Vertebral compression fractures

In a compression fracture of the vertebra, the bone tissue in the vertebra collapses. More than one vertebra may be affected. This condition may be caused by:

• Osteoporosis (the most common cause)
• Trauma to the back
• Tumor

When the fracture occurs as a result of osteoporosis, the vertebrae in the chest (thoracic) and lower spine are usually affected, and symptoms may be worse with walking.

Multiple fractures may lead to kyphosis , a hump-like curvature of the spine (like the Hunchback of Notre Dame).

• Back pain with sudden or chronic onset
• Shortened height
• Hunchback (kyphosis)

Note: There may be no symptoms.

Pressure on the spinal cord from kyphosis may produce symptoms of:

• Numbness
• Tingling
• Weakness

Symptoms depend on the area of the back that is affected; however, most fractures do not produce nervous system (neurological) symptoms.

• Physical examination may show hunchback (kyphosis). There is also tenderness over the injured vertebrae.
• A spine x-ray shows at least one compressed vertebra that is shorter than the other vertebrae.

Other tests that may be done:

• A bone density test to evaluate for osteoporosis
• A CT or MRI scan if there is concern that the fracture was caused by a tumor, or if the fracture was caused by high-energy trauma (such as a fall from a height or car accident)

Most compression fractures are found in elderly patients with osteoporosis. These fractures generally do not cause injury to the spinal cord. In these patients, the osteoporosis is treated with prescription medications and calcium supplements.

Otherwise, the pain from these fractures is treated with pain medicines. Some health care providers recommend back braces, but these may further weaken the bones and increase your risk of developing more fractures in the future.

While surgery is rarely needed, a new, minimally invasive technique can help patients with pain from compression fractures due to osteoporosis. A large needle is inserted into the compressed vertebra. A balloon is inserted into the bone through the needle and inflated, restoring the height of the vertebra. Sometimes, cement is injected into the bone to make sure it does not collapse again.

If the fracture is caused by a tumor, a piece of the bone may need to be surgically removed and examined under a microscope (biopsy). Then the tumor is treated.

Fractures from trauma often require a brace for 6 - 10 weeks to protect the bone as it heals. If there is bone in the spinal canal, you may need surgery to remove the bone and fuse the vertebrae together to stabilize the spine.

Surgery is almost always necessary if there is any loss of function because of bone pressing on the spinal cord or spinal nerves.

Most compression fractures from trauma will heal in 8 - 10 weeks with rest, bracing, and pain medications. Recovery time will be many weeks longer if surgery is necessary.

Fractures due to osteoprosis usually become less painful with rest and pain medications, but some can cause chronic pain and disability.

For compression fractures caused by tumors, the outcome depends on the type of tumor involved. Some common tumors that involve the spine include:

• Breast cancer
• Lung cancer
• Lymphoma
• Prostate cancer

• Failure of the bones to fuse (if surgery is necessary)
• Hunchback (kyphosis)
• Spinal cord or nerve root compression

Call your health care provider if you have back pain and suspect you may have a compression fracture.

Treating and preventing osteoporosis is the most effective way to prevent these fractures.

Freedman BA, Potter BK, Nesti LJ, Giuliani JR, Hampton C, Kuklo TR. Osteoporosis and vertebral compression fractures-continued missed opportunities. Spine J. 2008;8:756-762.

Lavelle W, Carl A, Lavelle ED, Khaleel MA. Vertebroplasty and kyphoplasty. Anesthesiol Clin. 2007;25:913-928.