Compression Fractures of the Spine

Definition

The spine is made up of a stack of strong bones, known as vertebrae. Vertebrae can break, just like any other bone. When the body of a vertebra collapses, it's called a vertebral compression fracture. Vertebral compression fractures occur most commonly in the thoracic spine (the middle portion of the spine), particularly the lower thoracic spine.

Sometimes compression fractures of the spine put pressure on the spinal cord and nerves, either from the compression or from a protrusion of bone into the nerves of the spinal cord. Vertebral fractures usually take about three months to fully heal. X-rays will probably be taken monthly to check on the healing progress. Surgery for compression fractures is rarely needed. 

Causes

Vertebral fractures often result from hard falls and other similar injuries. Most healthy bones can withstand pressure and absorb these kinds of shocks. Osteoporosis, however can weaken the spine, raising the likelihood that such a fall will result in one or more vertebral fractures.  Osteoporosis often acts as an underlying cause of compression fractures. As osteoporosis thins bones, they can become too weak to bear normal pressure. As osteoporosis progresses, even normal activity can cause a compression fracture of a vertebra. Simply bending forward can cause a compression fracture of the spine. Compression fractures of the spine can result in loss of body height, as well as a humped back (kyphosis), especially in the elderly. It's estimated that forty percent of women will sustain one or more spinal compression fractures by age 80, making that the most common type of fracture associated with osteoporosis.

Symptoms

Fractures resulting from sudden, high-force injury will likely produce severe pain in back, legs, and arms, as well as numbness or weakness if the fracture affects spinal nerves. In gradual bone collapse such as bone thinning, milder pain may result. There may even be no pain at all until the bone actually breaks.

Very severe compression fractures may result in spinal cord pressure as the vertebral body impinges on the spinal canal. Thankfully this depth of severity is fairly uncommon.

Diagnosis

  • A spinal X-ray often reveals the locations of breaks in vertebrae.
  • If a fracture is revealed in an X-ray, a CT scan may also be recommended in order to ensure that the broken bone is stable and nerves are not in danger. If there are any concerns about the spinal cord, the CT scan may be combined with a myelogram .
  • If nerves may have been hurt in the fracture or if there is some question of what is causing pain, an MRI might be recommended.
  • A bone scan might be ordered as well. This may help to determine the age of a fracture. Old fractures in the presence of other healed fractures may indicate osteoporosis, an important diagnosis in older patients, particularly women. If osteoporosis is a factor, treatment may include measures intended to prevent further vertebral fractures.
  • A neurological exam, including testing the nerves by checking your reflexes, muscle strength, and sensory perception, will also be a part of this diagnosis. Abnormalities may indicate nerve damage. Damage to the spinal nerves will affect your body movement and neurological responses. Neurological problems are rare, except in younger patients who were subject to violent injury.

Nonsurgical treatment

Thoracic compression fractures are most commonly treated with pain medications, activity modification, and bracing.

Minimally-invasive procedures

Kyphoplasty, a minimally-invasive procedure, can also be used to treat compression fractures.

Surgical treatment

Surgery might be necessary since bone fragments may need to be removed if they are pushing into the spinal cord and nerves, causing too much pressure.   If surgery is necessary to remove pressure from the spinal cord, your doctor may suggest some type of internal fixation to hold the vertebra in the proper position while it heals.