Spinal Conditions: Trauma and Osteoporosis
Spinal Trauma
Spinal trauma refers to any injury to the spinal cord or the vertebrae that make up the spine. Spinal trauma can be caused by a variety of factors, including car accidents, falls, sports injuries, and acts of violence. The severity of spinal trauma can range from mild to severe, and can have a significant impact on a person's mobility and quality of life.
A fracture is a break in a bone. A fracture of the spine can result in pain, deformity and neurological injury. A spinal cord injury occurs when there is damage to the spinal cord. This can result in paralysis, weakness and sensory problems in the arms and legs, breathing difficulties, bladder, bowel and sexual dysfunction. In trauma, spinal stability refers to the ability of the spine under normal physiological conditions to maintain its shape so that there is no initial or additional neurological deficit, no major deformity and no incapacitating pain. In the trauma setting, it is important to note that you can break your spine and not have a spinal cord injury (this is very common) and likewise you can have a spinal cord injury and not have broken your spine (this is uncommon). In addition, you can have a spinal fracture and have a stable spine and likewise you can have a spinal cord injury with a stable spine that is not fractured (although it is more likely to have a spinal cord injury with an unstable fractured spine).
Symptoms of Spinal Trauma
Symptoms of spinal trauma can vary depending on the location and severity of the injury. Some common symptoms of spinal trauma may include: pain in the neck or back, numbness or tingling in the arms or legs, weakness in the arms or legs, loss of sensation in the arms or legs, difficulty walking or maintaining balance, loss of bladder or bowel control.
Diagnosis and Initial Management of Spinal Trauma
Patients will usually have been involved in a significant injury and attended the Emergency Department at their local hospital. During this time the medical team will have taken a history and performed a physical examination. The diagnosis will be confirmed with radiological imaging such as an X-Ray, CT or MRI scan.
In the management of any spinal trauma, life threatening injuries must be treated first. The medical team will usually adopt an ABCDE / ATLS / ETS approach to the patient. During this time, with regards the spinal trauma, the team will firstly aim to protect the spine. They will aim to maintain a patent airway for the patient to be able to breath and will control the position of the spinal to prevent further injury. Once the patient has had a primary assessment, the team will then aim to detect whether the patient has a spinal injury.
In the trauma setting, CT scans of the spine are usually indicated in patients with multiple trauma (CT Head to Hips), when plain X-Rays have failed to adequately visualise the spine or when plain X-Rays have shown an injury and further information is required to categorise the injury. MRI scans are usually indicated if there is a neurological deficit, suspicion of ligamentous injury and in the exclusion of injury in difficult cases (ankylosing spondylitis). CT scans will show the bony anatomy of an injury whereas MRI scans will show the soft tissue anatomy (nerves, spinal cord and ligaments).
Treatment of Spinal Trauma
The treatment of spinal fractures will depend on their location, severity and patient factors. In some cases, no treatment is required, and the fracture will heal over time (stable injuries). Simple analgesics and modification of activities for a short period of time will suffice.
Conservative treatment, such as bracing, may be recommended to manage symptoms, promote healing in the correct position and prevent the development of spinal deformity. A period of physiotherapy and rehabilitation after the fracture has healed might be required. In general, it usually takes 3 months for a spinal fracture to heal.
In more severe cases, spinal surgery may be necessary to stabilize the spine, correct any deformity, relieve any pressure on the spinal cord or nerves and prevent any subsequent long term spinal pain, deformity of instability.
Patients with spinal cord injury require specialist input and rehabilitation (usually in a spinal cord injury centre). Spinal cord injuries are life changing events. Surgery in patients with spinal cord injuries depends on the nature of the injury and patient factors. The main aim being, to optimise conditions for neurological and functional recovery.
Osteoporosis
Osteoporosis is a bone disease characterized by a decrease in bone density and strength, which makes bones more fragile and susceptible to fractures. We often all these insufficiency fractures and they can occur with minimal or no trauma. The word "osteoporosis" is derived from Greek terms meaning "porous bone."
