FAQ Category: Thoracic Spine

Spinal cord injury from trauma is caused first by car accidents, then by falls, violence, and sports accidents. It seems that men in their 40s and 50s experience spinal cord injuries from all causes more than any other age group. Disc degeneration is more common in older adults, especially in the lumbar spine area.

Pressure on the spinal cord, the spinal nerve roots, and/or any compromised neural tissue can cause a set of signs and symptoms referred to as cauda equina syndrome (CES) or conus medullaris syndrome (CMS).

The word “syndrome” tells us that each one of these conditions is defined by a set or collection of signs and symptoms that are always present. The cauda equina syndrome affects the spinal cord where the main cord ends and a “tail” of nerves forms down to the tip of the tailbone and down the legs. The conus medullaris syndrome occurs when the injury has affected the area between the spinal cord and the spinal nerve roots.

Clinical signs and symptoms of these two syndromes can be so similar as to be confused and misdiagnosed. The clinical presentation may vary slightly depending on where the damage has occurred. In the case of the cauda equina syndrome, there is often an asymmetric presentation. In other words, the symptoms occur on one side (not both sides). In the conus medullaris syndrome, symptoms are more likely to occur symmetrically (evenly on both sides).

At first, the spinal cord may go into “shock.” The patient loses all function below the level of the injury. There may be paralysis of the legs, loss of bowel and bladder control, and for men, loss of penis erection. These symptoms may last a short time with recovery in 24 to 48 hours or there may be a longer period of time for recovery (several weeks).

The negative risk factors (those that predict poorer outcomes and less chance of recovery) include older age (over age 65) and a previous history of back and/or leg pain (sciatica). Long duration of symptoms from the disc problem also increases the risk of poor outcomes.

Some men report getting back the ability to have an erection but have a loss of penis sensation. Studies report between 25 and 50 per cent of patients with either of these syndromes may experience persistent sexual problems. That may not sound like a good prognosis but the positive way to view those statistics is to say that up to 75 per cent of men recover fully. Hopefully, with successful treatment, your partner will recover completely, though this could take weeks to months so be prepared to wait patiently before judging the final outcome.

In this review article, neurosurgeons from Thomas Jefferson University Hospital in Philadelphia take a look at the diagnosis, treatment, and results of treatment for spinal cord injuries. They focus specifically on fractures and cord injury at the thoracolumbar area.

The thoracic spine ends at T12 (the last thoracic vertebra). The lumbar spine (L1) begins right after T12. The union between T12 and L1 is call the thoracolumbar junction. Spinal cord injuries at this level can result in one of two neurologic injury syndromes. These are the cauda equina syndrome (CES) and the conus medullaris syndrome (CMS).

The word “syndrome” tells us that each one of these conditions is defined by a set or collection of signs and symptoms that are always present. The cauda equina syndrome affects the spinal cord where the main cord ends and a “tail” of nerves forms down to the tip of the tailbone and down the legs. The conus medullaris syndrome occurs when the injury has affected the area between the spinal cord and the spinal nerve roots.

Injuries to these areas of the spinal cord are most often the result of car accidents or traumatic sports injuries in young patients. At first, the spinal cord may go into “shock.” The patient loses all function below the level of the injury. There may be paralysis of the legs, loss of bowel and bladder control, and for men, loss of penis erection. These symptoms may last a short time with recovery in 24 to 48 hours or there may be a longer period of time for recovery (several weeks).

The ultimate (final) prognosis does not depend on early recovery of function. Instead, the timing of surgery may be a better indicator. Some studies show that surgical decompression (taking pressure off the spinal cord, spinal nerve roots, or other neural tissue) within the first eight to 48 hours yields the best results. Other factors that may impact prognosis are age (younger age patients have better results) and the presence of blood within the spinal column (as seen on MRI — blood is a poor prognostic sign).

Your son’s medical and surgical team will do everything they can to stabilize him and his spine. The two main goals of any treatment for spinal cord injury are first to stabilize the spine and second to restore as much neurologic function as possible. Surgery is required to accomplish both goals. Early stabilization of the spine surgically is the key to the best result.

