Compression fractures of the back

Definition

Compression fractures of the back are broken vertebrae, which are the bones of the spine.

Alternative Names

Vertebral compression fractures

Causes, incidence, and risk factors

Compression fractures of the vertebra may be caused by:

• Osteoporosis (the most common cause),
• Trauma to the back
• Tumors that started in the bone or spread to the bone from elsewhere
• Tumors that start in the spine, such as multiple myeloma

Multiple fractures may lead to kyphosis, a hump-like curvature of the spine.

Symptoms

Compression fractures may occur suddenly, causing severe back pain that is:

• Most commonly felt in mid to lower part of the spine, but may also be felt on the sides or in the front.
• Described as ?knifelike? and usually disabling, often taking weeks to months to go away

Compression fractures due to osteoporosis may cause no symptoms at first and may only be discovered when x-rays of the spine are done for other reasons. Over time, the following symptoms may occur:

• Back pain that starts slowly, which gets worse with walking but is not felt when resting
• Loss of height, as much as 6 inches over time
• Stooped over posture or kyphosis, also called a "dowager?s hump"

Pressure on the spinal cord from hunched over posture may rarely produce symptoms of:

• Numbness
• Tingling
• Weakness
• Difficulty walking
• Loss of control of the bowel or bladder

Signs and tests

Your doctor will perform a physical exam. This may reveal:

• A humpback, or kyphosis
• Tenderness over the affected spinal bone or bones

A spine x-ray shows at least one compressed vertebra that is shorter than the other vertebrae.

Other tests that may be done:

• A bone density test to evaluate for osteoporosis
• A CT or MRI scan if there is concern that the fracture was caused by a tumor or severe trauma (such as a fall from a height or car accident)

Treatment

Most compression fractures are seen in older people with osteoporosis. These fractures generally do not cause injury to the spinal cord. The condition is usually treated with medicines and calcium supplements to prevent further fractures.

Pain may be treated with:

• Pain medicine, including narcotics
• Bed rest

Other treatments may include:

• Back braces, but these may further weaken the bones and increase your risk of more fractures
• Physical therapy to improve movement and strength around the spine
• A medicine called calcitonin to help relieve bone pain

Surgery may be done if  you have severe and disabling pain for more than 2 months that does not get better with other treatments. Surgery can include:

• Balloon kyphoplasty done under general anesthesia.
• Vertebroplasty done under local anesthesia and sedation.

Other surgery may be done to remove some bone if the fracture is due to a tumor.

After surgery you may need:

• A brace for 6-10 weeks if the fracture was due to an injury
• More surgery to join certain spine bones together or to relieve pressure on a nerve

Support Groups

Expectations (prognosis)

Most compression fractures due to injury heal in 8 - 10 weeks with rest, bracing, and pain medications. However, recovery can take much longer if you had surgery.

Fractures due to osteoprosis usually become less painful with rest and pain medications, but some can lead to long-term (chronic) pain and disability.

Medicines to treat osteoporosis can help prevent future fractures. However, they cannot reverse damage that has already occurred.

For compression fractures caused by tumors, the outcome depends on the type of tumor involved. Some common tumors that involve the spine include:

• Breast cancer
• Lung cancer
• Lymphoma
• Prostate cancer

Complications

Complications may include:

• Failure of the bones to fuse after surgery
• Humpback
• Spinal cord or nerve root compression

Calling your health care provider

Call your health care provider if:

• You have back pain and you think you may have a compression fracture
• Worsening symptoms or difficulty with controlling your bladder and bowel function

Prevention

Treating and preventing osteoporosis is the most effective way to prevent these fractures.

visHeader

References

Klazen CA, Lohle PN, de Vries J, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet. 2010 Sep 25;376(9746):1085-92.

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.