Our spine is the structural foundation of the human body, which is why spinal injuries and diseases can have widespread effects on our quality of life and countless everyday activities. These injuries are not always the result of significant trauma, and some can occur spontaneously – especially in patients with a family history of osteoporosis or a history of back injuries. Like any bone, our vertebrae (the individual segments that make up the spine) can fracture and break over time. When these breaks occur due to axial loading, stress and pressure are applied along the spine’s axis – they are referred to as compression fractures.
Understanding Compression Fractures
The adult human’s spine is made up of 24 vertebrae, from the top of the neck down to the pelvis’s base. These vertebrae are divided into four distinct sections – the cervical spine (neck), the thoracic spine (upper and middle back), the lumbar spine (lower back), and the sacrum and coccyx (inside the hips), which are fused. Between each segment lies a spongy disc, which allows for a degree of flexibility in the spine.
Most spinal injuries are often the result of wear-and-tear degradation in these spinal discs, causing swelling and herniation that compresses the many nerve roots linked to the spinal cord. Yet, in some cases, the pain begins in the bones themselves rather than the discs between them. Different types of compression fractures, also known as spinal compression fractures and spinal compression fractures, depending on what caused the fracture.
Recognizing a Compression Fracture
The telltale symptoms for spinal compression fractures include:
- Loss of height
- Sudden back pain
- Loss of spinal mobility
- Height loss (severe cases)
- Increased pain while upright
- Decreased pain while laying down
- Spinal deformity and disabilities (severe cases)
Any one of these symptoms, or a combination thereof, might point towards a spinal compression fracture. However, more rigorous imaging tests are required before an actual diagnosis is made. A doctor will typically order at least one of the following tests to study a person’s vertebrae and discover the fracture:
- X-ray: X-ray machines utilize the radiation absorption differences between different types of tissues in the human body to create a clear outline between soft tissues like muscles and organs and our bones and joints. This allows a doctor to study the spine and look for any signs of a compression fracture.
- CT scan: CT scans allow for a segmented and more in-depth look at any given portion of the body, using x-rays and computer technology. This allows a doctor to highlight a portion of the spine with a compression fracture alongside a myelogram (an injection of harmless contrast dye near the spine) to study it more closely.
- MRI: Where X-ray machines use energy beams to produce images, MRIs utilize magnetic fields and are often used in cases where the fracture’s potential cause is a tumor or other soft tissue diseases. MRIs produce a more detailed image of the soft tissues surrounding the spine than X-rays do.
- DEXA scan: Because osteoporosis is so commonly linked to spinal compression fractures, DEXA scans are used to determine bone mineral density and diagnose low bone mass. DEXA scans utilize x-rays.
Types of Compression Fractures
Their shape and origin define the different types of spinal compression fractures. Spinal compression fractures caused by weakening bones, often because of osteoporosis, are known as wedge fractures. This is because one part of the vertebra is naturally less dense than the other, causing it only partially to collapse, leaving a wedge-shaped vertebra. Because one side of the vertebra remains intact, this type of fracture is mechanically stable.
When the entirety of the bone breaks evenly, it is known as a crush fracture. A less severe fracture, where both sides of the vertebrae lose at least some height, is known as a burst fracture. Crush and burst fractures are less mechanically stable than wedge fractures and can result in progressive spinal deformities and greater damage to the surrounding nerves.
What Causes a Compression Fracture?
By far, the most common cause of a spinal compression fracture is osteoporosis. Patients can go undiagnosed for years, leading to spontaneous fractures caused by everyday activities, such as bending over, coughing, sneezing, or getting out of bed. Compression fractures caused by osteoporosis can be recurrent, which means they can occur multiple times in multiple different vertebrae.
Physical trauma is another potential cause, especially from severe trauma such as a high fall or a car crash. Another common cause for a spinal compression fracture is a spinal tumor. Tumors not only compromise the structural integrity of the spine but can affect bone mass and density.
Where Are Compression Fractures Most Common?
In general, spinal compression fractures affect up to 1.5 million Americans per year and are most common among osteoporosis patients, specifically postmenopausal women. It is estimated that about a quarter of all postmenopausal women in the United States have had a spinal compression fracture.
Over two-thirds (60 to 75 percent) of all spinal compression fractures occur between the T12 and L2 vertebrae, a range that includes the lowest rung of the thoracic spine and the top two lumbar bones, roughly opposite to the belly button. About one-third (30 percent) of all spinal compression fractures occur below the L2 bone, up until the L5.
There are very few spinal compression fractures in the neck and upper back, though these can occur as well. There are multiple reasons why the lower back is more vulnerable than any other portion of the spine, including greater flexibility (and thus greater risk for shearing forces), as well as greater load.
Compression Fracture Treatments and Procedures
There are both non-invasive and surgical treatment options for spinal compression fractures, depending on the fracture’s cause and severity and its associated pain symptoms. Compression fractures are generally treated with pain management and appropriate non-invasive therapies, such as physical therapy and back bracing.
In osteoporosis cases, bone-strengthening medication may be used in coordination with appropriate physical therapy to strengthen and increase bone density and reduce the risk of a recurrent fracture. Other minimally invasive procedures to reduce pain and swelling include nerve blocks and corticosteroid injections. In severe cases, spinal surgeries such as kyphoplasty and vertebroplasty may remove fractured bone and strengthen the remaining structure with bone cement.