There are many causes of spinal fractures in patients. The three common causes are:
Tumors growing in or near the spine are another cause of compression fractures. Doctors frequently monitor those diagnosed with certain types of cancer, including multiple myeloma or lymphoma, for spinal breakage. Tumors also may spread to the spine as a result of cancer in other organs and areas of the body, such as the breasts, lungs and intestines.
The most common cause of spinal fractures in trauma is motor vehicle accidents for patients < 65 years of age and falls if greater than 65 years of age. The key component of spinal fracture care is taken place at the site of the accident. Only after the patient is stabilized with his or her breathing, circulation, and bleeding should focus turn to spinal fracture care.
Identification of the fracture is important in the management of spinal fractures. Treatment depends on the nature and characterization of the fracture. To identify the fracture, the physician may order x-rays, MRI, and/or CT scans.
In most cases, fractures can be treated nonoperatively.
History: A 25 year old tree cutter fell 15 feet at work. He sustained a broken arm and facial bones but more importantly suffered a broken spine. Remarkably he was not paralyzed but had a lot of back pain. On careful exam, he did have some loss of sensation to touch in his leg and had some weakness of his legs.
Images: A CT scan demonstrates a fracture of the L2 vertebral body (bone of the spine) (top arrow). In addition, the spinous process (the bony prominences that you can feel when you press on the middle of your back) is broken as well (bottom arrow). In the other image, a cross sectional view of the fracture level demonstrates a piece of bone (arrow) that is narrowing the area for the spinal cord and nerve roots. This is what is causing the weakness and sensation changes of his legs.
Surgery: Because of the nature of the fracture and other broken bones, it was decided he undergo surgery to stabilize the spine with screws and rods.
In addition, the area where the spinal canal was decreased due to the bony fragments was enlarged by decompressing the spine and reducing the fracture. The image on the left (before) demonstrates the narrowing of the spinal canal before surgery, and the right image (after) demonstrates a more open space.
Back pain is not just another inevitable aspect of growing older. It could be a sign of stress fractures within your spine called vertebral compression fractures.
What Is A Vertebral Compression Fracture?
Spinal fractures occur when the normal vertebral body is “squashed”, or compressed in height. When the load on a vertebra exceeds its stability or inherent strength, the bone can collapse. Pain, limited mobility, height loss and spinal deformity are often the result. In severe cases, part of the vertebral body may protrude into the spinal canal and put pressure on the spinal cord and nerves. Organ function, including that of the bowel or bladder, also may be compromised.
Vertebral compression fractures can happen for a number of reasons: trauma from a fall or a car accident; bone thinning due to osteoporosis or even the spread of a tumor into the spine.
Knowing how to prevent, recognize and treat vertebral compression fractures is critical for maintaining good spinal health. Here is some information to help you learn more about this type of spinal injury.
What Causes Vertebral Compression Fractures?
There is no one single cause; however, the vast majority of vertebral compression fractures are the result of osteoporosis, a condition that causes bones to progressively become more thin and fragile. When bones are brittle, even everyday activities and minor traumas, such as lifting a laundry basket, missing a step, or even coughing or sneezing, can cause these tiny fractures.
Osteoporosis-related compression fractures can occur anywhere in the spine, but are most often found in the lower vertebrae of the upper back. The vertebral bone tends to collapse toward the front of the spine, creating wedge-shaped vertebrae that cause the spine to curve forward (kyphosis), eventually leading to the “dowager’s hump” frequently associated with the advanced stage of the disease. Learn more about osteoporosis.
What Are The Symptoms of Vertebral Compression Fracture?
The primary physical symptoms of vertebral fracture include one or more of the following
- Sudden onset of back pain
- Increase in pain when standing or walking
- Variable pain relief when lying down
- Limited spinal mobility
- Weakness or numbness in the affected areas
- Height loss
- Deformity and disability
- Shortness of breath
These additional symptoms signal the possibility of multiple vertebral fractures
- Hunched back (“dowager’s hump”)
- Bulging abdomen
- Gastrointestinal problems - crowding of the internal organs can be a serious side effect of multiple compression fractures
- Shortness of breath - it’s possible for the torso to become so compressed that it’s difficult to breathe
- Hip pain (hip fracture)
How Are Vertebral Compression Fractures Diagnosed?
