Vertebral Compression Fracture

What are vertebral compression fractures?

Vertebral compression fractures occur when one or more of the 33 vertebrae in your spine either break or collapse. These cracked vertebrae are most common in the upper (thoracic) spine but can also occur in the lower back (the lumbar spine).

This can be challenging to diagnose and treat as they do not present in one consistent manner. Many people experience no significant pain. You might just have a minor ache every now and then. Or, they can cause severe discomfort from something as insignificant as sitting. In the worst cases, vertebral compression fractures can result in decreased mobility and long-term, chronic pain.

While pain normally resolves within a month, severe pain or pain that lasts longer than four weeks is an indication of the need for further medical care.

What causes vertebral compression fractures?

Vertebra are remarkably strong and well-supported by each other and various ligaments, tendons, and muscles. So how do vertebrae crack?

Most likely, osteoporosis leads to this break. This condition occurs as we age and causes thinning and softening of the bones. For severe osteoporosis, a compression fracture can occur with something as simple as a cough or a sneeze. When a compression fracture due to severe osteoporosis occurs, it may cause sudden pain. For others, it may cause nagging, long-term pain after attempting minor movements, like bending and lifting.

In cases where the bones are generally healthy, most vertebral compression fractures occur after trauma to the back. This may happen during a car accident, a fall, or high-impact sports.

How to diagnose vertebral fractures

To diagnose vertebral fractures, your doctor will take a complete medical history and conduct a physical exam. They’ll look for sensitivity or the presence of kyphosis, a humped back.

A simple X-ray can see if vertebrae are compressed or broken, though a bone scan for osteoporosis may also be in order. Loss of height over time is also a key indicator of osteoporosis and can help confirm your doctor’s diagnosis.

What are vertebral compression fracture treatments?

Treatment spans the same wide range as the symptoms associated with this condition.

First, if the fracture was caused from osteoporosis, the thinning bones must also be treated to protect the rest of the skeletal frame. Beyond this, vertebral compression fracture treatments may include:

1. Lifestyle changes: A calcium-rich diet and plenty of exercise (including weight-bearing exercise to strengthen bones) can help manage or prevent symptoms
2. Physical therapy: This type of therapy can help to build strength and flexibility to better support the spine
3. Medications: If you’re suffering from severe pain, some medications can help during pain flare-up and medications to treat and prevent osteoporosis are also a good place to start
4. Acupuncture: Acupuncture can help relieve back pain in many forms
5. Vertebroplasty: For more severe cases, a vertebroplasty procedure provides more support for the fractured bone with medical cement
6. Kyphoplasty: Similar to a vertebroplasty, this procedure allows for healing by placing a small balloon into the injured vertebrae and slowly inflating it to make room for cement

The last two treatment options are minimally-invasive surgeries that may be offered if other conservative approaches are unsuccessful. While these surgeries are generally safe and can help in many cases, there are always risks. Discuss these in detail with your doctor.

References

• Jones, R.; et al. (2010). Back Pain. First Consult. MD Consult Web site, Core Collection. Retrieved from http://www.mdconsult.com.ezproxy1.library.arizona.edu/das/pdxmd/body/262696692-3/1175420680?type=med&eid=9-u1.0-_1_mt_1014913#Contributors.
• Nidus Information Services. (2011). Compression fractures of the back. Patient Handouts. MD Consult Web site, Core Collection. Retrieved from http://www.mdconsult.com.ezproxy1.library.arizona.edu/das/patient/body/262696692-3/1175420669/10041/31768.html.
• Sheon, R.P.; Rosen, H.N. (2011). Clinical manifestations and treatment of osteoporotic thoracolumbar vertebral compression fractures. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
• Decker, J.E.; Hergenroeder, A.C. (2010). Overview of musculoskeletal neck injuries in the young athlete. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
• Kado, D.M. (2010). Overview of hyperkyphosis in older persons. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
• Nidus Information Services. (2011). Compression fractures of the back. Patient Handouts. MD Consult Web site, Core Collection. Retrieved from http://www.mdconsult.com.ezproxy1.library.arizona.edu/books/page.do?eid=4-u1.0-B978-1-4160-2261-9..50040-9–cesec8&isbn=978-1-4160-2261-9&sid=1175420675&uniqId=262696692-3#4-u1.0-B978-1-4160-2261-9..50040-9–cesec10.
• Evans, A.J.; et al. (2009). Prospective assessment of pain and functional status after vertebroplasty for treatment of vertebral compression fractures. J NeuroIntervent Surg. Vol 1, 66-70.