Vertebral Compression Fractures

Introduction

The spine is made up of strong bones called vertebrae. A vertebra can break, or fracture, just like any other bone in the body. Vertebral compression fractures in the spine occur when a vertebral body has been weakened due to osteoporosis or the presence of a tumor. These fractures happen most commonly in the thoracic spine (the middle portion of the spine), and lumbar spine (low back).

Causes

Vertebral compression fractures generally occur from too much pressure on a weakened vertebral body. If the vertebra is weakened, it may take very little pressure to cause it to collapse. Everyday activities such as lifting a child, bending down to pick something up, or even sneezing can cause a fracture. When a fracture occurs, the front, or anterior, portion of vertebra collapses, causing the vertebral body to become wedge shaped.

Osteoporosis is a common cause of compression fractures in the spine. Osteoporosis is a disease characterized by reduced bone strength due to low bone mass and reduced bone quality. The disease causes bones to become weak and fragile, leaving them susceptible to fractures from simple, everyday activities. Osteoporosis can progress painlessly over many years until a fracture occurs. Vertebral compression fractures are the most common type of fracture to result from osteoporosis (hip and wrist fractures are also common). According to the International Osteoporosis Foundation, 1 in 3 women and 1 in 5 men will experience a fracture due to osteoporosis in their lifetime.

The presence of a tumor in the spine is another cause of vertebral compression fractures. Metastasis is a term that refers to the spread of cancer cells into other areas of the body. The bones of the spine are a common place for many types of cancers to spread. Benign, or non-cancerous, tumors can also occur in the spine. Both types of tumors may cause destruction of part of the vertebra, weakening the bone until a vertebral compression fracture occurs.

Symptoms

Vertebral compression fractures may cause severe back pain, limited mobility, and/or a “hunched-over” appearance due to the change in shape of the vertebral body. If the bone collapse is gradual, the pain may be milder. It is estimated that only one in three vertebral compression fractures come to clinical attention.

Patients who experience a vertebral compression fracture are at significant risk for another fracture within the next five years. Multiple compression fractures can lead to reduced lung function, weight loss, depression and significant spinal deformity.

In very severe compression fractures, parts of the back of the vertebral body may protrude into the spinal canal and put pressure on your spinal cord resulting in weakness or numbness. Fortunately this is not a common occurrence.

Diagnosis

Before a doctor can diagnose your condition and design a treatment plan, a complete history and physical exam are necessary. There are many possible causes of back pain. It is important to determine what is and is not the root of the problem.

After your doctor has a better idea of what is causing your discomfort, diagnostic tests may be recommended.

• An X-ray of the spine will usually show if a vertebra is broken.
• If the X-ray shows a fracture, your doctor may also suggest a CT scan to make sure that the broken bone is stable and that the nerves are not in danger. The CT scan will be combined with a myelogram if there are any concerns about the spinal cord.
• A CT scan can examine the fractured vertebra in more detail to make sure that it is stable and that the nerves are not in danger. The CT scan may be combined with a myelogram if there are any concerns about the spinal cord.
• An MRI might be recommended if there is a chance that nerves are injured in the fracture. An MRI can also help determine the age of the fracture. A doctor may choose to treat an older fracture differently from one that occurred more recently.
• A bone scan may also be ordered to help determine the age of a fracture, especially in patients that are unable to undergo an MRI.
• A neurological exam will also be given. This includes testing the nerves by checking your reflexes, muscle strength, and sensory perception. Abnormalities in the neurological examination can point to nerve damage. If there is damage to the spinal nerves, your body movement and neurological responses will be affected.

If it is determined that you have a vertebral compressioin fracture, you doctor may also order a bone mineral density test to evaluate you for osteoporosis. This test is painless and uses x-rays to measure the density of your bones. If you are found to have osteoporosis, medications can be prescribed to increase your bone density and help prevent future fractures.

Treatment Options

Conservative Treatment

The most common treatments for a compression fracture are pain medications, decreasing activity, and bracing. Compression fractures usually take about three months to fully heal. Doctors are also using minimally invasive procedures called vertebroplasty (ver-tee-bro-las-tee) and vertebral augmentation, also called kyphoplasty (kye-fo-plas-tee). These methods have shown effective in the treatment of the pain associated with vertebral compression fractures.

Pain Medications

Pain medications may be prescribed. Remember that medications will not help the fracture to heal, but they can help control pain.

Decreasing Activity

You will most likely have to limit your normal activities when you have a compression fracture. Avoid strenuous activity or exercise. Do not lift heavy objects. Stay away from any activity that might place too much strain on your fractured vertebra. In some instances, your doctor may put you on bed rest. Treat a compression fracture as you would any other broken bone – carefully and seriously.

Bracing

Another common form of treatment for some types of vertebral compression fractures is bracing. Your doctor may prescribe a back support (called an orthosis). The brace supports the back and restricts movement. Braces are molded to conform tightly to your body, like a cast for any other fracture. Braces used to treat a compression fracture of the spine are designed to keep you from bending forward. They hold the spine in more extension (straightened). This takes pressure off the fractured vertebral body and allows it to heal. The brace protects the vertebra and stops further collapse of the bone.

Minimally Invasive Procedures

Vertebroplasty and vertebral augmentation are procedures specifically for the treatment of vertebral compression fractures that your doctor may recommend.

• Vertebroplasty is a minimally invasive procedure in which medical grade bone cement is injected into the broken vertebral body. This treatment is used to ease pain and improve the strength of the vertebral body.
• Vertebral Augmentation is a minimally invasive procedure in which a cavity is created within the broken vertebral body. Medical grade bone cement is then injected into the cavity. This treatment also eases the pain and improves the strength of the vertebral body. In some procedures, height restoration of the fractured vertebral body may also be attempted. This is done by inflating a small, medical balloon in the vertebral body before injecting the cement.

Kyphoplasty procedure for Vertebral Compression Fractures Video

Surgical Treatment

Spinal surgery is a serious undertaking and is only considered to fix vertebral compression fractures if there is evidence of sudden and serious instability of your spine or if fractured fragments are putting pressure on the spinal cord or nerves. If surgery is necessary, two approaches will be considered, anterior and posterior. Some type of internal fixation may be suggested to hold the vertebra in the proper position while it heals.