Associated compression fracture of the vertebral body: ..
The narrowing of the spinal canal due to a compression fracture can either lead to immediate ..
Vertebral Compression Fracture Treatment Home: About: Services: A ..
Pain > 6 weeks Chemonucleolysis Standard Discectomy - open - microdiscecotmy Percutaneous / Endoscopic Discectomy Mechanism - chymopapain dissolves nucleosus pulposis - older technique largely out of favour Results Muralikuttan et al Spine 1992 - RCT of discectomy v chemonucleolysis - inferior short term results with chemonucleolysis - no difference at one year Advantage - suitable for noncontained disc Results Dewing et al Spine 2007 - prospective followup of 183 single level lumbar discectomies - average age 27 - 85% satisfied with surgery - recurrent disc herniation in 3% - better outcomes in L4/5 than L5/S1 - better outcomes in sequestered / extruded discs than contained discs - poorer outcomes in smokers and patients with predominance of back pain Righesso et al Neurosurgery 2007 - RCT of open v microdiscectomy - no difference in outcome - longer scar and inpatient stay in open group - longer surgical times in microdiscectomy Indications - contained disc Technique - image guidance / endoscopic techniques - interlaminar or transforaminal - discectomy with cutting / suction probe Advantage - minimal scar - rapid recovery Results Ruetten et al Spine 2008 - RCT of endoscopic interlaminar and transforaminal v microdiscectomy - 82% relief of leg pain, no difference in each group - 6% recurrence, no difference in each group - reduced back pain and complications with improved rehab in endoscopic group Wrong level surgery Neural injury - paraplegia 1: 25 000 - nerve root injury - cauda equina 0.2% Dural tears A. Intraoperative Management - head down - stop ventilating / hand ventilate / anaesthetic valsalva - ensure free abdomen - CSF can make nerve root in danger / protect with patty - attempt primary repair with 6.0 prolene non cutting needle - supplement with Tisseel glue - +/- fat graft / thoracolumbar graft - subfascial drain - bed rest 2 days B. Postoperative CSF leak - ensure no meningitis symptoms - glucose / microscopy test to confirm - adequate fluids / head down / quiet room / bed rest - antibiotics controversial - MRI: small leak or large leak Non operative Management - insert drain below conus - decreases CSF pressure - bed rest / leave drain for 5 - 7 days Operative Management - failure nonoperative / large leak - thoracolumbar fascia / synthetic graft repair Incomplete decompression / failure to relieve symptoms Infection 2% Thromboembolism 1% Arachnoiditis / Intradural fibrosis Incidence 5% MRI changes 1. Central root clumping 2. Empty sac appearance 3. Soft tissue mass in subarachnoid space HNP recurrence Incidence - life long 6 - 7% - second time 50% - third time 90% Investigation - gadolinium MRI - scar enhances but recurrent HNP does not Management - disc resection +/- fusion
Most cases of compression fractures can be treated using medications to relieve pain, bed rest, and the use of a back brace. The brace helps relieve pain by immobilizing the fracture and reducing the height loss that occurs as a result of the compression. The brace is discontinued when x-rays show no change in the position of the vertebrae and healing of the fracture.
Nonsurgical Treatment for Spinal Compression Fractures Pain Patient
ALIF / Anterior Lumbar Interbody Fusion 4. Disc Replacement Concept - decortication of pedicles / lamina / transverse process - bone graft applied - instrumentation added to improve fusion rate Advantage - high fusion rate - no risk of interbody graft / cage migration - low risk neural injury Results Fritzell et al Spine 2001 - RCT of surgical treatment v non surgical with 2 year follow up - back pain reduced 33% to 7% - return to work 36% v 13% Fritzell et al Spine 2002 - RCT of PLF v instrumented PLF v PLIF - no significant difference in reduction in pain and disability - complications 6% v 16% v 30% - fusion rate 72% v 87% v 91% Principles - wide post decompression and removal of entire disc - graft / fusion cage placed between vertebral bodies - 360o fusion (PLF + interbody) Advantages over PLF - excise disc & decompress nerve roots - disc height restored with graft decompressing foramina vertically - fusion of anterior column / increased fusion surface / site of arthrodesis compressed Disadvantages - wide post decompression needed / newer minimally invasive techniques - risk of canal compromise by graft Results Leufven et al Spine - 29 patients treated with PLIF - fusion in 27/29 - excellent results in 31% and good in 21% - fair in 21% and poor in 27% Concept - anterior approach + complete discectomy and graft Results Penta et al Spine - 108 patients with ALIF at 10 years - only 34% good or excellent - not related to fusion rates - psychological rating intially and at review correlated with outcome Concept - maintain small degree of motion - prevents adjacent level degeneration Results Herkowitz et al JBJS Am 2006 - RCT of disc replacement v ALIF - 304 patients with single level disease L5S1 or L45 - 2 year follow up - clinical success 64% in disc replacement v 56% ALIF
