The main reason to use such a classification is to help determine whether a fracture is stable. A similar classification system does not exist for compression fractures. The Denis system, however, was created to classify traumatic fractures. Classification of these fractures is based on the 3-column anatomic theory of Denis, which describes anterior, middle, and posterior spinal columns consisting of aspects of the spine and their corresponding ligaments and other soft-tissue elements. Traumatic fracturesĭifferent types of fractures can occur in the lumbar (or thoracic) spine. Other disorders that can contribute to the occurrence of compression fractures include malignancy, infections, and renal disease. The most common underlying reason for these fractures in geriatric patients, especially women, is osteoporosis. In older patients, lumbar compression fractures usually occur in the absence of trauma, or in the context of minor trauma, such as a fall. These fractures can also result in serious neurological injury. Jumps or falls from heights cause burst fractures. Car accidents frequently cause flexion and flexion distraction injuries. In younger patients, fractures are usually due to violent trauma. These patients are also at risk for falls and accidents, increasing the risk of secondary fractures in the spine and elsewhere.įractures in the lumbar spine occur for a number of reasons. In trying to maintain their ability to walk, patients with kyphosis report secondary pain in their hips, sacroiliac joints, and spinal joints. Most often, the result is an increase in thoracic kyphosis, sometimes to the point that the patient cannot stand upright. Second, the fracture can alter the mechanics of the posture. First, the fracture itself can cause significant pain, and this pain sometimes does not resolve. Lumbar compression fractures can be a devastating injury, therefore, for 2 reasons. As the body attempts to compensate for the alteration in the lumbar spine in order to maintain an upright posture, this will tend to distort the curves of the thoracic and cervical spine. Any injury that changes the shape of a lumbar vertebra will alter the lumbar posture, increasing or decreasing the lumbar curve. Proper function of the lumbar spine requires that it have a normal posture (ie, a normal lumbar curve). The lumbar spine provides both stability and support, allowing humans to walk upright. However, medical and surgical options are now available that can relieve the severe pain and disability from these fractures. Suh and Lyles found that vertebral compression fractures were associated with significant performance impairments in physical, functional, and psychosocial domains in older women. While many patients improved with this regimen, some did not and were left with chronic, disabling pain. In the past, treatment options for lumbar fractures were quite limited, with bracing and rest prescribed most often. The image below reveals a wedge compression fracture. However, a thorough diagnostic workup is always required to rule out spinal malignancy. Osteoporotic spinal fractures are unique in that they may occur without apparent trauma. Osteoporosis is the underlying cause of many lumbar fractures, especially in postmenopausal women. Fractures of lumbar vertebrae, therefore, occur in the setting of either severe trauma or pathologic weakening of the bone. ![]() The strongest stabilizing muscles of the spine attach to the lumbar vertebrae. They begin at the start of the lumbar curve (ie, the thoracolumbar junction) and extend to the sacrum. The lumbar vertebrae are the 5 largest and strongest of all vertebrae in the spine.
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