When a bone in the spine collapses, it is called a vertebral compression fracture. This injury most often happens in the lower part of the thoracic, or middle, section of the spine.
What causes a vertebral compression fracture?
Compression fractures usually occur because of too much pressure on the normally strong vertebrae. When the vertebral body collapses, the bone tissue on the inside is crushed or compressed.
There are several reasons that may lead to a compression fracture, including:
- Osteoporosis: Osteoporosis is a common cause of compression fractures in the spine. This disease thins and makes the bones brittle, often to the point where they are too weak to withstand normal pressure, even the pressure of everyday activities. In some cases of severe osteoporosis, the bones are so weak that simply bending forward, coughing or sneezing can cause compression fractures.
- Cancer: When cancer has spread to the spine, patients are more likely to suffer vertebral compression fractures.
- Trauma: A spinal injury can cause a sudden minor or severe fracture. A fall, forceful jump and car accident are some examples of trauma that can cause compression fractures.
What are the symptoms and complications of a vertebral compression fracture?
- In most cases, bone collapse is gradual, so pain is mild or there may be no pain at all until the bone actually breaks.
- If the fracture is trauma related, the patient will likely feel severe pain in the back, legs and possibly arms. There also may be weakness or numbness in these areas if the fracture injures a nerve in the spine.
- Increased chance of developing a kyphotic deformity (sometimes called dowager’s hump or hunchback) is a common disorder in elderly women who have osteoporosis and frequent fractures. This occurs when the front of the vertebrae collapse, creating a wedge-shaped vertebrae and a resulting severely stooped posture.
- Increased lung and breathing problems as the deformed spine puts additional pressure on the chest cavity.
- Neurological complications, such as spinal stenosis, caused by increased pressure on the spinal cord or nerve roots.
How is a vertebral compression fracture treated?
Treatment is based on the severity of symptoms.
A vertebral compression fracture generally responds well to non-surgical care while the fracture heals. Most vertebral fractures usually take about three months to fully heal. Treatment may include the following:
- Pain medications: The medications reduce pain but do not actually help to heal the fracture.
- Decreased activity: Avoiding strenuous activity or exercise, heavy lifting or anything else that puts stress on the spine is recommended. For some people, bed rest may be required.
- Bracing: A back brace, or orthosis, that keeps the patient from bending forward also supports the spine in a way that takes pressure off the fractured vertebra so it can heal.
Two minimally invasive treatments—vertebroplasty and kyphoplasty—are sometimes used to treat compression fractures. These are done on an outpatient basis or only involve a single night in the hospital. These two procedures use small incisions, so healing time is kept to a minimum.
- Vertebroplasty: A special acrylic bone cement is injected into the broken vertebra to improve strength of the bone. The cement hardens in about 10 minutes.
- Kyphoplasty: In this surgery, which is used to treat a kyphotic (hunchback) deformity, surgeons insert a needle into the damaged vertebra and then a slide a thin tube with a deflated balloon inside the broken bone. After the balloon is inflated to help restore the height of the broken vertebra, acrylic bone cement is injected into the cavity formed by the balloon to hold the vertebra at its correct height. The cement hardens in about 10 minutes.
Major spinal surgery to fix a vertebral compression fracture is rarely required and only undertaken if there is a serious instability of the spine. Spinal fusion surgery is used to eliminate motion between two vertebrae. This surgical procedure “welds” or fuses together two or more of the spine’s vertebrae to create a solid bone bridge between the bones.