sAnatomy, Function WS

The spine is divided into cervical, thoracic and lumbar spine as well as sacral and coccyx bone. It consists of a total of 24 free vertebral bodies and 8-10 (intergrown) vertebral bodies, which make up the sacrum and coccyx. The spine supports the body and connects all parts of the human skeleton.

The S-shape visible from the side is intended to compensate and absorb axial shocks. The spinal cord (nerve tracts) runs through the spinal canal, which together with the central nervous system is responsible for controlling and executing movements of the extremities (arms and legs) and for transmitting sensory information (feeling, pain, heat/cold, etc.).

Accident mechanisms

In the case of injuries to the spinal column, the extent of the damage must first be differentiated:

1. Cervical spine

Frequent complaints after traffic accidents, e.g. distortion of the cervical spine (commonly known as "whiplash injury") after a rear-end collision, by falling on the head or a direct impact.

2nd Thoracic spine

Fall on the back (e.g. on an edge) by direct impact or by indirect injuries in traffic accidents (distortion/torsion).

3. Lumbar spine / sacral and coccyx bone

Frequent in the event of falls on the buttocks or serious traffic accidents. Damage caused by direct impact, e.g. a fall on the back, is also possible here. This also occurs occasionally as an accompanying injury in the context of a coccyx fracture or a pelvic fracture.

In addition to bone fractures of the spine, accompanying ligament injuries often occur. Through appropriate diagnostics (see below), these can be safely detected and treated accordingly. The extent of the accompanying injuries also determines the types of treatment to follow(see below).

Osteoporosis

Fractures caused by osteoporosis play an increasingly important role alongside traumatic fractures (caused by an accident). These fractures usually occur spontaneously without external force. The sinking in of vertebral bodies is called "sintering" and can be an expression of manifest osteoporosis. As an important step in the diagnosis of osteoporosis, we carry out special blood tests and a so-called bone density measurement (DXA) if suspected.

Diagnostic

If a patient comes to us with pain in the area of the spine after an accident, a structured clinical examination is first carried out. On the basis of the findings, we then decide which diagnosis is necessary. Usually x-rays are taken first. Computer tomography (CT) and/or magnetic resonance imaging (MRI) is often necessary to determine the exact extent of the injury.

Nachfolgend wird ein Behandlungsplan festgelegt. Prinzipiell wird zwischen einer Operation und einer konservativen Behandlung (ohne OP) unterschieden (s.u).   

A treatment plan is then defined. In principle, a distinction is made between surgery and conservative treatment (without surgery) (see below).

Treatment Options:

A distinction is made between conservative (without surgery) and surgical treatment. In principle, stable fractures without severe concomitant injuries (ligaments, spinal cord) i.d.R. be treated without an operation. For this purpose, X-ray checks and clinical examinations must be carried out at regular intervals. Often, an orthosis must be worn where biofeedback cah be measured and taken into account for futher diagnosis and treatment.

The right physiotherapeutic co-treatment plays an important role in all treatments. For this purpose, we have specially trained phyiotherapists who carry out the mobilization together with the patient according to the physician's instructions.

In the case of fractures in the area of ​​the spine with impending instability or divergent fractures (dislocation) as well as (threatening) injury to nerves (spinal cord), blood vessels, ligaments or other tissue damage as well as pain that can not be managed by conservative treatment, surgery is usually necessary. There are u.a. two procedures:

1. stabilisation by means of internal fixator ("internal retainer", stabilisation by means of tension belt).

For this purpose, the adjacent vertebral bodies are connected to each other from the back by means of titanium screws and rods, thus bridging the fracture. In many patients, especially older ones, the material can remain in the body for the rest of their lives after the operation.

The following example shows a vertebral body fracture from the 1st lumbar vertebral body (Figure 2+3). In the following operation, the book was splinted with an internal fixator from the overlying vertebral body (BWK-12) to the underlying vertebral body (Figs. 4+5). The red arrow points to the broken vertebral body.

In osteoporotic bone (reduced bone density), the stability or retention of the screws may be compromised. To ensure that the operation is successful, the screws that are turned into the vertebral body can be reinforced with bone cement. In addition, the cement penetrates through small holes in the screws into the vertebral body and thus ensures a firm fit of the screws and the entire osteosynthesis (see Figs. 8-10).
 

2. stabilization with vertebral body replacement ("cage", anterior stabilization).

In the case of vertebral bodies that are clearly deformed due to a bone fracture, stabilization from behind (fix. internal) is occasionally not sufficient, so that a so-called vertebral body replacement (cage) becomes necessary. For this purpose, both procedures are combined together. In the first operation, the posterior stabilization takes place. In a second phase, the anterior stabilization can then take place via a so-called "cage".

A height-adjustable metal cylinder (cage) is used to support the weight instead of the broken vertebral body. This can now transfer the force acting on the spinal column to the adjacent vertebral bodies.

Below is a surgical treatment with a cage for a fracture of the 1st lumbar vertebral body (in addition to the internal fixator, Figure 6+7).

Complications/risks

Due to the immediate proximity of the spinal column to the spinal cord and important blood vessels (including the aorta), vertebral body fractures can injure and damage these very structures. The consequences can range from nerve injuries to paraplegia, life-threatening bleeding and persistent pain. In the case of simpler fractures, which are held by important ligament structures, among other things, primary surgery can often be dispensed with. In principle, the risks and benefits of surgical and conservative treatment are compared and an individual solution is planned out together with the patient.

Range of services

Our clinic covers the entire spectrum of spinal surgery. State-of-the-art procedures, such as intraoperative 3D imaging, are used by us as standard. In addition to the usual open procedures, minimally invasive approaches and computer-assisted navigation are also possible.

Follow-up treatment

Depending on the type and method of primary therapy, a special follow-up treatment of the fracture or the concomitant injury is performed. In general, pain therapy is tailored to the patient's needs in order to ensure early mobilization.

In close cooperation with the physiotherapists, the patients are already mobilized in the hospital according to the patient's own schedule. The patients are also taught how to deal with their diagnosis and how to manage going about their daily lives after the surgery.

In addition, the university outpatient clinic cooperates closely with further treatment planning and regular follow-up checks.