- better ROM and restoration disc height in disc replacement Harrop et al Spine 2008 - systemic review looking at adjacent level degeneration in lumbar fusion v disc - radiographic degeneration 34% in fusion v 9% in disc replacement - symptomatic degeneration 14% in fusion v 1% in disc replacement Mortality 0.2% Infection 1.5% DVT 4% PE 2% Neural injury 3% Instrument failure 7% Failed back surgery syndrome
L4/5 disk hits L4 nerve root - Wiltse approach or complete facetectomy / follow nerve out Typical patient 20-45 year old male Pain - leg in dermatomal distribution Neurology - numbness / parasthesia / weakness Cauda Equina Syndrome - saddle anaesthesia / urinary incontinence / weak EHL Tension signs 1. SLR / Straight leg raise / Lasegue's Sign - elevate leg from hip with knee straight - reproduce pain below knee - L5 / S1 nerve roots Deville et al Spine 2000 - meta-analysis - SLR very sensitive 90% but lower specificity 26% - crossed SLR low sensitivity 29% but more specific 88% 2. Femoral nerve stretch test - patient prone, knee flexed, extend hip - reproduces pain - L4 nerve root DDx L4 nerve root - CPN / DPN palsy - test peroneals, tibialis posterior DDx L5 nerve root - CPN / DPN / Sciatic palsy - test peroneals / abductors DDx S1 nerve root - tibial nerve - test tibialis posterior T2 Sagittal - myelogram T1 Axial - see nerve root against white fat Infection / Tumour / Fracture Recovery - 80% improve after 6/52 - 90% improve after 3/12 - 95% improve after 6/12 Weakness just as likely to resolve as pain Peul et al BMJ 2008 - RCT of conservative treatment v microdiscectomy - symptoms 6 - 12 weeks - earlier symptomatic relief in surgical group - no difference at one or two years Medications - NSAIDs / opiates / steroids / tricyclic antidepressants Physiotherapy / lumbar stabilisation exercises Traction Chiropractic manipulation Epidural steroids Price Health Technol Assess 2005 - multicentred RCT placebo control - 220 patients with unilateral sciatica - minimal and transient value over placebo at 3 weeks - no difference after 6 weeks - not cost effective / drain on resources Arden et al Rheumatology 2005 - WEST study - exactly the same findings Transforaminal CS / Nerve Root Injections Riew et al JBJS Am 2000 - RCT of patients with unilateral nerve root compression - all considered suitable for operative intervention - effectively prevented need for surgery in more than half of the patients - LA + steroid more effective than LA alone Cauda Equina Syndrome Failure of non operative treatment Severe debilitating anatomical leg pain Progression neurological deficit 6/6 Nachemson 1.
Spondylolysis & Spondylolisthesis - USC Spine Center
Due to the weakening of the bone, the vertebra is squashed under the weight of those above it. As the bone thins it can't carry as much load and so fractures occur more easily. In patients with multiple compression fractures, they may start to develop a bent over appearance. This is because the vertebrae carry their weight through the bodies at the front and so become compressed at the front and remain the same at the back. Imagine a wedge shape!
If you have back pain after a fall, seek medical attention. After an examination, a Doctor may request an or a to confirm the diagnosis. Traumatic compression fractures usually require surgery to pin the vertebrae back together and avoid slippage or spinal cord injury.
Vertebral Compression Fracture - MRI Images - The …
Spondylolisthesis Treatment, Surgery & Symptoms
The clinical presentation and radiographs are consistent with an acute osteoporotic vertebral compression fracture
Learn about the types and symptoms of spondylolisthesis
The most common symptom of spondylolisthesis is lower back pain
There are a number of causes of spondylolisthesis, and a classification system was developed by Wiltse
Spondylolysis and Spondylolisthesis - OrthoInfo - AAOS
Compression fractures, as the name suggests, occur due to a compression force on the spine. This may happen during a traumatic injury such as a fall from a height, landing on the feet or buttocks. More frequently, vertebral compression fractures in older people with osteoporosis or other pre-existing spinal conditions where the bone is weak. There may not be one particular incident that causes it and pain may develop gradually.
Spondylolysis and spondylolisthesis - Mayfield Clinic
Spinal compression fracture symptoms include pain at the site of the fracture which may radiate into the hips, buttocks or thighs. Neural symptoms such as numbness, tingling and weakness may be present along with bladder or bowel symptoms depending on how the fracture is pressing onto the spinal cord.
Home / Conditions Treated / Spondylolysis & Spondylolisthesis
A compression fracture is a spinal fracture resulting from compression of the vertebra. Compression fractures can occur in any area of the spine. It can affect one or more vertebrae. Compression fractures typically develop in your mid or lower back. This can change the shape of your spine.
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