Compression fractures of the back
Compression fractures of the back are broken vertebrae, which are the bones of the spine.
Causes, incidence, and risk factors
Vertebrae are the bones of the back. In a compression fracture of the vertebrae, the bone tissue of the vertebral body collapses. More than one vertebra may be affected. This condition may be caused by osteoporosis (the most common cause), tumor, or trauma to the back.
When the fracture occurs as a result of osteoporosis, the vertebrae in the thoracic (chest) and lower spine are usually affected, and symptoms may be worse with walking.
With multiple fractures, kyphosis, a forward hump-like curvature of the spine (think the Hunchback of Notre Dame) may result. Pressure on the spinal cord may occur, producing symptoms of numbness, tingling, or weakness. Symptoms depend upon the area of the back that is affected, however, most fractures are stable and do not produce neurological symptoms.
- Back pain with sudden or chronic onset
- Shortened height
- Kyphosis (hunchback)
Note: There may be no symptoms.
Signs and tests
Physical examination may show 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.
If there is no history of significant trauma, a bone density test needs to be done to evaluate for osteoporosis.
If there is concern that the fracture was caused by a tumor eating away at and weakening the bone, a CT or MRI scan is necessary to get a better look at the bone. Also, if the fracture was caused by high-energy trauma (fall from a height, car accident, etc.) then a CT scan is needed to see if there are bone fragments pressing on the spinal cord.
Most compression fractures are found in elderly patients with osteoporosis. These fractures generally do not cause injury to the spinal cord. Treatment includes treating the osteoporosis with prescription medications and supplemental calcium.
Otherwise, these fractures are treated symptomatically with pain medicines. Some practitioners employ back braces, but these may weaken the bones more and predispose the patients to more fractures in the future.
While surgery is rarely needed, there is a new, minimally invasive technique that can help patients with intractable pain from osteoporotic compression fractures. A large needle is inserted with X-ray guidance 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 tumor, the tumor may need to be biopsied (a piece of bone surgically removed and examined under a microscope to determine the nature of the tumor) and treated.
Fractures from trauma often require rigid bracing to protect the bone as it heals for 6 to 10 weeks. If there is bone in the spinal canal, surgery to remove the bone and fuse the vertebra together to stabilize the spine may be necessary.
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 to 10 weeks with rest, bracing, and pain medications. This recovery time is extended by many weeks if surgery is necessary.
Osteoporotic fractures usually become less painful with rest and pain medications, but some do cause chronic pain and can be a source of great disability.
For compression fractures caused by tumors, the outcome depends entirely on the type of tumor involved and is variable. Some common tumors that involve the spine include breast cancer, prostate cancer, lung cancer, and lymphom
- Spinal cord or nerve root compression
- Kyphosis (hunchback)
- Failure of the bones to fuse (if surgery is necessary)
Calling your health care provider
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.
by Dave R. Roger, M.D.