Vertebral osteoporosis - fracture vertebral compression

Definition

Osteoporosis is a condition in which bones lose density, become fragile and more likely to break. In osteoporosis, the balance between the creation of new cells (osteoblasts) and the reabsorption of old cells (osteoclasts) in the bones is broken, leading to progressive depletion of bone tissue. Osteopenia is an intermediate condition.

Vertebral osteoporosis

Concerns the menopausal woman. In the population with medullar lesion , osteoporosis was observed by X-ray as early as six weeks after injury. This decrease in bone mineral density usually stabilizes about two years after the injury. The bone density at this stage is about the same as that of a 70-year-old woman (without vertebral lesions). About 80% of people with chronic spinal cord injury suffer from either osteopenia or osteoporosis. The lumbar spine maintains normal or superior bone mineral density after spinal cord injury. In the injured bone, the bone loss is the same in case of paraplegia and quadriplegia. The importance of injury: people with a complete injury have more bone loss than those with incomplete injury. Spasticity would help maintain bone mass after bone marrow injury due to muscle traction on the bone, similar to the loading effect. The duration of the injury: the longer is the time since the injury, the higher is the probability of significant bone loss.

Risk factors

The lack of mechanical load on the bone inhibits the stimulation of the cells that build the bone. Circulation disorders. Poor nutritional status. Hormonal alterations (testosterone, parathyroid hormone, glucocorticoids, calcitonin) resulting from bone marrow injury and play a role in maintaining bone formation and reabsorption. The automatic deregulation of the nervous system caused by the lesion causes a circulatory alteration and an alteration of gaseous and nutritive exchange in the bone.

Symptoms

A vertebral compression fracture causes back pain. The pain usually occurs near the fracture. Pain often gets worse with movement, especially when you change position. She is often relieved by rest or lying down. Coughing and sneezing can also increase pain. Projected pains (away from the fracture site) exist but remain rare.

Diagnostic

It is primarily clinical: while you are standing, your doctor will examine the alignment or straightness of your spine and your posture. It will also push on some areas of your back to try to determine if your pain is from a muscle or bone injury. A thorough neurological examination will be performed to eliminate any neurological motor and / or sensory impairment. Then X-ray: Imaging tests will help determine the age of the fracture-compaction (new (acute) or older (chronic)). Standard radiographs show crushing of the vertebra on spinal column views, thus losing its typical rectangular shape.



Very diminished height of the vertebra after fracture (arrow) in comparison with the vertebra below
Other problems in the spine may also appear on X-rays. Elderly patients with vertebral fracture-compression may also have narrowing of the disc spaces (degenerative disc disease) and / or scoliosis, which corresponds to lateral curve of the spine. Magnetic resonance imaging (MRI). This test will show in more detail any soft tissue damage around the fracture (nerves and discs). Because of the way it shows bones, MRI can help determine the age of the fracture. Where there is a new fracture, the bone involved will appear brighter than the surrounding bone. This suggests inflammation or "edema" in the region. If the fracture is old, the "signal" of the bone will be normal.



The white part of the fractured vertebra (decrease in vertebral body height) corresponds to edema or inflammation of a potential new fracture















Bone scintigraphy: can detect abnormal activity in bones, including the presence of fractures. It can also sometimes indicate whether a fracture is acute or chronic. The vertebral scanner can study both soft tissues and bones. A CT scan can help your doctor determine if your fracture has spread to your spinal canal, where the spinal cord and nerve roots are located. A bone densitometry will be performed when you have a vertebral fracture-compression, in search of osteoporosis and its gravity. X-rays often show thinning of the bone throughout the spine - a condition known as osteopenia. Osteopenia is a precursor to osteoporosis, in which the bone becomes much more fragile. The extent of bone loss can be determined using Dual Energy X-ray Absorptiometry (DEXA), a type of bone mineral density analysis. The results of the DEXA test help to assess the risk of additional fractures in the spine and other parts of the body. The results of DEXA will be useful in the general management of osteoporosis.

Treatment

Non-surgical

Most people who experience vertebral fracture-compression get better within 3 months without specific treatment to repair the fracture. Simple measures, such as a short rest period and limited use of pain medication, are often enough. In some cases, patients must wear a corset to limit movement and allow the fracture to heal. In case of general osteoporosis, you have an increased risk of additional compression vertebral fractures as well as other fractures such as hip and wrist. The prescription of treatments to restore bone density will be made with calcium and vitamin D or with bisphosphonates or other molecules (Denosumab, Raloxifene, Strontium Ranelate.

Surgical

If you have severe pain that does not respond to nonsurgical treatment, surgery may be considered. In the past, the only surgical options available to patients with vertebral compression fractures involved extensive procedures. Today, spinal augmentation procedures offer a minimally invasive alternative. The two types of vertebral augmentation methods available are kyphoplasty and vertebroplasty. The best candidates for these interventions are patients with acute pain caused by a recent vertebral fracture. In kyphoplasty and vertebroplasty, a needle is inserted into the fractured vertebra using an X-ray as a guide. A cement is then injected to restore the strength and integrity of the vertebra according to the severity of osteoporosis. Only in the kephoplasty, a small device with a balloon is then inserted into the needle and into the fractured vertebra. The balloon is inflated from the vertebra, restoring the height and shape of the vertebral body (or vertebral augmentation procedure).

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