A vertebral compression fracture occurs when a vertebral body collapses. Often, the cause is related to osteoporosis, a metabolic disease leading to loss of bone density that increases the risk of fracture. Osteoporosis can make a minor fall or simple bending and lifting movements traumatic. Compression fractures and other spinal fractures can also be caused by certain types of cancer or tumors, although this is not common.
Compression fractures affect thousands of Americans every year. Many people do not realize sudden and intense back pain may be a sign of a compression fracture. In some cases, they wrongly assume their symptoms are just part of growing older. Whether painful or not, compression fractures can lead to additional fractures, spinal deformity, and loss of the ability to function.
Symptoms
In addition to pain, signs and symptoms include:
- Loss if height (one of the reasons many older people seem to shrink as they age)
- Kyphosis (or humpback)
- Loss of balance (which increases the risk of falling)
- Neurological symptoms such as numbness, tingling, or weakness (which increases the risks of falling and breaking other bones)
Diagnosis
An accurate diagnosis of compression fractures should be made by a physician expert in spinal disorders. Such a diagnosis may include these steps:
- Medical history. The doctor will inquire about symptoms, their severity, treatments you have already tried and the results.
- Physical examination. The physician will examine you for limitations of movement, balance problems, and pain. The physician will test your reflexes at the extremities and evaluate muscle weakness, loss of sensation, and signs of neurological injury.
- Diagnostic tests. In many cases, an x-ray can quickly show if a vertebra is fractured. If there is concern about spinal cord damage, a CT scan or myelography may be performed. Myelography involves injecting contrast dye into the spinal column to visually enhance the spinal cord and nerve roots.
Nonsurgical Treatment
Most compression fractures can be treated with pain-relieving medication, activity modification, and bracing. Osteoporotic patients, who are not taking medication to control osteoporosis, may be prescribed a drug and supplement regimen to prevent disease progression.
Bracing limits fracture movement and immobilizes the spinal region affected. While braces are not always comfortable or fashionable, bracing can help reduce pain. Brace use is discontinued when x-rays show the fracture is stable and healed.
Surgical Treatment
Vertebroplasty and kyphoplasty are minimally invasive surgical procedures performed to treat vertebral compression fractures. Sometimes, treatment involves spinal instrumentation and fusion.
Vertebroplasty and kyphoplasty are similar, but distinct procedures. Both procedures involve injecting orthopaedic cement into the fracture. A primary difference between these procedures is that only kyphoplasty uses a balloon, which is inflated, to create a cavity for the orthopaedic cement. Kyphoplasty can help restore lost vertebral body height caused by a compression fracture.
A severe compression fracture may require spinal instrumentation and fusion. Instrumentation (i.e. screws, rods) and fusion (bone graft) joins two or more vertebrae together, stops movement, and stabilizes the spine.
If surgical treatment of compression fractures is recommended, the surgeon will discuss surgical options and associated risks and benefits. Not all patients are appropriate candidates for surgery.
Recovery and Prevention
Patients who require surgery for compression fractures may be hospitalized overnight, or a few days. The length of hospitalization depends on the severity of the fracture and the procedure performed.
Upon hospital discharge, patients are provided with written instructions for home care. Recovery during home care requires rest and a gradually increasing program of physical exercise. Physical exercise will include strenghtening exercises as well as exercises to build stamina. Pain can be managed with medication during this time, but pain typically diminishes and may go away completely after a week or two. The physical therapist will provide the patient with instructions about proper posture and body mechanics and can advise as to when normal everyday activities can be resumed and when the patient may return to work, if appropriate.