Lumbar

Compression
Fracture
Taufiq Hidayat
10542017210

PRELIMINARY
The human spine is the pillar / pillar that serves to support
the body and protect the spinal cord. The pillar consists of
33 vertebrae arranged in segmental comprising seven
cervical vertebrae, 12 thoracic vertebrae, 5 lumbar
vertebrae, 5 sacral vertebrae fused four vertebrae and tail.
Each vertebra can move from one another because of the
two joints in the area in the posterolateral and anterior
intervertebral discs.

Definiton
Compression fractures (wedge fractures) is compressed at the
front of the vertebral corpus depressed and formed a wedge
fracture. Compression fractures are the most common fractures
affecting the vertebral column.

Cont.
The lumbar vertebrae
Lumbar spine is part of the vertebral column consisting of five
vertebra by vertebra size is larger than the vertebrae of the
neck (cervical spine) and spine (vertebral thorakal). The
lumbar spine can be distinguished by the absence of the field
for the joint with the costa. Among the segments of the lumbar
vertebrae are intermediate vertebra comprising or composed of
cartilage thick and tight, shaped like a ring which allows the
movement between the vertebrae are located very close
together. The upper part of the lumbar vertebrae bordering the
12th thoracic vertebrae, the joint or joints called
thoracolumbal articulatio thoracolumbalis. and at the bottom is
adjacent to the sacral vertebrae. and the joints called the
lumbosacral joint or articulatio lumbosacralis.

Cont.
Lumbar vertebra characteristics include:
a. Corpus large and kidney-shaped.
b. Pediculus strong and leads to the rear.
c. lamina thick
d. Foramina vertebrale triangular.
e. Processus transversus longer and slimmer.
f. Spinous processus short, flat and rectangular shaped
and leads to the rear.
g. Facies articularis superior processus articularis facing
the medial and facies articularis processus articularis
inferior lateral facing.

Lumbar Vertebra Physiology

a. Supporting the upper body through which the
intervertebral disc cartilage that curves can provide the
flexibility to allow bending toward the front (flexion)
and toward the rear (extension), tilted to the left and to
the right on the lumbar vertebrae.
b. Her intervertebral discs can absorb any shocks that
occur when you are moving weight, such as running
and jumping.
c. Protects the brain and spinal cord from shock.
d. Protect the spinal cord from the pressures due to
slipping of the nucleus pulposus in the intervertebral
discs.

Epidemiology
Vertebral compression fractures are common types of
fractures and a serious problem. Every year about
700,000 incidence in Ameika States, where prevalence
increased by 25% in women aged over 50 years. One
in two women and one in four men over the age of 50
years suffer from osteoporosis-related fracture. The
incidence of vertebral compression fractures rises
progressively by the increasing age, and its prevalence
is equal between males (21.5%) and women (23.5%),
which is measured based on a study of radiological
examinations

Etiology
Direct
(direct)

trauma

Fractures caused by
direct impact on bone
tissue as in traffic
accidents, falls from
heights, and the hard
object collision by
direct force.

Trauma indirectly
(indirect)
Fractures were not
caused by direct
impact, but rather
caused by excessive
strain on muscle or
bone tissue, such as
the sportsman who
use only one hand to
rivet body burden.

Trauma
is
not
directly caused by
other
diseases
(indirect)
Fractures caused by
disease
processes
such as osteoporosis,
tumors and infections.

Cont.
The underlying causes of lumbar compression fractures
are osteoporosis. In women, the main risk factors for
osteoporosis are menopause or estrogen deficiency. Other
risk factors that may worsen the severity of osteoporosis
include smoking, physical activity, use of prednisone and
other drugs, and malnutrition. In men, the risk factors for
non-hormonal above are also influential. However, low
testosterone levels can also be associated with
compression fractures.

pathophysiology
The mechanism of trauma include:
a. flexion
Trauma caused by flexion and accompanied with a slight compression of
the vertebrae. Pressure crushed vertebra are formed which can cause
damage or without posterior ligament damage. If there is damage to the
posterior cruciate ligament, the fracture is unstable and can occur
subluxation.

Cont.
Flexion and rotation
This type of trauma is trauma flexion with rotation. There is a strain of
the ligaments and capsules, also found a fracture facets. In these
circumstances there is movement forward / dislocation of the vertebrae
above. All are unstable fracture dislocation.

