A vertebral compression fracture occurs when the body of a vertebra becomes compressed and loses height under pressure. These fractures can follow either major or minor trauma, and they are particularly common in people with osteoporosis. Treatment ranges from pain management and bracing to minimally invasive procedures or spinal fixation surgery.
A vertebral compression fracture may be more serious when it is accompanied by damage to the spinal cord or spinal nerves. In this situation emergency medical services should be contacted without delay.
How a Compression Fracture Develops
A vertebral compression fracture occurs when the body of a vertebra becomes compressed and loses height under pressure. These fractures can develop following either major or minor trauma. The condition may be more serious when it is accompanied by damage to the spinal cord or spinal nerves.
Over time, a compression fracture may cause further loss of vertebral height, leading to changes in the alignment and posture of the spine. In some patients, this can result in an excessive forward curvature of the spine known as kyphosis.
Who Is Most at Risk
Vertebral compression fractures are particularly common in postmenopausal women, largely due to the increased risk of osteoporosis. People with osteoporosis may sometimes experience a fracture without realizing that a fracture has occurred. As a result, they may live with persistent but relatively tolerable back pain for a long period before the condition is diagnosed.
Symptoms
The most common symptom of a vertebral compression fracture is pain in the back or lower back, corresponding to the level of the affected vertebra. Common symptoms include:
- Sudden-onset back pain
- Loss of height
- Forward curvature of the spine
- Pain that worsens when standing or walking
Diagnosis
After a detailed medical history and physical examination, the physician may request one or more of the following imaging studies to evaluate the fracture and determine its severity:
- X-ray
- Computed tomography (CT)
- Magnetic resonance imaging (MRI)
In some cases, increased bone fragility may be caused by an underlying bone tumor or metastatic cancer, resulting in what is known as a pathological fracture. When an underlying tumor is suspected, additional contrast-enhanced imaging studies may be required. In selected cases, a biopsy may also be performed to establish the diagnosis.
Conservative Treatment
Treatment generally focuses on pain management, activity modification, bracing, and medications that improve bone strength and density. Conservative treatment is sufficient for many patients with vertebral compression fractures. The primary goal is to control pain, protect the spine during the healing process, and improve bone strength.
Conservative treatment may include:
- Pain-relieving medications
- Temporary activity modification
- Spinal bracing
- Medications to improve bone strength and bone mineral density
With appropriate treatment and follow-up, the fractured vertebra may heal naturally in many cases.
Surgical Treatment
Surgery may be recommended when pain cannot be adequately controlled with conservative treatment, when the degree of vertebral collapse is considered significant, or for patients in whom conservative treatment is unlikely to provide sufficient benefit. There are two main surgical approaches.
Minimally Invasive Surgery
Minimally invasive treatment is performed under imaging guidance in an operating room. A needle is inserted through the skin into the fractured vertebra, and a special bone cement is injected to stabilize the vertebra. These procedures can often be performed without the need for general anesthesia.
Depending on the characteristics and severity of the fracture, the collapsed portion of the vertebra may be restored to some extent using kyphoplasty, or the vertebra may be stabilized directly with bone cement using vertebroplasty.
Kyphoplasty
A specialized balloon may be used to create a cavity within the collapsed vertebra and restore some of its height before bone cement is injected.
Vertebroplasty
Bone cement is injected directly into the fractured vertebra to stabilize it.
These procedures can reduce pain and improve the mechanical stability of the fractured vertebra. Depending on the patient's overall condition and the type of procedure performed, patients can often be discharged on the same day or the following day.
Spinal Fusion Surgery
Not every patient is suitable for vertebroplasty or kyphoplasty. Spinal fusion and fixation surgery may be preferred when vertebral collapse has reached a critical degree, when there is significant spinal instability or deformity, or when the fractured vertebrae have become unstable and abnormal movement occurs between the spinal segments.
This approach may also be necessary in severe traumatic fractures accompanied by spinal cord or nerve compression. In such cases, decompression of the affected neural structures can be performed during the same operation.
During spinal fixation, the affected vertebrae are stabilized using pedicle screws and rods. This helps prevent further spinal deformity, abnormal movement, and progression of the collapse while providing stability to the spine.
Conclusion
A vertebral compression fracture is a loss of vertebral height that can follow major or minor trauma and is particularly common in people with osteoporosis. Because a fracture can occur without being recognized, it may be diagnosed only after a long period of persistent back pain. Conservative treatment is sufficient for many patients, while minimally invasive procedures or spinal fixation may be considered when pain cannot be adequately controlled with conservative treatment or when the vertebra has become unstable.
Frequently Asked Questions
What is a vertebral compression fracture?
It occurs when the body of a vertebra becomes compressed and loses height under pressure. These fractures can develop following either major or minor trauma, and the condition may be more serious when it is accompanied by damage to the spinal cord or spinal nerves.
What are the symptoms of a vertebral compression fracture?
The most common symptom is pain in the back or lower back, corresponding to the level of the affected vertebra. Other common symptoms include sudden-onset back pain, loss of height, forward curvature of the spine, and pain that worsens when standing or walking.
Why are these fractures common in postmenopausal women?
Vertebral compression fractures are particularly common in postmenopausal women largely due to the increased risk of osteoporosis. People with osteoporosis may sometimes experience a fracture without realizing it has occurred, and may live with persistent but relatively tolerable back pain for a long period before the condition is diagnosed.
How is a vertebral compression fracture diagnosed?
After a detailed medical history and physical examination, the physician may request X-rays, computed tomography, or magnetic resonance imaging to evaluate the fracture and determine its severity. When an underlying tumor is suspected, additional contrast-enhanced imaging studies may be required, and in selected cases a biopsy may also be performed.
Can a vertebral compression fracture heal without surgery?
Conservative treatment is sufficient for many patients. It focuses on controlling pain, protecting the spine during healing, and improving bone strength, and may include pain-relieving medications, temporary activity modification, spinal bracing, and medications that improve bone mineral density. With appropriate treatment and follow-up, the fractured vertebra may heal naturally in many cases.
What is the difference between kyphoplasty and vertebroplasty?
In kyphoplasty, a specialized balloon may be used to create a cavity within the collapsed vertebra and restore some of its height before bone cement is injected. In vertebroplasty, bone cement is injected directly into the fractured vertebra to stabilize it. Both are performed under imaging guidance and can often be carried out without general anesthesia.
When is spinal fusion surgery needed?
Spinal fusion and fixation may be preferred when vertebral collapse has reached a critical degree or when the fractured vertebrae have become unstable and abnormal movement occurs between the spinal segments. It may also be necessary in severe traumatic fractures accompanied by spinal cord or nerve compression, in which case decompression can be performed during the same operation.