IF SYMPTOMS PERSIST
By DR. JOSE PUJALTE JR.
“For fate has wove the thread of life with pain,
And twins ev n from the birth are misery and man!”
— Alexander Pope (1688-1744), English poet
The Odyssey of Home (1726),Book vii. Line 263.
When a task is “arduous and exhausting, demanding great effort,” we simply say it’s “backbreaking.” But in a literal way, people do break their backs all the time. Spine or vertebral fractures, as they are called, are usually caused by high energy trauma. Think of a car crash, a motorcycle spill, though broken backs are also a result of falls from a height, gunshot, and of course, sports accidents.
Signs and Symptoms. Suspect a vertebral fracture(s), according to Spine Health (http://www.spine-health.com) with the following:
- Sudden onset of back pain.
- Back pain worsened by standing or walking.
- Lying down lessens pain.
- Limited spinal motion.
- Loss of height.
- Back deformity and disability.
Although necks are broken too, the most common fractures of the spine occur in the midback (or thoracic spine) and the lower back (lumbar spine). or in-between, the so-called thoraco-lumbar area. The two groups most at risk are men (4x more likely than women) and the elderly (who have honeycombed spines because of osteoporosis).
Types of Fractures. Basically, the doctor determines if the fracture comes with a spinal cord injury. That would really complicate things! That may mean partial or complete paralysis below the injury and usually has a bleaker prognosis compared to a purely bone problem. Fracture patterns fall mainly into three: flexion (compression or burst fracture), extension or the bone being pulled apart, and rotation which could include dislocation (making the spine practically unstable).
Diagnosis. It goes without saying that a patient with a broken back must be immobilized prior to transfer. Apply a cervical or neck collar and lay the patient on a backboard. A sad fact is that spine fractures, especially without cord injury, are missed in the initial physical examination because of other life-threatening conditions of the patient. But once the patient is stable, the doctor carries out a complete neurological exam. X-rays and C.T. scans are necessary to pinpoint the exact configuration of the fracture.
Treatment. The million-dollar question is: does the patient need an operation? That back needs to be opened if: the bones are shattered into too many pieces rendering the spine unstable; if there’s loss of vertebral body height; if there is nerve or spinal cord injury; if there is excessive forward bending or angulation at the site of injury. Rods, screws, bone cement are used to stabilize fracture sites. Otherwise, conservative treatment includes wearing a back brace for 6 to 12 weeks, physical therapy, and calcitonin. Let’s not forget that back bones also break from tumors (cancer), infection (Pott’s disease, or tuberculosis of the spine), and more commonly, because of brittle bones (osteoporosis). In the last case, compression fractures of the spine are an example of “fragility fractures.” This is the reason Grandma stoops. A broken back is a serious injury — you can’t, in a manner of speaking, turn your back on it.
Dr. Pujalte is an orthopaedic surgeon. email [email protected]