Vertebral body fractures
What are vertebral body fractures?
Vertebral body fracture is a fracture of the vertebrae (bones of the spine) that eventually cause a collapse of the vertebral body. These fractures are most commonly located in the thoracic spine (the middle portion of the spine) and are extremely common. This condition can cause pain and complications in 25% of all postmenopausal women. The major risk factor for vertebral body fractures are increasing age. They occur when the upper body weight exceeds the ability of vertebrae to support the load.
What causes vertebral body fractures?
Healthy bones are able to withstand the normal amount of pressure exerted on them. However, if the force put on the vertebrae exceed the threshold they can tolerate, or the threshold is lowered due to pathology to the vertebrae, then they will fracture and collapse. This is most commonly seen in patients with vertebral compression fractures is preexisting osteoporosis.
Metastatic cancer that spreads to the vertebrae can also cause a compression fracture. The bony spine is a common place for certain cancers to spread to. The lytic lesions in the spine cause weakness and may eventually cause collapse of the vertebrae. Any cancer patient who has a sudden onset of back pain or lower extremity neurological change should be immediately evaluated for metastatic disease.
Another cause of vertebral compression fractures is trauma to the vertebrae such as blunt trauma, a fall, or motor vehicle accident. Any force that surpasses the ability the spine is able to support can cause collapse of the vertebrae.
Your physician will perform a physical exam and may find tenderness over the vertebrae as well as kyphosis (curving of the spine). Other manifestations of nerve involvement include constipation, loss of lower extremity reflexes, and loss of sensory function. The physician may also order radiological imaging. The X-ray may be diagnostic enough because commonly seen is the classic wedge-shaped vertebral body with narrowing of the anterior portion in most compression fractures. However, depending on the clinical suspicion and history obtained, the physician may want to order additional studies such as MRI, CT scan, or a bone scan.
The symptoms of vertebral fractures typically include one or a combination of the following:
- Sudden onset of back pain
- Pain while standing or walking
- Pain relief when lying on one's back
- Limited spinal mobility
- Height loss
- Deformity and disability
Vertebroplasty and kyphoplasty
Patients who do not respond to the more conservative management described above may be good candidates for minimally-invasive procedures by your pain physician that have been proven effective, including vertebroplasty and kyphoplasty.
This procedure involves injecting acrylic cement into the fractured vertebra to stabilize and strengthen the vertebrae.
This is a newer method that involves placing an inflatable balloon into the vertebral body. When the balloon is inflated, it makes a space in the center of the vertebrae where an acrylic is injected.
Pharmacologic treatments such as NSAIDs and analgesics are used in the acute management of pain. Although these may help relieve discomfort, they do not correct the underlying problem causing the pain.