Cont.
c. Vertical compression (axial)
A vertical direct trauma of the vertebrae which will cause axial
compression. Will break the surface of the nucleus pulposus and the
vertebral bodies vertically. Discus material will fall into the vertebral bodies
and the cause became fractured vertebra (broken). At this traumatic
posterior elements are still intact so that fractures that occur are stable.

Cont.
d. Hyperextension or retrofleksi
Hyperextension usually occurs resulting in a combination of distraction and
extension. This situation is often found in the cervical vertebrae and rarely
in the thoracolumbar spine. The anterior cruciate ligament and the disc can
be damaged or fractures on the neural arch. These fractures are usually
stable.

Cont.
e. lateral flexion
Compression or trauma that cause lateral flexion distraction will cause
fractures in the lateral component that is the pedicle, vertebral foramen and
facet joints.
The division of trauma vertebra according to Beatson (1963) distinguishes
over 4 grades:
a. Grade I = Simple Compression Fractures
b. Grade II = Unilateral Fracture Dislocation
c. Grade III = Bilateral Fracture Dislocation
d. Grade IV = Rotational Fracture Dislocation

Clinical manifestations
Compression fractures are usually incidental, showed
symptoms of spinal pain of mild to severe. Could lead to
changes in posture since the occurrence kiposis and
scoliosis. Patients also showed symptoms of abdominal
stomach distress such as flavor, taste satiety, anorexia and
weight loss. Symptoms of the respiratory system can
occur due to reduced lung capacity.

Cont.
Common symptoms include pain in the lower back, the
anesthetic in the inner thighs, groin; difficulty walking,
weakness in the legs, lack of bladder control; Alvi
incontinence, and impotence.

diagnosis
Physical examination
Physical examination should be done by the patient is
standing, so signs of osteoporosis as kiposkoliosis will be more
visible. Then check is performed by pressing the vertebra with
a thumb from top to bottom that is on the spinous processes.
Vertebral compression fracture can occur from the occiput to
the sacrum, usually occurs in mid-piston region (T7-T8) and at
the junction thorakolumbal.
Deformity of the spine do not indicate the presence of a
fracture. If there are no sharp pain, chances are it is a spinal
disorder associated with age.

Cont.
Supporting investigation
a. Roentgenography: This examination was conducted to see
the vertebrae to see the fracture and shift the vertebrae
b. Magnetic Resonance Imaging
c. CT- Scan
d. Single-Photon Emission Computed Tomography (SPECT):
because their level of ability in describing bone density.
e. cintigraphy: Is a diagnostic method that uses gamma
radiation detection to describe the condition of the tissue or
organ

Management
a. Acute Painful vertebral compression fractures
Avoid prolonged bedrest
Analgesics
Calcitonin: have analgesic effect on compression fractures caused
by osteoporosis and patients with pain due to bone metastases.
Bracing is the usual therapeutic in acute manegemen nonoperative
Vertebroplasty:
This procedure can stabilize the fracture and
reduces pain quickly that in 90% of 100% of patients. But this
procedure can not correct the deformity occurs in the spine.
Kypoplasty

Cont.

b. Chronic pain management

Chronic pain commonly experienced by patients with multiple
fractures, height loss, and loss of bone density. In these
patients, it is recommended to remain active in muscle
relaxation and stretching programs, such as programs that
affect light as walking and swimming. In addition to
painkillers,
non-pharmacological
examination
as
transcutaneous electrical nerve stimulation, application of heat
and cold, or the use of bracing, can relieve pain temporarily

Cont.
c. Prevention of additional fractures
The majority of patients with acute osteoporotic fractures should be

given aggressive treatment of osteoporosis.

bone densitometry examination
National Osteoporosis Foundation recommends all women who undergo
spiral fractures and bone mineral density should be given treatments
such as osteoporosis.
Dietary supplements of vitamin D and calcium should be optimal
Raloxifene, a selective estrogen modulators, shown to reduce vertebral
fractures of 65% in the first year and about 50% in the third year.
Calcitonin showed decreased risk of new vertebral fractures around 1 in
3 women who experience a fracture vetebra.
Teriparatide (fortoe), a recombinant parathyroid hormone preparations
administered subcutaneously. It also indicates a low risk of vertebral
fractures and increase bone density in postmenopausal women with
osteoporosis.

complication
biomechanics

prognosis
Experienced pain and fractures that will
improve
with
therapeutic
support
pharmacological and pharmacological, but as
we grow older, the functions and structure of
bone physiology will decrease, it is necessary
vigilance in order to maintain spinal stability
and prevention of trauma in the elderly.

Prevention
Avoid strenuous physical activity

Thank you