The vertebra plana is a vertebral flattening that usually affects the cervical or lumbar spine and is associated with pain or poor posture. The disease mainly affects children and is associated with various primary diseases. Therapy consists of immobilization of the patient with a cast or corset.
What is vertebra plana?
The disease group of aseptic bone necrosis includes such necrosis in the bone tissue that has not been triggered by an infection. Various diseases fall into this group of diseases. One of them is the vertebra plana, also known as Calvé’s disease. The term vertebra plana literally means flat vertebra and actually refers to an isolated flattened vertebral body. For semicircular canal dehiscence explanation, please visit percomputer.com.
The patient’s intervertebral disc is preserved. If the flattening of vertebral bodies is not isolated, but several vertebrae are affected, it is called platyspondylia. The vertebra plana is usually located in the thoracic or lumbar spine. It mainly affects children between the ages of four and seven years.
A clinical characteristic is the widening of adjacent intervertebral spaces. In most cases, there are no neurological complications, since the flattening of the vertebrae only rarely affects the cervical spine.
In most cases, the vertebra plana is the symptom of an overriding disease. Diseases such as Langerhans cell histiocytosis or chronic, recurrent multifocal osteomyelitis are possible primary causes of changes in the spine. If, on the other hand, there are several flattening of the vertebral bodies, osteopetrosis is more likely to be assumed. Rarely, the cause in this case is osteomalacia.
Although the vertebra plana is referred to as aseptic bone necrosis, infections causally related to the disease have also been documented. Above all, fungal infections were identified as the primary cause in individual cases. A final possible cause is eosinophilic granuloma. In most cases, and also in connection with most of the primary diseases mentioned here, the flattening is a consequence of destruction of the cortex.
Symptoms, Ailments & Signs
Patients with vertebra plana mainly suffer from two characteristic symptoms. Most of those affected complain about pain that they characterize as load-dependent. Only in individual cases does the pain persist beyond stressful situations. Due to the flattening of the vertebrae, the spine is affected by functional restrictions. For this reason, many patients with vertebra plana report poor posture in addition to the pain.
Depending on the location of the affected vertebra, the poor posture is more or less pronounced and is more or less noticed by the patient. In rare individual cases, neurological deficits appear in addition to these symptoms. In these individual cases, the flattened vertebra is usually in the cervical spine. Sensory disorders or movement disorders are conceivable in this case. Since the vertebra plana does not typically occur in the cervical spine, these symptoms are not particularly characteristic of the disease.
Diagnosis & course of disease
Imaging of the spine is the crucial tool for diagnosing a vertebra plana. The doctor usually orders the imaging after a medical history that indicates the lesions involved. In addition to the flattening of the vertebrae, the X-ray image shows the widened intervertebral spaces. This clinical characteristic of the vertebra plana is helpful in differential diagnosis in order to rule out destruction in the context of spondylitis or bacterial osteomyelitis.
In both diseases, the intervertebral space is narrowed. Especially in children, tumor diseases that can be ruled out by imaging must also be considered in the differential diagnosis. An MRI of the spine is also theoretically possible as an imaging method. However, the doctor only gets a clear picture from this type of imaging if a contrast medium is administered. The prognosis is relatively favorable for patients with vertebra plana.
A vertebra plana can cause a number of complications. The pain that typically occurs can increase as the disease progresses and as postural damage occurs. Due to the flattening of the vertebra, functional restrictions of the spine occur. In individual cases, neurological deficits can occur, for example sensory disturbances or movement disorders.
If the vertebra plana is caused by a serious disease such as a tumor, further complications can arise as the underlying disease progresses. Patients in whom the vertebra plana occurs in connection with paraplegia suffer from further functional restrictions, and serious complications such as edema and circulatory disorders can also occur during the course of the paraplegic syndrome.
Complications can also occur when treating a vetebra plana. If the patient receives pain medication, there is a risk of side effects and interactions, such as gastrointestinal problems and skin irritation. Surgical treatment occasionally leads to wound healing disorders or infections.
During the procedure, nerve injuries and bleeding cannot be ruled out. Any accompanying measures such as warm-cold therapy or physiotherapeutic measures usually proceed without major complications, but in individual cases they can also cause health problems that require further treatment.
