Compression Fracture

Compression = the application of strong pressure
Fracture = a break in a bone
A compression fracture occurs when part of a vertebra, or bone in the spine, collapses.
The bones of the spine have two main section. The vertebral arch is a ring-shaped section that forms the roof of the spinal canal and protects the spinal cord. You can feel the spinous process, a projection from this arch, when you press on the skin in the middle of your back. The vertebral body is the cylindrical shaped portion of the vertebral one that lies in front and provides the majority of structural support. In a compression fracture, the vertebral body collapses.
The most common type of compression fracture is a wedge fracture, in which the front of the vertebral body collapses but the back does not, meaning that the bone assumes a wedge shape.
Sometimes, more than one vertebra fractures, a condition called multiple compression fractures. Multiple compression fractures can lead to kyphosis, a spinal deformity when the upper back curves forward, creating the appearance of a hunchback. In some cases, a person who experiences multiple compression fractures may notice a loss of height.
Compression fractures usually occur in the thoracic (middle) or lumbar (lower) spine.

Compression fractures may or may not cause symptoms. If compression fractures cause symptoms, these may include:

• pain in back, arms, or legs
• numbness and/or weakness in arms or legs (if the fracture has affected the spinal cord and/or surrounding nerves in the spine)
• over an extended period, patients may notice a loss of height

A compression fracture that occurs suddenly can be very painful, but a compression fracture that occurs gradually may cause pain only gradually.

Rarely, compression fractures occur in healthy vertebrae as a result of trauma.

More often, the vertebra with a compression fracture is already weakened. The most common cause of weakening is osteoporosis, a condition that causes weak and brittle bones. Osteoporosis is most common in elderly women, and it is for this reason that elderly women are the group most affected by compression fracture.

Less frequently, the vertebra may be weakened by a tumor or infection.

To diagnose compression fracture, a doctor will take a complete medical history and perform a physical examination. If a compression fracture is suspected, the doctor may order the following diagnostic procedures:

• X-ray (also known as plain films) –test that uses invisible electromagnetic energy beams (X-rays) to produce images of bones. Soft tissue structures such as the spinal cord, spinal nerves, the disc and ligaments are usually not seen on X-rays, nor on most tumors, vascular malformations, or cysts. X-rays provide an overall assessment of the bone anatomy as well as the curvature and alignment of the vertebral column. Spinal dislocation or slippage (also known as spondylolisthesis), kyphosis, scoliosis, as well as local and overall spine balance can be assessed with X-rays. Specific bony abnormalities such as bone spurs, disc space narrowing, vertebral body fracture, collapse or erosion can also be identified on plain film X-rays. Dynamic, or flexion/extension X-rays (X-rays that show the spine in motion) may be obtained to see if there is any abnormal or excessive movement or instability in the spine at the affected levels.
• Magnetic resonance imaging (MRI) – a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• Computed tomography scan (CT scan) – a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce detailed images of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
• Nuclear bone scan – a diagnostic procedure in which a radioactive substance is injected into the body to measure activity in the bones. (The amount of radiation is small–less than the radiation in half of one CT scan.) This scan helps identify damaged bones.

Since compression fractures usually occur in weakened bone, doctors may order additional tests to look for osteoporosis, tumor or infection.

For the most part, nonoperative treatments are recommended for compression fracture. These treatments include pain medications and modified physical activity. The doctor may recommend wearing a brace that helps support the back and prevents bending forward, and therefore removes pressure from the fractured vertebrae.

Vertebral fractures typically take about three months to fully heal. The doctor will order X-rays monthly to see how the fracture is healing.

If the fracture is caused by osteoporosis, treatment of the osteoporosis can help prevent additional fractures. Treatment may include calcium and vitamin D supplements, bisphosphonates, and weight bearing exercises.  

Surgery may be necessary if the spine appears to be unstable. The surgeon may perform a vertebroplasty or a kyphoplasty. During these surgical procedures, the surgeon injects a cement mixture into the fractured bone to stabilize the fracture, treat pain, and prevent a spinal deformity from progressing.

In some cases, the surgeon may need to perform a spinal stabilization and fusion surgery to support the spine until the bone heals. During these procedures, the surgeon places a bone graft across the area of instability, allowing the vertebrae to fuse (grow together). The surgeon secures the spine with an internal fixation implant, using screws and rods, to hold the vertebrae in place while the bone heals.

The surgeon will tailor the treatment to each individual patient and specific presentation.

Drs. Paul C. McCormick, Michael G. Kaiser, Peter D. Angevine, Alfred T. Ogden, Christopher E. Mandigo, Patrick C. Reid and Richard C.E. Anderson (Pediatric) are experts in treating compression fractures. They can also offer you a second opinion.