The American Academy of Orthopaedic Surgeons (AAOS) has just released Clinical Practice Guidelines (CPGs) for the treatment of symptomatic (painful) spinal compression fractures. These guidelines are based on research, published studies, and the resulting evidence currently available.

The AAOS points out that all guidelines are intended to be used as one tool in the treatment decision. All patient characteristics and individual factors must be taken into consideration when making the final decision. They do review surgical procedures including the vertebroplasty you had. Here’s what they had to say.

There is moderate support for acute fractures to be treated in the first four weeks with medications (calcitonin). Calcitonin is a non-sex, non-steroid hormone. Calcitonin binds to osteoclasts (the bone cells that reabsorb bone). It decreases osteoclast numbers and activity levels. The end result is that it prevents bone from melting away. It doesn’t build up missing bone but it at least keeps the bone that’s there from being broken down and reabsorbed.

Calcitonin is available in a nasal spray and should be used for osteoporotic spinal fractures within five days of the injury. Calcitonin has been shown to relieve pain when tested in four different positions (e.g., in bed, sitting, standing, and walking).

All other treatment recommendations (e.g., bed rest, use of complementary and alternative medicine, narcotics for pain) are not supported by enough evidence to make a strong case for or against them. The evidence is said to be weak or inconclusive. Likewise, evidence for the use of electrical stimulation to encourage bone growth is inconclusive.

Evidence regarding minimally invasive surgical procedures such as vertebroplasty and kyphoplasty was also reviewed. Minimally invasive means the incisions used are very small, and there is little disturbance of the muscles and bones where the procedure is done. These two procedures help the fracture heal without the problems associated with more involved surgeries.

Vertebroplasty helps reduce pain and strengthens the fractured bone, thus enabling patients to rehabilitate faster. A needle is inserted into the collapsed vertebra and a bone cement is injected into the main body of the vertebra. This fixes the bone so that it does not collapse any further as it heals. More than 80 percent of patients get immediate pain relief with this procedure.

Kyphoplasty is another way for surgeons to treat vertebral compression fractures. Like vertebroplasty, this procedure halts severe pain and strengthens the fractured bone. However, it also gives the advantage of improving some or all of the lost height in the vertebral body, helping prevent kyphosis.

Needles are inserted through the sides of the spinal column into the fractured vertebral body. These needles guide the surgeon while drilling two holes into the vertebral body. The surgeon then slides a hollow tube with a deflated balloon on the end through each drill hole. Inflating the balloons restores the height of the vertebral body and corrects the kyphosis deformity. Before the procedure is complete, the surgeon injects bone cement into the hollow space formed by the balloon. This fixes the bone in its corrected size and position.

There is strong evidence that vertebroplasty benefits patients with osteoporotic spinal compression fractures who are in pain but not experiencing any neurologic problems. Kyphoplasty as an option is supported but the evidence is still weak and further studies are needed.

The treatment of osteoporotic spinal compression fractures will continue to be investigated, discussed, and modified according to research findings and current evidence. Long-term studies including patients like yourself may tell a story all its own that will influence future treatment guidelines. Thanks for reporting your results!

Any spine surgery is a very delicate operation. Care must be taken to prevent damage to the spinal cord, spinal nerves, and blood vessels supplying these neural components. Damage to the blood vessels and loss of blood supply to the spinal cord can have serious consequences.

Surgeons do have an important tool available during spinal surgery to monitor patients called intraoperative neuromonitoring or IOM. IOM methods include the wake-up test, somatosensory-evoked potentials (SSEP), transcranial motor-evoked potentials (tcMEP), spinal cord MEPs, spontaneous electromyography (sEMG), and triggered electromyography (tEMG).

Each one of these tests has its own purposes and functions. But the basic idea behind this type of monitoring is to make sure moment-by-moment during the procedure that no injury has occurred. This is called real-time monitoring. Warning is given so that any damage can be prevented or reversed.

There isn’t one-individual test that works for all patients or that monitors all functions of the spinal cord. If the surgeon wants to monitor both sensory and motor function, then more than one test will certainly be needed. That’s referred to as multimodality intraoperative monitoring or MIOM. MIOM is a great help when the surgeon is trying to remove a spinal tumor completely but without damaging the neural tissues or creating paralysis or other disability.