If you think you may have a compression fracture, see a doctor. (To find one near you, visit our Physician Locator.) Here are some questions your doctor may ask
- How long have you been in pain? Was the onset sudden or gradual?
- Where is the pain located? What is the intensity?
- Does the pain radiate to other parts of the body?
- In what positions is the pain better or worse?
- Is the pain getting worse or better over time?
Your doctor also may recommend one or more of the following diagnostic tests
- A spinal X-ray to determine the presence of a fracture
- An MRI to check for the age of the fracture and other abnormalities in the soft tissues, including nerves and ligaments
- A nuclear bone scan, another test that can determine the presence and/or age of a fracture
- DEXA scan
How Are Vertebral Compression Fractures Treated?
Treatment of compression fractures includes measures to alleviate the pain, stabilize and repair the fracture, and diagnose the underlying cause of the breakage.
In most cases, fractures can be treated nonoperatively.
Dr Park's usual regimen is prescribing an external brace if the patient is in pain with a combination of various pain medications. Next, physical therapy is also started. The majority of patients respond to this regimen.
Non-surgical treatment options your doctor may recommend include
- Medications to relieve bone, muscle and nerve pain
- A reduction in activity or bed rest
- A spinal brace to limit motion
- Medication to stabilize or improve bone density
- Physical therapy
- Epidural spinal injection
- External soft bracing
- External hard bracing
If the fracture looks unstable or the patient has neurological damage or impending damage, or fails non operative management, surgery is indicated. Typically the surgery consists of a fusion to stabilize the spine and possible a decompression to remove any compression on the spinal cord or nerves. The physician will tailor the treatment plan according to the fracture.
As stated earlier, most vertebral fractures are treated nonoperatively with a brace. However, if brace wear fails or patients are having too much patient, a minimally invasive option called a KYPHOPLASTY / VERTEBROPLASTY is an option. This percutaneous approach provides stability to the fracture and pain relieve is usually instantaneous. Please see the following link for more information. Dr Park provides this service on an outpatient basis. Patients go home the same day!
Streaming - Vertebroplasty
How Can I Prevent Vertebral Compression Fractures?
The best way to avoid vertebral compression fractures is to begin taking preventive measures toward building a strong back and spine early in life. But, even if you didn’t, it’s never too late to start! Here are a few tips
Exercise - Exercise, especially strength/resistance training and/or lifting weights regularly, can help build strong bones. Engaging in some form of cardiovascular exercise and strength training at least three times a week can help combat bone loss, and the earlier you start exercising and strength training the better. Strong muscles also help you maintain balance to avoid falls and other accidents.
For back-strengthening programs at the beginner, intermediate and advanced levels, check out these exercises for the back and spine.
Eat Right –Eat a nutrient-rich, balanced diet, with sufficient intake of calcium, Vitamin D and phosphorus. Avoid smoking and excessive alcohol use; smoking contributes to bone density loss and too much alcohol inhibits bone formation. If possible, maintain a healthy weight – additional pounds place excess strain on the back.
Stay Hydrated –Drink between six and eight cups or water a day to keep the body well hydrated. Water helps reduce stiffness and contributes to overall spine health. Learn how to maintain bone density for a healthy spine.
Practice Good Posture –Maintaining a “neutral spine” is the foundation of good posture. In a neutral spine, the natural curves of the spine (the concave, or lordotic, curves, and the convex, or kyphotic, curves) are in proper balance. The spine is neither rounded forward nor arched back too much.
Proper posture keeps your bones properly aligned and alleviates excess stress on your musculoskeletal systems, allowing your muscles, joints, and ligaments to work as intended.
Maintain Calcium and Vitamin D intake - please check with your primary care physician if your calcium and vitamin D levels are normal. Dr Park can provide you with the normal recommended amount of calcium and vitamin D, but many patients need more than the typical amount. Please also check with your primary care physician with regards to osteoporesis management.