Vertebral Fractures

The spine is made up of vertebrae (7 cervical vertebrae, 12 dorsal or thoracic vertebrae, 5 lumbar vertebrae, sacrum and coccyx). These vertebrae can suffer fractures, fissures or crushing, which can be very painful, although it is not uncommon to find old fractures, already consolidated, in patients who have had no record of them.

The vertebrae most frequently fractured are those of the dorsal and lumbar spine, followed by the sacrum. Fractures of cervical vertebrae are very rare.

The trigger for a vertebra to suffer a fracture is usually a major or minor trauma, such as a fall. However, in elderly patients, with advanced osteoporosis, or with other diseases, fractures can occur with minimal trauma (e.g., a cough), or even without trauma.

The most frequent cause of vertebral fracture is osteoporosis, which, in turn, can have various causes. Less frequently, fractures may be due to other metabolic or endocrinological diseases, hematological diseases such as myeloma, or metastases from tumors in a location other than the vertebra.

Vertebral fractures usually cause very severe pain accompanied by a great inability to move. They are also accompanied by loss of height and curvature of the spine (kyphosis). Some patients cannot tolerate the decubitus position and need to sleep in a sitting position. The reverse can also occur.

Until relatively recently, the treatment prescribed for vertebral fractures was rigid bracing, bed rest and administration of analgesics and other medications. Such treatment was maintained for as long as it was deemed necessary for the fracture to consolidate and the pain to cease. However, in a large percentage of patients, the structural changes produced by the fracture led to the chronification of pain and the progression of disability and dependence. These consequences were increased in patients with more than one vertebral fracture, with a cumulative effect.

Currently, a therapeutic protocol consisting of potent analgesia, state-of-the-art antiresorptive medication (to prevent new fractures and promote consolidation of the fractured vertebra), and early rehabilitation is recommended. In some patients in whom pain relief is not achieved with these methods, there are new techniques that allow almost immediate pain relief, such as Vertebroplasty and Kyphoplasty. In different modalities, they consist of injecting medical cement inside the vertebra by introducing cannulas through the skin. In the last few years, an advance in these techniques has emerged under the name of Vesselplasty, making it possible to reduce the risks of the aforementioned techniques.

For patients who are not candidates for spinal cementation techniques and whose pain is not controllable with available drugs, there is the possibility of using continuous infusion of drugs at the spinal level, either by means of an external infusion pump or with a fully implantable and programmable pump.

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