For now, the use of intraoperative monitoring (IOM) is still optional, not required in all spinal surgeries. Because there’s not enough evidence to support specific protocols, there isn’t a legal requirement yet for use of these tests.

Patients must understand that even with the best of testing available, problems can develop — even permanent paralysis is still a possibility. Intraoperative monitoring (IOM) isn’t really needed for the more simple spinal procedures, so patients shouldn’t expect this to be a standard part of every spinal operation.

Your question is a good one and one that you can certainly pose to the surgeon. He or she may already be using one or more of these tests. The surgeon who understands IOM will know when and how to use it best. None of the tests can replace a clear understanding of neurologic and vascular anatomy. Likewise, final outcomes of complex spinal surgery still require a high level of technical skill on the part of the surgeon.

Every year, an estimated 44 million Americans will suffer back pain and disability from vertebral compression fractures (VCFs). This type of problem can do a lot of damage in terms of taking away a senior citizen’s independence. Finding a way to prevent (VCFs) is an important goal for many researchers.

The use of bisphosphonates is one way to target folks with low bone density (osteopenia or brittle bones(osteoporosis). Bisphosphonates are used to prevent bone fractures. They keep bone cells from being absorbed or destroyed.

Boniva (ibandronate sodium) and Fosamax, known to the pharmacist and doctor as alendronate are the most commonly prescribed bisphosphonates. Others include Actonel (risedronate), Aredia (pamidronate), and Zometa (zolendronate).

Your question is a good one: do bisphosphonates help prevent future vertebral compression fractures? Researchers are trying to find an answer. A recent study was done along these lines at a medical center where three surgeons performed kyphoplasties on 256 patients.

Two-thirds were women and the remaining one-third of the patients were men. Participants were divided into two groups based on age (over or under 75 years old). Data was also analyzed from the viewpoint of smoker vs. nonsmoker, bisphosphonate user vs. nonbisphosphonate user, and steroid user vs. nonsteroid user.

About one-fourth (22 per cent) of the entire group had a second vertebral compression fracture after the first was treated with kyphoplasty. All were treated conservatively (without kyphoplasty) at first.

Smoking and age did not seem to factor in to additional compression fractures. Bisphosphonates did not prevent future fractures (at least not in the short-run). And the single most important risk factor for second fractures was the chronic (long-term) use of steroid medications.

This study raised the question of whether bisphosphonates prevent additional vertebral compression fractures. In other words, does the patient benefit by taking them? Based on results of other studies, it’s possible that only long-term use (three years or more) of bisphosphonates makes a difference. But it’s something that should be investigated further.

Compression fractures are the most common type of fracture affecting the spine. A compression fracture of a spine bone (vertebra) causes the bone to collapse in height. Kyphoplasty to treat the problem involves inserting a deflated balloon into the fractured and collapsed vertebral body.

Hydraulic pressure is used to inflate the balloon. The balloon is inflated until the vertebral body height is restored to normal or until the balloon is fully inflated. The balloon is then collapsed and removed. The empty space left by the inflated balloon is quickly filled in with cement that is injected into the area.

Kyphoplasty procedures are minimally invasive — that’s one good advantage. They aren’t supposed to be a “quick fix”. They really are used to stabilize the spine and prevent further problems. But all too often, patients go on to develop another compression fracture. In most cases, the second fracture affects the adjacent vertebral body (next spine bone above or below the original compression fracture).

Surgeons are concerned about this potential complication. They are looking for ways to reduce the patients’ risk of another vertebral compression fracture after having kyphoplasty. Identifying possible risk factors and doing something about them is one approach.

In a recent study on this topic, surgeons studied the results of 256 kyphoplasty procedures. They were looking for clues (risk factors) that set patients who develop second vertebral compression fractures after kyphoplasty apart from those who don’t have any further problems.

They found that the main risk factor was taking steroid medications. These powerful anti-inflammatory drugs work well for what they were intended but they do have some significant side effects. Decreased bone density is one that adds to the risk of compression fractures.

