WHEN TO SEE A SPINE SPECIALIST

You should seek the advice of a spine specialist if neck or back pain persists for more than two weeks or if it is progressive in intensity and/or distribution. You should seek immediate healthcare attention if neck or back pain occurs as the result of an injury or if it is associated with serious illness and/or a high fever. Additional signs and symptoms which warrant prompt medical attention include:

• Neck or back pain associated with bowel and/or bladder dysfunction
• Neck or back pain associated with extremity weakness or difficulty with coordination
• Extremity numbness or muscle weakness
• Neck or back pain that is associated with impaired walking (gait) or difficulty with balance
• Numbness, tingling and/or muscle weakness associated with a back or neck injury

 SCREENING AND DIAGNOSIS

If you experience acute or persistent back pain, or if you suspect a compression fracture, go to a physician. Only a physician can diagnose a compression fracture. After a through personal and family history the attending physican may order one or more of the following diagnostic tests:

• spinal X-rays to determine whether a vertebra has collapsed
• a CT scan to provide detail of the fractured bone and the relationships to the spinal cord, spinal nerves and other soft tissue within and around the spine
• An MRI scan to show greater detail of soft tissues including nerves and adjacent intervertebral discs
• A bone density test to assess for thinning of bone (osteopenia/osteoporosis)

The physician may order a bone biopsy to assess the tissue within the involved bone. This is often done if a physican suspects cancer.

PROGNOSIS

Most spinal compression fractures which develop secondary to trauma will heal in 8 - 10 weeks with proper care and rest. If a post-traumatic compression fracture is severe, such as a burst fracture, displaced bone fragments complicate the healing process and lengthen the recovery time. In general the recovery time takes longer if surgery is performed.

Slow developing (chronic) compression fractures associated with severe thinning of the bone osteopenia/osteoporosis may not recover well at all because the loss of bone density and the increased spacing between supportive pillars within the bone (trabeculae) often have a poor prognosis without invasive intervention to stabilize the vertebral body to prevent further collapse of bone.

The prognosis for a compression fractures caused by a tumor depends on the type of tumor involved. A tumor may originate with vertebrae (primary tumor) or it may spread to and develop within vertebrae, through a process called metastasis. Some types of tumors that involve the spine include:

• Breast cancer
• Lung cancer
• Lymphoma
• Prostate cancer

COMPLICATIONS

The complications associated with a spinal compression fracture include:

• Failure of the bone to heal
• Development of a spinal deformity (hunched back and/or scoliosis)
• Compression of the spinal cord
• Compression of one or more spinal nerve roots
• Spinal segment instability
• Chronic pain