What Is A Vertebral Compression Fracture?

A vertebral compression fracture can be defined as a vertebra, or backbone, that has decreased at least 15% in height due to fracture. In other words, a vertebra collapses onto itself, causing compression. These compression fractures occur most commonly in the upper back, or thoracic spine, and lower back, or lumbar spine. They occur most commonly in females who have gone through menopause (postmenopausal), but they also can pose a health threat to some males. One-quarter of all postmenopausal females in the United States have had a vertebral compression fracture.

Vertebral compression fractures are usually characterized by acute back pain. Other symptoms may include loss of height, overcrowding of internal organs in the abdomen, loss of muscle, and limited range-of-motion in the spine. Left untreated these fractures can lead to spinal deformity caused by the fusion of collapsed vertebrae. The deformity is referred to as kyphosis, which is commonly called hunchback or dowager’s hump. Rarely do these fractures lead to nerve or spinal cord damage.

Causes Of Vertebral Compression Fractures

The causes of vertebral compression fractures may include osteoporosis, trauma, and metastatic cancers. Osteoporosis is characterized by bones that are weak and thin, which makes them more susceptible to fracture. It is the most common cause of compression fractures. Osteoporosis is diagnosed using an imaging technique called DEXA, or dual energy X-ray absorptiometry. The technique measures the density of bone, which is low in the case of osteoporosis.

Trauma of the vertebrae of the spine can also lead to vertebral compression fractures, even in those with healthy bones. The trauma could be caused by a fall, an automobile accident, a forceful jump, lifting a heavy object, or any stress that exceeds the breaking point of the spine.

Metastatic cancers should be suspected in patients younger than 55 with no history of trauma and vertebral compression fractures. A metastatic cancer refers to the spread of cancer from the part of the body where it started (the primary site) to other parts of the body (secondary sites). The cancer causes destruction of the bone in the vertebrae, which leads to weakening of the bone, and collapse. Cancers likely to undergo metastasis, or spread, to the bones of the spine are breast, prostate, and lung. Cancer frequently spreads to areas such as the upper arm bone (humerus), pelvis, upper leg bone (femur), ribs, and skull.

Risk factors for vertebral compression fractures include:

  • Being elderly
  • Osteoporosis
  • History of osteoporotic fracture
  • Female gender
  • Low weight
  • Steroid use
  • Smoking
  • Lack of exercise
  • Calcium or vitamin D deficiency

Many of the risk factors for vertebral compression fractures are the same as those for osteoporosis.

Vertebral Compression FractureApproximately two-thirds of vertebral compression fractures are not diagnosed. Diagnosis of compression fractures can be easily made with a thorough history, physical examination, and X-rays of the spine. Computed tomography (CT) and magnetic resonance imaging (MRI) can be used to rule out other causes of back pain. Nuclear bone scans may be needed to determine the age of the fracture.

Vertebral compression fractures can result in complications such as:

  • Reduced spinal range-of-motion
  • Lung disorders, such pneumonia or a collapsed lung
  • Crowding of internal organs
  • Constipation
  • Bowel obstruction
  • Progressive muscle weakness
  • Deep venous thrombosis (DVT), which refers to blood clots in the lower leg
  • Loss of independence
  • Increased admissions to nursing homes
  • Increased mortality, which refers to the number of deaths in a population

Treatments For Vertebral Compression Fracture

Most vertebral compression fractures respond to conservative treatment measures and require no surgery. Bed rest is usually recommended for a short period of time. However, prolonged bed rest should be avoided and early movement overseen by a physical, occupational, or recreational therapist is the new trend. Over-the-counter analgesics, or pain relievers, can be effective treatment for the pain of compression fractures. Both acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed. Examples of NSAIDs include ibuprofen (Advil, Motrin), aspirin (Bayer), and naproxen sodium (Aleve).

Narcotic pain medications and muscle relaxants can be helpful with severe pain. Examples of narcotic pain medications include oxycodone combined with acetaminophen (Percocet), and hydrocodone combined with acetaminophen (Vicodin). Examples of muscle relaxants include cyclobenzaprine (Flexeril), tizanidine (Zanaflex), and carisoprodol (Soma). These groups of medications should be used with caution and for short periods, as high potential for abuse and addiction have been reported. Furthermore, they should be prescribed to the elderly with caution, as severe confusion and disorientation have been reported.

In the majority of vertebral compression fractures, osteoporosis is identified as a major contributor. In these cases, treatment of osteoporosis should be undertaken, whether diagnosed prior to or after a vertebral compression fracture. Most commonly bisphosphonates are prescribed to treat osteoporosis. Examples of bisphophonates are pamidronate (Aredia), risedronate (Actonel), and alendronate (Fosamax). Bisphosphonates prevent loss of bone and build bone mass, which can prevent repeat compression fractures. Other measures to treat osteoporosis may include administration of calcitonin (Miacalcin), which has the additional benefit of decreasing the pain of compression fractures, and supplementation of calcium and vitamin D.

Failure of conservative therapy to relieve the symptoms of vertebral compression fractures may necessitate surgical intervention. The two most common surgeries to treat compression fractures are vertebroplasty and kyphoplasty, both of which have high rates of success and low rates of adverse effects. In vertebroplasty, special bone cement is injected through a hollow needle into the fractured vertebra. In kyphoplasty, a balloon is inserted and inflated to expand the compressed vertebra before filling the space with special bone cement. Kyphoplasty has the added benefit of restoring height.

Conclusion

Vertebral compression fractures are synonymous with the collapse of vertebrae. Common etiologies of these fractures are osteoporosis, trauma, and cancer spreading to bone. Only one-third of all compression fractures are diagnosed, usually with the aid of X-rays of the spine. Most vertebral compression fractures respond to conservative treatment. Failure of conservative therapy for compression fractures raises the spectre of surgical intervention with one of two minimally invasive techniques—vertebroplasty or kyphoplasty. Both techniques strengthen and stabilize the spine, which can decrease or relieve the pain of vertebral compression fractures.

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