Treatment of compression fracture of the spine and rehabilitation. Compression fracture of the thoracic spine

Olga:

Compression fracture spine T12. Loss of sensation in the legs. Is rehabilitation possible and how long will it take to recover?

Doctor's answer:

It all depends on the degree of fracture and the results of electroneuromyography, which shows the percentage of loss of conduction in the nerve endings, the lower the percentage, the faster the recovery. Rehabilitation activities very effective, try to use them as much as possible.

Olga:

Such studies have not been carried out, in Kazakhstan clinics there is no equipment for full inspection, doctors shrug their shoulders. No sensation from the knees, and weak above the knees. Please tell me which exercises are the most effective. The legs react to the cold, that is, when touched by the cold, the leg twitches. But it does not feel.

Doctor's answer:

At home, exercises can be done on the foot sewing machine or connect 2 plates of chipboard, connect with a spring, lying on your back, “turn the bike”, walking. In parallel, you need to take a complex of vitamins of group B, neuromidin, nucleo cmph or keltikan. These drugs will improve neuromuscular transmission, nourish the nerves and improve sensitivity. You have all the prerequisites for recovery, be patient and get better.

Pain in thoracic region spine is a type of pain that is felt in the region of the thoracic vertebrae, located between the cervical and lumbar vertebrae. Pain in the thoracic region can be caused by a wide range of reasons, whether it is a banal sprain, vertebral collapse or other serious pathology.

Features of the anatomy of the thoracic spine

The thoracic spine consists of 12 vertebrae. First thoracic vertebra designated as T1 (T - lat. thoracic, chest), and the latter, respectively, as T12. Whereas the cervical spine provides body mobility (such as turning the head) and the lumbar provides mobility and strength (such as lifting heavy objects and turning the torso), the thoracic spine provides stability. This stability plays important role in maintaining a straight body position, and also protects the vital important organs located in the chest.

There are several features of the thoracic spine that separate it from the lumbar and cervical regions:

  • Limited mobility. The thorax is connected to each level of the thoracic spine. Each rib is attached to one side of the vertebra, and the paired rib is attached to the other. The ribs attached to the T1-T10 vertebrae are also attached to the ribcage or sternum. Thus, the thoracic spine and chest together form a powerful frame that provides stability and protects the heart, lungs, liver and other vital organs from injury.
  • The ribs attached to the T11 and T12 vertebrae, located at the very bottom of the thoracic spine, are not attached to the sternum, but they do protect the kidneys from damage. Since T11 and T12 levels are less stable, they are more prone to problems that can cause pain in the thoracic spine;
  • More subtle intervertebral discs. Between the vertebrae are intervertebral discs - spongy pads that act as a shock absorber. The thoracic spine is thinner than the cervical and lumbar spine, which makes the thoracic spine even less flexible;
  • Narrower spinal canal. The cervical and thoracic spine form a protected hollow canal, inside which is located spinal cord. This canal is narrowest in the thoracic region, so with injuries to the thoracic spine, the risk of spinal cord injury is higher.

Causes

The thoracic spine is a complex structure made up of bones, connective tissue, nerves, muscles, vertebral segments and joints. Although the thoracic region is firm and relatively stable, it can also be a source of pain.

muscle problems

Pain in the thoracic region is most often associated with irritation or muscle tension. This condition is called myofascial pain. It can be caused by poor posture or any other cause that causes muscle fatigue.

Joint dysfunction

Another cause of pain in the thoracic spine is dysfunction of the joints that attach the ribs to the spine.

Herniated discs or degeneration of the intervertebral discs

Even though the hernia intervertebral discs occurs in the thoracic spine much less frequently than in the cervical and lumbar, it can also become a source of constant pain.

Spondylarthrosis

With an increase in the phenomena of osteochondrosis in the thoracic spine, pain, nerve compression and a decrease in the range of motion may appear. Often, as a result of wear, the cartilage in the facet joints becomes thinner, disappears altogether, or produces overgrowth. bone tissue and joint enlargement.

spine fracture

Compression fracture due to osteoporosis is the most common cause pain in the thoracic spine in the elderly over 80 years of age. Although compression fractures can occur anywhere in the spine, they usually occur in the lower thoracic region (T9-T12).

