An Overview of Vertebral Compression Fracture

 

vertebral compression fractureApproximately 10 million people in the U.S. have osteoporosis, with this condition affecting women more than men. The most common type of fracture in people with osteoporosis is a vertebral compression fracture (VCF).

An estimated 25% of postmenopausal women suffer a VCF during their lives. VCFs are also a health concern for older men. Patients who sustain one VCF are at five times the risk of having a second VCF.

Causes of VCF

VCFs occur when the vertebral body of the spine collapses, which results in severe pain and loss of height. Vertebral fractures occur most often in the thoracic spine (middle section). Osteoporosis is the most common cause of a VCF, but this fracture can occur from metastatic tumors and trauma.

For people with osteoporosis, a VCF can occur from minor activity, such as stepping from the shower, coughing, or sneezing. For individuals with healthy bones, a VCF occurs from trauma, such as a hard fall or motor vehicle accident. In addition, cancer can destroy a section of the vertebra, weakening the bone and making it collapse.

Symptoms of VCF

  • Severe back pain that is felt in the middle or lower spine, described as “knife-like,” prolonged, and often disablingMRI VCF compression fracture
  • Stooped posture (kyphosis)
  • Loss of height (as much as 6 inches)
  • Pain that is worse with walking and not felt with rest
  • Numbness
  • Weakness
  • Tingling
  • Loss of control of the bowel or bladder

Diagnosing a VCF

If you have any of the symptoms of VCF, the doctor will take a history of your injury/pain, and conduct a physical examination to look for kyphosis and tenderness along the spinal bones. In addition, he/she will order certain tests to assess the back, including:

  • X-ray – Done to evaluate for compression of vertebrae.
  • Magnetic resonance imaging (MRI) scan – To assess for tumors, disc problems, and structural damage.
  • Bone density test (DEXA) – Done to screen for osteoporosis.

Treatment Options

  • Vertebroplasty – The doctor injects bone cement into the crushed vertebral body to stabilize it and reduce pain.

 

  • Kyphoplasty – Insertion of needles into the damaged vertebrae to allow balloons to pass. The doctor will inflate the balloons under pressure to expand the compression fracture, correct the deformity, and inject liquid cement to restore shape.

Kyphoplasty

  • Bracing – braces such as a Jewett brace or TLSO can stabilize the fracture and provide excellent pain control.

 

  • Epidural Injection – The injection of a numbing agent and steroid medication into the painful spine region to stop pain sensations can be helpful. The fracture can irritate surrounding nerve roots.

 

  • Medications – Painkillers and calcitonin, which relieves bone pain.

 

  • Physical therapy – To improve strength, flexibility, and mobility of the spine.

 

Resources

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.

National Osteoporosis Foundation. 2013 Clinician’s Guide to Prevention and Treatment of Osteoporosis. 2013.

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.