Vertebral Compression Fracture

//Vertebral Compression Fracture
Vertebral Compression Fracture 2018-02-01T12:35:09+00:00

What Is A Vertebral Compression Fracture?

A vertebral compression fracture is a fracture in the spinal canal. It happens when a vertebra, or backbone, decreases by at least 15% in height due to the fracture. In other words, a vertebra collapses onto itself and the soft tissue around it, causing compression.

A spinal compression fracture occurs most commonly in the:

  • Upper back, or thoracic spine
  • Lower back, or lumbar spine

These spinal canal fractures occur most commonly in women who have gone through menopause (postmenopausal) and suffer from osteoporosis. However, they also can pose a health threat to some men. One-quarter of all postmenopausal females in the United States have had one of these fractures.

There are other types of fractures in the spine. A burst fracture typically occurs after a high-velocity accident. Similarly, most fractures occur in the front bone of the spine. When the harder bones in the back compress and fracture, it’s known as a wedge fracture.

Vertebral compression fracture symptoms

These fractures are usually characterized by acute back pain. Other symptoms of a spinal compression fracture may include loss of height and muscle.

Left untreated these fractures can lead to spinal deformity caused by the fusion of collapsed vertebrae. The deformity is referred to as kyphosis. You’ve likely heard of this condition as hunchback or dowager’s hump. Rarely do these fractures lead to nerve or spinal cord damage.

These fractures can result in other complications, however, 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 risk

Vertebral Compression Fractures Causes

Causes may include:

  • Osteoporosis
  • Trauma
  • Metastatic cancers

Osteoporosis 

Osteoporosis is characterized by bones that are weak and thin. This makes them more susceptible to fracture. It is the most common cause of compression fractures.

Your doctor can diagnose osteoporosis. They’ll use an imaging technique called DEXA, or dual energy X-ray absorptiometry. The technique measures the density of your bone, which will be low in the case of osteoporosis.

Trauma 

Trauma of the vertebrae of the spine can also lead to spinal compression fractures, even in those with healthy bones.

This trauma can occur from:

  • A fall
  • An automobile accident
  • A forceful jum
  • Lifting a heavy object
  • Any stress that exceeds the breaking point of the spine

Metastatic cancers

If you’re younger than 55 and have no prior history of trauma or osteoporosis, you may want to talk to your doctor about metastatic cancers. It is rare, but one of the causes of unexplained spinal fractures.

A metastatic cancer refers to the spread of cancer from one part of the body where it started (the primary site) to other parts of the body (secondary sites). This type of cancer causes destruction of the bone in the vertebrae. This leads to weakening of the bone and collapse.

There are certain types of cancers that are more likely to metastasize, including:

  • Breast
  • Prostate
  • Lung

Cancer frequently spreads to areas such as the upper arm bone (humerus), pelvis, upper leg bone (femur), ribs, and skull.

Vertebral Compression Fracture Risk Factors

Risk factors for these types of vertebral fractures include:

  • Advanced age
  • 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 these fractures are the same as those for osteoporosis.

Diagnosis

Approximately two-thirds of compression fractures are not diagnosed. However, if you’re aware of your symptoms and working closely with a specialized doctor, there are ways to diagnose this condition.

Doctors diagnose compression fractures by:

  • Taking a thorough health history
  • Performing a physical examination
  • Taking X-rays of the spine

Computed tomography (CT) and magnetic resonance imaging (MRI) can also be used. These can rule out other causes of back pain. Your doctor may also use nuclear bone scans to determine the age of your fracture.

Vertebral Compression Fracture | PainDoctor.com

Vertebral Compression Fracture Treatments

Most of these fractures respond to conservative treatment measures. In the end, many require no surgery.

Your doctor will likely first recommend bed rest, but only for a short period of time. Typically, you should avoid prolonged bed rest. Early movement that is overseen by a physical, occupational, or recreational therapist can lead to better results long-term.

Medication 

Your doctor may also prescribe medication to help with your pain from this condition. Over-the-counter analgesics, or pain relievers, can help treat the acute pain from compression fractures. Both acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs) can help. Examples of common NSAIDs include:

  • Ibuprofen (Advil, Motrin)
  • Aspirin (Bayer)
  • Naproxen sodium (Aleve)

Narcotic pain medications and muscle relaxants can be helpful in cases of severe pain. These groups of medications should be used with caution and for short periods, as there is a  high potential for abuse and addiction. Furthermore, they can lead to severe confusion and disorientation, as well as a host of other side effects.

Treating osteoporosis

In the majority of fractures, osteoporosis is a major contributor. In these cases, treating the osteoporosis can help, whether it’s identified before or after your diagnosis.

Osteoporosis treatments typically include prescribed bisphosphonates. Bisphosphonates prevent loss of bone and build bone mass, which can prevent repeat compression fractures. Examples of bisphophonates include:

  • Pamidronate (Aredia)
  • Risedronate (Actonel)
  • Alendronate (Fosamax)

Other methods for treating osteoporosis include taking calcitonin (Miacalcin). This has the additional benefit of decreasing the pain of compression fractures. You can also take calcium and vitamin D supplements.

Surgery, for severe cases 

If more conservative therapies don’t work, you may need to undergo surgery to treat your fracture.  The two most common surgeries to treat compression fractures are vertebroplasty and kyphoplasty.  They are similar approaches, with small differences.

In vertebroplasty, special bone cement is injected through a hollow needle into your fractured vertebra.

In kyphoplasty, your doctor first inserts and inflates a balloon into the compressed space in order to expand the compressed vertebra. They then fill the space with special bone cement. Kyphoplasty has the added benefit of restoring height.

Both vertebroplasty and kyphoplasty have high rates of success and low rates of adverse effects. However, they’re still surgical procedures, with risks. Only attempt these after conservative treatments have failed. Make sure to ask your doctor any and all questions you have about them.

Conclusion

Vertebral compression fractures are synonymous with the collapse of vertebrae. They’re often caused by 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. If conservative treatment doesn’t work, your doctor can also look into one of two minimally invasive techniques—vertebroplasty or kyphoplasty.

Both of these techniques strengthen and stabilize your spine. This can decrease or relieve your pain.

To learn more, talk to a pain specialist. You can find a pain doctor in your area by clicking the button below or looking for one in your area by using the tips here: https://paindoctor.com/pain-management-doctors/.

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References

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  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693826/
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  8. Yoon JY, Kim TK, Kim KH. Anterolateral percutaneous vertebroplasty at C2 for lung cancer metastasis and upper cervical facet joint block. The Clinical journal of pain. Sep 2008;24(7):641-646.

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