Compression Fractures of the Spine

In older people with osteoporosis, the bones of the spine (vertebrae) may collapse within themselves and become squashed (compressed). These fractures are called vertebral compression (crush) fractures. Bones affected by osteoporosis are less dense and weaker. Consequently, vertebral fractures can result from very slight force—for example, from turning, bending, or standing. Sometimes they occur for no apparent reason. Vertebral compression fractures are more likely to occur in the middle to lower back.

Symptoms and Diagnosis

When vertebral compression fractures occur, they may cause sudden, sharp pain or no pain. Pain may gradually develop. It may be mild to very severe. Sitting for a long time, standing, bending forward, twisting, carrying heavy objects, and walking usually make the pain worse. Sneezing and coughing may cause pain.

People with many large vertebral compression fractures can lose height, and the back may become rounded and bent. This condition is sometimes called a dowager's hump (kyphosis). Standing up straight may be impossible. Some people have difficulty bending, reaching, lifting, climbing steps, and walking.

Rarely, vertebral compression fractures damage the spinal cord or spinal nerves. In such cases, symptoms include weakness in the leg, numbness, paralysis, and loss of control of the bowels or bladder (fecal or urinary incontinence).

Doctors suspect a vertebral compression fracture on the basis of symptoms: pain in the middle to lower back that is worsened by sitting or standing, loss of height, and a rounded back. X-rays are usually taken. If osteoporosis is suspected, bone density is measured, and blood tests may be done.

Treatment

The goals of treatment are to relieve pain, to enable the person to function normally again, and to prevent other fractures. Pain relievers, such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), can be taken. Sometimes the pain is so severe that opioids are needed. If the fracture is located in the lower back, wearing a brace may make walking less painful. Sometimes a few days of bed rest may be needed to relieve pain. But walking as soon as possible can help people recover more quickly. Walking helps prevent loss of muscle tone and additional loss of bone density. Some people need physical therapy to help them walk and to strengthen muscles.

An experimental procedure to reinforce vertebrae (called vertebroplasty) is sometimes tried. After a local anesthetic is injected near the fractured vertebra, cement is injected into a vertebra through a needle. The cement hardens in about 2 hours and stabilizes the vertebra. The person can go home the same day. This operation may effectively relieve pain, sometimes immediately, and may improve quality of life. Kyphoplasty is a similar procedure. It uses a balloon to expand the compressed vertebra before the cement is injected. The long-term consequences and safety of these treatments are still being studied.

When a fracture is putting pressure on spinal nerves, surgery to relieve the pressure is done within hours if possible. Prompt treatment is necessary to prevent injury to the spinal nerves from becoming permanent.

Outlook

Usually, vertebral compression fractures eventually heal on their own. Pain rarely lasts more than a few months before it gradually subsides. However, a few people, usually those who have many large vertebral compression fractures, need help with daily activities indefinitely. Also, people who have had a vertebral compression fracture are likely to have osteoporosis and thus are likely to have other, sometimes more serious, fractures.