When should you go to the doctor?
In the case of vertebra plana, a doctor should always be consulted, as this disease cannot heal on its own. Early diagnosis with subsequent treatment always has a very positive effect on the further course of the disease, so that a doctor should be contacted as soon as the first symptoms and signs appear. A doctor should be contacted for vertebra plana if the person concerned is suffering from severe pain. This pain occurs mainly in the spine area, and it gets worse with stress. This severe pain can also lead to restrictions in the movement of the person concerned.
Emotional disturbances can also point to the vertebra plana. If they occur over a longer period of time and do not go away on their own, a doctor should definitely be contacted. The initial diagnosis can be made by a general practitioner or by an orthopedist. Further treatment depends on the cause of the vertebra plana, so no general prediction can be made.
Treatment & Therapy
In most cases of vertebra plana, therapy is not absolutely necessary. The vertebral bodies often rebuild spontaneously and allow all symptoms to subside. Until this spontaneous reconstruction occurs, patients should avoid straining the spine, such as lifting heavy objects or similar activities. Immobilization is recommended for some time. The main aim is to prevent the formation of a gibbus.
In order to support the patient in immobilization, various therapeutic steps can be considered. Those affected can stabilize their spine with a corset, for example. Depending on the location of the flattening, the use of a cast may also be an option. Immobilization is particularly important to ensure that there are no functional or static impairments after the vertebrae have rebuilt themselves.
Patients may be given medication to treat severe pain. By immobilising the spine, at least stress-related pain should resolve itself. Depending on the underlying disease, further treatment steps may have to be taken to eliminate the cause of the vertebra plana and thus rule out recurrences. In the case of fungal infections, for example, anti-infectious drugs are indicated for therapy.
If the vertebra plana affects the cervical spine and there are neurological deficits, warm-cold therapies, for example, can be used to remedy sensory disturbances. Movement disorders can be treated with physiotherapeutic care. In the very rarest of cases, surgical intervention is indicated for a vertebra plana. This therapeutic step is limited to cases in which there is no spontaneous remission of the symptoms or paraplegia with a focus of infection.
Vertebra plana can be prevented by taking preventive measures for the causative diseases.
A vertebra plana typically resolves on its own. If Calvé’s disease is caused by diseases such as Langerhans cell histiocytosis or chronic recurrent multifocal osteomyelitis, spontaneous reconstruction of the vertebral body is possible. Follow-up includes a physical check-up and an interview with the patient.
Depending on the cause of the vertebra plana, imaging methods are also used. X-rays or CT, for example, are possible depending on the type and severity of the condition. During the consultation with the patient, the doctor asks how the patient is feeling. During the anamnesis, the symptoms are discussed and further treatment options are discussed. If no abnormalities were found during the physical examination, the patient can then be discharged.
An orthopedist or chiropractor will provide aftercare. If necessary, an osteopath or another specialist doctor can also be involved. No lengthy follow-up care is required for vertebra plana. A final examination is usually sufficient. In the case of chronic complaints, further examinations are necessary. Affected persons should consult the doctor responsible for this. If necessary, the patient can be referred to a physiotherapist for further treatment.
You can do that yourself
The vertebra plana is primarily treated with immobilization. The affected vertebra must not be loaded. Immobilization usually has to be maintained for a few weeks to months. If the course is positive, the condition will improve by itself.
The vertebra plana rebuilds as recovery progresses and the vertebral body returns to its original position. Physiotherapy and special physiotherapeutic measures are also available to support this process . The orthopedist or physiotherapist can provide the exact measures and monitor the treatment. Patients should take it easy and do the exercises according to the doctor’s instructions. Then the vertebra plana should regress within a few weeks to months.
The vertebral body can still cause pain some time later. These are treated with conventional painkillers. Alternatively, natural painkillers from the field of naturopathy can be used. For example, preparations with valerian and various globules have proven effective . Schuessler salts can also help to relieve the pain. In consultation with the doctor, massages are also an effective way to relieve tension and promote blood circulation in the affected vertebral bodies.