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Compression Fracture (Vertebral) vs. Herniated Disc (Slipped Disc)

What Is the Difference Between Compression Fracture and Herniated Disc

A vertebral compression fracture occurs when the block-like part of an individual bone of the spine (vertebra) become compressed due to trauma.

Discs are protective shock-absorbing pads between the bones of the spine (vertebrae). When a disc bulges, splits, or ruptures the disc cartilage and nearby tissue can fail (herniate), allowing the inner gel portion of the disc to escape into the surrounding tissue. This protruding, jelly-like substance can place pressure on the spinal cord or on an adjacent nerve to cause symptoms of pain, numbness, or weakness either around the damaged disc or anywhere along the area supplied by that nerve.

  • Symptoms of vertebral compression fracture include pain in the lower back, middle or upper back, or neck. Hip, abdominal, or thigh pain may also occur. Other symptoms include numbness, tingling, weakness, and loss of control of urine or defecation (incontinence) or inability to urinate (urinary retention).
  • Symptoms of a herniated disc (slipped disc) include pain in the back or neck along with numbness or weakness in the corresponding organs, arms, or legs.
  • Causes of vertebral compression fractures include osteoporosis, trauma, and diseases affecting bone (pathologic fracture).
  • Risk factors for a herniated disc include degeneration from aging, injury from improper lifting, and excessive strain associated with physical activities or exercise.
  • Treatment for vertebral compression fractures includes rest, over-the-counter (OTC) or prescription pain relievers, ice, stretching and strengthening (as advised by a doctor), back brace, and in severe cases, surgery.
  • Treatment for a herniated disc includes rest or limited activity for several days followed by gradual increase in activity over the next few weeks ice or cold packs used soon after an injury, heat packs used later, physical therapy, exercise (as advised by your doctor), massage, anti-inflammatory medications, muscle relaxers, steroids, and narcotic pain medications. If conservative treatments do not resolve the pain, then surgery may be indicated.

What is a Compression Fracture?

A vertebral compression fracture occurs when the block-like part of an individual bone of the spine (vertebra) become compressed due to trauma. Usually the trauma necessary to break the bones of the spine is quite substantial. In certain circumstances, such as in elderly people and in people with cancer, these same bones can be fragile and can break with little or no force. The vertebrae most commonly broken are those in the lower back, but they may break in any portion of the spine.

What is a Herniated Disc?

The discs are protective shock-absorbing pads between the bones of the spine (vertebrae). The discs of the spine are also referred to as intervertebral discs. Although they do not actually "slip," a disc may bulge, split, or rupture. This can cause the disc cartilage and nearby tissue to fail (herniate), allowing the inner gel portion of the disc to escape into the surrounding tissue. This protruding, jelly-like substance can place pressure on the spinal cord or on an adjacent nerve to cause symptoms of pain, numbness, or weakness either around the damaged disc or anywhere along the area supplied by that nerve.

Many people experience no symptoms from a herniated disc, and the majority of people who have herniated discs do not need surgery.

The layman's term "slipped disc" is, therefore, a misnomer and actually refers to a condition whereby portions of an abnormal, injured, or degenerated disc have protruded against adjacent nerve tissues. This condition is also known as a slipped disk, herniated disc, ruptured disc, or prolapsed disc. The most frequently affected area is in the low back, but any disc can rupture, including those in the neck.

What are the symptoms of Compression Fracture vs. Herniated Disc?

Compression Fracture

  • Pain: It tends to be in the lower back but may occur in the middle or upper back or neck. Some people may also have hip, abdominal, or thigh pain.
  • Numbness, tingling, and weakness: Such symptoms could mean compression of the nerves at the fracture site.
  • Losing control (incontinence) of urine or stool or inability to urinate (urinary retention): If these symptoms are present, the fracture may be pushing on the spinal cord itself.

