What symptoms should elderly people have to be alert to lumbar fractures? How to treat it?

Author: Tao Sheng, Chief Physician of the Eighth Medical Center of the General Hospital of the Chinese People's Liberation Army

Reviewer: Zhang Zhihai, Chief Physician, Guang'anmen Hospital, China Academy of Chinese Medical Sciences

Generally speaking, if elderly people over 65 years old experience back pain, especially after lifting heavy objects, lumbar fracture should be considered.

The incidence of osteoporosis is relatively high in people over 65 years old, especially in women after menopause. Osteoporosis can cause very minor fractures, such as slipping off a stool, coughing, or even carrying a basin of water, which can lead to a lumbar fracture.

Figure 1 Original copyright image, no permission to reprint

Therefore, we remind the elderly that once lumbar pain occurs, they should seek medical attention promptly, regardless of whether there is obvious trauma.

In clinical practice, many elderly people experience low back pain and think they have accidentally twisted their waist. The symptoms are relieved after resting, but the pain worsens after one to two months and they go to the hospital for treatment only when it becomes unbearable. At this time, they are often diagnosed with old fractures and the best time for treatment has been missed.

The fracture caused by osteoporosis is very minor. The first symptom is back pain. The second typical symptom is that the pain is most obvious when the body position changes. Whether it is from standing to sitting or from lying to standing, the pain will worsen during this process. Therefore, if the elderly have back pain, especially when the pain is significantly aggravated when the body position changes, they should be highly alert to lumbar fractures and seek medical attention in time.

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For the elderly, fractures caused by osteoporosis are mild violent fractures with mild compression of the vertebrae, which rarely involve the nerves and spinal cord, and therefore rarely cause paralysis or symptoms of lower limb nerve compression.

Lumbar fractures caused by osteoporosis in the elderly are likely to cause malformation if internal fixation is not performed for unstable fractures. It is very difficult to perform surgery after malformation, so in this case, surgical treatment is generally chosen. For compression fractures caused by osteoporosis, especially for people over 80 years old, doctors often recommend more aggressive surgical treatment. There is evidence that the mortality rate of elderly people who stay in bed for more than 3 weeks is 30%-50%. Especially for those with poor basic physical conditions, such as diabetes, heart disease, and poor lung function, staying in bed for more than 3 weeks will cause a series of complications, such as urinary tract infection, venous thrombosis, pulmonary embolism, etc., which can be life-threatening. In contrast, the mortality rate of surgical treatment is lower. For example, during vertebroplasty, death rarely occurs.

In addition, for lumbar fractures caused by osteoporosis, you cannot just treat the fracture, you must also treat osteoporosis at the same time. Osteoporosis treatment is divided into two categories: one is basic treatment, which is calcium tablets plus vitamin D; the other is anti-osteoporosis treatment, which includes oral medications, subcutaneous injections, and intravenous injections. Listen to the doctor's advice and choose the appropriate medication according to your own situation. Both basic treatment and anti-osteoporosis treatment are long-term treatment processes. Anti-osteoporosis treatment should be performed before and after fracture treatment, especially after fracture. Literature statistics show that the incidence of re-fractures in spinal fractures caused by osteoporosis is 30% higher than that in osteoporosis patients who have not had a fracture, so anti-osteoporosis treatment is very necessary.

There are two surgical options for lumbar fractures caused by osteoporosis, one is open surgery and the other is closed surgery.

The most common closed surgery is vertebroplasty, which can solve more than 90% of patients. Vertebroplasty includes balloon dilatation and bone cement injection. Injection of bone cement means injecting liquid semi-paste cement into the fractured vertebral body through a syringe or other methods before the cement solidifies, so that it is evenly distributed. Generally, it will solidify after 20 minutes and can play a supporting role. Although the bone has not healed, it is full of solid cement and can be walked on the ground.

Open surgery is mainly used for cases where the fracture fragments are large and compress the cauda equina nerve. Minimally invasive surgery cannot solve the problem and open surgery is necessary for decompression. After decompression, if the vertebral body is severely crushed and unstable, it must be fixed with nails. However, since the patient has osteoporosis, the bone is too porous to be fixed firmly with nails alone. Therefore, before or at the same time as the nail is driven in, bone cement is used to fill the space around the nail to enhance its fixation strength.