Lumbar Spinal FracturesBY: AMADEO BERAUN

Pathomechanics-Denis’ 3 columns

Anterior

Middle

Posterior

Spinal instability

“The loss of the ability of the spine under physiological loads to maintain relationships between vertebra in such a way that there is neither damage or subsequent irritation to the spinal cord or it’s nerve roots, and in addition there is no development of incapacitating deformity or pain.”-White and Panjabi.

What specific forces acting on the lumbar spine produce fractures?

COMPRESSIVE FORCE

ROTATIONAL FORCE

TENSILE FORCE

SHEAR FORCE

Compressive/Tensile force

Rotational/Shear force

Explanation-Why are lumbar spinal fractures common?

5 lumbar vertebrae are the strongest of the spine.

As we age we all lose bone mass, therefore bone density.

Most people aren’t aware of the awkward direction of forces they place on the lumbar region.

We don’t utilize good form when lifting from the ground.

People seem to care more about the look of their arms and abs instead of their back muscles.

Who is more susceptible to fractures of the lumbar spine?AGE—DECREASE IN BONE DENSITY

WEIGHT—CURVATURES OF SPINE

GENDER—FEMALES AFTER MENOPAUSE (HIGH RISK)-

NUTRITION—NEED CALCIUM, VITAMIN D, AND VITAMIN K

FITNESS—APPLY LOADS TO BUILD STRONGER BONES

CONGENITAL—GENETICS

Age

Elderly Young adult

Weight

Lean Obese

Gender

Male Female

Nutrition

Good Bad

Fitness

Active Sedentary

Congenital

Where on the lumbar spine region do fractures most commonly occur?

THORACOLUMBAR REGION

FLEXION/ROTATION (FRACTURE-DISLOCATION)

T-11 through L-1

Flexion/Rotation

ThoracicLumbar

Justification

Recovery Back brace

Massage

Physical therapy

Medication

Nutrition

Calcium-Restore

Vitamin D-Absorption

Vitamin K-Transport

Prevention Exercise-load bearing

Posture

Good form when lifting

Controlled movements (not fast jerking motions)

What can be done to prevent the occurrence of lumbar spine fractures?

POSTURE

TISSUE STIFFNESS

Posture

Good Bad

Tissue Stiffness

Anterior Posterior

How are fractures of the lumbar spine treated?

ASSESSMENT

CT SCAN

BRACE

Assessment

CT Scan

Brace

External Internal

What is the rehabilitation process for fractures of the lumbar spine?

CONSERVATIVE MANAGEMENT

OPERATIVE MANAGEMENT

Conservative Management

Operative Management

Description-Lumbar spine fractures Compression fracture-anterior segment

Chance fracture-horizontal plane

Burst fracture-anterior and middle segments Organs-poly trauma

Flexion/distraction (fracture-dislocation)-middle and posterior segments Vehicle accident-seat belts

Personal Reaction-Lumbar fractures

Realize compression fractures are most common.

Most fractures occur in thoracolumbar region. (function change)

Exercising the stabilizer muscles is very important.

Understand the importance of good form for lifting and posture.

The lumbar spine consists of our strongest vertebrae, but we shouldn’t take that as a challenge to test it.

Be aware of bone density decreasing with age.

Videos

http://www.youtube.com/watch?v=1-mhBesMAwQ

http://www.youtube.com/watch?v=nLYVpOPT2JQ

http://www.youtube.com/watch?v=ExaS8ocTKZI

References

Gardner, A., S. Grannum, and K. Porter. "Thoracic and Lumbar Spine Fractures." Trauma 7.2 (2005): 77-85. Academic Search Premier. Web. 26 Apr. 2014.

Waterloo, Svanhild, et al. "Prevalence of Vertebral Fractures in Women and Men in the Population-Based Tromsø Study." BMC Musculoskeletal Disorders 13.1 (2012): 1-9. Academic Search Premier. Web. 26 Apr. 2014.

Scannell, Joan P, and Stuart M McGill. "Lumbar Posture--Should It, and Can It, Be Modified? A Study of Passive Tissue Stiffness and Lumbar Position during Activities of Daily Living." Physical Therapy 83.10 (2003): 907-917. Academic Search Premier. Web. 26 Apr. 2014.

Bakhtiary, Amir Hoshang, Ziaeddin Safavi-Farokhi, and Asghar Rezasoltani. "Lumbar Stabilizing Exercises Improve Activities Of Daily Living In Patients With Lumbar Disc Herniation." Journal of Back & Musculoskeletal Rehabilitation 18.3/4 (2005): 55-60. Academic Search Premier. Web. 26 Apr. 2014.