A doctor should evaluate back pain in these situations:

  • In any elderly person (age greater than 65)
  • In a person with cancer
  • In anyone whose pain is exactly the same at rest as it is during activity
  • In a person with unintentional weight loss
  • Pain while sleeping is worse than when awake
  • In a child under 12 years of age

Seek medical help at a hospital's emergency department if you have the following symptoms with back pain:

  • Loss of control of urine or defecation
  • Severe pain, numbness, or weakness
  • High fever (temperature greater than 100.4 F or 38.0 C)

Herniated Disc

The nerves of the body exit the spine at each spinal level in the low back, mid back, and neck. A herniated disc can produce symptoms anywhere along the course of that nerve, though the injury and irritation of the nerve are at the spine itself. (This is known as referred pain, as the pain is "referred" from the source of the problem in the spine to the area supplied by the affected nerve.) A slipped disc can produce varying degrees of pain in the back or neck along with numbness or weakness in the corresponding organs, arms, or legs as follows:

  • For slipped discs in the neck: Neck symptoms and other associated symptoms include numbness, tingling, weakness, or pain in the shoulder, neck, arm, or hand. Symptoms of a herniated disc in the neck often increase or decrease with neck motion.
  • For slipped discs in the lower back, back symptoms include
    • Pain down the back of each leg from the buttocks to the knee or beyond (this is called sciatica, as it affects the sciatic nerve)
    • Numbness, tingling, weakness, or pain in the buttocks, back, legs, or feet or all of these as in sciatica
    • Numbness and tingling around the anus or genitals
    • Pain with movement, straining, coughing, or doing leg raises
    • Difficulty controlling bowel movements or bladder function

What Causes Compression Fracture vs. Herniated Disc?

Compression Fracture

Vertebral compression fractures can be caused by osteoporosis, trauma, and diseases affecting bone (pathologic fracture).

  • Osteoporosis
    • Osteoporosis is a disease of bone in which bone density is reduced, which may increase the chance that a person could sustain a vertebral compression fracture with little or no trauma.
    • Osteoporosis most commonly occurs in women who have completed menopause, but it can also occur in elderly men and in people who have had long-term use of a steroid medication such as prednisone.
  • Trauma: Injury severe enough to cause a vertebra to break can occur with a fall from a tall height in which the person lands on his or her feet or buttocks. It can also occur in a person involved in a car accident.
  • Pathologic fracture
    • Pathologic fracture is a fracture occurring in the vertebra due to preexisting disease at the fracture site.
    • Most commonly, this type of break is from cancer in the bone, which has often traveled from other sites in the body (called metastasis), such as from the prostate, breast, or lungs.
    • Pathologic fracture can also occur with other diseases, such as Paget's disease of bone and infection of bone (osteomyelitis).

Herniated Disc

Risk factors that lead to a slipped disc include aging with associated degeneration and loss of elasticity of the discs and supporting structures; injury from improper lifting, especially if accompanied by twisting or turning; and excessive strain forces associated with physical activities. Sudden forceful acute trauma is an uncommon cause of a slipped disc.

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What Is the Treatment for Compression Fracture vs. Herniated Disc?

Compression Fracture

  • Rest
  • Pain relief with ibuprofen or naproxen (nonsteroidal anti-inflammatory drugs)
  • Apply ice to the injured area for the first week, then heat or ice, whichever feels better. Ice should be applied in the following fashion: Place the ice in a bag, wrap the bag in a towel, and then apply to the injured area for 15-20 minutes each hour. Heat applied in the first week after an injury draws more fluid to the area, thereby increasing swelling and pain.
  • When allowed by your doctor, a home stretching and strengthening program
  • Back brace
  • Rest and ice to the area: Later use heat compresses on the area.
  • Pain relief with opiates (hydrocodone or oxycodone [OxyContin])
  • Admission to the hospital: Depending on severe pain, weakness, inability to urinate (retention), or inability to control your urine or stool (incontinence), you may be admitted to the hospital.
  • Exercise: On approval from the doctor, a stretching and strengthening program is important to decrease further osteoporosis and to strengthen muscles supporting the back.
  • Pain medication
  • Surgery may be required to prevent the spine from pressing on the spinal cord or to stabilize the vertebra adjacent to the fracture site.
  • Percutaneous vertebroplasty: This is a relatively new procedure in which a needle is inserted through the skin of the back by a specialist. A cement or "biomaterial" compound is injected into the vertebra with the osteoporotic fracture. The material (usually methylmethacrylate) hardens, like cement, stabilizing the compressed vertebra. Studies using this technique have shown promise in relieving chronic pain associated with osteoporotic fractures. A similar procedure is referred to as a kyphoplasty if a small balloon is used to restore the height of the compressed vertebra prior to injection of the bone cement.