Kyphosis (hump)

In addition to a spinal fracture, kyphosis can also be caused by a variety of factors, such as poor posture or curvature of the spine in Bechterew's disease or Scheuermann's disease. Despite the fact that kyphosis is primarily a deformity, it can also be a source of pain symptoms.

Scoliosis

Scoliosis is a condition in which there is a lateral curvature of the spine. Scoliosis can also cause pain in the thoracic spine.

Symptoms

Symptoms of pain in the thoracic spine depend on the condition or disease that led to the appearance of pain symptoms.

Pain in the thoracic spine more often than pain in the cervical and lumbar can be caused by a serious pathology. However, in most patients, pain in the thoracic spine has a mechanical cause.

Alarming factors suggesting a possible serious pathology are:

  • a recent serious injury (for example, resulting from an accident or a fall from a height);
  • minor trauma in people with osteoporosis;
  • age less than 20 or more than 50 years;
  • a history of cancer, HIV, immunosuppressant drug use, or long-term use of corticosteroids;
  • fever, fever, chills, unexplained weight loss;
  • recent bacterial infection;
  • pain that:
    * constant, strong and progressive
    * non-mechanical, no relief after rest or posture change
    *does not go away despite treatment for 2-4 weeks
    *accompanied by severe stiffness in the morning ( rheumatoid arthritis or ankylosing spondylitis);
  • structural deformation;
  • severe or progressive neurological deficit in lower limbs.

Intervertebral hernia of the thoracic spine

  • The pain is localized in the spine and/or spreads along the corresponding dermatome;
  • Sensitivity disorders:
    a) a violation of sensitivity may appear in the area of ​​the dermatome;
    b) a wider distribution of sensory impairment is combined with myelopathy as a result of spinal cord compression.
  • Weakness:
    a) rarely occurs at the onset of the disease;
    b) weakness in the lower extremities may indicate spinal cord compression;
    c) impaired control of urination and/or defecation may indicate spinal cord compression or myelopathy.

To make a diagnosis of intervertebral hernia of the thoracic spine, the patient needs to undergo magnetic resonance imaging (MRI). This survey is the most informative for the attending physician, since only with its help it is possible to most fully assess the condition of the spine. The magnetic flux voltage M R T-device should be from 1 to 1.5 Tesla. With the help of the obtained images, the attending vertebrologist will be able to prescribe the necessary treatment.

Surgery intervertebral hernia of the thoracic spine can lead to a number of severe complications associated with spinal cord injury.

Differential Diagnosis

Diseases of the lungs (including Pancoast tumor), esophagus, stomach, liver, gallbladder, and pancreas can cause referred pain in the interscapular region.

Pain in the interscapular region may occur as a result of an intervertebral hernia or dysfunction of the cervical or thoracic spine.

Complications

Pain in the thoracic spine can significantly reduce the quality of life.

Treatment

In most cases, pain in the thoracic spine resolves without any treatment. Treatment chronic pain directly depends on the cause.

Pain in the thoracic spine caused by spondylarthrosis, spondylosis, intervertebral hernias and protrusions responds well to complex treatment spine, including load-free traction of the spine. Since the thoracic region is the most immobile part of the spine, the patient is recommended to do special exercises 2 times a day and limit static postures and weight lifting at work and at home. In general, conservative treatment gives excellent results.

Surgical treatment of symptomatic herniated discs of the thoracic spine is associated with significant serious health consequences.

For conservative (non-surgical) treatment intervertebral hernias of the thoracic spine, such techniques as load-free traction of the spine, manual massages, vacuum massage, special physiotherapy, acupuncture, etc. The patient is advised to observe a certain regimen of the day, not to overwork.

Forecast

The prognosis of pain in the thoracic spine depends on the cause and the specific circumstances in which the person is located.

