Compression Fracture of the Spine

What is a compression fracture of the spine?

A compression fracture is a crumbling or collapse of small sections of the bones of the spine. The bones of the spine are called vertebrae. The crumbling or collapse tends to happen more in the front of the bone than the back. This makes you bend forward.

The medical name for this problem is vertebral compression fracture.

How does it occur?

Compression fractures in older adults are usually caused by osteoporosis. Osteoporosis is a disease that thins and weakens bones to the point where they may break easily. It usually starts developing in women after menopause, between the ages of 45 and 55. Men tend to get the disease later in life, typically in the 70s.

Often, a compression fracture in older adults happens during routine chores, such as making a bed, opening a door, or picking something up from the floor. Sometimes, a cough or hard jolt in the car can cause the fracture. Younger adults can get a compression fracture from severe injury, such as in a car accident.

Adults of any age who take steroid medicine, such as prednisone, for a long time have a much higher risk for osteoporosis and compression fracture.

What are the symptoms?

The most common symptom is sudden pain in the lower back or mid-back. The pain usually is moderate to severe. The pain may extend throughout the back, hips, and legs. It may get worse when you sit or stand. It can make it hard to move or walk. Many people recall the exact moment the pain started and what they were doing at the time.

You may have a compression fracture without knowing it. It does not always cause severe pain or a change in the way your body works. However, over time, compression fractures may make you shorter by as much as several inches.

In some cases, several compression fractures in the upper part of the back (the region between the shoulder blades) can lead to kyphosis of the spine, commonly known as dowager hump. However, not all people with this condition have compression fractures as the cause.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you. Your provider will look for where you have pain and what kinds of motions hurt. Your provider also will check for nerve problems in your arms and legs.

An X-ray of the spine is needed to confirm the diagnosis. Most fractures show up on simple front and side views of plain X-rays of the spine.

Depending on your symptoms and what the plain X-rays show, other tests may be done, such as:

• bone scan
• CT scan
• MRI

How is it treated?

Treatment for a compression fracture may include:

• Resting in bed for several days until your pain decreases. Then you will slowly get more active according to how much you feel you can do.
• Wearing a corset or back brace to make you more comfortable by giving the fractured area support.
• Taking medicine for pain, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or opioid (narcotic) pain medicines.
• NSAIDs, such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days for any reason.
• Opioid pain medicines cause constipation and may cause confusion or grogginess. Also, these medicines are addictive. You may need 3 to 6 weeks of pain medicine, so opioid pain medicines should be used only for flare-ups of more severe pain.
• Taking a nasal spray medicine called calcitonin to treat osteoporosis and possibly help with pain.
• Getting physical therapy to strengthen spinal muscles.

If you have severe pain that is not getting better, your healthcare provider may recommend vertebroplasty or kyphoplasty.

• Vertebroplasty is a procedure done in a hospital by an orthopedic surgeon or other specialist. A needle is inserted in the spine to inject bone cement into the weakened vertebrae. This stiffens the vertebrae and helps reduce pain.
• Kyphoplasty is similar to vertebroplasty. It uses an inflatable device called a balloon tamp in addition to an injection. Your healthcare provider makes a very small cut in your skin and inserts a small tube containing a deflated balloon. The balloon tamp is guided into the right place and inflated. The fractured vertebra is lifted up as the balloon expands. Once the vertebra height has been restored, the vertebra is filled with bone cement and the balloon is removed. Kyphoplasty helps keep the spine from curving too much and helps you have less pain.

In several studies, vertebroplasty has been as good as kyphoplasty. Vertebroplasty can be done as an outpatient procedure and costs less because no balloon injection device is needed. These procedures can be of great benefit but they are not for everyone. Your healthcare provider can discuss the benefits and risks of this type of treatment with you.

If the compression fracture is causing vertebrae to press onto nearby nerves or the spinal cord, surgery may be needed.

How long will the effects last?

As your fracture heals with treatment, you will have less pain and will be able to do more. Healing can take several months. Proper use of pain medicine with a gradual increase in activity is important.

There is a risk that you will have more fractures

How can I help take care of myself?

• To lessen pain, lie in the 90/90 position:
  • Lie on your back on the floor with a pillow under your head.
  • Support your legs on a chair with hips and knees at right angles.
  • Relax in this position.
• When you feel pain in your back, stop what you are doing and put either heat or cold on your back, depending on which feels better.
• Use a cane or walker if you need help with walking
• Avoid stretching or stooping to prevent further injury.
• Call your healthcare provider right away if:
  • You have new back pain and lose control of your bowels or bladder.
  • You lose hand, arm, or leg strength and coordination.
  • You cannot relieve new back pain by changing your position or using heat and cold on your back.

How can compression fractures be prevented?

Doing what you can to prevent osteoporosis can help prevent compression fractures. For example:

• Make sure you have had your bone mineral density checked according to your healthcare provider’s recommendations. This painless test can check for osteoporosis. It can give an idea of your risk for compression fracture.
• Try to have a healthy lifestyle with a good diet that includes enough calcium and vitamin D.
• Get regular, weight-bearing exercise.
• Don’t smoke.

Talk to your healthcare provider about other ways to lower your risk of osteoporosis.

If you have osteoporosis, ask about treatment. There are several medicines that slow bone loss and help lower your risk of fractures.

Using your body wisely when doing everyday tasks may help prevent compression fractures. For example:

• Avoid lifting heavy objects.
• Avoid unusually vigorous physical activity. Build your activity level gradually.
• Wear shoes that provide good support, such as shoes designed for running or walking.
• Use support for walking, such as a cane, if you need it.
• Bend your legs rather than your back when you pick up something from the floor. Hold objects close to your body when lifting them.
• When you are getting out of a chair, put your weight over your feet and slide to the front of the chair. Then, using the arms of the chair, raise yourself to a standing position.