What Is a Vertebral Compression Fracture?

According to the shape of the fracture line, the fractures are divided into: fracture fractures, subperiosteal fractures, green branch fractures, tear fractures, transverse fractures, oblique fractures, spiral fractures, comminuted fractures (fractured pieces are broken into more than three pieces, which is called comminuted Fractures), impact fractures, depression fractures, compression fractures. Compression fractures are a type of fracture.

Compression fracture

Damage to the integrity and / or continuity of the bone is called a fracture. Different types of fractures have different treatments.

Compression fracture

Lumbar vertebral compression fractures are one of the common spinal injuries in the elderly. Because most fractures are relatively stable, conservative treatment can be used. The clinical treatment is mainly lying on the hard bed brake, cushioning the injured back, and stretching the back of the waist. In order to promote the recovery of the injured, the sick elderly should carry out timely rehabilitation exercises under the guidance of a doctor.

Recovery of patients with compression fractures

Generally within 3 months after the injury, it belongs to the healing period, and the patients are mainly bedridden. Rehabilitation exercises should be started as soon as possible and can be performed 1-2 days after injury to increase lumbar and back muscle strength and restore spine stability. The five-point support method can be used for lower back muscle training, that is, the patient takes a supine position, uses the head, elbows, and feet to support the body. Stretching, head and chest back, straightening the abdomen, or straightening and lowering the lower limbs, patients with good constitution can also extend the upper and lower limbs at the same time, showing an arc shape. It is worth noting that this is the healing period of the bones. To avoid spinal forward flexion, it is not appropriate to stand upright prematurely, so as not to increase the deformation of the fractured vertebral body and affect the healing of the fracture.

Patients should pay attention to the activities of the joints of the limbs while performing waist exercises to prevent wasteful muscle atrophy of the limbs, joint contracture and bone decalcification. Rhythmic movement of the joints of the lower limbs can promote blood circulation and prevent thrombosis of the lower limbs. Patients should also strengthen respiratory function exercises to maintain normal lung function. Commonly used methods are deep breathing, lip shrinking breathing (such as whistling) and so on.

The recovery period was entered 3 months after the injury. Patients should continue to strengthen low back muscle exercises to prevent low back pain. At the same time doing spine flexibility and flexibility exercises, patients can ride on a gymnastic bench to bend the spine in all directions to prevent the spinal joints from replacing the waist. Back muscle enhancement training can be performed in conjunction with appropriate abs training (such as sit-ups).

Compression fracture

Signal changes of vertebral malignant compression fractures: Compression vertebral signals are mostly diffuse low signals on T1WI (spin echo sequence), equal or high signals on T2WI, and lipid phase (short-term reverse recovery sequence or T2WI There is a high signal on fat pressure, and this signal change can be uniform or non-uniform. Gd-DTPA can show uneven abnormal enhancement of the lesion [1, 2]. Sometimes there are focal irregular low-signal lesions in the vertebra and normal bone marrow signals are present. This may be that only part of the bone marrow in the vertebra is replaced by abnormal tissue, but it is rare. Similar signal changes can occur when adjacent uncompressed vertebral bodies and accessories are violated, and the intervertebral space is normal.

It is generally believed that the morphological features of malignant compression fractures on MRI are: compression of the vertebral body is flattened, the posterior margin of the cortex is curved or spherical, the pedicle is invaded, the epidural and spinal canal soft tissue Mass formation. According to a group of cases observed by the author, the sensitivity of the epidural soft tissue mass to the diagnosis of malignant compression fracture is 81% and the specificity is 100%. The posterior edge of the vertebral body was curved or spherical and the pedicle was invaded by 75%, 92%, 82%, and 94%, respectively.

Benign compression fracture

Signal changes in vertebral bodies of benign compression fractures vary with fracture time. Taking osteoporotic compression fractures as an example, the typical manifestations on T1WI in the acute phase are: focal low-signal shadows are present near the compression vertebral endplate fracture, and the size is not in the first 2 to 4 months. The signal on the contralateral side is normal. The signal on the T2WI shows that the signal of the compressed vertebra is basically the same as that of the adjacent normal vertebra. A linear low-signal shadow can be seen below the endplate, which is caused by the fracture line or the trabecular bone embedded in each other. The enhanced scan shows that the compressed vertebral body is partially or completely the same as the adjacent normal vertebral body; there is a focal linear or triangular high signal shadow near the endplate fracture on the fat-pressing (short-term reversal recovery or T2WI fat-pressing) sequence. Called fluid sign, this is a feature of acute or subacute osteoporotic compression fractures, which is rare in malignant compression fractures.

