Thoracic Vertebral Compression Fracture

THE CLINICAL SYNDROME

Thoracic vertebral compression fracture is one of the most common causes of dorsal spine pain. Vertebral compression fracture is most often the result of osteoporosis of the dorsal spine. This is also associated with trauma to the dorsal spine due to acceleration/ deceleration injuries. In osteoporotic patients or in patients with primary tumors or metastic disease involving the thoracic vertebra, this may occur with coughing (tussive fractures) or spontaneously.

The pain and functional disability associated with fractured vertebra are determined in large part by the severity of injury (e.g., the number of vertebra involved) and the nature of the injury (e.g., whether the fracture allows impingement on the spinal nerves or the spinal cord itself). The severity of pain associated with thoracic vertebral compression fracture may range from a dull, deep ache with minimal compression of the vertebra without nerve impingement to severe sharp, stabbing pain that limits the patient’s ability to ambulate and cough.

SIGNS AND SYMPTOMS

Compression fractures of the thoracic vertebra are aggravated by deep inspiration, coughing, and any movement of the dorsal spine. Palpation of the affected vertebra may elicit pain and reflex spasm of the paraspinous musculature of the dorsal spine. If trauma has occurred, hematoma and ecchymosis overlying the fracture site may be present. If trauma has occurred, the clinician should be aware of the possibility of damage to the bony thorax and the intra-abdominal and intrathoracic contents. Damage to the spinal nerves may produce abdominal ileus and severe pain with resulting splinting of the paraspinous muscles of the dorsal spine, further compromising the patient’s ability to walk and pulmonary status. Failure to aggressively treat this pain and splinting may result in a negative cycle of hypoventilation, atelectasis, and ultimately pneumonia.

Osteoporosis is a common cause of thoracic vertebral fractures.

TREATMENT

The initial treatment of pain secondary to compression fracture of the thoracic spine should include a combination of simple analgesics and the nonsteroidal anti-inflammatory drugs or the cyclooxygenase-2 inhibitors. If these medications do not adequately control the patient’s symptomatology, short-acting potent opioid analgesics such as hydrocodone represents a reasonable next step. Because the opioid analgesics have the potential to suppress the cough reflex and respiration, the clinician must be careful to monitor the patient closely and to instruct the patient in adequate pulmonary toilet techniques.

The local application of heat and cold may also be beneficial to provide symptomatic relief of the pain of rib fracture. The use of an orthotic device (e.g., the Cash brace) may also help provide symptomatic relief. For patients who do not respond to these treatment modalities, thoracic epidural block with local anesthetic and steroid is a reasonable next step.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age –related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.