Compression Fractures

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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 of height (one of the reasons many older people seem to shrink as they age)
• Kyphosis (or humpback)
• Loss of balance (increases the risk of falling)
• Neurological symptoms such as numbness, tingling, or weakness (increases the risks of falling and breaking other bones)

Diagnosis

An accurate diagnosis of compression fracture should be made by a physician with expertise in spinal disorders. Such a diagnosis may include these steps:

• Medical History

The physician asks about your symptoms, their severity, treatments tried, and the results.

Physical Examination
The physician evaluates limitations of movement, balance problems, and pain. He tests your reflexes and evaluates muscle strength, weakness, loss of sensation, and checks for signs of neurological injury.

Diagnostic Tests
A x-ray can quickly show a vertebra fracture.  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 enhance visualization of the spinal cord and nerve roots.

Non-surgical Treatment

Symptoms of a compression fracture may be treated with pain-relieving medication, activity modification, and/or bracing.  Osteoporotic patients, who are not taking medication to manage 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, 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 different procedures.  Both procedures involve injecting orthopaedic cement into a fracture.  However, kyphoplasty uses a balloon which, when inflated, creates a cavity for the orthopaedic cement. Kyphoplasty may 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) join two or more vertebrae together, stops movement, and stabilizes the spine.

When surgery is recommended to treat a compression fracture, the surgeon discusses surgical treatment options and possible benefits and risks associated with each procedure.  Not every patient is a candidate for surgery.

Recovery and Prevention

Patients who require surgery for a compression fracture 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 written instructions for home care. Recovery at home requires rest, gradually increasing a program of strengthening and stamina-building exercise.

Medication may be recommended for pain.  However, pain typically diminishes and may completely resolve within a week or two. The patient's physical therapist provides additional instruction about proper posture and body mechanics