Currently, a universal classification of injuries of the thoracic and lumbar spine has been developed (F. Magerl et al., 1994), based on pathomorphological criteria. The same classification can be used to a certain extent for injuries of the cervical region.

In accordance with the main mechanisms of damage, and also taking into account the aspects of predicting the possibility of a cure, they distinguish three types of damage- A, B and C. Each type includes three subtypes, each of which in turn contains three subgroups of injuries with some features of damage to the vertebrae. All types have a basic structure of damage, which is determined by three main mechanisms that affect the spine: compression, distraction, and axial torsion (Fig. 3).

For ease of understanding, we will consider three main types of injuries of the spine and spinal cord, which are of primary importance for the choice of treatment tactics (subtypes and subgroups include various options injuries within the same type and do not affect the choice of surgical tactics).

Rice. 3. Scheme of the three main mechanisms of spinal injury

Type "A" based on different schemes vertebral body compression injury. It is most common in catatrauma, diving, or when a heavy object is dropped on the head (Fig. 4).

Rice. 4. Compression fractures of the vertebrae:

a - CT scan of the cervical spine, sagittal section: compression unstable fracture of the C7 vertebral body, its arches and spinous process with the introduction of bone fragments into the lumen spinal canal and kyphotic deformity of the spinal column at this level (arrow), fracture of the spinous process of the C6 vertebra; b - CT scan of the cervical spine, sagittal section: unstable compression fracture of the C6 vertebral body with the introduction of bone fragments into the lumen of the spinal canal; c - CT scan of the thoracic spine, sagittal section; d - CT scan of the thoracic spine in 3D reconstruction of patient M. with a compression unstable fracture of the T12 vertebra, a fracture of the spinous process of the T11 vertebra

Type "B" characterized anterior or posterior transverse rupture of the anterior and posterior elements of the spine and its variants (interarticular, supra- and interspinous, posterior, anterior longitudinal), discs, vertebral bodies. Ruptures of ligaments and vertebrae occur, as a rule, with a sharp flexion / extension of the neck, torso (for car passengers during a sharp stop or acceleration, falling on the shoulders) (Fig. 5).

Rice. 5. Distraction fractures of the vertebrae:

a - X-ray of the cervical spine in the lateral projection: fracture of the tops of the superior articular processes of the C6 vertebra, a significant increase in the distance between the spinous processes of the C5-6 vertebrae (rupture of the interspinous ligament) and anterior bilateral overturning interlocking dislocation of the C5 vertebra (arrow);

b - CT scan of the cervical spine, sagittal section: complete dislocation of the C5 vertebral body into the lumen of the spinal canal (arrow), indirect signs fractures of the C4, C5 vertebral arches (an increase in the distance between the posterior sections of the vertebral bodies and these spinous processes; c - CT scan of the lumbar spine, sagittal section: sliding anterior dislocation of the L4 vertebra, indirect signs of rupture of the L4-5 disc, stable compression fracture of the L5 vertebral body.

Type "C" (damage to the anterior and posterior elements with rotation) - injuries received due to axial twist. Damage of the last type very often overlaps damage of the first two types. Such a mechanism of injury happens to passengers when the car rolls over onto the roof, when falling from a height, and beating. With this mechanism of injury, dislocations of the vertebrae, fractures of the articular processes and arches, disc ruptures, and asymmetric compression of the vertebral bodies occur (Fig. 6). This is the most severe type of vertebral injury.

The severity of damage increases both from type "A" to type "C", and within each type and subgroup.

The cornerstone in orthopedics and spine surgery is the concept fracture stability. Stable injury refers to the ability of a damaged organ to perform its physiological loads. An unstable spinal injury means that the patient cannot perform daily activities without the risk of orthopedic or neurological complications.

To determine the stability and instability of a fracture of the spine, F. Denis (1983) created a classification based on the concept of a triple mechanical column (Fig. 7) . The anterior column refers to the anterior 2/3 of the vertebral body and disc and the anterior longitudinal ligament. The middle column is the posterior 1/3 of the vertebral body and its disc and the posterior longitudinal ligament. The posterior column is all the bone-ligamentous structures located behind the posterior longitudinal ligament and the roots of the arches.

