What Is a Vertebral (Spinal) 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 Causes a Vertebral Compression Fracture?
Vertebral compression fractures can be caused by osteoporosis, trauma, and diseases affecting bone (pathologic fracture).
- 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).
What Are the Symptoms and Signs of a Vertebral 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.
When Should You Call a Doctor for a Vertebral Compression Fracture?
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 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)
What Procedures and Tests Diagnose Vertebral Compression Fractures?
- X-rays: People older than 65 years, who have cancer, or who have had significant trauma may have X-rays performed. If you are younger than 65 years and do not have any medical problems or severe pain, then X-rays may not be necessary.
- CT scan of spine: If a fracture (bone break) is discovered, then the doctor may want you to have a CT scan to determine the extent of the fracture.
- MRI of spine: If you cannot hold urine or stool (incontinence) or cannot urinate (retention), weakness in one or both arms or legs, or you are unable to feel your arms or legs, then an MRI may need to be performed. Some hospitals do not have an MRI. You may need to be transferred to another hospital to get the MRI.
- Spine surgery consultation: If you have a severe fracture, then the emergency doctor may call a specialist to examine you. This may mean that you need surgery for the fracture. Surgery is normally reserved for those with severe pain, weakness, or inability to feel their arms or legs.
What Medications and Home Remedies Relieve Pain and Treat Vertebral Compression Fractures?
- Apply ice to the injured area for the first week, then heat or ice to the injured area for 15-20 minutes each hour. whichever feels better. Ice should be applied in the following way:
- Place the ice in a bag.
- Wrap the bag in a towel.
- Apply to 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
What Is the Medical Treatment and Management of Vertebral Compression Fractures?
- 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.
Management of Vertebral Compression Fractures
- Follow the instructions exactly as given by the doctor and ask questions if you are unsure what to do.
- Take the medications as prescribed.
- Apply ice for the first week. A good rule of thumb is to place the ice in a bag, wrap the bag with a towel, and then apply the ice for 15-20 minutes every hour. After the first week, either ice or heat may be applied. Apply the one that makes the injury feel better. Applying heat in the first few days after an injury draws more blood to the injury site, thus increasing swelling and pain.
- Avoid strenuous and painful activities until approved by your doctor.
- See your doctor frequently to ensure that the bones are healing.
Will Surgery Fix Vertebral Compression Fractures?
Surgery may be required to prevent the spine from pressing on the spinal cord or to stabilize the vertebra adjacent to the fracture site.
What Procedures Fix Vertebral Compression Fractures?
- 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.
What Are the Long-Term Side Effects of a Vertebral Compression Fracture? What Is the Prognosis?
- 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.
How Can You Prevent a Vertebral Compression Fracture?
The most important method of preventing vertebral compression fractures is to prevent osteoporosis.
- Eat a well-balanced diet.
- Regular exercise, including weight-bearing and strength-training exercise, has been shown to increase the strength of bone.
- Stop smoking. Tobacco smoke has been shown to weaken bone.
- All people at risk for osteoporosis should take calcium and vitamin D supplements.
- In women past menopause, estrogen replacement therapy is likely indicated to prevent osteoporosis. Medications, such as alendronate (Fosamax) and risedronate (Actonel), have been shown to reduce the development of osteoporosis when taken along with appropriate doses of calcium and vitamin D. They have also shown benefit in decreasing the rate of bone loss in those who already have osteoporosis.
- If you are on daily steroid therapy for another medical condition, discuss with your doctor methods of reducing the dosage of your steroid medication as possible because decreasing the doses reduces the chance of developing osteoporosis. In some medical conditions that require steroid therapy, other medications may be useful in reducing your steroid dosage.
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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.