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Vertebral Wedge Fracture

Peer Reviewed
Introduction
A wedge fracture is a vertebral compression fracture occurring anteriorly or laterally. Viewed, the affected vertebra resembles a wedge. These fractures are more commonly found in the thoracic spine, which is rather rigid displaying only a few degrees of flexion and extension. Although the thoracic spine does maintain a wide range of torsion (ability to rotate), it responds poorly to movement defined as hyperflexion (beyond normal limits).
?normal

In general wedge fractures are stable without neurologic involvement. Wedge fractures are considered serious when the fracture affects adjacent vertebrae, anterior wedging is 50%, severe hyperkyphosis (bent forward) is present, or bone fragment(s) are suspect in the spinal canal. In the latter, symptoms and sign of myelopathy (spinal cord dysfunction) may be present.

Diagnosis
Wedge fractures require immediate medical care by a spine specialist. The physical examination will include a neurological assessment of the patient's motor (function), sensory (sensation), and reflex responses.

Radiographs may include lateral and AP (anterior/posterior, front/back (AP) x-rays of the affected spinal segment. The physician may request a CT Scan, with (myelography) or without a contrast medium to help identify the fracture type, its status (stable versus unstable), and if fragments have entered the spinal canal.

?mri?

Further, an MRI may be ordered if soft tissue trauma or hematoma (blood clot) is suspected. The physical and neurological examinations along with the radiographic findings are compared to make the diagnosis.

Treatment
Wedge fractures affect the height of the vertebral body. This reduction of height is quantified to help the spinal physician determine a course of treatment. If the loss of vertebral height falls in the 10-30% range, the treatment is conservative. This includes bed rest with hyperextension of the affected spinal level for a week to 10 days followed by bracing for 3 to 8 weeks. During bracing, if progress is good after 3 weeks, the patient may be allowed to walk and begin physical therapy.

When the loss is in the 30-50% range, conservative treatment includes traction under radiologic control to reduce the fracture. Following traction, the patient wears a plaster jacket for 45 days followed by a brace for the next 2 months to maintain fracture reduction. Physical therapy follows. Surgery is indicated when the loss exceeds 50%. Spinal instrumentation and/or fusion can be utilized to restore lost height.

Surgery
Surgically treating wedge fractures includes restoration of vertebral height and providing spinal column stability using instrumentation and fusion. Spinal Instrumentation and Fusion can be used to provide permanent stability to the spinal column. These procedures join and solidify the level where a spinal element has been damaged or removed (i.e. intervertebral disc). Instrumentation, the use of medically designed hardware such as rods and screws, can be combined with Spinal fusion (arthrodesis) to permanently join two or more vertebrae.

?instrumentation?

Recovery
Post-operative pain and/or discomfort should be expected. Patient Controlled Analgesia (PCA) enables the patient to control their pain without hospital staff assistance. PCA is eventually replaced by oral medication.

?pca?

The patient may be encouraged to get up and walk the following day. Activity enhances circulation and healing. Physical therapy is added post-operatively enabling the patient to build strength, flexibility, and increase range of motion. The patient continues physical therapy on an outpatient basis for a period of time. Additionally, the therapist provides the patient with a customized home exercise program.

Prior to release from the hospital, the patient is given written instructions and prescriptions for necessary medication. The patient's care continues during follow-up visits with their spinal specialist.

Updated on: 02/01/10
Iain Kalfas, MD
These articles provide an excellent overview of a complex injury: fractures in the thoracolumbar region of the spine. These fractures can result in a variety of clinical presentations ranging from mild low back discomfort to complete paralysis. The author correctly emphasizes the need for early recognition of these injuries in order to prevent serious neurological consequences. The articles provide a concise description of the more common fracture types in this region and accurately review the accepted management options for each injury type.
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