Rice. 6. Rotational mechanism of damage to the spinal column:

a - scheme; b - photograph of the preparation of an interlocking dislocation of the C6 vertebra - the lower articular process of the C6 vertebra is in front of the superior articular process of the C7 vertebra - in the intervertebral foramen (images provided by Dr. Wolfgang Rauschning);

c - MRI of the cervical spine in the sagittal projection and T2-weighted image: complete anterior dislocation of the C6 vertebral body (spondyloptosis, indicated by the arrow), compression fracture of the upper anterior edge of the C7 vertebra, spinal cord compression;

d - CT scan of the lumbar spine in sagittal reconstruction: complete destruction of the body of the L1 vertebra with occlusion of the lumen of the spinal canal by bone fragments and violation of the axis of the spine;

e - direct X-ray of the lower thoracic and upper lumbar spine: unstable fracture-dislocation of the T12 vertebra in the consolidation stage with violation of the spinal axis in the frontal plane (arrows)

Taking into account the classification of F. Denis and the Chicago classification, taking into account the degree of angular deformation of the spinal column, the degree of narrowing of the spinal canal and the amount of displacement of the vertebrae, the algorithm of surgical tactics for vertebral fractures and spinal cord injury is determined:

1. The number of damaged columns (if the middle column or two columns are damaged, the spine is considered unstable and requires mandatory stabilization).

2. If the vertebrae are mixed more than 25%, stabilization is necessary.

3. If the angular deformity of the vertebra is more than 11° in cervical region, 40° - in the chest and 25° - in lumbar spinal stabilization is indicated.

4. If the spinal canal is narrowed by more than 25%, decompression is indicated (for large values ​​- high risk development of neurological disorders).

5. If the height of the vertebral body is reduced by more than 50% (calculated by the overlying vertebra), stabilization is also necessary, since in late period there is a high risk of developing neurological disorders.

Rice. 7. Determination of the stability of the spinal column according to F. Denis:

a - diagram of three columns (explanation in the text); b - scheme of a stable compression fracture of a vertebra, type A1, only the anterior column is damaged; c - scheme of an unstable compression fracture of a vertebra with damage to the anterior and middle columns and the introduction of bone fragments into the lumen of the spinal canal, type A3

Krylov V.V., Grin A.L. Traumatic disease of the spinal cord. Etiology and pathogenesis, clinical picture of spinal cord injury. Surgical treatment of injuries of the spine and spinal cord// Rehabilitation of patients with traumatic illness spinal cord / Under the total. ed. G.E. Ivanova, V.V. Krylova, M.B. Tsykunova, B.A. Polyaev. - M.: JSC "Moscow Textbooks and Cartolithography", 2010. - 640 p. pp. 14-19.

The growth in the number of playgrounds, various inflatable attractions, has radically changed the nature of the injuries received. Previously, doctors had to treat patients with fractures of the legs, arms, indentation of the skull, and today compression fractures of the spine are leading.

In a separate line are injuries received on the playground, and behind them are all the rest - from accidents, falls from a height, landing on the "fifth point", lifting weights.

The mechanism of obtaining fractures has changed. Until recently, it was believed that after a direct blow, the vertebrae are compressed. As a result of deformation, they take the form of a wedge. Most often, the elements of the lumbar and thoracic spine are affected. And now you can get injured by simply falling unsuccessfully on your back or flat on your face.

Perhaps the reason lies in the peculiarities of modern nutrition, the lack of nutrients.

Sometimes a fracture reports itself after some time. After the fall, the person rises, goes home. But then the pain returns, accompanied by limitation of movement and other symptoms.

Compression fracture, what is it? This name is given to damage to the vertebrae as a result of strong compression, when their height decreases. They literally flatten, their body cracks. This happens when the spine flexes and contracts at the same time.

In medicine, the disease has its own alphanumeric designation - microbial code 10. This is done on purpose to facilitate the work with documents. The code has several options, depending on the damage to individual vertebrae or components.

