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The Thin Bone Between a Mid-Back Fracture and Nerve Problems

If you have osteoporosis, don't wait to treat it. Early treatment can help prevent problems later on. This is the advice of doctors at the Hershey Medical Center in Pennsylvania.

They reviewed many studies of osteoporosis and conducted one of their own. Fractures of the spine from osteoporosis with damage to the spinal cord or nerves were the subject of each study. Most fractures affecting the mid-back from osteoporosis do not cause nerve problems and are safely treated with methods other than surgery. However, the neurologic problems that do occur are hard to treat.

Surgery may be needed to fuse the spine in this area if nerve problems have occurred. With the underlying osteoporosis, more fractures can develop. Often, the pain, weakness, and loss of sensation don't get better. Some patients are left with permanent symptoms. Some even have loss of bowel or bladder function.

The main problem is that these symptoms don't show up right away. Patients can be pain-free without even knowing that they have a fracture in one or more of the vertebrae. It isn't until much later that the bone collapses enough to cause nerve damage. For some patients, by the time symptoms occur, the damage is permanent.

Fortunately, only a small number of older adults have mid-back vertebral fractures with neurologic symptoms. Treatment for more severe injuries like these has up to a 70 percent complication rate.

The authors offer some ideas to help prevent worse problems. First, once the osteoporosis is found, drug therapy is important. If treated early with medications, vertebral collapse can sometimes be avoided. Second, doctors must keep trying to find better operations to fix the fractures. Third, a back brace after surgery is advised for anyone having a spinal fusion who also has osteoporosis. The authors conclude by saying that more studies are needed to find better ways to treat this problem.

References: Hoan-Vu Nguyen, et al. Osteoporotic Vertebral Burst Fractures With Neurologic Compromise. In Journal of Spinal Disorders. February 2003. Vol. 16. No. 1. Pp. 10-19.

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