The 24 bones of the spine are called vertebrae. A vertebral compression fracture (VCF) is a break of one of these small, irregular-shaped bones. The vertebrae stack one on top of the other and are separated by quarter-sized cushioning discs. VCFs occur due to osteoporosis, bone cancer, or trauma.
Are vertebral compression fractures common?
Yes. Approximately 50% of women will have at least one spinal bone fracture by age 80 years.
What parts of the spine are affected by vertebral compression fractures?
The most common portion of the spine affected by VCF is the middle back (thoracic spine). There are 12 of the thoracic vertebrae, and these bones are between the seven cervical (neck) vertebrae and the five lumbar (lower back) vertebrae.
What causes VCFs to occur?
Vertebral compression fractures usually occur when pressure is exerted on a weakened vertebra. A combination of downward pressure and bending forward can cause a VCF. Other causes are falling from a chair in a sitting position while bending forward, as well as trauma from an automobile accident or serious injury. A fracture occurs when the front aspect of the vertebra forms a wedge shape, and this crushes the inside of the bone. If several VCFs occur in sequence, it can result in kyphosis (humpback), where the vertebrae protrude into the spinal canal and press on the spinal cord.
Who is at risk for a vertebral compression fracture?
There are several risk factors for VCFs. These include:
- Having osteoporosis – Thinning of the bones causes them to weaken and be unable to bear normal pressure. Osteoporosis is a condition where the bones thin due to lack of adequate calcium and decreased bone density. A person with osteoporosis can fracture a vertebra by simply sneezing.
- Having cancer with bone metastasis – Any cancer that metastases to the bone can cause VCF. The cancer cells invade the bone tissue, weaken the bone, and lead to fractures.
- Any major trauma – An automobile accident, serious fall, or impact injury can result in a fracture vertebra.
What symptoms are associated with VCF?
When the vertebral compression fracture occurs due to a sudden, forceful injury, the patient will have instant, severe back pain. If nerve root compression occurs, there may be radiating pain down the buttock, thigh, leg, and/or foot. Some patients report weakness, tingling, and/or numbness at the fracture location, as well as the extremities.
How is a vertebral compression fracture diagnosed?
The doctor will inquire about your symptoms, ask questions about your injury or trauma, take a medical history, and conduct a detailed clinical examination. To visualize the spinal bones, x-rays are taken. For detailed imaging, a magnetic resonance imaging (MRI) scan may be done, or the doctor may order a computed tomography (CT) scan. Bone scans and bone density testing are often done for patients with VCF.
How is a vertebral compression fracture treated?
The treatment for VCF depends on the symptoms, the type of fracture, how long the fracture has been present, and the patient’s general health. Treatment options are:
- Bracing – A well-molded brace conforms tightly to the patient’s body to provide support. Bracing helps a person with VCF keep from bending forward, which will damage the spine further. The brace will hold the spine in a hyperextended state, which means the back is not slumped over. The brace relieves pressure from the fractured vertebra so it can heal, and it also prevents further bone collapse.
- Medications – For pain, the doctor can prescribe nonsteroidal anti-inflammatory agents, such as ketoprofen and naproxen. For severe pain, opioid pain relievers are used short-term. Special medications may be prescribed for osteoporosis to prevent further bone loss as well.
- Selective nerve root block – When the patient has nerve root compression secondary to the VCF, a block can be performed. This procedure involves inserting a small needle into the back using x-ray guidance. Once the needle is positioned near the affected nerve, an anesthetic, corticosteroid, and/or neurolytic agent is injected onto the nerve. In a recent medical study, researchers found that nerve blocks lessened pain for people with VCF who had nerve-related pain.
- Epidural steroid injection (ESI) – When severe nerve irritation occurs due to the vertebral fracture, the doctor can inject a corticosteroid agent into the space around the spinal cord. This eases nerve inflammation and reduces pain. Most clinical studies show that ESI has an 80-90% efficacy rate.
- Vertebroplasty – When the VCF is fairly new, bone height can be restored by inserting a small needle into the vertebra and injecting bone cement. This procedure involves use of fluoroscopy to assure correct needle placement. In a recent medical study involving 4,400 patients, vertebroplasty has an 87% success rate for pain relief.
- Kyphoplasty – Another procedure involves inserting a needle into the collapsed bone and inflating a balloon. This restores bone height to normal, and then cement is injected to hold the bone in place. Like vertebroplasty, kyphoplasty involves use of x-ray guidance. In a large study involving over 1,600 patients, kyphoplasty had a 92% efficacy rate for pain relief.
Colorado Clinic offers kyphoplasty with Board Certified physicians in Boulder, Loveland, Greeley, Fort Collins, Longmont and surrounding areas. Most insurance is accepted, and successful outcomes exceed 90% for the treatment!
Botwin KP, Gruber RD, Bouchlas CG, et al. (2002). Fluoroscopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis: an outcome study. Am J Phys Med Rehabil, 81(12):898-905.
Min SH & Yoon SH (2014). Clinical results and efficacy of selective nerve root blocks with vertebroplasty in treatment of patients with osteoporotic compression fracture accompanied by spinal stenosis. J Kor Orthop Assoc, 49(3), 202-208.
Zoarski GH, Snow P, Olan WJ, et al. (2002). Percutaneous vertebroplasty for osteoporotic compression fractures: quantitative prospective evaluation of long-term outcomes. J Vasc Interv Radiol, 13:139–48.