How Serious Is a Spinal Compression Fracture?

Spinal compression fractures are small breaks or cracks in the bones that make up the spinal column, called vertebra. The breaks occur in the thick, rounded section in the front of each vertebra, called the vertebral body. Spinal compression fractures cause the spine to weaken and collapse, leading to back pain, mobility problems, and a hunched posture.

Anyone can get a spinal compression fracture (often as a result of a spinal injury), but females over 50 are at higher risk due to the onset of osteoporosis after menopause. Treatments include oral pain relievers, back braces, medications that help build bones, and surgery.

This article explores the symptoms and causes of spinal compression fractures and explains how this common orthopedic condition is diagnosed and treated.

How Can You Tell if You Have a Spinal Compression Fracture?

Spinal compression fractures often cause symptoms that are nonspecific and don't readily point to a compression fracture as the cause. Some fractures are less serious than others and cause fewer symptoms but can progress and get worse if left untreated.

If you have a spinal fracture you may experience:

• Sudden and long-lasting back pain felt anywhere between your shoulders and lower back
• Pain that eases when you lie down and worsens when you stand or walk
• Decrease flexibility of the spine, such as an inability to twist or bend over
• Tingling or numbness in the back radiating to the lower limbs (which can get worse with walking)
• A notable loss of height
• A hunched appearance (sometimes referred to as a "hunchback" or "dowager's hump")
• A loss of bladder or bowel control (usually when the abovelisted symptoms are severe)
  

What Causes a Spinal Compression Fracture?

A compression fracture occurs when the normal vertebral body of the spine is squished, or compressed, to a smaller height. This tends to happen in three groups of people:

• People in traumatic accidents: When a load placed on the vertebrae exceeds its stability, it can collapse. This is commonly seen after a fall from a height in which you land vertically (upright).
• People with osteoporosis: Osteoporosis is the thinning of bones due to mineral loss. As the bone becomes more porous, it is less able to support the weight of even the upper body. In such cases, the spine may collapse gradually or spontaneously with normal activity.
• People with spinal bone tumors: If a tumor spreads to a bone of the spine, as can occur with cancer like multiple myeloma, it can cause weaknesses in the bone structure that lead to a collapse. These are commonly referred to as pathologic fractures.

How Spinal Compression Fractures Are Diagnosed

Imaging studies are central to the diagnosis of spinal compression fractures. The diagnosis will typically involve a specialist in disorders of the muscles and bones, called an orthopedist or orthopedic surgeon.

The imaging studies most commonly used are:

• Spinal X-ray
• Computed tomography (CT) scans, composed of multiple X-ray images
• Magnetic resonance imaging (MRI), which is better suited to visualize soft tissues like the spine
• Dual-energy X-ray absorptiometry (DEXA), also known as a bone scan
• Myelogram, an imaging technique that uses a contrast dye to make X-ray or CT scans clearer
  

Spinal Compression Fracture Treatment

The focus of treatment in most people with a compression fracture is to control the pain and get the individual back up and moving. In most cases, nerve function is not impaired, and the focus is placed on acute pain management and rehabilitation.

Treatment options include:

• Pain medications: These range from over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like Advil to prescription muscle relaxers or opioid drugs for shorter-term relief of severe pain.
• Back braces: Available from specialist medical supply stores, these not only help support the spine to aid with healing but also relieve pain by keeping the spinal column in a more vertical position.
• Medications to strengthen bones: These include drugs called bisphosphonates like Fosamax (alendronic acid) and Boniva (ibandronic acid) that slow bone loss in people with osteoporosis.
• Physical therapy: This can help heal spinal compression fractures by strengthening the back muscles supporting the lower lumbar spine.
• Vertebroplasty: This a treatment performed on an outpatient basis that injects cement into a cracked or broken spinal bone to help relieve pain.
• Kyphoplasty: This is a technique used with vertebroplasty that widens the space between vertebrae with a small balloon before the cement is injected.

On rare occasions, spinal surgery may be needed, most commonly after a serious traumatic spinal injury.

Recurrence is likely, so will need to take steps to avoid future episodes. This may include eating a healthy diet rich in calcium and vitamin D, quitting cigarettes (which contribute to osteoporosis), and getting regular checkups (especially if you have osteoporosis).

Summary

Compression fractures of the spine are common injuries often associated with conditions that weaken the bone. Pain, loss of spinal flexibility, and a hunched posture are all possible symptoms.

Treatment is typically aimed at controlling the pain, stabilizing and supporting the spine to aid with healing, and preventing future injury. Seldom is surgery needed.