Don't ignore this kind of back pain! - Osteoporotic spinal compression fracture

This is the 3847th article of Da Yi Xiao Hu

Aunt Wang is 72 years old. A week ago, she felt her waist "twitched" while doing housework. Suddenly, she felt so painful that she couldn't move. Aunt Wang thought it must be a "slipped waist" and she would be fine after lying in bed for a few days. However, Aunt Wang, who was lying in bed, not only felt severe pain when turning over, getting up, and changing positions, but also had been unable to defecate for almost a week. Her bloated stomach was very uncomfortable and she had to use suppositories to relieve it a little. Aunt Wang's daughter had no choice but to send Aunt Wang to the community hospital. When Dr. Lu from the trauma department heard Aunt Wang's medical history and examined her body, he found that her waist was very painful. He told Aunt Wang's daughter that it was almost certain that Aunt Wang had osteoporotic spinal compression fracture and she had to go to a comprehensive hospital for systematic diagnosis and treatment.

Osteoporotic spinal compression fractures are a common osteoporotic fracture that occurs most frequently in postmenopausal women and elderly men. The National Osteoporosis Foundation reported in 2013 that one osteoporotic fracture occurs every three seconds worldwide, and approximately 50% of women and 20% of men will suffer osteoporotic fractures after the age of 50. Vertebral fractures have the highest incidence among osteoporotic fractures, which can seriously reduce the patient's life expectancy. The mortality and disability rates of long-term bed rest are extremely high.

Since the spine bears the "weight of the body", the pain often makes people bedridden. Most osteoporotic spinal compression fractures occur in the thoracic and lumbar spine, which is closely related to the mechanical structure of the spine. Osteoporotic spinal compression fractures may be induced by minor violent trauma, or even without an obvious history of trauma. The hunchback and height loss of the elderly are closely related to this. Some severe osteoporotic spinal compression fractures and severe spinal deformities can even cause nerve damage, which deserves my high attention!

X-rays are of great significance in imaging examinations, but early osteoporotic spinal compression fractures are often missed due to the lack of obvious vertebral height loss in X-rays, which delays the disease and causes it to worsen. Magnetic resonance imaging is an important means of diagnosing acute and chronic osteoporotic spinal compression fractures, and can assist in the diagnosis and treatment of osteoporotic spinal compression fractures.

During treatment, conservative treatment and surgical treatment need to be weighed. Pain relief, the use of braces (lumbar support or thoracolumbar support) and walking aids are essential. Bed rest is the most basic and important treatment. Random standing and moving will cause the fractured vertebra to deform more and more with the flexion stress and axial compression force, causing more serious consequences.

Percutaneous vertebroplasty is a revolutionary method for treating osteoporotic spinal compression fractures. It strengthens the vertebral body by injecting bone cement or artificial bone into the affected vertebral body. Since the 1990s, its minimally invasive and rapid-acting characteristics have greatly improved the quality of life of patients. At the same time, some severe osteoporotic spinal compression fractures that invade the spinal canal require surgical treatment with spinal canal decompression and pedicle screw fixation.

MRI revealed a new type of compression fracture of the third lumbar vertebra

Aunt Wang was diagnosed with a fracture of the third lumbar vertebra by magnetic resonance imaging. After comprehensive decision-making, she underwent percutaneous vertebroplasty at the Orthopedic Injury Center of Yueyang Hospital. The pain was significantly relieved immediately after the operation, and she was able to walk with a lumbar brace the next day. After this, the doctor told Aunt Wang to pay more attention to her osteoporosis and avoid falling, otherwise she might have another fracture.

X-ray images after percutaneous vertebroplasty

References:

Guidelines for the diagnosis and treatment of osteoporotic fractures Osteoporosis Group of the Chinese Medical Association Orthopedics Branch

Author: Yueyang Hospital of Integrated Traditional Chinese and Western Medicine affiliated to Shanghai University of Traditional Chinese Medicine

Feng Shengyi Li Bo

Quyang Road Community Health Service Center, Hongkou District, Shanghai

Acupuncture and Traumatology Lu Wenting