Do compression fractures kill?

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Welcome back to the Forensic Chiropractor podcast.

Today I want to talk about fractures.  There are lots of different types of fractures.  Fractures often heal well since they have a large supply of blood.  Unlike ligaments and discs most fractures heal quick.  Some fractures like a burst fracture can damage spinal cord or nerve roots and would be a very serious injury.  Some fractures are minor injuries that resolve and some are permanent injuries.  In almost all cases fractures are painful.  Today I want to talk about a specific type of fracture I see on occasion doing personal injury work and that is compression fractures. 

A compression fracture is when the vertebra collapses and the loses height.  This is a very common fracture with osteoporosis.  This is also a common fracture seen with trauma.  Compression fractures can be very painful. 

Todays study is Mortality Outcomes of vertebral augmentation for osteoporotic vertebral compression fractures published by Kenji Hinde et al in the radiology journal from 2020.  This study covers surgical and nonsurgical management.  Notice how they say management since there is no fixing this type of injury.  The nonsurgical management was reported as bed rest, analgesia and bracing while the fracture heals. 

This study covers 2 types of surgical management.  First is vertebroplasty which is introduction of bone cement into the fracture.  The second is a kyphoplasty which aims to restore vertebral body height by inflation of a balloon in the fracture and creating a cavity for the cement injection. 

These 2 surgical procedures saw good results in the 1990’s and 2000’s for pain relief.  In 2009 a study showed that vertebroplasty was no better than a placebo in reducing pain for up to 6 months after procedure.  Following this study the frequency of vertebroplasty decreased by over 60%. 

Thistoday study showed that vertebral deformities are independently predictors of hospitalization and mortality.   Treatments to help with vertebral deformities such as kyphoplasty should therefore increase survival rates.  Today’s study looked into just that.  They did a systematic review and came up with 16 studies published between 2006 and 2018 to be included. 

As a side note most of these studies included patients only over 65.  Some of the studies went as low as patients 37 years of age.  The likely reason for the age is compression fractures are often seen in the elderly.  This is a common fracture seen with osteoporosis.  It would be hard to do such a large study on young patients since this is not a common fracture for them.  To give you an idea today’s study estimated that in the USA there are around 700,000 compression fractures every year. 

If we go back to the nonsurgical management of compression fractures we have bed rest, opioid analgesia, muscle relaxants and braces.  Today’s study reported that all of these nonsurgical managements carry an adverse risk.   Some of the risks include lack of movement and addictions to medication. 

Today’s study was able to look at over 2 million patients from 5 countries and showed that patients with the kyphoplasty were 22% less likely to die compared to patients treated without the nonsurgery over the following 10 years.   This shows that we really need to consider kyphoplasty with compression fractures.  We need to get patients out of pain and keep them moving and avoid bed rest, medications and braces with compression fractures.    The knowledge from this study could literally save lives. 

The majority of the time the lives saved will be the elderly and not related to a personal injury case, but sometimes they will be.  To summarize this article compression fractures are common and nonsurgical management includes bed rests and braces which decrease movement and leads to worse outcomes including death for a lot of these patients.  The other nonsurgical management would be pain medication which has a lot of risks.  The kyphoplasty surgery where a balloon is inserted into the fracture and attempts to restore vertebral height and then adding a cement mixture to the fracture has been shown to help people get out of pain and get moving without pain meds.  This surgical procedure was shown to lead to 22% less deaths than the nonsurgical management. 

Real world example

For the real world example I want to share a case I just did an IME on.  The patient a male in his early 20’s.  He was in a very high impact collision and had multiple compression fractures.  He had a difficult recovery and after all treatments he remained in a lot of pain. 

His doctor recommended a kyphoplasty, but he felt too young to have the surgery.  He did not have the surgery and was placed at MMI.  My report showed that his fractures are likely causes for ongoing pain given the rich innervation from the basivertebral nerve and potential for ongoing pain.  The compression fracture also alters the biomechanics of his spine which will lead to degenerative osseous changes and degenerative disc changes overtime.  I recommended future care would be best with his doctor’s recommendation to have the kyphoplasty.  The kyphoplasty would potentially prolong this patient’s life over time.  The altered function and pain related with this type of fracture was shown in today’s study to have a large impact including increased risk of death.

I hope that today’s podcast will others understand the importance of compression fractures and the impact they have on a patient’s life.  For a lot of reasons kyphoplasty is likely one of the best treatment options available for this type of injury. 

THanks