The best way to prevent the need for additional kyphoplasty procedures is to monitor patients who are at risk for vertebral compression fractures. Anyone taking steroid medications should be aware of the importance of reporting any signs and symptoms of spinal fracture to the physician right away. Early intervention with conservative care may be able to help patients prevent going to surgery for this condition.

That is a good question and one her orthopedic surgeon will have to evaluate and answer. We can give you some information that might help you decide what’s best for your mother’s care.

Older adults can recover from vertebral compression fractures just as your mother did. But usually the spine heals in a compressed position. With a delay in treatment, there is the potential for increased spinal deformity.

If the vertebral body collapses further, pressure on the spinal nerve roots creates more pain. The flexed posture of the spine (called kyphosis) shifts the center of gravity forward and puts pressure on the vertebrae above and below the fractured segment. The result can be additional vertebral compression fractures.

Some benefits of early treatment are the reduction of pain and the use of less pain medications. Function is improved and quality of life is reportedly better. There are some newer, less invasive procedures that can be done for this problem that your mother might be a candidate for. One is called kyphoplasty.

Kyphoplasty involves inserting a deflated balloon into the fractured and collapsed vertebral body. Hydraulic pressure is used to inflate the balloon. The balloon is inflated until the vertebral body height is restored to normal or until the balloon is fully inflated. The balloon is then collapsed and removed. The empty space left by the inflated balloon is quickly filled in with cement that is injected into the area.

Not everyone is a good candidate for this procedure. It might be something to ask her physician about. The sooner the better as results appear to be best when the procedure is done in the first two weeks after the fracture.

Compression fractures are the most common type of fracture affecting the spine. A compression fracture of a spine bone (vertebra) causes the bone to collapse in height. Compression fractures are commonly the result of osteoporosis (decreased bone density or “brittle bones”).

About 750,000 cases of compression fractures due to osteoporosis occur each year in the United States. Spine bones that are weakened from osteoporosis may become unable to support normal stress and pressure. As a result, something as simple as coughing, twisting, or lifting can cause a vertebra to fracture.

Kyphoplasty to treat the problem involves inserting a deflated balloon into the fractured and collapsed vertebral body. Hydraulic pressure is used to inflate the balloon. The balloon is inflated until the vertebral body height is restored to normal or until the balloon is fully inflated. The balloon is then collapsed and removed. The empty space left by the inflated balloon is quickly filled in with cement that is injected into the area.

The results can be measured and compared before and after treatment using patient perceived level of pain and even the amount of pain medications needed for comfort. X-ray analysis of spinal correction/deformity can be compared from before to after the procedure. There are also ways to measure your activity level, function, and change in disability to demonstrate change from before to after treatment.

Although the surgeon can order X-rays and see what’s happening inside the spine, your own satisfaction with the results is the best gauge or measure of outcomes.

Compression fractures are the most common type of fracture affecting the spine. A compression fracture of a spine bone (vertebra) causes the bone to collapse in height. Compression fractures are commonly the result of osteoporosis.

But you are not alone. About 750,000 cases of compression fractures due to osteoporosis occur each year in the United States. Spine bones that are weakened from osteoporosis may become unable to support normal stress and pressure. As a result, something as simple as coughing, twisting, or lifting can cause a vertebra to fracture.

Conservative care is often the first line of treatment. Pain relievers, rest, and physical therapy are ordered. The physical therapist will help fit you with a brace to support your spine in an upright position so you won’t heal with deformities. The brace will also help offload the spine a bit and bring some pain relief.

The therapist will also give you some helpful exercises to maintain spinal alignment and strengthen the core muscles of your trunk. If you don’t already have a regular exercise program for osteoporosis, the therapist will help you get started. Preventing future fractures is an important goal of treatment.

The natural course of bone healing is usually four to six weeks for a vertebral compression fracture. Poor nutrition, smoking (or other tobacco use), and health problems like diabetes can slow down your rate of healing, extending this four to six weeks time line.

Many patients obtain fast relief (within one day to one week) from percutaneous vertebroplasty. Your surgeon may offer this procedure as a possible treatment option.

