Compression fractures of the back are broken vertebrae, which are the bones of the spine.
Vertebral compression fractures
In a compression fracture of the vertebra, the vertebral bone collapses. More than one vertebra may be affected. This condition may be caused by:
When the fracture occurs as a result of osteoporosis, the vertebrae in the chest (thoracic) or the lower back are usually affected. During the early stages, a break in the bone can get worse without any symptoms. Pain or other symptoms may be worse with walking, and are often not present when resting.
Multiple fractures may lead to kyphosis, a hump-like curvature of the spine (like the Hunchback of Notre Dame).
Compression fractures may cause no symptoms and only be discovered when x-rays of the spine are done for other reasons. Over time, the following symptoms may occur:
Compression fractures may also occur suddenly, causing severe back pain that is:
Pressure on the spinal cord from kyphosis may rarely produce symptoms of:
Other tests that may be done:
Most compression fractures are found in elderly patients with osteoporosis. These fractures generally do not cause injury to the spinal cord. In these patients, the osteoporosis is treated with prescription medications and calcium supplements.
Otherwise, the pain from these fractures is treated with pain medicines and bed rest at first. Narcotics are often needed. Some health care providers recommend back braces, but these may further weaken the bones and increase your risk of developing more fractures in the future.
Patients may benefit from some physical therapy to help with movement and building up muscle strength around the spine.
Surgery is rarely considered. However, if 2 months or more of bed rest, pain medicines, and physical therapy cannot relieve the back pain, surgery can be option. Two minimally invasive techniques are available:
If the fracture is caused by a tumor, a piece of the bone may need to be surgically removed and examined under a microscope (biopsy). Then the tumor is treated.
Fractures from trauma often require a brace for 6 - 10 weeks to protect the bone as it heals. If there is bone in the spinal canal, you may need surgery to remove the bone and fuse the vertebrae together to stabilize the spine.
Surgery is almost always necessary if there is any loss of function because of bone pressing on the spinal cord or spinal nerves.
Most compression fractures from trauma will heal in 8 - 10 weeks with rest, bracing, and pain medications. Recovery time will be many weeks longer if surgery is necessary.
Fractures due to osteoprosis usually become less painful with rest and pain medications, but some can cause chronic pain and disability.
While medications to treat osteoporosis can help prevent future fractures, the collapse of the vertebrae that has already occurred cannot be reversed.
For compression fractures caused by tumors, the outcome depends on the type of tumor involved. Some common tumors that involve the spine include:
Call your health care provider if you have back pain and suspect you may have a compression fracture.
Treating and preventing osteoporosis is the most effective way to prevent these fractures.
Wardlaw D, Cummings SR, Van Meirhaeghe J, et al. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet. 2009;373(9668):1016-24.
Freedman BA, Potter BK, Nesti LJ, Giuliani JR, Hampton C, Kuklo TR. Osteoporosis and vertebral compression fractures-continued missed opportunities. Spine J. 2008;8:756-762.
Kim DH, Vaccaro AR. Osteoporotic compression fractures of the spine; current options and considerations for treatment. Spine J. 2006 Sep-Oct;6(5):479-87.