Spinal Compression Fractures

*What is a Compression Fracture?*
A compression fracture is the most common type of fracture that affects the spinal column. A compression fracture occurs when the vertebral body is squished, compressed, or reduced in height.

*Causes*
Compression fractures occur when there is blunt trauma to the spine or when the bones of the spine are not strong enough. Forceful impacts, such as an automobile accident or fall, generally causes the vertebrae to crack in the posterior portion of the back and osteoporosis affects the anterior portion of the spine. Majority of cases of compression fractures are due to osteoporosis, a disease that weakens the bone due to a loss of bone density. Different types of cancers can cause a compression fracture too. Cancers from other places in the body tend to metastasize to the spine and weaken the vertebrae, resulting in a compression fracture. A compression fracture can also occur in blunt trauma to the spine. Patients that fall or receive whiplash from a MVA can produce mild to severe cases of compression fractures.

*Symptoms*
Back pain is the most common problem that patients experience with compression fractures. Patients with osteoporosis may develop multiple compression fractures from a curving in their spinal column. Most often the spine curves forward, known as Kyphosis. With compression fractures to the posterior portion of the vertebrae, nerve complaints may be a symptom. This type of fracture can affect the spinal cord and nerves. Majority of the time pain is centered around the fracture. A traumatic compression can also cause pain to radiate down the legs.

*Treatment*
The best treatment of a compression fracture is prevention treatment before a fracture ever occurs. This is best done by treating osteoporosis by exercising, watching calcium, and taking other necessary medications. If back pain becomes severe and the compression fracture becomes problematic two types of minimally invasive procedures can be done to fix the problem. The first procedure is known as Kyphoplasty. Kyphoplasty is generally done under local anesthesia in a special procedures suite. A balloon catheter is placed in the vertebra and inflated with a liquid. The inflated balloon helps to restore the collapsed vertebra. Once the balloon is fully inflated, it is deflated and the enlarged cavity is filled with a cement to correct the compression fracture. The second procedure is Vertebroplasty. This procedure is similar to Kyphoplasty, but in this procedure the cement is injected under pressure directly into the fracture vertebra. The cement hardens in about 10 minutes and provides immediate stability. These two invasive procedures are successful about 90% of the time.

*Complications*
These two procedures are done to help alleviate pain and fix compression fractures, but like any other invasive procedure there are complications that can occur. The most common complication is the leakage of the cement out of the vertebra before it hardens. If these occurs it can compress the spinal cord and nerves, causing new pain and possible neurological problems. Majority of these cases correct the problem though and reduce or eliminate the pain the patient had been experiencing.










Lateral radiograph of the cervical spine showing compression fracture on C5, loss of pedicle, spinous process, and transverse process.



http://www.jkns.or.kr/fulltext/htm/0042002015f1.htm

Compression fracture in the lumbar vertebrae

Carotid Artery Aneurysm

*What is a Carotid Artery Aneurysm?*
An aneurysm is identified as a ballooning or bulging of an arterial wall. This occurs when the artery becomes weakened and the wall becomes thin. If the wall becomes too thin the aneurysm will most likely rupture, resulting in internal bleeding. When a carotid artery aneurysm takes place, significant damage to the brain will occur.

*Symptoms*
Carotid artery aneurysms may form clots in the brain that impede the flow of blood to the head that can cause significant damage to the brain. These aneurysms may also bring about symptoms such as transient ischemic attacks (TIAs) or even a stroke to occur. Depending on the location of the aneurysm and how large it is, it can damage and affect surrounding nerves. If this occurs, patients may experience facial swelling, difficulty swallowing, or even hoarseness to their voice. On other occasions, patients may have a carotid artery aneurysm that produces no symptoms at all.

*Treatment*
Patients with carotid artery aneurysms are evaluated and treated individually. If the aneurysm is small and not affecting the patient, the physician may just opt to watch and evaluate the aneurysm frequently. Another treatment that may be used to eliminate the clots that are blocking the blood flow is Thrombolysis. This treatment is known as thrombolytic therapy and it uses a drug to dissolve the clot. Another treatment option is endovascular stent grafting. This is a surgery that is preformed inside the artery. The graft is expanded inside the artery and helps to manage the blood flow in the artery. Finally, surgical repair can be done to treat the aneurysm. This surgery entails the reconstruction of the portion of the artery that is involved with the aneurysm and then a bypass is preformed to redirect the blood flow form the original artery to the new portion.