To perform a vertebroplasty, the surgeon uses a fluoroscope to guide a needle into the fractured vertebral body. A fluoroscope is a special X-ray television that allows the surgeon to see your spine and the needle as it moves. Once the surgeon is sure the needle is in the right place, a special bone cement is injected through the needle into the fractured vertebra. A reaction in the cement causes it to harden very quickly. This fixes the bone so that it does not collapse any further as it heals.

There are some complications with the vertebroplasty procedure. If your surgeon thinks you are a good candidate for vertebroplasty, then he or she will go over all the potential problems that can occur. Many studies have shown that the end-results (six months after the incident) are the same whether you opt for the conservative care versus the surgical treatment.

The ethical dilemmas of choosing one treatment over another while weighing out the pros and cons of time, pain, suffering, and end-result can be very difficult. Patients and physicians face this every day.

With a vertebral compression fracture (VCF), we know that the bone has collapsed because of weakness. The underlying cause could be osteoporosis (brittle bones), tumor, or some other disease process that affects bone strength.

Conservative care is usually the first line of treatment offered or suggested. It is safe, effective, and low-cost (compared to surgery). For patients in acute pain and in danger of lung compromise, vertebroplasty is a procedure that can provide immediate pain relief. Up to 95 percent of patients get pain relief quickly with this treatment. The vertebroplasty restores spinal stiffness and increases spine strength needed for pain free stability.

But complications such as fever and cement leaking out have been reported. The oozing cement can put pressure on the spinal cord or nearby nerves or even travel to the lungs as a cement clot (embolism). There have been some studies showing that patients can develop other fractures in the adjacent vertebrae. But whether these new fractures are a result of the osteoporosis that caused the first vertebral compression fractures or perhaps the result of the vertebroplasty is unknown.

Long-term studies now available show that the results from the vertebroplasty don’t last. And recovery is about the same when compared with patients who were treated conservatively with physical therapy, postural exercises, and pain relievers. The main difference is how quickly pain relief is delivered: immediately with vertebroplasty versus two to four weeks later with nonoperative care.

If your mother is suffering from compromise to the lungs so that breathing is a problem, it may be worth it to take a second look at vertebroplasty. But talk with her surgeon first and get all the facts. The decision may be one that really has a clear conclusion right from the start when all the factors are weighed in.

Efforts to treat vertebral compression fractures (VCFs) with kyphoplasty have met with some problems and complications. It sounds like you might have run into some of these.

For those who don’t know, kyphoplasty involves inserting a deflated balloon into the fractured and collapsed vertebral body. Hydraulic pressure is used to inflate the balloon. The balloon is then collapsed and removed. The empty space left by the inflated balloon is quickly filled in with a cement that is injected into the area.

Researchers are recognizing that more and more patients are not good candidates for the kyphoplasty procedure. Experiments with human cadavers (bodies preserved after death for study) are underway. This is the first step in the investigational process.

One of those studies created vertebral compression fractures, and then treated them three different ways. All vertebral bodies from the thoracic spine (T4) to the lumbar spine (down to and including L5) were used.

The first treatment was with kyphoplasty — just the way a patient would be treated with this technique. The second treatment was with a titanium mesh implant cemented in place. The implant looks like a diamond-shaped Chinese finger trap with the center expanded out on each side. The collapsed mesh implants are inserted into a channel or pathway drilled into the vertebral body. A special machine is used to expand the device.

The third treatment was with the same titanium mesh implant but without cement. Fluoroscopy, a special 3-D moving X-ray was used to guide implantation in all three treatment methods.

Results were measured by calculating the stiffness of the vertebral bodies and the mechanical load they could withstand. These values were then compared to normal, intact, healthy bone. Subgroups that were compared included males versus females and thoracic (midspine) versus lumbar (low back) vertebral fractures.

They found that the titanium mesh implants most closely approximated normal bone strength, function, and stiffness. The authors concluded that titanium mesh implants may provide a safe and effective alternative to kyphoplasty for the treatment of vertebral body compression fractures. Cement isn’t really needed, so leaving that out can reduce some of the more typical complications associated with kyphoplasty.

