few months later, the graft consolidates with the bodies of the lower and upper vertebrae into a single bone structure (conglomerate). To fix the graft and the damaged spinal segment in a physiologically correct position, stabilizing systems are used, which may consist of plates, bridges of screws and beams. The components of stabilizing systems are made of titanium or alloys (titanium carbide) - durable, inert (non-active) materials that do not cause rejection reactions from the body.

Back access. Often, stabilization of the spine can be performed through a skin incision in the back (posterior approach). Such an operation with a posterior approach is most often performed in the absence of dorsal anterior compression of the spinal cord by areas of the damaged vertebral body. Internal fixation of the damaged spinal segment in a physiologically correct position with the help of special stabilizing systems helps prevent damage to nerve structures (spinal cord or roots), ensure early activation of the patient, and help optimal fusion of bone structures. Most often in last years in surgical practice, transpedicular stabilization of the spine is used. With this technique, fixation screws are secured through the vertebral pedicles into the vertebral body. The screws on each side are connected by strong beams that unite the vertebrae into a single conglomerate. These stabilizing systems are distinguished from others by their high strength and reliability, which allows the patient to be activated from the very first days after the operation.

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Household injuriesSome types of spinal injury