*Outcome*
There can be complications with any treatment option that the patient selects. The biggest concern with invasive procedures is the possibility of stroke occurring during or after the procedure. Another risk that can lead to a negative outcome is damage to surrounding vessels, nerves, and tissues during the procedure. Patients are also at risk of a procedure not working 100%. The treatment may not work properly and the aneurysm can come back or the aneurysm can reject the treatment and still be at risk of rupturing.






MRI showing a large right intracavernous carotid artery aneurysm.

http://www.nature.com/eye/journal/v20/n12/fig_tab/6702272f2.html

This coronal reformat of a CT cerebral angiogram shows a right internal carotid artery aneurysm arising from the clinoid or proximal ophthalmic segment (probably at the origin of the ophthalmic artery). The aneurysm erodes the sphenoid bone and protrudes into the sphenoid sinus.

http://www.radpod.org/2007/08/15/internal-carotid-artery-aneurysm/

Goiter

*What is a goiter?*
The thyroid gland resembles a butterfly shape and is located at the base of the neck just below the Adam’s apple. When the thyroid grows abnormally large it is known as a goiter. Most goiters are painless, but the larger they grow the more difficult it is for a patient to breathe and swallow. A goiter can occur in a gland that develops too much hormone (hyperthyroidism), too little hormone (hypothyroidism), or the correct amount of hormone (euthyroidism). Any of these conditions would indicate there is some abnormality of the thyroid.

*Causes*
One of the most common causes of goiter formation worldwide is iodine deficiency. This is not the case for majority of First-World countries, where iodine is added to table salts and other foods. Another cause of goiters can be Graves’ disease. In Graves’ disease antibodies produced by the immune system mistakenly attack the thyroid causing it to produces excess thyroxine. This overproduction of hormone (hyperthyroidism) causes the thyroid to swell. Another cause of goiters is Hashimoto’s disease. This disease is due to an underactive thyroid. The pituitary senses the low hormone level (hypothyroidism) and produces and excessive amount of thyroid-stimulating hormone (TSH), which causes the thyroid to swell. Some other causes of goiters are thyroid cancer, pregnancy, and inflammation of the thyroid.

*Symptoms*
Not all goiters show symptoms. When symptoms do take place they may include, but are not limited to: a visible swelling at the base of the neck that may range from a small nodule to a large lump, and a tight feeling in the throat. The enlarged thyroid can put pressure on the esophagus that can lead to a cough, difficulty swallowing, and difficulty breathing.

*Treatment*
Goiter treatment depends on the size of the goiter, the cause of the goiter, and the symptoms the patient experiences. Some possible treatment options include, but are not limited to: observation, if the goiter is small and the thyroid is functioning normally and not causing the patient any difficulties the doctor may choose to monitor the size of the goiter and the symptoms of the patient before taking the next step. Medications are another treatment that some patients take. There are medications that can make up for the difference of hypothyroidism and hyperthyroidism. Hypothyroidism medications slow down the release of TSH and hyperthyroidism medications normalize the hormone levels. With inflammation of the thyroid, medications such as aspirin can be prescribed to the patient to try and reduce the size of the goiter. Another treatment option is surgery. If a patients symptoms worsen and the size of the goiter becomes extremely large the patient can have a partial or total thyroidectomy. The last treatment option is radioactive iodine. Radioactive iodine is taken orally and destroys thyroid cells. This treatment reduces the size of the goiter. Hormone medicine may have to be taken by the patient after the treatment to maintain normal hormone levels.






Lateral neck x-ray shows goiter extension.


www.ispub.com/.../ija/vol10n1/goiter.xml









MRI--"red arrow" shows a goiter
http://www.learningradiology.com/caseofweek/caseoftheweekpix2006/cow231arr.jpg

An example of a grade III (visible and large) goiter

www.faqs.org/nutrition/Foo-Hea/Goiter.html