Can rehabilitation be performed for compression fractures of the 10th and 11th vertebrae?
I was involved in a car accident on February 16 of this year and was immediately taken to Yonghe Cheng Hsin Hospital.
The physician diagnosed me with the following: (1) head trauma with cerebral contusion, (2) renal contusion, and (3) cervical spine contusion.
I was hospitalized for two weeks and then discharged.
However, I have been experiencing persistent pain in my lower back (which I did not have prior to the accident).
When I consulted my physician, I was told that it was a sciatica issue unrelated to the accident, and I was scheduled for outpatient electrocoagulation (which is said to be a non-invasive alternative to surgery, painless, and with a quick recovery) and prescribed medication.
After one session of electrocoagulation, I was informed that I would need to wait two months before undergoing further treatment, during which time I could only rely on pain medication.
When the medication was ineffective in controlling the pain, I followed a friend's recommendation to visit a well-regarded hospital in Beitou on May 5.
After explaining the circumstances of my accident to the physician, they began rehabilitation treatment without first taking X-rays to assess my condition.
During the third follow-up appointment, I underwent rehabilitation again, but afterward, I was unable to get out of bed due to severe pain (a situation I had not experienced in the previous two sessions).
The physician then instructed the nurse to wheel me to the X-ray room.
After reviewing the X-ray images, the physician indicated that there was a fracture in the eleventh lumbar vertebra that could not be treated, suggesting it might be an old injury from the accident that precluded further rehabilitation.
I was advised to purchase a bottle of calcium supplements at my own expense (which caused persistent diarrhea; the physician later pointed out that the calcium content in those supplements was very low and not very effective) and was referred to Veterans General Hospital for further care.
After this treatment, my condition worsened to the point where I could no longer walk and had to rely on a wheelchair.
Seeing the situation deteriorate, my family took me to National Taiwan University Hospital, where on May 28, the physician reviewed my X-rays and indicated that the tenth and eleventh lumbar vertebrae had degenerated and required immediate surgery to remove them, or I risked paralysis in my lower body.
Consequently, I underwent surgery at National Taiwan University on May 31, which alleviated the pain and resolved my inability to walk.
Ayu, 50~59 year old female. Ask Date: 2004/11/18
Dr. Xu Zhenrong reply Rehabilitation
Dear Ms.
A-Yu,
Based on the limited information mentioned in your letter, it can be inferred that osteoporosis is associated with vertebral fractures, which are often difficult to diagnose, leading to treatment only after visits to multiple hospitals.
Osteoporosis is common in women around the time of menopause and often presents with no symptoms.
It is recommended that women in this age group undergo regular bone density screenings.
If osteoporosis is detected, calcium supplementation is advised to prevent falls.
Patients with osteoporosis are prone to thoracic and lumbar vertebral fractures, typically resulting from falls or minor trauma.
Symptoms include severe back pain that radiates to the abdomen, which can lead to complications such as immobility, constipation, and pneumonia.
Diagnosis relies on comparing X-rays of the thoracic and lumbar spine taken after the fracture with previous X-rays, revealing a change in vertebral shape from square to triangular.
Treatment for osteoporosis with vertebral fractures can be divided into acute and chronic phases.
During the acute phase, it is recommended to administer subcutaneous injections of miacalcic (1 vial/day) for one week, along with physical therapy involving electrical stimulation, anti-inflammatory analgesics to alleviate pain, and laxatives to relieve constipation.
In addition to bed rest, patients should wear a thoracolumbar brace when getting out of bed to reduce the risk of complications associated with prolonged immobility.
After a few weeks, as back pain gradually subsides, Fosamax (one tablet weekly) can be introduced, along with physical therapy focused on strengthening the abdominal and back muscles, effectively creating a "natural brace" to replace the "artificial brace."
However, if neurological symptoms such as urinary incontinence, muscle weakness, or diminished tendon reflexes occur during the acute phase of osteoporosis with vertebral fractures, surgical intervention is recommended.
Thank you for your letter.
Wishing you good health,
Rehabilitation Department, Taipei City Hospital
Reply Date: 2004/11/18
More Info
Rehabilitation can indeed play a crucial role in the recovery process following compression fractures of the lumbar vertebrae, especially after traumatic events such as car accidents. Your experience highlights several important aspects of managing such injuries, including the challenges of diagnosis, the importance of appropriate treatment, and the potential benefits of rehabilitation.
Compression fractures of the lumbar spine often occur due to trauma, such as a car accident, and can lead to significant pain and functional limitations. In your case, the initial treatment involved pain management and possibly non-invasive procedures like electrotherapy, which may not have addressed the underlying issues effectively. This is a common scenario where patients may experience persistent pain despite conservative treatments, leading to frustration and a search for more effective solutions.
The key to successful rehabilitation after a compression fracture lies in a comprehensive approach that includes pain management, physical therapy, and possibly surgical intervention if conservative measures fail. In your situation, it appears that the initial assessments did not fully capture the extent of your injuries, particularly with the lumbar vertebrae. This underscores the importance of thorough imaging studies, such as X-rays or MRIs, to evaluate the condition of the spine accurately.
Once a compression fracture is diagnosed, rehabilitation typically begins with a focus on pain relief and stabilization. This may involve the use of braces or supports to limit movement and allow the fracture to heal. As healing progresses, physical therapy becomes essential to restore strength, flexibility, and function. A tailored rehabilitation program can help improve mobility, reduce pain, and enhance overall quality of life.
In your case, after the surgical intervention, rehabilitation would likely focus on gradually increasing activity levels, strengthening the core muscles that support the spine, and improving overall physical conditioning. It is crucial to work closely with a physical therapist who can design a program that considers your specific needs and limitations. They can guide you through exercises that promote healing while avoiding movements that could exacerbate your condition.
Regarding your concerns about bending and other movements, it is essential to follow your healthcare provider's recommendations. Initially, certain movements may be restricted to prevent further injury. However, as healing progresses, many patients can gradually resume normal activities, including bending and lifting, with proper guidance and technique.
In summary, rehabilitation after compression fractures of the lumbar vertebrae is not only possible but also highly beneficial. It requires a multidisciplinary approach involving pain management, physical therapy, and possibly surgical intervention. The goal is to restore function, alleviate pain, and improve the overall quality of life. If you are experiencing ongoing issues, it is vital to communicate with your healthcare team to ensure that you receive the appropriate care and support throughout your recovery journey.
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