The main causes of such fractures are:

  • traffic accidents, accidents;
  • diving into a shallow body of water and hitting its head against its bottom;
  • landing while jumping on straight legs;
  • falling on the back of a heavy object.

Trauma is associated with the risk of damage to the spinal cord by fragments of the vertebrae, which leads, as is known, to paralysis.

Compression fracture of the lumbar spine

The vertebrae 11 and 12 most often suffer from fractures, because they experience strong pressure.

According to the strength of the deformation, compression fractures are divided into three types:

  1. Fractures of the 1st degree are characterized by a change in the height of the vertebrae by less than half.
  2. With a fracture of the 2nd degree, the vertebral body is flattened twice.
  3. A grade 3 fracture means a decrease in height of more than 50%.

Self-medication or complete inactivity can cause backfire in the form of deformation of the spinal column, injury to nerve endings. When a damaged vertebra presses on the nerve roots, destroys the soft cartilage tissue disk, then osteochondrosis may develop.

Video:

Symptoms of a fracture in the lumbosacral region (damage group code S32):

  • a sign of a compression fracture is pain in the back and limbs, it gradually increases;
  • the head begins to spin, the person quickly gets tired, becomes weakened;
  • there is increased compression of the spinal cord.

Treatment should begin immediately after the first signs of the disease appear. Consult a doctor who will prescribe a course of medical procedures.

Most often, a positive effect is achieved through the use of conservative techniques: the use orthopedic corset for fixation of the spine, new methods of building up the vertebral body - kyphoplasty, vertebroplasty.

Rehabilitation is considered an important stage of recovery after treatment. The entire outcome of treatment depends on its successful completion.

Main medical method with compression of the vertebrae is exercise therapy complex, which strengthens the muscles, preparing them for active movement. The correct formation of the muscular corset is the key to successful restoration of the vertebrae.

Gymnastics must be included in any rehabilitation program.

Exercises are selected by the doctor based on the patient's condition and the complexity of the fracture. Most of the exercises are performed while lying on your back. Turns are made on the stomach, practiced correct breathing. Initially, it is forbidden to raise the legs with the heels off the bed. Then the movements gradually become more complicated, their number and intensity increase.

Compression fracture of the thoracic spine

This type of fracture ranks second after the lumbar. The first vertebra is most severely damaged, and then the rest. The cause is a variety of injuries - domestic, industrial, accidents, sports,.

Symptoms of fractures of the thoracic vertebrae (group code S22):

  • Visually determined spinal deformity;
  • The muscular frame is tense;
  • A person experiences pain, shortness of breath, weakness, numbness of the hands;
  • Difficulty moving the spine.

According to the strength of the damage, fractures of the thoracic vertebrae are also divided into three degrees of deformation. The easiest way to manage fractures related to 1 degree. They are hard to spot, but they can have serious consequences in the form of radiculitis or osteochondrosis.

The danger is fragments of the vertebrae, which easily affect nearby tissues and the spinal cord, which leads to numbness of the limbs, reduced sensitivity. Curvature may also occur chest with a hump on the back.

With the destruction of the vertebrae of the thoracic region of a person, it is necessary to immobilize immediately so that the bone fragments do not have time to move. The patient should be placed on the stretcher slowly, as carefully as possible. The surface should be hard, a roller is placed under the lower back. After that, you can give the person pain medication.

The course of treatment is chosen after a thorough diagnosis of the patient's condition. The procedures are carried out in the clinic under the supervision of an instructor.

Rehabilitation is carried out using special equipment. It is designed to eliminate the deformation of the spine, ensure blood flow to diseased tissues, restore flexibility and mobility to the back.

Physical therapy is mandatory. Recovery exercises can be done at home, but when a specialist is nearby, they will be more effective. The gymnastic complex is aimed at normalizing breathing, improving the work of the muscular corset, and preparing for loads in a vertical position.

Compression fracture of the spine in children

The main cause of injury to children is neglect on the part of parents, their inattention to their own children - where they are, what they do.

