Post-Traumatic Kyphosis

Overview | Problems and Challenges | Conservative Treatment | Surgical Correction

Overview

If you have healthy bone, it takes a considerable amount of force to break your back. The most common causes of spinal fracture are falls from a height and motor vehicle accidents. When vertebra are injured and fracture, collapse is often the result. In cases where the collapse is significant, abnormal stresses arise in the adjacent facet joints and disks, often causing pain. Pain can also be caused by muscle fatigue from trying to compensate for the stooping posture and stand straight. Premature arthritic changes in the involved and adjacent joints can also occur.

Mild fractures in the upper, middle, and lower back can be tolerated fairly well if the hips are not arthritic and the rest of the spine is healthy and flexible. The only treatment required is symptomatic relief with analgesics and a daily exercise program to keep the spine core muscles strong. Occasional brace wear can also be helpful for some. Most people never need anything more than this.

If the fractured vertebra collapses to the point of causing > 20 – 30 degrees of kyphosis, pain will likely result. In such severe cases, the decision to proceed with surgical correction is made on an individual basis based on clinical and radiographic factors. Typically, surgery is not urgent unless there is progression of the deformity, neurologic compromise, and pain unresponsive to conservative care.

Osteoporosis and Spine Fractures

Osteoporosis is a skeletal disorder in which bones become fragile and are more likely to break. If not prevented or treated, osteoporosis can progress painlessly until a bone breaks. These broken bones, called fractures, are most likely to occur in the hip, spine or wrist. Possible causes include hormonal imbalances, pregnancy, metabolic diseases, cancer, or in otherwise healthy people over age 60 to 65.

Twenty-eight million Americans are at risk for developing osteoporosis. Every year, there are 1.5 million new fractures in people who have soft bone caused by osteoporosis. Of these, 700,000 people annually sustain spine fractures, 300,000 hip fractures, 250,000 wrist fractures and 250,000 fractures of other bones, all as a result of osteoporosis. With 700,000 spine fractures a year, this translates to one compression fracture every 45 seconds. After a patient sustains their first compression fracture, the risk of an additional fracture goes up more than five fold.

Problems and Challenges

Problems Associated with Compression Fractures

When soft osteoporotic bone breaks, patients describe onset of significant back pain. Pain can be in the upper or lower back. When the fracture occurs, severe pain can cause a patient to be bedridden for a few weeks. If the vertebra collapses, a deformity forms in the back and the patient begins to hunch forward. This posture can lead to difficulty with breathing and digestion, problems standing up straight, increasing back pain, decreased ability to walk even medium distances, and an overall decrease in the quality of life. When the fracture settles and the patient begins to slouch forward, additional vertebrae are much more likely to fracture, increasing the problem and the hunching forward even further.

The Human Cost of Compression Fractures

The pain from a fractured vertebra causes a decrease in the level of activity. Patients describe the inability to be up and walking and performing daily activities. Often, depression sets in. Patients develop a lower self esteem as they become more reliant on others for their daily care. Anxiety is common as patients are concerned about their increasing dependence on others.

According to a 1998 study there is a significant decrease in the lung function in patients with thoracic or lumbar fractures. Each thoracic or upper back fracture causes a 9% loss of vital capacity of the lungs (Journal of American Respiratory Disease).

In a retrospective analysis of five-year survival rates done at the Mayo Clinic, patients with osteoporotic compression fractures of the vertebra were found to have a worse than expected survival rate for the five years following the fracture. This decrease in survival rate was found to be similar to those patients who sustained a hip fracture. The most common cause of premature death was pulmonary disease, emphysema and pneumonia.

Conservative Treatment

Non Operative Treatment of Spinal Fractures

The usual treatment for compression fractures has been management with pain medication. Narcotic pain medicines are used for a few months until the pain decreases. Pain from fractured bone can last from three months to more than a year, depending on the circumstances and the severity of the broken bone.

After the pain from the fracture improves, patients need to build up bone strength. A few medications are available to increase bone density. The treatment is slow and continues for years. It is the only treatment we have at this point to increase bone mass and therefore should be used by patients who are at risk for osteoporotic compression fractures, and those who have had fractures in the past. By building the bone density, we hope to prevent future fractures.

Immobilization of the spine with a brace can help decrease pain from broken vertebra. The most appropriate brace is a soft elastic waistband with Velcro straps. Sometimes metal strips or a plastic insert in used in the back of the brace for added support. The brace is only helpful for fractures of the lower back.