Vertebral Compression Fractures - Clinical Manifestations, Diagnosis, and Treatment

What Is Vertebral Compression Fracture?

Vertebral compression fractures are the collapse of the vertebral body (the thick and rounded portion that forms the front part of the vertebra and provides attachment for the discs between the vertebra) of the spinal cord. Tiny cracks or breaks appear between the bones of the vertebra (bones that form the spinal cord), which weakens the spine, leading to fracture and collapse. Compression fractures happen when the body cannot bear the compressive load (load level beyond which bending deformation of the bone occurs). These fractures mainly occur in the thoracic spine (middle portion of the spine).

What Is the Etiology of Vertebral Compression Fracture?

• Trauma- Road traffic accidents or accidental falls on the surface.

• Osteoporosis- It causes the bones to weaken, and thus the bones are more prone to fractures.

• Osteomyelitis (bone infection).

• Pathologic Fractures like cancer. The cancer spreads to the spine resulting in weak vertebrae, which causes the bone to break easily.

What Are the Signs and Symptoms of Vertebral Compression Fracture?

• Sudden onset of localized back pain ranging from mild to severe.

• Pain increases while moving or standing and decreases while resting or lying on the back.

• Vertebral compression fractures are rarely associated with radicular pain (pain, numbness, or tingling sensation involving the anterior chest and abdominal wall).

• Gradual height loss.

• Deformity and disability with an increase in time.

• A stoop shape to the spine.

What Is the Diagnosis of Vertebral Compression Fracture?

• X-ray- It shows the vertebral structure and joint outlines. Bone alignment, spinal disc degeneration, and bony spurs (irritates nerve root) are also visible on the X-rays. Visualization of the thoracic spine is difficult. X-ray does not provide a sharp image compared to MRI and CT scans.

• Computed Tomography (CT Scan)- It can diagnose compression fractures within the spinal column. A myelogram is performed along with a CT scan for additional information on the fracture. Contrast dye is used before a CT scan to see the images clearly in the spinal cord.

• Magnetic Resonance Imaging (MRI)- It gives 3-D images using magnets and computer technology. It shows the spinal cord, nerve roots, surrounding areas, and degeneration and enlargements involving the spinal cord.

• Bone Densitometry or Dual Energy X-Ray Absorptiometry (DXA or DEXA)- This test measures bone mineral density and thus helps in determining osteoporosis. It is a painless and rapid test and can detect even small changes in the bone mass of the spinal cord and the extremities. DEXA scanner directs X-rays from two sources at a set frequency towards the bone that has to be examined alternatingly.

What Is the Treatment for Vertical Compression Fractures?

Vertebral instability due to slow healing or non-healing of the fracture causes pain in vertical compression fractures. The pain decreases gradually over a few days or weeks. The treatment plan should focus on relieving pain, stabilizing the bones, and preventing secondary fractures. The treatment plan may include the following:

• Pain Relief Medication- Over-the-counter medications like nonsteroidal anti-inflammatory drugs (NSAIDs) and Acetaminophen are most commonly used. Muscle relaxants are often prescribed along with pain relief medicines. Opioid analgesics should be used for short periods in acute pain cases.

• Back Braces- These provide stability and additional support to the spinal cord. It also restricts movement during the healing period of the fracture. A rigid back brace is used in vertebral compression fracture cases, thus limiting spine-related movements and activities like bending forward and twisting while maintaining a proper body posture.

• Bone Strengthening Medicines- These medicines are prescribed to the patient to avoid subsequent fractures and restore bone loss. The most prescribed medicine is bisphosphonates, and it includes Alendronate, Ibandronate, Risedronate, and Zoledronic acid.

• Surgery- It is considered when the conservative treatment has little or no effect. Vertebroplasty and kyphoplasty are surgical and minimally invasive procedures to treat vertical compression fractures. In vertebroplasty, a needle is inserted into the vertebra, and then bone cement is injected into the fractured vertebra. The bone cement hardens, thus stabilizing and strengthening the vertebra. In kyphoplasty, an inflatable device (balloon) is filled with bone cement and directed at the fractured vertebra. It also increases the height of the collapsed bone. Thus, kyphoplasty relieves both pains and restores the height of the damaged vertebra.

What Are the Indications of Surgery in Vertical Compression Fracture?

• Pain in the fractured area lasted for more than two weeks.

• Painful metastasis of bone tumor.

• Painful vertebral hemangiomas (benign vertebral vascular lesion).

• Vertebral osteonecrosis (death of bony tissue due to lack of blood supply).

What Are the Contraindications of Vertebral Compression Fracture?

• Vertebral compression fracture that is responding to the conservative treatment.

• Surgery should be avoided in a vertebral compression fracture if the pain has lasted more than one year.

• Osteomyelitis (bacterial infection of the bone).

• Scoliosis (sideward bending of the spine) or kyphosis (abnormally curved spine resulting in forward bending of the spine) is caused due to reasons other than osteoporosis, like ankylosing spondylitis.

• Spinal cord compression is not caused due to osteoporosis.

What Are the Complications of Vertebral Compression Fracture?

• Loss of Height- Fracture of the spinal cord shortens the spine. If many vertebrae collapse, the patient looks shorter.

• Stomach Problem- As the vertebra collapses, the spine becomes short and compresses the stomach. It causes digestive problems like constipation, weight loss, and weak appetite.

• Breathing Problem- A short spine compresses the lungs and results in breathing problems.

• Hip Pain- The rib cage gets closer to the hip bones due to a short spine. If these two bones rub against each other, it causes hip pain.

• Kyphosis (Curved Back)- The spine bends forward due to vertebral collapse. As the body tries to adapt, neck and back pain occurs.

What Is the Prognosis of Vertebral Compression Fracture?

The outcome of the vertebral compression fracture depends on the patient's age and the fracture's type and severity. Patients with osteoporosis are more prone to subsequent fractures and respond poorly to conservative treatment.

Conclusion

Vertebral compression fractures are very common fractures. The risk increases with age and usually results from osteoporosis. The risk can be lowered by visiting healthcare providers regularly, eating a healthy diet, and taking supplements of calcium and vitamin D. Bone density tests and medicines that prevent bone loss should be taken by elderly people to slow bone loss. Mild vertebral injuries require conservative treatment. However, severe cases of vertebral compression fractures require a specialized team of orthopedic surgeons, neurologists, physicians, and nurses to perform the surgery and monitor the recovery from neurological defects. Instructions from the healthcare provider should be followed for proper recovery.