Compression fracture (referred to vertebral/osteoporotic/wedge fracture) is a cause of back pain and is commonly caused by osteoporosis. A compression fracture is typically a reduction of vertebral height typically around up to 20% because of the fracture and can happen in any area of the spine but most commonly are in the thoracic spine in the levels of T10-L1. Other names for spinal fracture are: wedge fracture which is most common type of fracture (this is considered mechanically stable and rarely related with any spinal cord damage) in front of the vertebral spine where the rest of the spine is unaffected. Other types include crush fracture where the entire vertebra breaks as well as burst fracture which is more unstable and includes both front and back region of the vertebral body. There can be a hump like malformation with the vertebral compression causing a loss of height and this in turn can push internal organs closer together and loss of muscle because of not enough exercise. Symptoms include onset of back pain, more pain with standing, decrease in pain when lying down and marked loss of height. Women who are over 45 with immediate onset of back pain with osteoporosis are assumed to have compression fracture. Back pain onset with a regular activity such as picking something up from the floor can be associated with such a fracture.
For osteoporosis that is complex minor activity such as sneezing can cause fracture of the vertebra during which the pain can be present for four to six weeks. As the bone improves over time the pain is described as less severe and more constant, persistent type of pain with a pin point area where the fracture has occurred. The pain can eventually subside or can persist due to the change in the bone structure and musculature due to lack of activity. Unfortunately, by the time a vertebral fracture happens, the osteoporosis is considered highly developed and there is a risk for numerous fractures to occur into the future.
The most frequent cause of vertebral compression fractures is osteoporosis, especially in women over the age of 50 and is fairly common in men over age 50. The bones become thin and become more thin and weak and are more likely to fracture which will cause increased amounts of pain and the contour of the spine will be changed. Causes of osteoporosis especially with complex cases include everyday events such as sneezing, turning over in bed or coughing or activities such as opening of a window. Trauma which includes any event that causes stress upon bones such as a car accident, fall, a forceful jump can cause extra stress onto the vertebra. Cancers can cause diminishing strength of vertebra causing fracture and metastatic cancer that begins in another part of the body can eventually proliferate into the spine. Patients who have hypercalcemia, unexplained weight loss, proteinuria or hypercalcemia it is important to regard this being related to cancer or multiple myeloma.
This would depend of patient’s history, physical examination as well as any other tests that maybe needed which would include CAT scan (helps to rule out whether the bone that is fractured is irritating the nerves around it), MRI (to rule out any other causes such as a disc herniation and also to establish whether the fracture is old – chronic or new- acute) in or a nuclear bone scan (helps to see the age of when the fracture occurred which can assist in the treatment outcome). In order to treat fracture associated with osteoporosis it is important to treat both the osteoporosis possibly with medications as well as the actual fracture. Verterbral fracture does not always involve surgery and can be managed with rest, special orthotic braces to be work for certain amount of time, pain medication, use of ice and or heat and gradual return to daily activities. Surgery includes vertebroplasty or kyphoplasty:
Vertebroplasty– this is a minimally invasive procedure which helps to keep the bone stable and also decreases or gets rid of the pain that is caused by a vertebra that is fractured. The process involves a special type of cement injected under high pressure right into the vertebra that is fractured. The cement injected gets around the fracture fragments and places them in a permanent position that they are currently in.
Kyphoplasty. Similar to vertebroplasty, kyphoplasty is also another type of minimally invasive procedure which helps to stabilize the bone and also to reduce or stop the pain caused by a spinal fracture.