Vertebral Compression Fracture

Written by staff | 06 July 2011

In developed countries such as the United States, there is more than a 70% chance that an individual will experience back pain at some time¹. One fairly common cause of back pain is a vertebral compression fracture, in which one or more bony vertebrae -- which comprise the spinal column and protect the spinal cord -- break or otherwise collapse². Most of these fractures are asymptomatic, although they can result in limitations in movement and chronic pain^{3, 6}.

Vertebral compression fractures can be caused by a variety of reasons; osteoporosis (demineralization and softening of bone) is by far the most common cause². Vertebral compression fractures typically present with a sudden onset of pain after seemingly minor stressors such as bending, coughing, or lifting^{3, 6}. This pain is variable; it can be sharp or dull and aggravated by sitting or moving.

Fractures will most often occur in the mid thoracic vertebrae (upper back), down to the junction between thoracic and lumbar vertebrae (lower back)³. The pain generally resolves in 4-6 weeks, however severe pain that persists beyond this time frame indicates a need for further medical evaluation.

Diagnosis of a vertebral compression fracture is determined with a comprehensive history, physical exam, and supplemental testing and imaging². Specifically, a physician will look for kyphosis (humpback) and a loss of height over time³. An x-ray will typically reveal any compressed vertebrae, and a physician may also order a bone scan to ascertain the density of the vertebral bones if osteoporosis is suspected².

Treatment options for vertebral compression fractures range from conservative management with medications to spinal surgery depending on the severity of the fracture and the damage to nearby structures such as nervous tissue². More conservative treatments include^{3, 6}:

• Medications are generally the front line treatment for compression fracture symptoms. These can include over-the-counter pain medicines such as acetaminophen (Tylenol™) or short-term ibuprofen (Advil™). Narcotic analgesics may also be prescribed for severe pain
• Physical therapy can strengthen the muscles that stabilize and support the spine to help relieve symptoms
• Calcitonin may be useful in conjunction with other pain relievers for symptom relief. Parathyroid hormone (PTH) may reduce the severity and onset of new fractures
• Lifestyle changes such as cessation of tobacco and alcohol, and maintaining a calcium rich diet reduce osteoporosis and fracture risk

• Percutaneous Vertebroplasty, in which a cementing material is injected into the fractured bone
• Balloon Kyphoplasty, in which a balloon is injected into the fractured vertebrae and inflated to restore the height of the affected vertebrae. This is often done in conjunction with vertebroplasty

References

1. Jones, R.; et al. (2010). Back Pain. First Consult. MD Consult Web site, Core Collection. Retrieved from www.mdconsult.com.ezproxy1.library.arizona.edu/das/pdxmd/body/.
2. Nidus Information Services. (2011). Compression fractures of the back. Patient Handouts. MD Consult Web site, Core Collection. Retrieved from www.mdconsult.com.ezproxy1.library.arizona.edu/das/patient/.
3. Sheon, R.P.; Rosen, H.N. (2011). Clinical manifestations and treatment of osteoporotic thoracolumbar vertebral compression fractures. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
4. Decker, J.E.; Hergenroeder, A.C. (2010). Overview of musculoskeletal neck injuries in the young athlete. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
5. Kado, D.M. (2010). Overview of hyperkyphosis in older persons. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
6. Nidus Information Services. (2011). Compression fractures of the back. Patient Handouts. MD Consult Web site, Core Collection. Retrieved from www.mdconsult.com.ezproxy1.library.arizona.edu/books/page.
7. Evans, A.J.; et al. (2009). Prospective assessment of pain and functional status after vertebroplasty for treatment of vertebral compression fractures. J NeuroIntervent Surg. Vol 1, 66-70.