The results of this study are considered preliminary — too early to make firm recommendations. Further study is needed to test the abilities and limits of titanium mesh implants. At first glance, these devices appear to provide a protective mechanical scaffold when placed inside the vertebral bones. But the long-term effects have not been calculated or compared against kyphoplasty.

Patients with osteoporosis (decreased bone density or brittle bones) are prone to compression fractures in the spine bones, or vertebrae. The bone cracks under pressure, causing it to collapse in height.

The fracture angles the spine forward and produces a hunchbacked appearance, called kyphosis. Patients with this condition are subject to debilitating pain, disturbed sleep, decreased lung and intestinal function, and difficulty completing routine activities.

Kyphoplasty restores the size and strength of the fractured vertebra. This realigns the spine and reduces pain. Nearly 95 percent of patients get immediate relief of pain with this procedure. But there are some potential complications or problems that can occur. One is, as you mentioned, the oozing of cement into the surrounding soft tissues.

But the cement oozes out and damages nearby blood vessels and nerves. The oozing cement can also form an emboli (clot) that can travel to the heart or brain and make matters much worse.

One other problem is that injecting cement into the main body of the vertebral bone creates a rigid bone that is actually too stiff for the weak (osteoporotic) bone. The result can be even more fractures in the vertebrae above and below the cemented level.

But vertebral compression fractures (VCFs) caused by weak, osteoporotic bones can’t be just left to heal on their own. The end result would be further collapse of spine, chest, and abdomen affecting breathing, appetite, and digestion. And since most of the VCFs occur in adults aged 65 or older, there can be additional complications associated with these problems.

Older patients aren’t the only ones affected. Younger patients can experience any of these problems, too. In addition, the implant is expected to be permanent. It doesn’t break down and it isn’t absorbed by the body. This feature could cause problems later for the younger patients.

You aren’t likely to actually feel the movement of cement into the soft tissues. You are more likely to experience symptoms from the effects of the cement coming in contact with blood vessels and nerves. The heat from the chemical process involved may be what injures these tissues. Irritation of the nerves can cause pain, numbness, or other sensory symptoms. Emboli can result in a heart attack or stroke.

Patients are usually told what to look for as potential symptoms of the more serious complications of kyphoplasty from cement extravasation (oozing). Fortunately, you did not experience any of these!

Vertebroplasty was first used in the early 1980s when a bone cement was invented that could hold the fractured pieces of bone together while waiting for the bone to heal itself. The goal of the procedure is to strengthen and stiffen the vertebra, which reduces pain considerably and helps the patient return to normal activities.

It was first used for painful vertebral compression fractures associated with osteoporosis (brittle bones) in older adults. Vertebral compression fractures refers to bone fractures that occur just from the weight of the spine on an unstable and weak vertebra. The vertebra cracks under pressure, causing it to collapse in height. More than 700,000 such fractures occur every year in the United States. These fractures often cause poor back posture, debilitating pain, and difficulty completing routine activities.

In more recent years, the use of this procedure has expanded to include other problems like cancer and acute trauma (falls, car accidents). It’s not recommended for anyone with vertebral fractures. For example, unstable fractures that could damage the spinal cord must still be stabilized with an open surgical procedure. Patients with bleeding disorders, blood infections, or other more local infections are also excluded from this treatment option.

Additionally, the patient must be able to lie prone (face down) for up to two hours. If this position is not possible or if there’s a chance the pressure from this position could cause additional fractures, then vertebroplasty isn’t advised.

Vertebroplasty is a minimally invasive procedure that doesn’t require an open incision and can be done by certain medical doctors with advanced training. Orthopedic surgeons, neurosurgeons, radiologists, internists and even anesthesiologists are doing vertebroplasties.

The procedure involves a percutaneous (through the skin) approach. Very small instruments are used to perform the vertebroplasty. This lessens the chance of bleeding, infection, and injury to muscles and tissues. The physician uses a special real-time X-ray called fluoroscopy to see inside the body and accurately guide the needle used to inject the vertebral body with a special bone cement.

