Short stature may be related to this disease

Osteoporotic vertebral compression fractures refer to fractures caused by osteoporosis that result in decreased vertebral bone density and bone quality, and decreased bone strength. They occur under the action of slight or even no obvious external force. They are the most common type of osteoporotic fractures (brittle fractures). Clinically, they are mainly manifested by chest/lumbar and back pain, with or without lower limb neurological symptoms.

Osteoporosis is the fourth largest chronic disease in my country. It is not a "physiological phenomenon of aging". It is a chronic disease that can be prevented, treated and controlled. To use a vivid metaphor, human bones are like the trunk of a tree. When the trunk is hollowed out by insects, the tree will break by itself or by the wind.

What are the symptoms of spinal fragility fractures?

1. Symptoms:

(1) Pain in the lower back; (2) Other clinical manifestations: In some patients with thoracolumbar compression fractures, the chest volume decreases and the vital capacity decreases, resulting in significant limitation of lung function. In some patients, the kyphosis of the spine worsens, increasing the pressure of the ribs on the abdomen, causing the patient to feel full and lose appetite. Some patients also experience increased lumbar lordosis, spinal stenosis, lumbar spondylolisthesis, etc.

⒉Signs:

(1) Tenderness and percussion pain in the back and waist: After a fracture, the tenderness of acute back pain in patients is usually at the spinous process. Patients may also have thoracolumbar kyphosis/scoliosis, which may progressively worsen. (2) Spinal kyphosis: Severe vertebral compression fractures, especially multiple vertebral fractures, can cause spinal kyphosis, and patients may develop hunchbacks and become shorter. (3) Signs of neurological damage: Generally, there is no neurological damage, but if the fracture is severe, there may also be neurological damage such as decreased lower limb sensation, weakened muscle strength, and changes in reflexes.

How are fragility fractures of the spine treated? Is surgery necessary?

The principles of treatment are reduction, fixation, functional exercise and anti-osteoporosis treatment.

The treatment of fractures should be determined according to the patient's age, complications, and degree of osteoporosis, with the main principle being to relieve pain and restore the patient's functional activities as soon as possible. Fractures are more common in middle-aged and elderly people, and reduction and fixation should be based on the principle of simple, safe and effective methods, with the goal of restoring normal quality of life as soon as possible; methods with less trauma and less impact on function should be selected as much as possible, with an emphasis on functional recovery.

While symptom control and rehabilitation treatment are being performed, attention should also be paid to the treatment of osteoporosis itself. Whether conservative treatment or surgical treatment, it must be combined with anti-osteoporosis treatment to fundamentally increase bone mass and bone strength and avoid re-fracture.

Treatment of osteoporosis. The pathological basis of osteoporotic vertebral compression fractures is osteoporosis. After the fracture, standardized anti-osteoporosis drug treatment (such as calcitonin, etc.) should be actively adopted to relieve pain, inhibit acute bone loss, increase bone strength, improve bone quality, and reduce re-fracture.

1. Non-surgical treatment:

(1) Purpose: to relieve pain, resume activities early, and maintain spinal stability;

(2) Indications: Suitable for patients with mild symptoms, mild vertebral compression fractures shown by imaging examinations, no nerve compression, no impaired stability or inability to tolerate surgery. For acute analgesia of osteoporotic vertebral compression fractures, oral analgesics can be used as the first choice and progressive treatment can be carried out according to the World Health Organization (WHO) analgesia ladder. Calcitonin can also be considered in combination. After pain control, appropriate early bed activities can be considered under the protection of a spinal brace. If conservative treatment is unsatisfactory, fracture healing is poor, leading to pseudoarthrosis, further collapse of the vertebral body, spinal deformity or even spinal cord compression (such as paraplegia), persistent pain, limited daily activities, and decreased quality of life, surgical treatment should be considered in a timely manner.

⒉Surgery:

(1) Minimally invasive surgery;

(2) Open surgery.

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Professor Xu Wei is an associate chief physician and doctor of medicine at the Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine. He is a visiting scholar at the University of California, USA; an "Outstanding Young Scholar" in the Shanghai Health and Family Planning System; and a senior research scholar in the Overseas Visiting Program for Young and Middle-aged Teachers in Shanghai Universities.
Member of North American Society of Spine Surgeons (NASS)

Secretary and member of the Traumatology Group of the Spine Committee of the Shanghai Association of Integrated Traditional Chinese and Western Medicine

Member of the Deformity Group of the Spine Committee of the Shanghai Association of Integrated Traditional Chinese and Western Medicine

Member of the Clinical Research Promotion Committee of the Chinese Medical Education Association

In the past five years, the first applicant applied for five national patents and obtained authorization for three of them.

In the past five years, he has published more than 20 SCI papers as the first or corresponding author, with a total impact factor of 80.