Compression fracture of thoracic vertebrae and back pain
Last reviewed: 23.04.2024
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Compression fracture of the thoracic vertebrae is one of the most common causes of pain in the thoracic spine. Compression fracture of the spine is often a consequence of osteoporosis, but it can also occur as a result of a spinal injury like "acceleration-inhibition." In patients with osteoporosis, a primary tumor or metastatic disease affecting the thoracic vertebrae, a fracture can occur with a cough (cough fracture) or spontaneously.
Pain and functional impairment associated with a vertebral fracture are determined by the severity of the lesion (ie, the number of vertebrae involved) and the nature of damage to the neural structures (compression of the spinal nerves or spinal cord). The pain associated with a compression fracture of the thoracic vertebrae can range from blunt, deep pain (with minimal compression of the vertebrae and lack of compression of the nerves), to severe acute, shooting pain, which limits the patient's ability to walk and cough.
[Symptoms of a compression fracture of the thoracic vertebrae
The compression fracture of the thoracic vertebrae is aggravated by deep breathing, coughing and any movement of the spine. Palpation and percussion of the affected vertebra can cause pain and reflex spasm of the paravertebral muscles. If the fracture is caused by a trauma, a hematoma or an ecchymosis may be found above the fracture site, and the clinician should be aware of the possibility of damage to the chest, chest and abdominal organs. Damage to the spinal nerve can cause intestinal obstruction and severe pain, leading to rigidity of the axial muscles and further impairment of breathing and the ability to move. Unsuccessful active treatment of this pain and muscle rigidity can lead to hypoventilation, atelectasis and, eventually, pneumonia.
Examination
An overview radiography of the spine is shown to exclude other latent fractures and bone pathology, including swelling. MRI is able to identify the nature of the fracture and distinguish between benign causes of pain from malignant. In the presence of trauma, radionuclide scanning (scintigraphy) of the bone can be informative to exclude latent fractures of the vertebrae and sternum. If the injury was not, then to assess osteoporosis, bone densitometry, serum protein electrophoresis and hyperparathyroidism are prescribed. Based on the clinical picture, it is also possible to study a general blood test, the level of prostate-specific antigen, ESR, the level of antinuclear antibodies.
CT scan of chest organs is indicated for suspected hidden tumor processes and significant trauma. Electrocardiography is indicated to exclude closed traumas of the heart for all patients with traumatic sternal fractures or precarious trauma of the anterior spine. To prevent pulmonary complications, early injection equipment should be used.
Differential diagnosis
In case of trauma, the diagnosis of a compression fracture of the thoracic vertebrae is usually clear. In the case of a spontaneous fracture secondary to osteoporosis and a mastatic disease, the diagnosis may be less pronounced. In this case, often the pain from the latent compression fracture of the spine is mistaken for the pain of the heart or visceral (cholelithiasis) etiology, which leads to a visit to the emergency room and the unnecessary cardiologic and gastrointestinal benefits. Acute stretching of the thoracic axial muscles can be taken as a compression fracture of the thoracic vertebrae, especially if the patient coughs. Due to the fact that pain with herpes zoster precedes the rash for 3-7 days, it can be erroneously attributed to compression fracture of the vertebrae.
Clinical features of the compression fracture of the thoracic vertebrae
Compression fracture of the thoracic vertebrae is a common cause of pain in the spine. It is necessary to accurately diagnose the correct treatment of these painful conditions and prevent the passage of serious pathology of the thoracic and abdominal cavity. Pharmacological drugs usually provide adequate pain control. If necessary, thoracic epidural blockade can provide significant relief of pain.
Treatment of compression fracture of thoracic vertebrae
Initial treatment of pain in compression fracture of the thoracic vertebrae includes a combination of simple analgesics and non-steroidal anti-inflammatory drugs. It is possible to prescribe antiresorptive drugs with an analgesic effect (synthetic salmon calcitonin). In the event that these drugs do not sufficiently reduce pain, the next step is reasonably the appointment of short-acting opioid analgesics, such as tramadol. Due to the fact that opioid analgesics can depress the cough and respiratory centers, the patient should be instructed about adequate techniques of airway cleansing. Local applications of heat and cold or the use of orthopedic devices (Cache cache) can provide relief of symptoms. Patients who do not respond to such therapy are shown a thoracic epidural blockade with local anesthetics and steroids. Kifoplasty with a cement fixation of the fracture site is a good choice if, because of pain, a decrease in motor activity becomes a problem.
Complications and Diagnostic Errors
The main problem in managing patients with a presumed compression fracture of the thoracic vertebrae is a late diagnosis of compression of the spinal cord or recognition of the metastatic nature of the fracture. Patients with a compression fracture of the thoracic vertebrae require early pain control and early standing to prevent complications such as pneumonia and thrombophlebitis.