Vertebral Fractures and Osteoporosis—Proper Diagnosis and Treatment of Symptoms in the Clinic

A vertebral body is, on the whole, an extremely stable bone structure. Nevertheless, it can fracture in severe accidents.

In many cases, the spinal canal—which houses the spinal cord—is also affected. A vertebral fracture can cause the spine to shift, or bone fragments may obstruct the spinal canal. In such cases, patients may even develop paraplegia.

In Germany, approximately 230,000 people between the ages of 50 and 79 suffer a vertebral fracture each year. About two percent of all fractures are vertebral fractures.

In many cases, patients do not realize they have a vertebral fracture because there are no symptoms. The fracture is therefore often not detected until the surrounding tissue is also affected. If the spinal cord is compressed, motor function or sensation in the affected patients can be significantly impaired.

In medicine, vertebral fractures are classified as either

• impaction fracture,
• a spondylolysis, and
• a burst fracture

. The latter can occur in different directions and result from a twisting motion.

If the vertebral fracture was caused by rotation, the transverse processes and spinous processes may break off under certain circumstances. Damage to the rib attachments is also possible.

In most cases, a vertebral fracture results from a direct, forceful impact or compression. A common cause is

• a traffic accident,
• a fall from a great height, or
• physical violence.

This can cause the healthy bone to fracture.

Accidents are by far the most common cause of vertebral fractures. The risk of vertebral fractures increases with age, as bones wear down over time. At that point, even a minor impact is enough to cause a fracture.

Osteoporosis can also increase the risk of a vertebral fracture. Osteoporosis reduces bone density, making the bone unstable and porous.

Typically, patients see a doctor when they experience pain. At that point, a vertebral fracture can be diagnosed, and surgery can be scheduled.

The orthopedic specialist first takes a medical history. During this process, they ask the patient about their symptoms. Only then do they proceed with a physical examination and further tests. The doctor has already gained insight into which tests are necessary based on the medical history.

For example, they may measure nerve conduction velocity to assess the extent to which the spinal cord is affected.

Once the suspicion is confirmed, a provisional diagnosis is made, and the patient is referred to a radiologist.

Using imaging techniques, such as a CT scan, the doctor can determine the type of fracture. Only once this has been clarified does the doctor decide, together with the patient, how the vertebral fracture should be treated.

The type of treatment for a vertebral fracture depends on

• the severity of the fracture in each individual case, and
• the cause of the fracture.

For example, a multidirectional burst fracture involving multiple vertebrae must be treated differently than a fracture of a single vertebra caused by osteoporosis. The goal of treatment is to ensure that the bone fragments heal together securely.

In some cases, conservative treatment is possible, meaning surgery is not necessary. This requires a stable fracture in which the vertebra has retained its shape. Furthermore, the surrounding tissue must not be affected.

Conservative measures include, for example,

• the administration of pain medication,
• wearing a support brace,
• massage, and
• physical therapy.

If symptoms appear, the vertebral fracture usually requires surgical treatment as part of spinal surgery. There are various options available for this as well.

Vertebroplasty and Kyphoplasty

In this procedure, a hollow needle is inserted into the affected vertebra. Bone cement is then injected through the needle. Once the cement hardens, the individual bone fragments quickly fuse together. This allows the vertebral body to stabilize rapidly.

While vertebroplasty can be performed under local anesthesia, kyphoplasty is currently performed exclusively under general anesthesia.

In this procedure, a small balloon is first inserted into the vertebral body and then inflated. This also helps to realign the vertebral body and stabilize it with bone cement.

However, both treatment methods should be performed only four to six weeks after the actual fracture.

Spondylodesis

In the case of a severe vertebral fracture associated with complications, spondylodesis is usually the only treatment option. During this procedure, the surgeon removes individual fragments or entire vertebrae from the spine and replaces them with a cage.

The doctors then use screws and plates to fuse the vertebrae located above and below the fracture site.

This procedure is used to treat severe fractures. It also restores the stability of the spine. This helps prevent damage to internal structures such as the spinal cord.