The cement strengthens and stiffens the vertebra, which reduces pain considerably and helps the patient return to normal activities. More than 80 percent of patients get immediate relief of pain with this procedure. In the hands of an experienced physician, the rate of major complications with vertebroplasty is a reportedly low 0.5 per cent.

Burst fractures occur as a result of a high-energy load through the spine causing the vertebra to break or shatter into many tiny pieces. That’s why they call them burst fractures.

Burst fractures are most often caused by car accidents or by falls. The danger of these fractures is that the bone fragments can shift and press into the spinal cord or spinal nerve roots causing temporary and even permanent neurologic damage.

The healing time for any type of typical bone fracture is still six to eight weeks. For a long time, bed rest was routinely recommended for this condition. Bracing has been used to keep the spine stable while the bone heals. Supportive bracing was also used with the idea in mind of preventing neurologic damage from bone fragments piercing the spinal nerve roots.

Recent research from a group of orthopedic surgeons in the U.S. and Canada has shown that if a burst fracture is stable, bracing may not be needed. The patient can be up and moving with only a few restrictions. What does stable mean? In the case of thoracolumbar burst fractures, if the surrounding ligaments have not been damaged, then the fragments or pieces of the spine are contained by the soft tissues. In other words, they have no where to go and just stay where they are until fully healed.

Even though the healing time is eight full weeks, this doesn’t mean the patient can’t be up and moving. If the area is stable and no brace is needed, then patients are advised to maintain good, upright posture. They are not to bend or twist the spine. Hip flexion is also limited to 90-degrees and not beyond. But your wife’s physician will give you all the necessary precautions, so be sure and ask what to expect and how to modify activities.

If there are no complications, no other injuries or trauma, and your wife is in good health, she should have a very good outcome. Depending on the type of work she does, she may only miss a week or two at the most. If the job entails lifting, bending, or twisting, then she may be off work the full amount of time for healing to occur. Again, her doctor will give you all of the guidelines necessary for her particular injury and situation.

Your husband may be developing a condition called hyperkyhosis. This is a forward curvature of the spine. You may have heard it by another more common name: Dowager’s hump. People think this problem only affects women, hence the name. But, in fact, it is just as common among men.

No one knows for sure what brings this on, so the optimal treatment to prevent it or correct it has not yet been discovered. Physical therapists offer postural exercises, strengthening, and flexibility training but studies have not been done to compare differences in results between people with hyperkyphosis who follow the treatment versus those who don’t get the treatment.

The same is true for bracing, surgery, or devices like shoulder harnesses. Clearly, telling someone who is unaware of the problem to stand up straight doesn’t have much of an effect. Habit, gravity, and muscle imbalances pull them right back into the posture.

Studies show that there are often other health issues that accompany hyperkyphosis. It may be best to have a medical exam to rule out other possible causes for the problem. Your primary care physician or orthopedic specialist can help make the diagnosis and recommend appropriate treatment.

The Dowager’s hump in medical terms is called hyperkyphosis. It is an increase in the forward curvature of the spine — usually in the lower cervical (neck) and upper thoracic areas. A visible hump appears along the back of the spine. The head juts forward like a turtle out of the shell and eventually the chin drops down to the chest if the curve is pronounced enough.

There’s always been an assumption that having a Dowager’s hump increases the risk of vertebral compression fractures. The forward bend of the vertebrae compress the front half of the bone causing a wedge-shaped deformity when viewed from the side on an X-ray. Over time, with age-related degenerative disc disease and osteoporosis developing and/or progressing, vertebral fractures can occur.

But it’s no longer so certain that the hyperkyphosis is actually a cause of vertebral compression fractures. Several studies have shown that just as many people with hyperkyphosis don’t ever develop vertebral fractures. So is there a link between the two? We don’t know yet.

Because this is a fairly common problem about which we don’t know much, there’s been a call for increased research to identify the underlying causes, ways to treat it, and ways to prevent it.

Physical therapists, like everyone else in the health care field, are working hard to find ways to treat patients safely and effectively. Instead of treatment as usual, therapists are striving to find scientific evidence to support (or refute) current treatment approaches.

