Outline:   
Compression fracture of thoracolumbar vertebrae is a common fracture in clinic. It is often caused by indirect or direct violent forces resulting in pressure between vertebral bodies due to hyperanteflexion of the spinal column. The fracture often occurs between the 10th thoracic vertebra and the 2nd lumbar vertebra, especially the 12th thoracic vertebra and the 1st lumbar vertebra where there is a large mobility. Usually only one, maybe two or three, vertebral bodies are affected. Thoracolumbar spendylexarthrosis is likely to develop in the fractures complicated by rupture of superaspinal and interspinal ligaments, or fracture of articular process, thus leading to severe spinal and nerve root damage. The disease is quite common in the young adults.

Major points for diagnosis  
1. The patient has a typical traumatic history such as a sudden fall or a heavy blow or compression.
 
2. The patient can not sit because of pain in the waist. There may occur abdominal distension and pain, nausea, vomiting, difficulty in urination and defecation and general malaise due to the stimulation of retroperitoneal hematoma.
 
3. Fracture may be accompanied by local pain, posterior convex deformity, and widened spaces between spinous processes.
 
4. The cases complicated by spinal nerve damage are characterized by various degrees of functional losses such as disturbances of sensation, motion and sphincter below the level of the involved segments.
 
5. Roentgenogram may confirm the type and nature of the fracture.

Reduction:   
1) Manual reduction: This is suited for the patients of young adults. A proper anesthetic should be given. The patient takes a prone position. One assistant pulls the axillary region of the patient and the other assistant holds the two ankles with both hands, then they apply counter-traction. The operator first adopts massotherapy to relax the lumbar-dorsal muscles, then, presses the posterior bulge of the fracture with both hands overlapped. When the assistants do gradual pulling traction to a certain extent, the distal assistant lifts up the two lower limbs slowly. At the same time, the operator presses with great force the posterior bulge downwards, thus, the deformity may be partly or completely corrected.
 
2) Reduction through suspensory traction of two malleoli: The patient takes a prone position with malleoli wrapped up with cotton cushions, and tied up with pieces of wide cloth bands. Then, two malleoli are suspended through cord and pulley to keep the thoracolumbar region in a hyperextension position. Thus, the compression fracture can be pulled apart through the patient’s own weight. At the same time, the operator presses the posterior bulge with both hands to gain reduction.

3) Reduction by putting pillow: The patient takes a supine position. First, a thinner pillow is put under the waist, then gradually the height of the pillow is increased so as to make the waist hyperextended to get reduction.

Fixation:
After manual reduction or reduction through suspensory traction of two malleoli, a thick pillow is put under the waist for fixation. Or spinal splints or lumbodorsal supports are used to fix thoracolumbar spine in a hyperextension position.

Functional exercise:
After reduction and fixation, the patient takes a supine position on a hard wooden bed. When the pain has subsided, the patient is encouraged to practice exercises of the waist successively using methods of Five-point support, Three-point support, Arch-bridge support and Flying-swallow-touching-the-water. Such exercises are repeatedly done in sequence and step by step, the patient can reinforce his lumbodorsal muscles and obtain a satisfactory reposition, and finally restore his function.

Herbal therapy  
Internal treatment based on syndrome differentiation  
 
1. In the early stage
Main symptoms and signs:
Lumbago and backache, abdominal distension and fullness, nausea and vomiting, difficulty in urination and defecation, thick and greasy tongue coating, slippery and rapid pulse.
     
Therapautic methods:
Promoting blood flow to remove the stasis, and activating qi flow to eliminate the stagnation.
      
Recipe and herbs:
Modified Shunqi Huoxue Decoction. Specifically, Dangguiwei (Extremitas Radix Angelicae Sinensis) 12 g, Sumu (Lignum Sappan) 10 g, Zisugeng ( Caulis Perillae Frutescentis )  10g,  Chi shaoyao ( Radix Paeniae Rubrae)  l0 g,  Taoren ( Semen Persicae) lo g, Zhike (Fructus Citri Aurantii) 10 g, Houpo ( Cortex Magnoliae Officinalis ) 10 g,  Xiangfu (Rhizoma Cyperi Rotundi) 10g, Muxiang ( Radix Aucklandiae Lappae )  10 g,  Sharen ( Fructus Amomi) (to be decocted later) 9 g, Honghua (Flos Carthmi) 6 g and Gancao (Radix Glycyrrhizae) 3 g.
    
Modification: For the case of constipation, add Shengdahuang (Radix et Rhizoma Rhei) (to be decocted later) 10 g; for the case of severe blood stasis, add San-leng ( Rhizoma Sparganii Stoloniferi )  10 g and Ezhu (Rhizoma Curcumae) lo g.
 
2. In the middle stage
Main symptoms and signs:
Subsided pain and not completely healed fracture.
    
Therapeutic method:
Uniting the bones, tendons and ligaments.
    
Recipe and herbs:
Modified Xinshang Xuduan Decoction.  Specifically, Dangguiwei (Extremitas Radix Angelicae Sinensis ) 12 g,  Zhechong ( Eupolyphaga seu Steleophaga) 10 g,  Ruxiang ( Gummi Olibanum) 5 g, Moyao (Myrrha) 5 g, Danshen (Radix Salviae Miltiorthizae )  10 g,  Xuduan ( Radix Dipsaci )  1 2 g,  Duanzirantong ( Pyritum Carcinatum )  ( to be decocted first) 20 g,  Gusuibu  ( Rhizama Drynarii )  12 g,  Zhixiangfu (Rhizoma Cyperi Rotundi Praeparata) 10 g, Huainiuxi (Radix Achyranthis Bidentatae) lo g, Sumu (Lignum Sappan) 10 g and Gancao (Radix Glycyrrhizae) 5 g.
 
3. In the late stage        
Main symptoms and signs:
Soreness and pain in the back and 1oin, lassitude of legs, weakness of muscles and joints.    

Therapeutic methods:
Reinforcing the liver and kidney, and strengthening muscles and bones.     

Recipe and herbs:
Modified Bushen Huoxue Decoction. Specifically, Shudihuang (Radix Rehmanniae Praeparata) 18 g, Shanzhuyu (Fructus Corni Officinalis) 9 g, Roucongrong (llerba Cistanch.es Deserticolae) 9 g, Moyao ( Myrrha )  9 g,  Honghua  ( Flas Carthmi )  9 g, Duhuo ( Radix Angelicae Pubescentis )  9 g,  Duzhong (Cortex Eucommiaeulmoidis) 9g, Gouqizi (Fructus Lycii) 12 g, Buguzhi (Fructus Psoraleae Corylifoliae) 12 g, Tusizi ( Semen Cuscutae)  15 g, Danggui (Radix Angelicae Sinensis) 15 g and Gancao (Radix Glycyrrhizae) 5 g.