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Suggest Treatment For Severe Back Pain After A Fall
Question: I missed a stair step and fell on a slate floor New Year's Day, jamming from my knee through my back. After several days of pretty bad back pain, I consulted my doctor who sent me for X-rays. I have 2 compression fractures, L-1 & L-2. I will see a spine specialist on Monday. What should I expect in terms of treatment? Are there precautions I should be taking? I am a 67 year old woman with no significant health issues and take no medications.
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
Compression fractures usually involve only the anterior portion of the vertebral body. Fortunately these fractures are usually stable, meaning there are no moving fragments which risk compression of adjacent structures (in particular spinal cord or nerve roots). Therefore being stable their treatment is usually conservative, without surgery. Usually bracing for up to 3 months and a gradual physical therapy are the management of choice.
Of course I am speaking in general. The purpose of the visit to this spine specialist is to have a neurological exam to test strength, sensitivity, reflexes, bladder control etc in order to make sure there are no symptoms or signs indicating compression of spinal cord or nerve roots. He/she will also review the X-rays. If exam and X-ray are clear in indicating there is no danger to the spine he might leave it at that, otherwise may ask for additional tests like CT or MRI. As I said though in most cases compression fractures are stable and do not require surgery so should not panic.
An additional aspect to be considered is also the presence of osteoporosis. Compression fractures are more common in women with osteoporosis after menopause. So an evaluation in that regard through bone density measuring tests may be done, so that if marked osteoporosis is present you can initiate treatment in order to try to avoid other potential fractures in the future.
Up to the visit I would advise rest and back bracing.
I remain at your disposal for other questions.
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
Compression fractures usually involve only the anterior portion of the vertebral body. Fortunately these fractures are usually stable, meaning there are no moving fragments which risk compression of adjacent structures (in particular spinal cord or nerve roots). Therefore being stable their treatment is usually conservative, without surgery. Usually bracing for up to 3 months and a gradual physical therapy are the management of choice.
Of course I am speaking in general. The purpose of the visit to this spine specialist is to have a neurological exam to test strength, sensitivity, reflexes, bladder control etc in order to make sure there are no symptoms or signs indicating compression of spinal cord or nerve roots. He/she will also review the X-rays. If exam and X-ray are clear in indicating there is no danger to the spine he might leave it at that, otherwise may ask for additional tests like CT or MRI. As I said though in most cases compression fractures are stable and do not require surgery so should not panic.
An additional aspect to be considered is also the presence of osteoporosis. Compression fractures are more common in women with osteoporosis after menopause. So an evaluation in that regard through bone density measuring tests may be done, so that if marked osteoporosis is present you can initiate treatment in order to try to avoid other potential fractures in the future.
Up to the visit I would advise rest and back bracing.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you very much. I understand from my primary care physician that a procedure involving injecting a cement like substance into the fractures may be recommended. Is there significant downtime from the procedure? What are the risks and what other questions should I ask before consenting?
And yes, I believe I do have osteoporosis based on a recent bone scan but had not started taking any medications prior to my fall. Thank you again... I am usually such a healthy person so this is all a XXXXXXX to me.
And yes, I believe I do have osteoporosis based on a recent bone scan but had not started taking any medications prior to my fall. Thank you again... I am usually such a healthy person so this is all a XXXXXXX to me.
Brief Answer:
Read below
Detailed Answer:
Hello again!
Yes that procedure is a known approach used for some time, otherwise called vertebral augmentation. It is considered a generally safe procedure and you should be back home that very day or the next morning at most.
The main risks are leakage of the cement out of the vertebral body causing pain due to compressing surrounding structures. There have been also some rare cases of pulmonary embolism. However complications rate is really very very low.
The main question you should ask is simply whether it's really necessary. It is not done automatically for all cases, for mild to moderate pain usually the conservative approach is preferred at least initially. It is used in the case of very severe pain or in cases where control imaging show wedging and progressive vertebral collapse, or failure of the fracture to heal.
Let me know if I can further assist you.
Read below
Detailed Answer:
Hello again!
Yes that procedure is a known approach used for some time, otherwise called vertebral augmentation. It is considered a generally safe procedure and you should be back home that very day or the next morning at most.
The main risks are leakage of the cement out of the vertebral body causing pain due to compressing surrounding structures. There have been also some rare cases of pulmonary embolism. However complications rate is really very very low.
The main question you should ask is simply whether it's really necessary. It is not done automatically for all cases, for mild to moderate pain usually the conservative approach is preferred at least initially. It is used in the case of very severe pain or in cases where control imaging show wedging and progressive vertebral collapse, or failure of the fracture to heal.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you very much for your reply. I expect to get a recommendation for osteoporosis treatment tomorrow. After some research on the internet, I am somewhat alarmed at the side effects of the most common medications. Any thoughts or advice on that issue?
Brief Answer:
No cause for alarm.
Detailed Answer:
I do not know what medications did you see, there are several classes, but the most common ones, the bisphosphonates, do not have many side effects, mainly some digestive issues which are not that frequent and some of them are taken once a week or a month anyway.
Every medication has potential side effects, but they certainly are not among the most dangerous ones, are used by millions of people worldwide (my mother included).
So I do not see any reason for panic on that regard.
No cause for alarm.
Detailed Answer:
I do not know what medications did you see, there are several classes, but the most common ones, the bisphosphonates, do not have many side effects, mainly some digestive issues which are not that frequent and some of them are taken once a week or a month anyway.
Every medication has potential side effects, but they certainly are not among the most dangerous ones, are used by millions of people worldwide (my mother included).
So I do not see any reason for panic on that regard.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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