Risk Factors for Osteoporosis
While the exact cause of osteoporosis is unknown, several factors can increase one's risk, including:
- Age: Bone density tends to decrease naturally with age.
- Gender: Women are more susceptible, especially after menopause.
- Family history: A history of osteoporosis in the family can raise one's risk.
- Hormonal imbalances: Low estrogen (in women) and testosterone (in men) can lead to weaker bones.
- Certain medications and medical conditions.
- Inadequate calcium and vitamin D intake.
Symptoms and Diagnosis
In the early stages, osteoporosis may not show any symptoms. However, as the disease progresses, signs can include: back pain due to fractured vertebrae, gradual loss of height, stooped posture, and bone fractures that occur easily. Diagnosis often involves a bone density test, which indirectly measures the amount of calcium and other minerals in a segment of bone.
Treatment
Osteoporosis treatments aim to slow the rate of bone loss, increase bone density, and prevent bone fractures. Common treatments include:
- Medications to slow bone loss or increase bone formation. These may include bisphosphonates, hormone therapy, or calcitonin.
- Vitamin D and calcium supplements.
- Lifestyle changes, such as maintaining a healthy diet, exercising regularly, and avoiding tobacco and excessive alcohol consumption, may help reduce the risk of further bone loss.
- Hormone-related therapies for postmenopausal women.
- Pain management strategies, such as pain relievers or anti-inflammatory medications, may be recommended to help manage pain from insufficiency fractures of the spine.
- Physical therapy may be recommended to improve mobility and strengthen the muscles that support the spine.
Prevention
Preventing osteoporosis involves maintaining good bone health throughout one's life. Recommendations include: consuming a balanced diet rich in calcium and vitamin D, engaging in regular weight-bearing exercises, avoiding smoking and excessive alcohol consumption, having regular check-ups, especially if you have risk factors.
Management of Osteoporotic Spinal Fractures
Osteoporotic fractures in the spine are a common complication of osteoporosis, and can cause significant pain and disability. The management of osteoporotic fractures in the spine is usually non-surgical.
Non-surgical management of osteoporotic fractures in the spine may include:
- Pain management: Pain relievers or anti-inflammatory medications may be prescribed to help manage pain.
- Bracing: A back brace may be recommended to help support the spine, reduce pain and prevent progressive deformity at the fracture site.
- Physical therapy: Physical therapy may be recommended to help improve mobility and strengthen the muscles that support the spine.
- Lifestyle modifications: Lifestyle modifications, such as maintaining a healthy diet, exercising regularly, and avoiding tobacco and excessive alcohol consumption, may help reduce the risk of further bone loss and improve overall health.
Surgical Management osteoporotic fractures in the spine may be recommended in cases where non-surgical management is not effective or if there is significant spinal deformity or instability. Surgical options may include:
- Vertebroplasty or Kyphoplasty: These minimally invasive procedures involve injecting a special cement into the affected vertebra to stabilize the fracture and reduce pain.
- Spinal Surgery – Instrumentation and Fusion: involves the use of screws rods and sometimes cages to stabilize the spine and correct / prevent deformity. Spinal surgery is often high risk and instrumentation can fail given the poor bone quality in the osteoporotic spine.
Recovery after surgery will depend on the type of procedure performed, as well as overall health and medical history. It is important to note that osteoporotic fractures in the spine can have long-lasting effects on a person's mobility and quality of life. Rehabilitation and physical therapy may be necessary to regain strength and mobility, and additional medical care may be required to manage ongoing symptoms and complications.
Further Information on Spinal Trauma and Osteoporosis
More information on spinal trauma and osteoporosis can be found in the following documents and in the Useful Links section of this site. Please note that some of these documents are written for health care professionals.
Information from spinalcord.com
Information from the spinal injuries association
Information on Osteoporosis from the NHS
Information on Osteoporosis from the Patient Information
Information on Osteoporosis from the Royal Osteoporosis Society
Osteoporosis Handbook from the SRS