Pathological fractures of the spinal column, symptoms and treatment

What is a pathological fracture?

Fractures that occur in malignant tumors, metabolic bone disease, and other pathologies are called pathological fractures. They can occur in every age group, but are most common in older people. In contrast to normal fractures, pathological fractures are the result of a mild injury and are divided into several types depending on the etiological cause:

Tumor-like bone lesions

Primary – the disease comes from the bone tissue itself and weakens the fracture zone. They occur mostly in children and adolescents. Fibrous dysplasia, cystic bone lesions, eosinophilic granuloma, etc. can be referred to this group of diseases.

The figure shows the lesion of a benign vertebral tumor, which led to a pathological fracture

Secondary – metastatic, due to the metastasis of malignant tumors in human bones. Tumors of the breast, lung, prostate, and gastrointestinal tract very often metastasize to the spinal column.

Malignant tumors lead to fractured vertebrae

Metabolic lesions

1.Osteoporosis – it is a decrease in bone density and an increase in fragility due to age.

2. Hyperparathyroidism – it is decreased bone density, due to increased function of the parathyroid glands, which contribute to the leaching of calcium from the bones.

3. Paget’s disease – in this disease, the bones are more brittle than usual. The cause is still unclear.

Hereditary diseases

Incomplete osteogenesis (osteogenezis imperfectis) is a disease that is characterized by a tendency for bones to fracture due to collagen deficiency. It is also among the diseases that most often lead to pathological fractures.

Infectious diseases

Mycobacterium tuberculosis, brucella, and other microorganisms can lead to infectious damage to the spine. If the disease is not treated in time, it can lead to fractures. An abscess can form around the vertebrae. If not diagnosed in time, it can lead to the development of paralysis of the upper and lower limbs. If the disease progresses, the infection can penetrate the cerebrospinal fluid and further lead to infectious lesions of the brain and spinal cord, which ends in death in 60-80% of cases.

Symptoms

The main symptoms are pain, swelling, deformity, and moving difficulty at the fracture area.

Diagnosis

In most cases, the diagnosis can be made with an X-ray examination. To identify the etiologic cause, a CT, MRI, blood test and biopsy should be performed. It is imperative to identify the primary focus of the lesion.

Treatment

All features of the development of pathological fractures should be considered, in order to choose conservative or surgical treatment tactics. These include: the degree of severity of the disease, the age of the patient, the patient’s general condition, secondary diseases and the localization of the pathological fracture.

If the fracture occurred because of a benign bone lesion, it is necessary to perform surgical treatment, and to correct the bone defect. Fractures caused by malignant neoplasms require comprehensive diagnosis and treatment.

The image shows surgical fixation of a posterior pathological fracture of the spinal column