Question:

Good morning, my husband had a very bad fall on Thursday last. He had a scan which the findings indicate ” an acute fracture of the vertebral body of T12 with approximately 50% loss of vertebral height. the fracture involves the superior end plate and superior body of T12. there is increased signal intensity noted in the superior body of T12 on the STIR and T2 weighted sequences with some decreased signal intensity seen here. There is decreased signal intensity seen on the T1 weighted sequences. Findings in keeping with contusion. There is minimal retropulsion present with some flattening of the vertevral body posteriorly. COMMENT: Acute fracture of the vertebral body of T12 with approximately 50% loss of height and minimal retropulsion. Degenerative discopathy as described above. At the level of L3/4 there is hyperostosis of the paravertebral joints as well as broad based postcentral and bilateral disc herniation with impingement of the L3 nerve roots bilaterally in the lateral recess as a result of the hyperostosis. At the level of L4/5 there is a broad based postcentral and bilateral disc bulge with some impingement of the traversing L5 nerve roots. At the level of L5/S1 there is a postcentral disc bulge with some impingement of the traversing S1 nerve roots.

when the doctor spoke to my husband he did not give any indication of what he must do in fact no information of any description. He only gave him a prescription for Voltaren. What must actually be done in the rehabilitation of this type of injury. He is in extreme pain in any movement whatsoever particularly when he coughs. Does it need physio.What do we need to do. thank you so much

Answer:

Although the “acute fracture of the vertebral body of T12” may be responsible for all of his pain, it’s possible he could have additionally sustained injury to one or more of the degenerative discs depicted by the MRI scan.

Although the following techniques are controversial and have some degree of associated risk, acute vertebral compression fractures may be treated by a spinal interventionalist (nonsurgical spine physician with special expertise in performing minimally invasive spine procedures) by injecting “bone cement” into the fractured vertebra to stabilize the fracture (which is called vertebroplasty), or alternatively, the compressed vertebra may first be re-expanded using a balloon, then cement can be injected to stabilize a fractured vertebra whose height has first been restored (which is called kyphoplasty). Either technique can provide prompt and marked pain relief.

Acute vertebral compression fractures are of course extremely painful, and often require potent pain medication for a period of time to reduce suffering. Voltaren may help pain which is mild to moderate in severity. 

A back brace (which would need to extend above – as well as below – the T12 level, which would not be the case for a typical “low back brace”) may help reduce pain, particularly if vertebroplasty or kyphoplasty are decided against.

Physical Therapy to mobilize, stretch or strengthen would not be appropriate at this time, although it’s possible a treatment such as electrical stimulation (via a TNS unit=Transcutaneous Nerve Stimulator) which PT could provide could reduce his pain somewhat.

For more information:

Go to the Rehabilitation health topic.