Lumbar Spinal Fractures By: 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 Sedentary Active

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 Lumbar Thoracic

Justification Recovery Prevention Back brace Massage Physical therapy Medication Nutrition Calcium-Restore Vitamin D-Absorption Vitamin K-Transport 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.