Herniated Disc

The doctor often prescribes rest or limited activity for several days followed by gradual increase in activity over the next few weeks. Strict bed rest is generally not advised because people with back pain have been shown to recover more quickly with normal activity as long as lifting, bending, and straining are limited.

Treat with ice or cold packs early after an injury and switch to heat later. Heat may be used early if the pain and symptoms are not caused by a sudden injury.
Physical therapy, exercise, and massage can be helpful if indicated (always check with your doctor before resuming any physically stressful activites).

Anti-inflammatory medications, such as ibuprofen (Motrin) and others, may be recommended. These can generally be safely taken with acetaminophen (Tylenol) as home remedies for a slipped disc. Medicines to relax the surrounding muscle tightness and spasms are sometimes used (cyclobenzaprine, [Flexeril] or diazepam [Valium]). A short course of a medical steroid (corticosteroids, similar to cortisone), such as prednisone, prednisolone, and methylprednisolone (Medrol), also may be used. Injections of cortisone (Depo-Medrol, Kenalog) can help suppress the inflammation and therefore the associated pain. For pain relief, narcotic medication is sometimes added for a short period of time.

Sometimes, drugs that treat "nerve pain" such as gabapentin (Neurontin), pregabalin (Lyrica), or tramadol (Ultram) can help relieve the pain.

If the medical measures are not successful within a reasonable time (6 weeks or more), and the tests confirm a herniated disc as the source of symptoms, surgical repair may be considered. Except in extreme situations or in those that have a high potential for permanent nerve damage, surgery is not considered early. Neck surgery and back surgery are serious procedures and considered under specific situations where unrelenting pain and risk of permanent damage to nerve tissue exists. Frequently, time and basic spine care resolve most slipped disc symptoms without the need for operation. Several surgical options exist. Your doctor will refer you to a spine surgical specialist (an orthopedic or neurosurgeon) to discuss which option is best for you and what the likelihood of success will be.

What Is the Prognosis for Compression Fracture vs. Herniated Disc?

Compression Fracture

The back fracture should heal in most cases without problems. However, severe fractures may need surgery to keep the spine in alignment. Also, a pathological back fracture may not heal because cancer may be present.

A person who has a fracture caused by osteoporosis can decrease the chance of further fractures with adequate dietary supplementation (calcium), exercise, and hormone replacement, if indicated.

Fractures causing chronic, severe pain benefit from a multidisciplinary approach that may include the primary medical doctor, an orthopedic or neurosurgeon, physical therapy, and pain clinic referral.

Herniated Disc

The vast majority of disc problems improve without any surgical intervention. Most people are able to return to normal function (with emphasis on protecting the spine from recurrent or new injury) within a short time. It is not unusual for similar symptoms to return in the future, however. Therefore, long-term maintenance exercise regimens are recommended for prevention of re-injuring a slipped disc.

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References
Canale, S. Terry, and James H. Beaty. Campbell's Operative Orthopaedics. 11th ed. Philadelphia: Mosby, 2008.

Longo, Dan, et al. Harrison's Principles of Internal Medicine. 18th ed. United States: McGraw-Hill Professional, 2011.

Wardlaw, Douglas, et al. "Balloon kyphoplasty in patients with osteoporotic vertebral compression fractures." Expert Review of Medical Devices 9.4 (2012): 423-436.

Klippel, J.H., et al. Primer on the Rheumatic Diseases. New York: Springer, 2008.
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