What are compression fractures?
The spine is made up of strong bones called vertebrae. A vertebra can break just like any other bone in the body. When the vertebral body collapses, it’s called a vertebral compression fracture. These fractures happen most commonly in the thoracic spine (the middle portion of the spine), particularly in the lower part. Vertebral fractures are usually caused by a condition such as osteoporosis, a very hard fall, or another type of injury.
What causes compression fractures?
Compression fractures of the spine generally occur from too much pressure on the vertebral body. The fracture occurs when the vertebral body collapses, causing the front part of the vertebral body to become wedge shaped. The bone tissue on the inside of the vertebral body is crushed, or compressed.
Osteoporosis is a common cause
Osteoporosis is a common cause of compression fractures in the spine. This disease thins bones, often to the point they become too weak to bear normal pressure. They can eventually collapse during normal activity, leading to a spinal compression fracture. Notably, spinal compression fractures are the most common type of fracture from osteoporosis. Forty percent of all women will have at least one by the time they turn 80 years old.
After your doctor has a better idea of what is causing your discomfort, diagnostic tests may be recommended.
- X-ray: an X-ray of the spine will usually show where the vertebra is broken
- CT scan: if the X-ray shows a fracture, your doctor may also suggest a CT scan to make sure that the broken bone is stable and that the nerves are not in danger. The CT scan will be combined with a myelogram if there are any concerns about the spinal cord.
- MRI: an MRI might be recommended if there is a chance that nerves are hurt in the fracture or if there is some question about what is causing the pain.
- Bone scan: a bone scan might be ordered to help determine the age of a fracture. If the fracture is old and there appear to be other fractures that have healed, this may indicate osteoporosis.
- Neurological exam: a neurological exam will also be given, which includes testing the nerves by checking your reflexes, muscle strength, and sensory perception. Abnormalities in the neurological examination can point to nerve damage. If there is damage to the spinal nerves, your body movement and neurological responses will be affected. Neurological problems are rare, except in younger patients who have experienced a violent injury, such as a car crash.
If the fracture is caused by a sudden, forceful injury, you will probably feel severe pain in your back, legs, and arms. You might also feel weakness or numbness if the fracture injures the nerves of the spine. If the bone collapse is gradual, such as a fracture from bone thinning, the pain will usually be milder. There might not be any pain at all until the bone actually breaks.
In very severe compression fractures, parts of the back of the vertebral body may actually protrude into the spinal canal and put pressure on the spinal cord. Fortunately, this is not a common occurrence.
- Bracing: Another common form of treatment for some types of vertebral compression fractures is bracing. Your doctor may prescribe a back support (called an orthosis). The brace supports the back and restricts movement; just as an arm brace would support a fractured arm.
- Vertebroplasty: Vertebroplasty is a minimally-invasive procedure in which special cement is injected into the broken vertebral body. This treatment is mainly used to ease pain and improve the strength of the vertebral body.
- Kyphoplasty: Kyphoplasty is a minimally-invasive procedure in which a tube with a deflated balloon is slipped inside the broken bone. Once inside, the balloon is inflated to help restore the height of the broken vertebra. Then bone cement is injected into the space formed by the balloon to hold the vertebra at its corrected height.
- Surgical treatment: Spinal surgery is a serious undertaking and is only considered to fix vertebral compression fractures if there is evidence of sudden and serious instability of the spine. For instance, if the fracture leads to a loss of 50 percent of the vertebral body height, surgery might be necessary to prevent the bone from collapsing onto the spinal nerves and causing more serious damage.
Mild pain medications may be prescribed. Remember that medications will not help the fracture to heal, but they can help control pain.