Compression Fractures of the Spine

What is a Compression Fracture of the Spine

Compression Fracture, MRI
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The spinal column is made of stacked rectangular-shaped bones called vertebrae.  There are 33 vertebrae including 7 cervical (neck), 12 thoracic (chest), 5 lumbar (low-back), and 9 fused vertebrae that form the sacrum and coccyx (tailbone). Each of the upper 25 vertebrae are separated by a soft disc made of cartilage and connected by strong ligaments. 

A normal vertebral column is straight when viewed front to back, bust has a smooth s-shaped curved when seen from the side.

The vertebrae together forms the vertebral column, and surrounds the spinal canal, which contains the spinal cord.

Compression Injuries to the Vertebrae

When a vertebrae is injured, the most common problem is a fracture. The most common type of vertebral fracture is called a compression fracture. A compression fracture occurs when the normal vertebral body of the spine is squished, or compressed, to a smaller height. This injury tends to happen in three groups of people.

  1. People who are involved in traumatic accidents. When a load placed on the vertebrae exceeds its stability, it may collapse. This is commonly seen after a fall.
  2. People with osteoporosis. This is much more commonly the cause. Osteoporosis is a condition that causes a thinning of the bone. As the bone thins out, it is less able to support a load. Therefore, patients with osteoporosis may develop compression fractures without severe injuries, even in their daily activities. They don't have to have a fall or other trauma to develop a compression fracture of the spine.
  1. People with tumors that spread to the bone or tumors such as multiple myeloma that occur in the spine.

Signs of a Compression Fracture

Back pain is by far the most common symptom in patients with a compression fracture. You may experience sudden, severe back pain, or it may be more gradual in onset. In more severe traumatic injuries, the cause of the compression fracture is clear.

In other situations where the bone is weakened by osteoporosis or another condition, the timing of the fracture may be less clear.

When the vertebral fracture is due to osteoporosis, you may not have symptoms at first. Patients with osteoporosis who sustain multiple compression fractures may begin to notice a curving of the spine, like a hunchback, called a kyphotic deformity or dowager's hump. The reason for this is the vertebrae are compressed in front, and usually normal in back. This wedge-shaped appearance causes the spine to curve forward. When enough compression occurs, this may become a noticeable curvature. Patients with compression fractures also often notice a loss of their overall height because of the decreased size of the spinal column.

Nerve complaints are unusual in compression fractures because the spine and its nerves are behind the vertebra, and, as mentioned above, the front of the vertebra is compressed, and the back remains normal. In some serious traumatic fractures, called "burst fractures," the compression occurs around the spinal cord and nerves. This is more serious and may require immediate treatment to prevent or relieve pressure on the spinal cord or nerves.

Treatment for Compression Fractures of the Spine

The focus of treatment in most people with a compression fracture is to control the pain and get the individual back up and moving. A careful examination should ensure that nerve function is normal, and if there is concern about the fracture causing nerve or spinal cord symptoms, further testing and treatment may be necessary.  In most cases, nerve function is not impaired, and the focus is on pain management. 

Pain management is aimed at controlling symptoms, while minimizing the use of potentially harmful narcotic pain medications. Once pain has been adequately controlled, mobilization, often with the aid of physical therapy, can help people restore the function and normal activities.

 

If the pain is severe, and collapse is becoming problematic, a procedure called a vertebroplasty may be considered. In this procedure, an interventional radiologist restores the height of the bone and injects cement into the vertebra to stabilize the fracture and prevent further collapse.

Compression fractures tend to heal completely in about 8 to 12 weeks. Patients who have one compression fracture are much more likely to have more, and, therefore, prevention of future compression fractures must be addressed. Often when I talk to a patient with a newly diagnosed compression fracture, I focus much more on the prevention of future injury, rather than on the injury that has already occurred. The current injury is likely to heal uneventfully, however, the usefulness of medications and interventions is really much better at preventing another injury down the road!

A Word From Verywell

Compression fractures of the spine are common injuries, and often associated with conditions that weaken the bone. In these situations, the fractures may go undetected, or they may cause symptoms of pain. Treatment efforts are typically aimed at controlling the pain, mobilizing the individual, and preventing future injury by treatment of bone weakening. Seldom is surgical treatment necessary in the treatment of a compression injury.

Source:

C. Benjamin Ma, MD. "Compression Fractures of the Back, MedlinePlus, U.S. National Library of Medicine. 7/13/2015.

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