FAQ’s on Vertebral Compression Fracture
What is a vertebral compression fracture?
A vertebral compression fracture (VCF) occurs when one of your vertebrae collapses. This usually follows a period of extended and progressive damage to the vertebra. Most vertebral compression fractures occur in the front (anterior) portion of the vertebra, creating a wedge shape that is smaller in front than in the back. The resulting humpbacked posture is referred to as kyphosis or dowager’s hump.
The symptoms of a compression fracture will vary depending on the presentation. Acute fractures are usually felt as sudden, severe back pain that is most commonly felt in the middle to the lower part of the spine. This can take weeks, or even months, to resolve. Chronic fractures are due to progressively degenerative conditions, such as osteoporosis, and have symptoms such as slowly progressive back pain that is aggravated by walking, a loss of height, or progressive kyphosis. If the spinal cord and/or nerve roots are affected, you may also experience symptoms such as tingling, loss of sensation, weakness, or incontinence (loss of bladder control).
What causes vertebral compression fracture?
Conditions that cause progressive weakening and degeneration of the vertebra can cause vertebral compression fractures. They are often seen in patients with osteoporosis, and the prevalence is noted to increase with age. Non-modifiable risk factors include susceptibility to falls and injury, dementia, Caucasian race, female gender, and previous history of fractures in adulthood. People who are at risk can suffer a sudden compression fracture induced by falls and lifting heavy objects, or even trivial actions such as sneezing.
How is vertebral compression fracture diagnosed?
Vertebral compression fractures are often missed, particularly in the aging population that tends to dismiss back pains as a “normal” sign of aging. Thus, it is important to consider the possibility of a compression fracture with patients older than 50 who suddenly experience back pain.
The diagnosis is made after a complete medical history and physical examination. Your physician may request additional diagnostics, such as X-rays, Computerized Tomography (CT) scans, and Magnetic Resonance Imaging (MRI) scans to visualize the injury. Compression fractures can occur anywhere along the vertebral column, and the classic presentation is that of a wedge-shaped vertebra with a narrowed anterior portion.
How is vertebral compression fracture treated?
Treatment can be either surgical or non-surgical. The initial symptoms of pain can be managed by analgesic (painkiller) medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics. The underlying condition, if any, has to be treated as well. Risk factors for re-injury should also be assessed, particularly for older patients. You may be advised lifestyle modification and given advice on unsafe home situations.
Nonsurgical management focuses on providing support to the spinal column while the fracture heals. Patients are given pain medications while placed on bed rest. The use of a back brace has also been shown to provide benefits, and you may be placed on a program of physical therapy and rehabilitation to promote healing and prevent future injury.
Patients who are unresponsive to conservative management are candidates for surgery. Several procedures have been developed to address compression fractures. Percutaneous balloon kyphoplasty has been useful in restoring height to collapsed vertebrae, while percutaneous vertebroplasty uses the injection of acrylic cement to strengthen the spine. Most patients show significant improvements following surgery, and can return to normal function with the assistance of physical therapy and rehabilitation.
Lee JH, Lee DO, Lee JH, Lee HS. (2014). Comparison of radiological and clinical results of balloon kyphoplasty according to anterior height loss in the osteoporotic vertebral fracture. The Spine Journal. doi: 10.1016/j.spinee.2014.01.028
S Hosseini H, Clouthier AL, Zysset PK. (2014). Experimental and Finite Element Analysis of Human Vertebral Collapse: Deformation of Trabecular Bone is Associated With Failure of the Cortical Shell. Journal of Biomechanical Engineering. doi: 10.1115/1.4026409
Yu CW, Hsieh MK, Chen LH, et al. (2014). Percutaneous balloon kyphoplasty for the treatment of vertebral compression fractures. BMC Surgery. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/24423182