There is a morphological change of the compressed vertebral body, which has a high specificity for the diagnosis of benign compression fractures, that is, the posterior superior angle of the vertebral body is shifted backward to the spinal canal, which can basically reach 100%, but it is rare. Vertebral osteoporotic compression fractures usually have no signs of pedicle involvement and no epidural mass formation. The chronic vertebral compression signals are mostly normal on T1WI and T2WI images, and sometimes localized low signals can be seen, but the rest of the signals are normal. Enhancement scans show slightly uneven enhancement.

In addition, osteoporotic compression fractures are sometimes seen on plain films with fissure-like vacuum signs in the compressed vertebrae. This is due to ischemic necrosis of the bone below the endplate. This sign can indicate benign lesions, and in MRI, The performance on the T1WI is low signal; the signal on T2WI varies with the patient's supine time. When the patient is lying on the T2WI scan immediately, it shows a low signal, and the delayed scan has a high signal shadow. This signal The change may be caused by the slow influx of fluid after the patient is lying flat, which causes the signal to change.

Multiple vertebral compression fractures do not suggest benign or malignant lesions. It is not uncommon to have both benign and malignant compression fractures in the same patient. Therefore, when observing multiple vertebral compression fractures, each vertebra should be analyzed one by one for its morphological and pathological changes. Perform diagnosis and differential diagnosis one by one.

MRI MRI imaging sequence of compression fracture

Although common imaging sequences (T1WI and T2WI fast spin echo) can generally identify benign and malignant vertebral compression fractures, the role of T2WI (non-lipid compression) sequence in identifying vertebral trauma and compression fractures caused by metastases It's very limited. The fat-pressing (short-term reversal recovery and T2WI fat-pressing) sequence can enhance the signal comparison between normal bone marrow and diseased tissue, and it is more helpful to display the diseased tissue. Therefore, the above-mentioned imaging sequence is generally used as a routine. At present, some new imaging technologies such as dynamic enhanced scanning and diffusion weighting have been used to identify benign and malignant compression fractures of the vertebral body. However, due to the lack of clinical applications, its effectiveness needs to be further verified. In addition, these new technologies have higher hardware requirements for MRI, and it is difficult to promote them in the short term.

MRI Advantages and disadvantages of MRI for compression fractures

Because MRI is very sensitive to changes in the signal of the compressed vertebra, coupled with its multi-axis imaging function and high soft tissue resolution, it can not only show the morphology and signal changes of the compressed vertebra, but also The lesions of the surrounding soft tissue are well displayed. Therefore, MRI can make a correct diagnosis and differential diagnosis of most cases of vertebral benign and malignant compression fractures.

However, MRI has a limited diagnostic effect on vertebral compression fractures caused by some diseases, such as multiple myeloma. The vertebral compression fractures caused by MRI are not uncommon in clinical practice, and most cases show obvious malignant lesions. However, most of these cases have the same MRI performance as benign osteoporotic compression fractures, and only a few patients have malignant compression fractures. Therefore, care should be taken when identifying cases that are not traumatic and have benign compression fractures on MRI.

In the acute phase of traumatic vertebral compression fractures, the upper vertebral body showed diffuse low signal on T1WI. At the same time, due to the vertebral soft tissue damage (contusion, hematoma), a mass-like appearance can occur, so it is easy to be confused with malignant compression fractures. However, patients with a history of acute trauma and other signs such as disc damage, vertebral fractures, and spinal contusions can help identify them.

Compression fracture to determine whether a fracture occurred after trauma

Trauma is the main cause of fracture . To determine whether a fracture occurs after trauma, it can be analyzed from two aspects: post-injury symptoms and dysfunction. If the injured area is severely painful, the local swelling is obvious, there is a serious possibility of fracture when there is severe subcutaneous blood stasis, bruising, and appearance deformity. In terms of dysfunction, when hurting his arm, such as poor hand grip, he can't even lift things; he can't stand or walk after a lower limb injury; he can only lie supine and cannot sit after a waist fracture. All fractures should be considered. The use of a simple tapping method can also help determine fractures . If the upper limb is broken , you can use the other palm to pat the injured palm gently. If the pain is obvious, the fracture may be large. It is a lower limb injury. You can use fists to lightly press the heel. The injury is very likely to be a fracture.

It should be noted that the elderly due to osteoporosis are sometimes prone to fracture under the condition of small external force, and the elderly are less sensitive to pain nerves, which makes the pain less obvious or the symptoms lag behind after the fracture. . Therefore, once the elderly suffers a fall injury or a foreign object impact, they should pay attention to judging whether a fracture will occur in a timely manner, and if necessary, they should go to the hospital for inspection.