Vertebral Compression Fractures

What Are Vertebral Compression Fractures?

Your spine is made of small bones called vertebrae, which act like building blocks stacked on top of each other. A vertebral compression fracture occurs when one of these bones collapses or becomes compressed. This usually happens due to osteoporosis (weakened bones) or trauma such as a fall or accident.

Causes of Vertebral Compression Fractures

Osteoporosis – the most common cause, where bones become fragile and more likely to break.
Trauma or Injury – accidents, falls, or heavy lifting can cause fractures in otherwise healthy bones.
Cancer or Tumors – in rare cases, weakened bones from cancer can lead to fractures.

Osteoporosis: osteoporosis is a skeletal condition in which the loss of bone mineral density leads to decreased bone strength and an increased risk for fractures. It usually affects postmenopausal women and the elderly population. If you have moderate osteoporosis, you might get a compression fracture from a fall or another type of accident. If you have severe osteoporosis, you can fracture a bone during daily activities.

Trauma: In younger patients without osteoporosis, compression fractures usually result from trauma such as a car accident.

Cancer: cancer is another cause of compression fractures in younger patients without osteoporosis. Cancerous tumors can spread to the spine and weaken the vertebrae, causing the bones to break.

Signs and Symptoms

Sudden or gradual back pain
Pain that worsens with standing, walking, or lifting
Loss of height over time
A stooped or hunched posture (kyphosis)
Limited mobility and difficulty bending or twisting
Numbness, tingling, or weakness if nerves are affected
Chronic back pain (usually near the fracture itself) that usually gets better with lying down and worsens with activity like standing or walking
Decreased mobility or flexibility of the spine. You may not be able to twist or bend over
Appearance of hunched back
Loss of height as the vertebrae compress and the back curves
Pinched nerves and nerve damage, which can cause tingling or numbness in the back and difficulty walking
Problems controlling the bladder or bowels (this happens with severe, untreated fractures)

Diagnosis

Doctors typically use a combination of:

Physical Examination – checking posture, mobility, and pain response.
Imaging Tests – X-rays, MRI, or CT scans to confirm fracture and rule out other causes.
Bone Density Testing – to assess osteoporosis risk.
Medical History: Discussion of symptoms, past medical conditions, age and any history of injuries.
Physical Examination: Assessment of spinal alignment and posture, point tenderness, sensation, reflexes, and muscle strength.
Diagnostic Imaging: X-rays to assess spinal alignment and presence of fracture, MRI scan to visualize spinal structures and soft tissue, CT scan to evaluate if fracture has extended into spinal canal (where spinal cord and nerve roots are located), myelography (contrast dye injection followed by imaging) in some cases, and a Dual-energy X-ray absorptiometry (DEXA) scan which measures bone density and can evaluate for osteoporosis.

Treatment Options

Treatment depends on the severity of the fracture, underlying cause, and the level of pain. Most patients improve without surgery.

1. Conservative Treatments

Rest and activity modification
Pain management with over-the-counter medications
Bracing to support the spine
Physical therapy to strengthen muscles and improve posture
Medications: Such as nonsteroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen or Naproxen
Braces: a special back brace can support your vertebrae and relieve pain by reducing how much you move your spine
Rest: limit activity and sports/exercise, if applicable

2. Osteoporosis Management

If your doctor has also diagnosed you with osteoporosis, you are at increased risk for additional vertebral compression fractures and other fractures. Medications that can help with this condition include:
Bisphosphonates: a drug that can slow further bone loss, stabilize the bones, and prevent fractures (ex: Ibandronic acid (Boniva) or alendronic acid (Fosamax)
Vitamin D and calcium supplementation may help prevent future fractures
Also avoid excessive alcohol and smoking, which can increase your risk of fracture with osteoporosis

Understanding the Spine and Anatomy

To better understand fractures, it helps to know the key parts of your spine:

Vertebrae – bones that support the body and protect the spinal cord
Discs – cushions between vertebrae that absorb shock
Spinal Cord and Nerves – pathways that carry messages between brain and body

Living With Vertebral Compression Fractures

Stay Active (with guidance): Gentle exercise can improve recovery.
Posture Matters: Proper body mechanics help reduce strain.
Bone Health: Eating a calcium-rich diet and following osteoporosis treatment can prevent new fractures.
Follow-up Care: Regular visits with your pain management specialist are important for monitoring healing and preventing complications.

Interventional Pain Management

Epidural Steroid Injections – reduce inflammation and pain
Nerve Blocks – target specific nerves to relieve pain

Minimally Invasive Surgical Options

Kyphoplasty: Under image guidance, your doctor will insert an inflatable device into the vertebra that they fill with cement. This helps strengthen the vertebra and return it to its natural height.
Vertebroplasty: Under image guidance, your doctor will insert a needle into the vertebra and directly inject bone cement. This helps strengthen the vertebra and return it to its natural height.
Spinal Fusion – in rare, severe cases to stabilize multiple vertebrae

Understanding the Spine and Anatomy

Vertebrae – bones that support the body and protect the spinal cord
Discs – cushions between vertebrae that absorb shock
Spinal Cord and Nerves – pathways that carry messages between brain and body

Prognosis and Impact of Compression Fractures

Most compression fractures get better within 3 months without specific repair of the fracture. A short period of rest and limited use of pain medication are often all that is required.

Compression fractures can lead to several conditions if severe and untreated:

Spinal cord injury: the abnormal pressure placed on the spinal cord causes damage and results in spinal cord dysfunction.
Deformation of the spine: compression fractures can cause loss of height, scoliosis (a side-to-side curve of the spine), or kyphosis (a forward curve of the spine that causes a hunched posture)
Myeloradiculopathy: Myeloradiculopathy occurs when there is damage to the spinal cord and nerve roots.

Living With Vertebral Compression Fractures

Stay Active (with guidance): Gentle exercise can improve recovery.
Posture Matters: Proper body mechanics help reduce strain.
Bone Health: Eating a calcium-rich diet and following osteoporosis treatment can prevent new fractures.
Follow-up Care: Regular visits with your pain management specialist are important for monitoring healing and preventing complications.

Conclusion

Vertebral compression fractures can cause significant discomfort, but with the right treatment plan, most patients regain mobility and reduce pain. Whether through conservative care, medication, or minimally invasive procedures, support is available to help you live more comfortably.

If you’re experiencing back pain or suspect a fracture, schedule an appointment with Maywell Health’s pain specialists to explore your treatment options.