Overview
Compression fractures of the back are known by several names, such as spinal compression fracture, vertebral compression fracture, compression fracture of the spine, or simply compression fractures.
Usually, with aging, the bone density reduces. This causes the small bones that make the backbone weak and develop tiny cracks even with simple everyday activities like bending, lifting your grandchildren, etc. These tiny cracks over time cause the vertebrae to collapse.
What Are Back Compression Fractures?
The backbone, otherwise known as the spine, supports the central body and is not a single bone. It is made up of numerous small bones called vertebrae and intervertebral disks to cushion the vertebrae. The spinal cord passes from the brain to the lower back through the spaces in the vertebrae called vertebral canals. Whenever any vertebral bone collapses or breaks, it is called a compression fracture.
These vertebral bones are stacked upon one another to form the spine. Whenever a break or fracture of one or more vertebral bones occurs, it can cause the vertebrae to collapse, resulting in the shortening of the person’s stature. Back compression fractures can also impact the spinal cord. The collapsed vertebral bones can press against the spinal cord and nerves. Due to this, the blood supply to the spinal cord can get compromised.
What Causes Back Compression Fractures?
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Osteoporosis - The predominant cause of compression fractures is osteoporosis. In osteoporosis, the bones become fragile and break easily. With aging, the bones tend to lose calcium and other minerals, resulting in osteoporosis. The backbone loses its ability to withstand normal forces from everyday activities.
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Severe Osteoporosis: People with severe osteoporosis can be susceptible to compression fractures even with simple day-to-day activities like lifting lightweight objects or forceful sneezing or coughing.
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Moderate Osteoporosis: Activities such as lifting heavy weights, falling down from the bed, or while standing can cause compression fractures in people with moderate osteoporosis.
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Trauma - People with healthy bones can develop compression fractures due to trauma to their back from a car accident, sports injury, falling down hard, etc.
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Tumors - A tumor of the spine such as multiple myeloma can weaken the vertebral bones and cause compression fractures.
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Metastatic Cancer - A tumor from somewhere else in the body can metastasize and spread to the backbone. This, too, can cause compression fractures.
If back compression fractures are reported in people aged less than 55 years without any history of trauma, metastatic tumors are mostly suspected to be the cause. The backbone is the region where metastatic cancer more commonly spreads to.
What Symptoms Do Back Compression Fractures Cause?
People with compression fractures can experience one or more of the following symptoms:
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Abrupt severe back pain.
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The pain can be perceived on all parts of the spine and on the sides of the back, but it is more pronounced in the middle and lower spine.
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The pain can be sharp.
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Pain worsens with standing or walking.
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Pain decreases in intensity and improves while lying on the back.
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Limited range of motion and flexibility of the spine.
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Kyphosis (stooped and humped posture of the upper body).
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Shortening stature.
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Eventual disability.
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When the fracture puts pressure on the spinal cord, there can be problems with walking and controlling bowel and bladder function, muscle weakening, and tingling sensation of regions supplied by the affected nerve.
Who Is at Risk for Spinal Compression Fracture?
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Older adults (aged 55 and above).
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Women around menopausal age.
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People with osteoporosis.
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People with a history of compression fracture.
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People with cancer.
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Asians and white women have a high risk.
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Smokers.
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Slim women.
How Can Vertebral Compression Fractures Be Diagnosed?
Your physician can establish a diagnosis with a physical examination and your medical history. But the following tests can help confirm the diagnosis:
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X-Ray - This can reveal any bony spurs that are irritating the spinal nerves and cause disc degeneration.
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CT (Computed Tomography) - This picturizes the vertebral canal and shows any space narrowing.
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MRI (Magnetic Resonance Imaging) - MRI can reveal any tumors in the backbone, degeneration, enlargement, the spinal cord, and nerve roots.
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DEXA (Dual-Energy X-ray Absorptiometry) Scan - Also known as bone densitometry, DEXA scan can measure the bone mineral density and diagnose osteoporosis.
How Are Compression Fractures Treated?
Conservative Management:
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Post a vertebral fracture, your physician will advise you to limit certain activities that strain your back.
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The medications commonly advised for compression fractures are:
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Acetaminophen.
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Nonsteroidal anti-inflammatory drugs.
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Muscle relaxants.
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Opioids.
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You will need to wear a back brace to prevent the movement of a fractured vertebra.
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If osteoporosis is diagnosed, the following drugs to strengthen your bones and slow down the progression of the condition will be prescribed;
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Bisphosphonates.
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Raloxifene.
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Teriparatide.
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Zoledronic acid.
Surgical Management:
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Vertebroplasty - This procedure is done either under general or local anesthesia. It takes upto two hours for the procedure. With X-ray guidance, acrylic bone cement is injected with the help of a needle into the affected vertebra. This cement stabilizes the fractured vertebra as it hardens. As the fractured components stabilize, the patient experiences an improvement of pain.
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Kyphoplasty - This procedure is similar to vertebroplasty except that a balloon is introduced into the vertebrae through a hollow needle to create space between the collapsed vertebrae, and then cement is placed.
Both are minimally invasive procedures that are only preferred after conservative management methods have failed to show results. You can go home the same day or stay in observation for that night and leave. You can carry on your daily activities and strictly limit strenuous physical activities.
How Can Compression Fractures Be Prevented?
The following factors help prevent the risk of bone thinning and fractures:
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Take calcium supplements.
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Prevent frequent falling.
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Get more vitamin D from sun exposure and supplements if needed.
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Quit smoking.
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Regularly practice strength-building exercises.
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If you have osteoporosis consult a doctor and take bone-strengthening medicines.
Conclusion:
Back compression fractures target elderly people the most. Hence, women above the menopausal age (above 50 years) and men aged 55 years and more need to be cautious of their bone health. Calcium supplementation can be started early with a doctor’s advice. If you have constant back pain, do not conclude it to be due to arthritis or joint pain, seek a medical opinion to rule out compression fractures.
