A wedge deformity is a type of spinal compression fracture or bone deformation. It involves a change in the shape of a vertebra, a bone of the spinal column. The altered shape can affect the stability and alignment of the spine, potentially leading to discomfort and other complications.
Understanding Wedge Deformity
A wedge deformity occurs when a vertebra, particularly in the thoracic (mid-back) or lumbar (lower back) regions, collapses. This collapse typically happens in the front part of the vertebral body, while the back portion remains relatively intact. The uneven compression causes the bone to take on a triangular or wedge-like appearance, similar to a building block with one corner removed.
The vertebral body is the large, cylindrical segment at the front of each vertebra. When the anterior aspect of this body collapses, it shortens the front height of the vertebra. This change in shape can disrupt the spine’s natural curvature and alignment, potentially leading to an abnormal forward bend.
Common Causes and Contributing Factors
The primary cause of a wedge deformity is a weakening of the vertebral bone, making it susceptible to collapse under normal or minor stress. Osteoporosis, a condition characterized by reduced bone density and increased fragility, is a leading factor. In individuals with osteoporosis, even routine activities like bending, twisting, or a minor fall can lead to a wedge fracture.
Traumatic injuries, such as falls, car accidents, or forceful jumps, can also cause wedge deformities. Certain medical conditions and treatments can also contribute by weakening bone structure. These include long-term use of corticosteroids, which can reduce bone density, or the presence of bone tumors, which can invade and compromise vertebral integrity.
Identifying Symptoms and Diagnosis
A person with a wedge deformity may have various symptoms, though some individuals might initially have no noticeable signs. The most common symptom is sudden onset of localized back pain, which may worsen with standing or walking and find some relief when lying down. This pain can be sharp and stabbing.
As the deformity progresses, other signs may emerge, including a gradual loss of height or the development of a stooped or hunched posture, medically known as kyphosis. Medical professionals diagnose a wedge deformity through a physical examination, assessing spinal alignment, posture, and checking for tenderness. Imaging techniques like X-rays are often the initial step to confirm a wedge-shaped vertebra or a decrease in vertebral height. Further imaging such as MRI or CT scans may be used to differentiate between acute (recent) and chronic fractures, assess for nerve involvement, or rule out other underlying conditions like tumors.
Management and Treatment Options
Treatment for wedge deformities aims to alleviate pain, restore function, and prevent further progression of the spinal change. Conservative management is the first approach, particularly for stable fractures. This includes pain management with over-the-counter or prescription medications like NSAIDs, acetaminophen, or opioids.
Rest is recommended, along with physical therapy to strengthen back and abdominal muscles, improve posture, and enhance mobility. Spinal bracing, such as a thoracolumbosacral orthosis (TLSO), may be prescribed to support the spine and limit movement, typically for 4 to 12 weeks until pain resolves and healing occurs. For osteoporotic cases, medications like bisphosphonates may be used to reduce bone loss and prevent future fractures.
If conservative treatments do not adequately relieve pain after several weeks, or if the fracture is unstable or associated with severe symptoms, interventional procedures may be considered. Vertebroplasty involves injecting bone cement directly into the fractured vertebral body to stabilize it and alleviate pain. Kyphoplasty is a similar procedure where a balloon is first inserted into the compressed vertebra and inflated to create a cavity, aiming to restore some vertebral height, before the bone cement is injected into the created space. These minimally invasive procedures can help reduce pain and improve mobility.