Treatment and recovery after injury to the vertebrae help physiotherapy, massage, physiotherapy, swimming.

How to determine if a child has a compression fracture? Ate the baby fell, complains about severe pain then there is no need to panic. Lay the child on his back, ask him to inhale through the nose and exhale through the mouth several times. This is necessary to normalize breathing. If you notice a spasm respiratory organs, then this will be the first sign of a fracture of the vertebrae.

If the child can move his legs, arms, hear you, react to your words, then everything is fine. Pick it up carefully and take it home. When children cannot get up, do not force them, but immediately call an ambulance.

Say that the child is injured while walking on the street. For doctors, this will be a signal that it is necessary to arrive promptly. If, after undergoing a tomography, violations are detected, then the fracture will be treated immediately.

And in general, it will never be superfluous to show the child after an unsuccessful fall to the traumatologist. You never know ... delay in treatment will turn into prolonged treatment and subsequent rehabilitation.

If the damage is small, then the symptoms may be hidden. It is possible to determine the presence of a compression fracture through a thorough diagnosis. On palpation, you can feel the sore spot. After pressing on the head or area of ​​the forearms, the child will experience pain due to the damaged vertebra.

More complex injuries of the thoracic region limit movement, make breathing difficult, and are accompanied by girdle pain in the abdomen. If at the same time several vertebrae are damaged, then a corset is prescribed. During treatment, children are prescribed bed rest in order to relieve the spine as much as possible.

A growing body quickly returns to normal after a fracture, tissues grow quickly, and rehabilitation is successful. Complicated cases are treated with surgical minimally invasive methods. Injuries in children can have their own consequences - the development or, osteochondrosis. Therefore, the condition of an injured child is monitored by doctors for two years.

In the elderly

With age, in the absence of optimal physical activity the process of demineralization of bone tissue begins. Due to a deficiency of magnesium, calcium and other elements, in older people the bones become brittle and brittle. This condition inevitably increases the likelihood of spinal compression.

Sometimes a person manages to earn 5-6 compression fractures of the spine at the same time. His spinal column folds like a deck of cards. In this case, axial loads should be avoided.

After 70, osteoporosis contributes to the destruction of the vertebrae, a hump begins to form as a result of kyphotic curvature. Tumors, coupled with metastases, put pressure on the spine, which is damaged over time. Treatment should be started on time to avoid complications associated with spinal cord injury.

In old people pain syndrome does not appear immediately, but increases over time, gradually. A person immediately suspects that he has compression. He continues to live, actively move, as if nothing had happened, and this leads to vascular damage, nerve fibers. At a later stage, the state of health begins to deteriorate, the ability to work decreases, weakness appears - this is a symptomatology of a compression fracture.

The doctor prescribes treatment after examining the symptoms of the disease. big picture damage helps to make x-rays in different projections. More accurate diagnosis allows for computed tomography.

How to treat a fracture

For such diseases, medicine provides a whole range of procedures. Not only the cause of the disease itself is treated, but also the pathologies that accompany it. It is usually recommended to take painkillers, anti-inflammatory drugs, chondroprotectors and conservative physiotherapy. The vertebrae are fixed in the correct position with the help of corsets. At the same time, osteoporosis is treated.

Upon completion of the main course, you will have to take a long time vitamin complex to nourish the bones beneficial substances. Daily gymnastics helps to return to the usual rhythm of life.

If a conservative methods do not help, there is a threat to the health of the patient, surgical intervention in order to fix the vertebrae and return them to their original shape. In modern ways elimination of compression are kyphoplasty and vertebroplasty.

A number of tips will help you not to put yourself in danger of getting a compression fracture of the spine:

  1. Exercise caution at home, at the workplace, during outdoor recreation;
  2. Try not to violate traffic rules on the road;
  3. Eat right, especially in old age, eat less fried, salty;
  4. Strengthen your back muscles with regular gymnastic exercises;
  5. Treat inflammations, tumors, tuberculosis of bones in a timely manner.