If It’s A Back Fracture, Why Can’t We Cast It?

A vertebral compression fracture (VCF) is, indeed, a fracture. However, it is a very different fracture that that seen in other parts of the body. For example, with most long bones, such as the humerus or femur, a fracture usually occurs as a break into two or more pieces.

Although I am simplifying things when I tell my patients that this is like snapping a stick in two, that is a simple concept that most people can grasp. By contrast, though, a vertebral compression fracture is usually more of a crushing injury than a simple break. It is more akin to crushing a can with your foot. A better analogy is probably crushing a brick with a sledge hammer. The injury usually results in many small broken pieces that are harder to put together.

Also, vertebral compression fractures (VCF) are notoriously difficult to fix and usually have a hard time healing, compared to other fractures. The multiple pieces in these types of crush fractures are typically two small to put surgical in screws. Many talented surgeons have tried throughout the years to come up with an effective way to treat these fractures at surgery, but have failed.

Second, a key to healing a fracture is relieving the broken pieces from stress. If a fracture of the radius in two pieces starts to heal, and you pick up something heavy with your arm, it will often refracture. Then the process of healing has to start over again. An example would be using glue to put our broken stick back together. If we pick the stick up before the glue has set, then the other piece falls off.

Thus, most fractures are initially placed in a cast—to immobilize the fracture fragments and allow them to heal. If you have a vertebral compression fracture (VCF) and we were trying to put it in a cast, we would use a device known as a TLSO, or thoracolumbosacral orthosis. Commonly known as a back brace, a TLSO provides support for the spine and decreases weight-bearing forces. This stabilizes the spine and also decreases pain by physically redirecting axial loading forces from the spine to the pelvis.

Cervical Kyphoplasty

There are very few doctors who perform vertebroplasty or kyphoplasty in the upper thoracic or cervical spine. Luckily for our patients, we do.

This is a rotary kyphoplasty we performed today at the C7 vertebral body. This patient had suffered from the pain for over 7 years. It's another key example of a fracture that a radiologist called "old" or chronic, yet responds to treatment.

Due to potentially life-threatening complications, cervical fracture fixation is not to be taken lightly and should only be performed by experienced doctors. Although there are about 20 doctors in our area who have trained to fix fractures, only one or two of us perform them in the cervical spine. Who would you rather have fixing a fracture in your loved one?