The spinal cord is protected by a column of bones called vertebrae, separated by specialized spongy discs. Over time, stress and weakening bones can cause vertebrae to become more brittle and eventually fracture. When these fractures cause a vertebra to slowly compress and lose at least 15 to 20 percent of its height original height, they are called vertebral compression fractures. Because our spinal column is integral in protecting the spinal cord and its many nerve roots, vertebral compression fractures are a serious issue, as they can lead to long-term spinal deformities, significant pain, a compromised spinal canal and compressed spinal cord, and associated myelopathy and neuropathy.
What Causes Vertebral Compression Fractures?
Vertebral compression fractures can occur because of severe physical trauma – like a car accident or major fall – but compression fractures are usually caused by weakening bones, often due to osteoporosis. Weakened and brittle bones are the main characteristic of osteoporosis. Because osteoporosis is most common in older women, about 25 percent of postmenopausal women have a vertebral compression fracture. These fractures can occur entirely without heavy strain for patients with very severe osteoporosis – even sneezing or coughing can cause them.
An estimated 700,000 are affected by vertebral compression fracture every year in the United States. Osteoporosis is a significant risk factor. Age also matters as vertebral compression fractures become far more common (40 percent prevalence) among women aged 80 and older. Older men can be affected by vertebral compression fractures, too. Other illnesses and diseases that attack the integrity and mineral density of the bones in the body can also lead to vertebral compression factors, common ones including certain types of cancer and benign spinal tumors.
One of the biggest dangers surrounding a vertebral compression fracture is its sudden nature. Unless you were previously diagnosed with osteoporosis and knew to watch out for the signs, the spinal column can very easily weaken to a dangerous state without any previous apparent loss of strength, stability, or quality of life. It can very simply catch you off guard and lead to severe and unexplained numbness and back pain as a silent disease.
Vertebral Compression Fracture Signs & Symptoms
Your vertebrae are composed of a body and a spinous process, a series of hook-like bony protrusions at the end of each vertebra. These are typically harder than the vertebrae body, causing the spine to deteriorate into a wedge-like shape in cases of vertebral compression fracture. This is called a wedge fracture. This can cause someone to lose a little bit of height physically and force them into a hunchback posture.
Medically, this is called kyphosis. This type of fracture can cause problems down the road but does not typically endanger the whole spine’s structural integrity. Mechanically, it can be a stable fracture. However, the vertebrae can fracture in different ways. A crush fracture is when the entire bone breaks.
A burst fracture is when both the front and back walls of the vertebra’s body lose some height, which can cause instability throughout the entire spine. Significant and advancing spinal deformations and height loss, either after an injury or in patients with osteoporosis, are some of the more common signs of a vertebral compression fracture. Other signs include:
- Sudden back pain
- Loss in spinal mobility
- Increased pain while standing
- Decreased pain while lying down
The following symptoms necessitate a visit to the emergency room or call for urgent care:
- High fever
- Severe pain and numbness
- Loss of bowel and/or bladder control
A vertebral compression fracture is most accurately diagnosed by an imaging test and a physical examination. A patient with a history of osteoporosis complaining about back pain may also be specifically examined for a potential vertebral compression fracture or other spinal damage signs. The most common imaging tests used for vertebral compression fracture include:
- CT scan
- DEXA scan
Once the imaging tests prove a compression fracture, treatment can begin. Without proper treatment, a vertebral compression fracture can carry several long-term consequences based on how and where the fracture occurred.
Complications and Long-Term Issues
Like any structure, the spinal column depends on the integrity of each vertebra. However, certain fractures, such as wedge fractures, may cause minimal structural damage and can be supported with a brace until it heals. More severe fractures and breaks and ones that introduce instability can expose the spinal cord to compression and damage from astray and protruding bone and progressively bend the spine while limiting mobility. The ensuing myelopathy (spinal cord damage) and neuropathy (nerve damage) can lead to significant pain and, in worse cases, paralysis.
Treating a Vertebral Compression Fracture
Treatment for a vertebral compression fracture can be either non-surgical or surgical, depending on their severity. Certain fractures can be left to heal and manage through external bracing and pain medication. Others require immediate attention to avoid further damage to the spine and spinal cord. Only a medical professional can determine what treatment is most appropriate for any given fracture.
Spinal braces are often used to treat excessive spinal curvature, such as cases of diagnosed severe scoliosis. In cases of a vertebral compression fracture, they can help relieve stress from the spine’s discs and bones and help provide structure to prevent further deterioration and encourage healing. Like a leg brace, a spinal brace provides a rigid structure for the bone to heal in.
Over-the-counter pain medication, a non-opioid medication, and opioids may be prescribed depending on the patient’s medical history and the severity of the pain. In cases of intense neuropathic pain, a short-term nerve block utilizing a corticosteroid or other medication may be used. A nerve block involves injecting an analgesic agent into the area around the damaged or impinged nerve, reducing swelling in the area, shutting the nerve down temporarily, or blocking pain signals.
Surgical interventions may be necessary when immediate action is required or when more conservative therapies have failed. Different surgeries are used to address cases of a vertebral compression fracture, including vertebroplasty and kyphoplasty. Specific conditions and risk factors may rule out surgery as an option, such as bone inflammation and pre-existing spinal curvature. A vertebral compression fracture can be a very frightening diagnosis, but early and appropriate treatment can help address the issue and reduce the chance for long-term complications.