There’s plenty of evidence that thoracic spine thrust manipulation has a positive effect in treating patients with mechanical neck pain. Mechanical refers to generalized neck and/or shoulder pain that are made worse by certain neck positions, movement, or pressing on muscles of the head and neck. This indicates that the source of pain is one of the soft tissue structures, not coming from a fracture, infection, or tumor.

It’s also true that patients improve more with thoracic spinal manipulation procedure when combined with the heat and electrotherapy than with just heat and electrotherapy alone. A series of studies done by physical therapists in Spain on just this topic showed there was a greater reduction in neck pain, better function, and improved neck range of motion with multimodal (more than one treatment modality of technique) therapy.

It may take more than one manipulation. Most of the studies done included patients who had at least three thrust manipulations performed over a period of three to six weeks. It isn’t always the case that your spine will crack or pop with this treatment. If it does, the sensation isn’t usually painful as much as it just sounds like it should be.

Don’t hesitate to discuss your concerns and fears with your therapist. There may be other ways to approach your problem without joint manipulation. They may take longer to have the same effect, but they can alleviate your worries about snapping or popping the spine.

Compression fractures are the most common type of fracture affecting the spine. When stress on the spine from everyday movements is greater than the strength of the bone, the bone fractures and collapses down on itself. That’s a vertebral compression fracture (VCF). Compression fractures are often the result of osteoporosis, a common problem in older adults (especially postmenopausal women).

Osteoporosis is a disease that weakens bone. Sometimes the bones in the spine weaken to the point that even mild forces can lead to a compression fracture. Spine bones that are weakened from osteoporosis may become unable to support normal stress and pressure. As a result, something as simple as coughing, twisting, or lifting can cause a vertebra to fracture. Even a simple action like reaching down to pull on a pair of socks can cause a weakened vertebra to fracture.

An injury to the spine, such as from a hard fall on the buttocks or blow to the head, can cause a spinal compression fracture. Let your aunt’s physician know you are suspicious of some type of trauma. There may be signs of a fall or trauma or other unrecognized injuries that should be identified.

Weakening of the bones can occur for other reasons besides osteoporosis. For example, Cancer weakens the spine bones and makes them prone to fractures. And cancer from other parts of the body often metastasizes (spreads) to the spine. Diseases or conditions that affect the parathyroid gland (near the thyroid) can also weaken bones. The physician will do a complete examination and rule out any of these other possible causes of vertebral compression fractures.

A treatment procedure called vertebroplasty was developed about 15 years ago. A long, thin tube called a cannula (needle) is inserted through the skin into the vertebral bone. Cement is injected through the needle into the compressed area. The cement hardens quickly and stabilizes the fracture. The surgeon uses a special X-ray imaging called fluoroscopy to guide the needle and ensure accurate placement of the cement.

Studies are showing that percutaneous vertebroplasty works well for the treatment of VCFs. It reduces pain, maintains the height of the vertebral body, and can prevent serious health problems. The majority of patients with vertebral compression fractures who have a vertebroplasty do well. The procedure reduces their back pain and this, in turn, increases their movement and speeds up their return to daily function. Nine out of 10 patients are able to reduce (or stop) taking pain relievers.

But not everyone can have this procedure. If the fracture is stable and isn’t causing any symptoms, the surgeon may adopt a wait-and-see approach. There’s no sense in subjecting a patient to the expense of a procedure that’s not really needed.

Alternately, anyone with cancer causing the vertebral compression fracture and collapse may not be a good candidate for vertebroplasty. The risk of cement leakage is greater when bone has been eaten away by cancer. And cement leaking into the spinal canal can cause further problems. This doesn’t mean that cancer patients can’t have a vertebroplasty. Vertebroplasty for cancer patients must be evaluated on an individual basis.

Vertebroplasty can’t be done if a bone fragment from the fracture has shifted or moved into the spinal canal or is pressing on the spinal cord. And there are some patients who are allergic to the bone cement.

There may be an important reason why vertebroplasty hasn’t been offered to your father as a possible treatment option. It’s reasonable to ask if he might be a good candidate for this procedure. The physician may have discussed this with your parents. Sometimes patients and family members don’t catch all that is said during their appointment. It never hurts to ask for further information.