Definition
Brought on by force, a compression fracture is a break in a vertebra that causes it to collapse. The vertebrae are the box-shaped bones that make up the spine.
Typically, a compression fracture is wedge-shaped, with more collapse in the front, due to force on the spine from forward bending - causing the front of the vertebrae to collapse, without disrupting the back aspect vertebral body.
What is going on in the body?
The spinal column of vertebrae, stacked one on top of another, supports the body in an upright position. When the force on the bone is greater than the strength of the bone, a compression fracture occurs.
Fractures can also occur when the bones have been weakened. For example, in osteoporosis, fractures can occur spontaneously with no known injury.
Compression fractures occur most often in the lower back or lumbar area. However, they can also occur in the chest or thoracic area of the spine.
What are the signs and symptoms of the condition?
Mild, moderate, or severe back pain, particularly in the upright position, is the main complaint. Lying down may relieve some of the discomfort. In most cases, the discomfort lessens a great deal within 6 to 8 weeks.
If several vertebrae are compressed, a rounded or hunched back may be noticed. This is called kyphosis.
Rarely, the compression fracture may be severe enough to cause pressure on the spinal cord or nerves. If this occurs, it could result in numbness, weakness, or paralysis of the legs, bladder, or bowels.
Other signs include tenderness over the compressed vertebra and spasm of the muscles around it. Standing with an erect posture may be hard.
What are the causes and risks of the condition?
Most often, an injury is the cause. In young, healthy bone, a violent force such as a car accident or fall from a height is necessary to break the bone. In weak, thin bone, minor force such as sitting down hard or vigorous sneezing can cause the compression. Bone can be weak for various reasons, the most common being osteoporosis. Cancer
can also weaken a vertebra.
What can be done to prevent the condition?
Fractures can be avoided by keeping bones healthy through a healthy diet, which includes calcium and vitamin D intake. Weight-bearing exercise also helps stimulate bone growth and strength.
For people with thinning bones (either osteopenia or osteoporosis) medications (such as bisphosphonates) can be prescribed to prevent compression fractures.
How is the condition diagnosed?
Compression fractures of the back are suspected based on the medical history, symptoms, and signs. The diagnosis is confirmed by spine X-rays, particularly from the side view.
The DEXA (Dual Energy X-ray Absortiometry) bone scan is the gold standard for assessing bone density and should be preformed in every person with a non-traumatic compression fracture.
Rarely, special X-ray tests such as a bone scan, MRI, or CT scan are used to make the diagnosis. The MRI and CT scan can show greater detail in more severe injuries that press on the spinal cord.
What are the long-term effects of the condition?
The majority of compression fractures will heal without long-term problems. The greater the collapse, however, the greater the chance of future back pain. It's possible for the collapse to worsen and cause nerve problems or require surgery.
What are the risks to others?
There are no risks to others.
What are the treatments for the condition?
Often rest, reduced activity, and pain medicine are enough to relieve the discomfort. Temporary use of a back support, such as a brace, corset, or girdle, may also help. For more serious compression fractures, a larger brace or body cast may be needed. This will help protect the spine during the healing phase and prevent future collapse. For the most severe injuries, especially those resulting in nerve problems, surgery to correct the collapse and fuse the spine may be considered. As the fracture heals, it is important to exercise the muscles that help strengthen and straighten the back. Physical therapy may be used to teach the person the right ways to use the body for lifting and other activities.
What are the side effects of the treatments?
Surgery might result in nerve injury, failure to correct the deformity, infection, or failure of the bone fusion to heal.
What happens after treatment for the condition?
Pain is often relieved following rest, reduced activity, pain medicine, and physical therapy.
How is the condition monitored?
Comfort level and posture should be monitored by the doctor. Any new or worsening symptoms should also be reported to the doctor.
Author: John A.K. Davies, MD Date Written: 07/29/00 Medical Review: Jeff Ginther, MD Date Written: 10/3/2006 Reviewer: Walt Larimore, MD Date Reviewed: 10/10/2006
Contributors
Potential conflict of interest information for reviewers available on request
